Prevalence Of Coronary Heart Disease Research Articles

Rationale, design and baseline patient characteristics of the optimal type 2 diabetes management including benchmarking and standard treatment study in Greece

To describe baseline data of the optimal type 2 diabetes management including benchmarking and standard treatment (OPTIMISE) study in Greece. "Benchmarking" is the process of receiving feedback comparing one's performance with that of others. The OPTIMISE (NCT00681850) study is a multinational, multicenter study assessing, at a primary care level, whether using "benchmarking" can help to improve the quality of patient care, compared with a set of guideline-based reference values ("non-benchmarking"). In the Greek region, 797 outpatients (457 men, mean age 63.8 years) with type 2 diabetes were enrolled by 84 office-based physicians. Baseline characteristics of this population are presented. Hypertension was the most prevalent concomitant disorder (77.3%) and coronary heart disease was the most frequent macrovascular complication of diabetes (23.8%). Most patients were overweight or obese (body mass index 29.6 ± 5 kg/m(2)), exhibiting mostly abdominal obesity (waist circumference 102.6 ± 13.6 cm). Biguanides were the most prevalent prescribed drugs for the management of diabetes (70.1% of all prescriptions), whereas statins (93.5% of all prescriptions) and angiotensin receptor blockers (55.8% of all prescriptions) were the most prevalent prescribed drugs for hyperlipidemia and hypertension, respectively. Only 37.4% of patients were on aspirin. Despite treatment, pre-defined targets for fasting plasma glucose (< 110 mg/dL), glycated hemoglobin (< 7%), systolic blood pressure (< 130 mmHg and < 125 mmHg for patients with proteinuria) and low density lipoprotein cholesterol levels (< 100 mg/dL and < 70 mg/dL for patients with coronary heart disease) were reached in a relatively small proportion of patients (29%, 53%, 27% and 31%, respectively). In a Greek population with type 2 diabetes, the control of glycemia or concomitant disorders which increase cardiovascular risk remains poor. Despite relevant treatment, there is a poor control of diabetes, hypertension and hyperlipidemia in Greek outpatients with type 2 diabetes.

Association between road traffic noise and prevalence of coronary heart disease

There is an established evidence that exposure to high levels of road traffic noise is associated with elevated risk of coronary heart disease (CHD). The results however have been heterogeneous and mostly inconclusive. The present investigation aimed to examine this association in adult subjects, with a secondary aim of identifying potentially vulnerable sub-populations. Similar studies have never been reported from Indian population. For exposure assessment, the time-weighted road traffic noise indicator, L den, was used as a continuous and categorical predictor. A cross-sectional study was designed, and sociodemographic and lifestyle- and health-related characteristics were recorded for 909 (533 females and 376 males) subjects aged 18-80 years. The respondents living in areas with L den < 60 dB(A) were designated as the reference group. Odds for self-reported CHD in relation to traffic noise exposure were estimated by univariate and multifactorial logistic regression with adjustments for potential confounders and effect modifiers. The adjusted odds ratio (OR) for self-reported CHD was 1.72 (95 % CI 1.36-2.19) per 5 dB(A) increase of L den (range 55-80 dB(A)). A gender-related risk difference was observed among male (OR 1.47 (1.07-2.02)) and female (OR 1.83 (1.27-2.65)) respondents. A stronger effect for subjects in the age group 55-64 years old was found, with age, residence period, body mass index, and self-reported stress being significant confounders. This study suggests epidemiological evidence that exposure to road traffic noise of L den > 65 dB(A) may be associated with occurrence of CHD in adult subjects. A trend was observed indicating increasing risk with higher exposure levels. The study results are also suggestive of higher risk of outcome among those with other chronic ailments (diabetes, pulmonary, or renal issues) and residing in the same location in excess of 15 years. Orientation of bedroom windows was identified as a significant effect modifier.

