Progetto Atena Research Articles

Association between atherogenic index of plasma and carotid intima-media thickness in a cohort of Mediterranean women

The association between early atherosclerosis (IMT) and Atherogenic index of plasma (AIP), a marker of atherogenicity (log triglycerides/HDL Cholesterol) was evaluated in a population-based cohort study in women, aged 30–69, living in the metropolitan area of Naples, Southern Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, Triglyceride, Insulin, HOMA, Apo B, hs-CPR were measured in 390 menopausal women, as a part of 5.062 participants of the cohort. Women in the second and third tertile of AIP showed an increased common carotid intima-media thickness compared with those in the first tertile: II vs I tertile (O.R. = 2.24, p = 0.007), III vs I tertile (O.R. = 2.29, p = 0.005), adjusted for age and Systolic pressure or II vs I tertile (O.R. = 2.19, p = 0.014), III vs I tertile (O.R. = 2.13, p = 0.026), adjusted for age, Systolic pressure, Body mass index and Apo B. Women in the second and third tertile of AIP compared to those in the first tertile, showed an OR of 2.14 (p = 0.016) and 1.99 (p = 0.033) respectively, of having elevates level of IMT, adjusted for traditional cardiovascular risk factor (age, Systolic Pressure, BMI, LDL Cholesterol, Diabetes diagnosis). This finding shows that in this group of menopausal women increased IMT is associated with elevated AIP independently of age and different cardiovascular risk factors. These results are in line with the hypothesis that AIP may be an useful clinical tools to give additional information in the risk assessment for atherosclerotic disease, in particular in postmenopausal women.

Lipoprotein (a) is an independent predictor of cardiovascular events in Mediterranean women (Progetto Atena).

Lipoprotein (a) is an independent predictor of cardiovascular events in Mediterranean women (Progetto Atena).

Association between Lp(a) and small dense LDL in menopausal women without metabolic syndrome

Background: Lipoprotein (a) (Lp [a]) is associated with premature atherosclerosis in menopausal women without metabolic syndrome (MS). MS is the main confounder in the relationship between Lp(a) and atherosclerosis in menopausal women. We have evaluated the relationship between Lp(a) and small dense-low density lipoprotein (sd-LDL) in 228 menopausal women participating to Progetto Atena.Methods: Lp(a) was measured and LDL particle separation was performed: mean LDL diameter and LDL score (% of sd-LDL) particles calculated.Results: Women without MS and elevated Lp(a) have increased number of sd-LDL (p < .05) and higher LDL score compared with those below the median of the studied population (p < .05). The association between Lp(a) and sd-LDL was evaluated taking into account different adjustment models. Women with elevated levels of Lp(a) show the following OR of having a small LDL diameter (in the lowest quartile): 1.02, p = .003; adjusted for age; 1.02, p = .002; adjusted for age, and triglycerides, or a high LDL score (in the highest quartile): 1.02, p = .006; adjusted for age; 1.02, p = .002; adjusted for age and triglycerides.Conclusions: In this group of menopausal women without MS, the independent association of Lp(a) with sd-LDL might explain at least in part the association of Lp(a) with premature atherosclerosis.

Association between body shape index and small dense LDL particles in a cohort of mediterranean women: findings from Progetto ATENA

Small dense LDL particles (sd-LDL) and body shape index (ABSI), were evaluated in 228 women, living in Naples, Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, insulin, HOMA, Apo B, hs-CPR and sd-LDL were measured. LDL particle separation was performed by Lipoprint System: seven LDL subfractions were obtained and LDL score (% of sd-LDL particles) calculated. ABSI was calculated according to Krakauer’s formula: ABSI (m11/6 kg−2/3). The association between sd-LDL and ABSI was evaluated taking into account different adjustment models. Women with elevated levels of ABSI show the following OR of having high LDL score: 2.39, p = 0.002; unadjusted; 2.47, p = 0.002; adjusted for age; 2.13, p = 0.011; adjusted for age and Apo B; 1.93, p = 0.026; adjusted for age and Apo B and triglycerides. ABSI was associated with elevated LDL score independently of age, Systolic pressure, Apo B and triglycerides. Median of LDL diameter decreased among ABSI quartiles: quartile I: 271.5 nm, quartile II: 270.7 nm, quartile III 270.5 nm, quartile IV 269.4 nm; Kruskall Wallis Test: p = 0.016. These results are in line with the hypothesis that ABSI could be a marker of visceral abdominal associated to adverse metabolic changes including presence of elevated sd-LDL, a risk factor for premature cardiovascular disease.

Abdominal adiposity is an early marker of pulmonary function impairment: Findings from a Mediterranean Italian female cohort

Background and aimsAbdominal adiposity may influence the respiratory function, especially in women. The aim of this prospective study is to evaluate the predictive role of body mass index (BMI) and waist circumference (WC) on lung function in healthy women. Methods and resultsIn 600 women randomly selected from the cohort of the “Progetto ATENA,” anthropometric measures such as BMI, WC, and weight gain were recorded at baseline, and the spirometric parameters were measured 10 years later. The percentage values of forced expiratory volume in 1 s (FEV1%) and forced vital capacity (FVC%) and the ratio of FEV1/FVC were compared with the anthropometric measures after adjustment for several variables measured at baseline such as age, height, socioeconomic status, smoking habits, and history of respiratory allergies grouped in a basal model.WC