Association of TERC and OBFC1 Haplotypes with Mean Leukocyte Telomere Length and Risk for Coronary Heart Disease

ObjectiveTo replicate the associations of leukocyte telomere length (LTL) with variants at four loci and to investigate their associations with coronary heart disease (CHD) and type II diabetes (T2D), in order to examine possible causal effects of telomere maintenance machinery on disease aetiology. MethodsFour SNPs at three loci BICD1 (rs2630578 GγC), 18q12.2 (rs2162440 GγT), and OBFC1 (rs10786775 CγG, rs11591710 AγC) were genotyped in four studies comprised of 2353 subjects out of which 1148 had CHD and 566 T2D. Three SNPs (rs12696304 CγG, rs10936601G>T and rs16847897 GγC) at the TERC locus were genotyped in these four studies, in addition to an offspring study of 765 healthy students. For all samples, LTL had been measured using a real-time PCR-based method. ResultsOnly one SNP was associated with a significant effect on LTL, with the minor allele G of OBFC1 rs10786775 SNP being associated with longer LTL (β=0.029, P=0.04). No SNPs were significantly associated with CHD or T2D. For OBFC1 the haplotype carrying both rare alleles (rs10786775G and rs11591710C, haplotype frequency 0.089) was associated with lower CHD prevalence (OR: 0.77; 95% CI: 0.61–0.97; P= 0.03). The TERC haplotype GTC (rs12696304G, rs10936601T and rs16847897C, haplotype frequency 0.210) was associated with lower risk for both CHD (OR: 0.86; 95% CI: 0.75-0.99; P=0.04) and T2D (OR: 0.74; 95% CI: 0.61–0.91; P= 0.004), with no effect on LTL. Only the last association remained after adjusting for multiple testing.ConclusionOf reported associations, only that between the OBFC1 rs10786775 SNP and LTL was confirmed, although our study has a limited power to detect modest effects. A 2-SNP OBFC1 haplotype was associated with higher risk of CHD, and a 3-SNP TERC haplotype was associated with both higher risk of CHD and T2D. Further work is required to confirm these results and explore the mechanisms of these effects.

Predictive Value for the Rural Chinese Population of the Framingham Hypertension Risk Model: Results From Liaoning Province

A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population. A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially. The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population. The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.

Troponin T and N-terminal pro-B-type natriuretic peptide: a biomarker approach to predict heart failure risk--the atherosclerosis risk in communities study.

Among the various cardiovascular diseases, heart failure (HF) is projected to have the largest increases in incidence over the coming decades; therefore, improving HF prediction is of significant value. We evaluated whether cardiac troponin T (cTnT) measured with a high-sensitivity assay and N-terminal pro-B-type natriuretic peptide (NT-proBNP), biomarkers strongly associated with incident HF, improve HF risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. Using sex-specific models, we added cTnT and NT-proBNP to age and race ("laboratory report" model) and to the ARIC HF model (includes age, race, systolic blood pressure, antihypertensive medication use, current/former smoking, diabetes, body mass index, prevalent coronary heart disease, and heart rate) in 9868 participants without prevalent HF; area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, net reclassification improvement (NRI), and model fit were described. Over a mean follow-up of 10.4 years, 970 participants developed incident HF. Adding cTnT and NT-proBNP to the ARIC HF model significantly improved all statistical parameters (AUCs increased by 0.040 and 0.057; the continuous NRIs were 50.7% and 54.7% in women and men, respectively). Interestingly, the simpler laboratory report model was statistically no different than the ARIC HF model. cTnT and NT-proBNP have significant value in HF risk prediction. A simple sex-specific model that includes age, race, cTnT, and NT-proBNP (which can be incorporated in a laboratory report) provides a good model, whereas adding cTnT and NT-proBNP to clinical characteristics results in an excellent HF prediction model.

Association between sugar consumption, sociodemographic, anthropometric and biochemical profiles

BackgroundThe increase in prevalence of coronary heart disease, type 2 diabetes, obesity and abnormal blood lipid levels has raised the question of a possible relationship between these conditions and the consumption of sugar.ObjectivesThis study investigated the sugar consumption of financially-restricted Black women in Mangaung, South Africa.MethodFive hundred women were selected randomly and divided into younger (25–34 years) and older (35–44 years) groups. Dietary intake, sociodemographic status, anthropometry and biochemical data were obtained. Total sugar (TS) and added sugar (AS) consumption were compared between older and younger women as well as sociodemographic, anthropometric and biochemical categories.ResultsAS intake contributed 12% and 13% of total energy intake in younger and older women, respectively. AS consumption was higher in younger women living in brick houses and those who possessed a microwave oven. In older women, it was higher in husband-headed households. Underweight women with the lowest body mass index had higher sugar consumption than overweight and/or obese women. Women with a lower body fat percentage had a higher AS consumption than women with a high body fat percentage. Sugar consumption was significantly lower in younger women with elevated serum lymphocyte counts. TS and AS consumption was higher in younger women with elevated serum glucose levels. Older women with elevated serum insulin had a significantly higher TS consumption compared to those with normal insulin concentrations.ConclusionThe amounts of TS and AS consumed by women in this observational study were unlikely to contribute to overweight and/or obesity.

Geographic distribution of cardiovascular comorbidities in South Africa: a national cross-sectional analysis

Objectives: We sought to estimate the spatial coexistence of hypertension, coronary heart disease (CHD), stroke and hypercholesterolaemia in South Africa. Design: Cross-sectional. Setting: Sub-Saharan Africa and South Africa. Participants: Data were from 13,827 adults (mean±SD age 39±18 years, 58.4% women) interviewed in the 1998 South African Health and Demographic Survey. Interventions: N/A. Primary and secondary outcome measures: We used multivariate spatial disease models to estimate district-level shared and disease-specific spatial risk components, controlling for known individual risk factors. Results: In univariate analysis, observed prevalence of hypertension and CHD is was high in the south-western parts, and low in the north east. Stroke and high blood cholesterol prevalence appeared to be evenly distributed across the country. In multivariate analysis (adjusting for age, gender, ethnicity, education, urban-dwelling, smoking, alcohol consumption and obesity), hypertension and stroke prevalence were highly concentrated in the south-western parts, whilst CHD and hypercholesterolaemia were highly prevalent in central and top north-eastern corridor, respectively. The shared component, which we took to represent nutrition and other lifestyle factors not accounted for in the model, had a larger effect on cardiovascular disease prevalence in the south-western areas of the country. It appeared to have greater effect on hypertension and CHD. Conclusion: This study suggests a clear geographic distribution of cardiovascular disease in South Africa, driven possibly by shared lifestyle behaviours. These findings might be useful for public health resource allocation in low-income settings.

Coronary heart disease differences across Europe

In the Seven Countries Study of Cardiovascular Diseases, 16 cohorts of middle-aged men were enrolled in eight nations of seven countries in three continents in the late 1950s and early 1960s for a total of 12 763 individuals. Thirteen cohorts were located in Europe, two in Finland, one in the Netherlands, three in Italy, two in Croatia - former Yugoslavia, three in Serbia - former Yugoslavia, and two in Greece. Another cohort was enrolled in the USA and two cohorts in Japan. Baseline prevalence of coronary heart disease (CHD) was largely different across areas, as well as 10-year incidence of major CHD events and CHD mortality for periods ranging from 25 to 40 years of follow-up. Higher rates were found in Northern Europe, lower rates in Southern Europe and intermediate rates in Eastern Europe, represented by Serbia. Differences across countries were partly explained by different entry mean levels of serum cholesterol, blood pressure, consumption of saturated fatty acids and adherence to traditional dietary patterns. Forty-year trends of CHD mortality were largely explained by early changes in serum cholesterol and blood pressure levels, with large risk increases in Serbia and Greece, and the tendency to declines in Finland and the Netherlands. These trends in Seven Countries' experience are in line with those manifests in official mortality data. An attempt of interpretation is presented pointing to socio-economic evolution in the involved countries, which heavily modifies health and dietary habits and contributes to explaining these differences at population level.

Aortic Stenosis: New Thoughts on a Cardiac Disease of Older People

We have entered a new era in understanding degenerative aortic stenosis in elderly patients. With the aging of the US population and the progressive decrease in coronary heart disease prevalence in the past 50 years, aortic stenosis has become a major cardiac concern. New perspectives of the disease now lead us to see the condition in terms of the response of the left ventricle and of systemic features, rather than just in terms of the valve area itself. A new classification of aortic stenosis recognizes 4 categories based on flow state (normal or low) and valve gradient (high or low). "Paradoxical" low-flow, low-gradient stenosis has a dismal prognosis in spite of a normal left ventricular ejection fraction. New measures of aortic flow and the response of the left ventricle provide new insights into the treatment of patients with this condition.

Circulating levels of carboxy‐methyl‐lysine (CML) are associated with hip fracture risk: the Cardiovascular Health Study.

Advanced glycation end products (AGE) in bone tissue are associated with impaired biomechanical properties and increased fracture risk. Here we examine whether serum levels of the AGE carboxy‐methyl‐lysine (CML) are associated with risk of hip fracture.We followed 3373 participants from the Cardiovascular Health Study (age 78 years; range, 68–102 years; 39.8% male) for a median of 9.22 years (range, 0.01–12.07 years). Rates of incident hip fracture were calculated by quartiles of baseline CML levels, and hazard ratios were adjusted for covariates associated with hip fracture risk. A subcohort of 1315 participants had bone mineral density (BMD)measurement. There were 348 hip fractures during follow‐up, with incidence rates of hip fracture by CML quartiles of 0.94, 1.34, 1.18, and 1.69 per 100 participant‐years. The unadjusted hazard ratio of hip fracture increased with each 1 SD increase (189 ng/mL) of CML level (hazard ratio, 1.27; 95% confidence interval [CI], 1.16–1.40]; p<0.001). Sequential adjustment for age, gender, race/ethnicity,body mass index (BMI), smoking, alcohol consumption, prevalent coronary heart disease (CHD), energy expenditure, and estimated glomerular filtration rate (based on cystatin C), moderately attenuated the hazard ratio for fracture (1.17; 95% CI, 1.05–1.31; p=0.006).In the cohort with BMD testing, total hip BMD was not significantly associated with CML levels. We conclude that increasing levels of CML are associated with hip fracture risk in older adults, independent of hip BMD. These results implicate AGE in the pathogenesis of hip fractures.

Gender Differences in the Age-Stratified Prevalence of Risk Factors in Korean Ischemic Stroke Patients: A Nationwide Stroke Registry-Based Cross-Sectional Study

Although ethnic or cultural differences affect prevalence of cardiovascular risk factors, limited information is available about the age- and gender-stratified prevalence of the risk factors in Asian stroke population. We assessed gender- and age-stratified prevalences of major risk factors in Korean stroke patients, and assumed that the gender differences are attenuated by adjustment with lifestyle factors. Using the nationwide hospital-based stroke registry, we identified 9417 ischemic stroke patients admitted between April 2008 and January 2011. Prevalence of hypertension, diabetes, hyperlipidemia, atrial fibrillation, prior stroke, and coronary heart disease was assessed in both genders by age groups. We analyzed gender differences of the prevalence among the age groups by calculating prevalence ratio, and further explored the influence of lifestyle factors on the gender difference in multivariable analyses. Hypertension and hyperlipidemia were more common in men until middle age, but after that more common in women, whereas diabetes was more common in women after 65 years of age. Atrial fibrillation increased steadily with age in both genders but was more common in women through all age groups. Prior stroke and coronary heart disease showed inconsistent gender differences. Gender differences in hypertension and diabetes among the age groups were attenuated by adjustment with accompanying risk factors including lifestyle factors. Korean women with stroke had more hypertension and hyperlipidemia after middle age, more diabetes after 65 years, and more atrial fibrillation throughout all ages. Strategies to control risk factors in women at risk for stroke are eagerly needed.

Attending Religious Services and Its Relationship with Coronary Heart Disease and Related Risk Factors in Older Adults: A Qualitative Study of Church Pastors’ and Parishioners’ Perspectives

A qualitative study was undertaken to explain findings of a cross-sectional study of Canadian Community Health Survey (CCHS) 4.1 data showing older persons who attend religious services more than once a week, compared to persons who do not attend at all, have lower prevalences of coronary heart disease (CHD), diabetes and high blood pressure. Twelve semi-structured interviews with ordained pastors and three focus groups with older parishioners from Canadian churches were conducted. Interviews were transcribed and analyzed for emergent themes through a process of direct content analysis. All participants claimed that religious service attendance (RSA): (1) enhances mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours that lower CHD risk. These three themes appear to be underlying mechanisms that help to explain the inverse association between RSA and the prevalence of adverse health outcomes found in the CCHS 4.1 data.

Effects of Avena nuda L. on metabolic control and cardiovascular disease risk among Chinese patients with diabetes and meeting metabolic syndrome criteria: secondary analysis of a randomized clinical trial

Most patients with Type 2 diabetes mellitus(DM) also have metabolic syndrome (MetS), which is associated with an increased risk of coronary heart disease prevalence. Limited information is available on the effect and effective doses of oat intake with a structured dietary intervention in metabolic control and cardiovascular disease (CVD) risk prevention with the population who has Type 2 DM and meets the MetS criteria. A total of 260 Type 2 DM patients meeting MetS National Cholesterol Education Program Adult Treatment Panel III criteria were selected from 445 patients between 50 and 65 years of age, and they participated in a single-blinded, 30-day centralized management of a dietary program in China. Participants in the program were randomly assigned into one of the four groups: usual care group (control group, only basic health advice), diet group (systematic diet plans and intensive education), 50 g-organic naked oat with whole germ group (ONOG) and 100 g-organic naked oat with whole germ group (daily ONOG replacement boiled into porridge based on diet group). The primary outcomes were the relative changes in glycosylated hemoglobin (HbA1c) and insulin resistance after a 30-day intervention among the four groups. HbA1c decreased significantly with the increase in interventions (Ptrend<0.05). Similar results were also obtained in plasma glucose, serum lipid and hypersensitive C-reactive protein (hs-CRP). For the 100 g-ONOG group but not 50 g-ONOG group, HbA1c and hs-CRP reduced significantly by 0.51% and 1.29 mg/l (P<0.05, vs diet group), respectively. The 100 g-ONOG group showed a reduction by 0.22 U*mol/l(2) in insulin resistance, compared with the 50 g-ONOG group (P=0.039). Compared with diet alone or no diet, 50-100 g/day ONOG supplement to structured dietary intervention, at a dose of 100 g/day especially, contributes to the Type 2 DM patients meeting MetS criteria in their metabolic control and CVD risk prevention, with external factors being controlled.

Prevalence of myocardial infarction and coronary heart disease in adults aged 40–79 years in Germany. Results of the German health interview and examination survey for adults (DEGS1)

Background Cardiovascular diseases are still the most common cause of death in Germany. In recent years however, a clear reduction in the mortality rates due to cardiovascular diseases (ICD-10:I00-I99) can be noted. How did the prevalence of myocardial infarction and coronary heart disease change within the last 10 years? Methods In the German Health Interview and Examination Survey …

Ursachen und Risikofaktoren der Arteriosklerose

BackgroundThe arterial vascular diseases grouped under the term arteriosclerosis are characterized by fibrous changes in the blood vessel walls.Aim of the studyThis article reviews the epidemiology and manifestations of arteriosclerosis, as well as the risk factors associated with developing the disease.Materials and methodsThe current article is a literature-based review that considers important studies relating to arteriosclerosis.ResultsAtherosclerosis is the most common form of arteriosclerosis. The relevance of atherosclerosis for the health care system is highlighted by the following figures: in Germany, the prevalence of coronary heart disease (CHD) amongst the population aged 65 years and older is measured at 18 % for women and at 28 % for men. In 2004, CHD mortality rates were calculated to be 80.57 per 100,000 women and 149.21 per 100,000 men. According to the 1998 Federal Health Monitoring Report, about 3 million people in Germany were affected by peripheral artery occlusive disease (PAOD).ConclusionThe prevalence of atherosclerosis has increased dramatically during the last decade. In high-income countries like Germany, this increase is estimated at 13.1 %. As for the risk factors associated with PAOD, smoking has the greatest influence on disease development in high-income countries and in relative terms, hypercholesterolemia the least. In contrast to PAOD, data from the UK suggest that the incidence of abdominal aortic aneurysm (AAA) is on the decline. Correspondingly, the age-adjusted AAA mortality rate in England and Wales decreased from 40.4 per 100,000 inhabitants in 1997 to 25.7 per 100,000 in 2009.

Is pulse pressure an independent risk factor for incident acute coronary heart disease events? The REGARDS study.

Increased attention has been given to pulse pressure (PP) as a potential independent risk factor for cardiovascular disease (CVD). We examined the relationship between the three indices of blood pressure consisting of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP (= SBP - DBP), respectively, and incident acute coronary heart disease (CHD). Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a national cohort study of 30,239 black and white participants > 45 years of age, were enrolled between 2003 and 2007. The participants' SBP, DBP, and PP values were separated into the four groups of < 45mm Hg, 45-54.9mm Hg, 55-64.9mm Hg, and ≥ 65mm Hg, and were analyzed on a groupwise basis. Reported CHD events were confirmed by expert adjudication. Cox proportional hazards models were used to examine the association of incident CHD (first acute CHD event) for the four groups of BP measurements with multivariate-adjusted sociodemographic and clinical risk factors. Analyses were done for 22,909 men and women (40.4% black, 44.6% male) ≥ 45 years of age (mean age = 64.7±9.4 years) without prevalent CHD at baseline. Associations were found for 681 CHD events, over a mean 3.4 years of follow-up (maximum 6 years), with each unadjusted PP group (hazard ratio [HR] with 95% confidence limits for PP of 45-54.9mm Hg, 55-64.9mm Hg, and ≥ 65mm Hg, respectively, of 3.82, 3.08, and 4.73 as compared with PP < 45mm Hg; P < 0.0001 for linear trend), and this persisted after full adjustment, including that for SBP (1.50, 1.08, 2.09; P trend < 0.01). Subgroup analyses showed no statistically significant differences across age, race, or region of the country, but did suggest the possibility that men were more sensitive to PP than were women. Pulse pressure is positively and independently (particularly so with regard to independence from SBP) associated with incident CHD, and there were no significant racial or regional differences in this association.

Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A‐I determine marked cardiometabolic risk

Risks for coronary heart disease (CHD) and diabetes (T2DM) of the 'hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant. In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg). LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0.80 [95%CI 0.65; 0.97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2.84) and high apoA-I/HDL-C ratio (OR 1.50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio. HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).

The Relationship between Hypomagnesemia, Metformin Therapy and Cardiovascular Disease Complicating Type 2 Diabetes: The Fremantle Diabetes Study

BackgroundLow serum magnesium concentrations have been associated with cardiovascular disease risk and outcomes in some general population studies but there are no equivalent studies in diabetes. Metformin may have cardiovascular benefits beyond blood glucose lowering in type 2 diabetes but its association with hypomagnesemia appears paradoxical. The aim of this study was to examine relationships between metformin therapy, magnesium homoeostasis and cardiovascular disease in well-characterized type 2 patients from the community.Methods and FindingsWe studied 940 non-insulin-treated patients (mean±SD age 63.4±11.6 years, 49.0% males) from the longitudinal observational Fremantle Diabetes Study Phase I (FDS1) who were followed for 12.3±5.3 years. Baseline serum magnesium was measured using stored sera. Multivariate methods were used to determine associates of prevalent and incident coronary heart disease (CHD) and cerebrovascular disease (CVD) as ascertained from self-report and linked morbidity/mortality databases. 19% of patients were hypomagnesemic (serum magnesium <0.70 mmol/L). Patients on metformin, alone or combined with a sulfonylurea, had lower serum magnesium concentrations than those on diet alone (P<0.05). There were no independent associations between serum magnesium or metformin therapy and either CHD or CVD at baseline. Incident CVD, but not CHD, was independently and inversely associated with serum magnesium (hazard ratio (95% CI) 0.28 (0.11–0.74); P = 0.010), but metformin therapy was not a significant variable in these models.ConclusionsSince hypomagnesemia appears to be an independent risk factor for CVD complicating type 2 diabetes, the value of replacement therapy should be investigated further, especially in patients at high CVD risk.

PP03 A Big Problem for a Big Country. The Health and Economic Burden of Cardiovascular Diseases in Russia

BackgroundCardiovascular disease (CVD) mortality in Russia is 2-3 times higher than in the rest of the developed world and accounts for 57% of all deaths. It has been observed that...

OP61 The Future Health and Economic Consequences of Recent Obesity Trends in Ireland

BackgroundGiven the scale of the current obesity epidemic and its consequences for health there has been increasing concern about the economic burden placed on society in terms of direct healthcare...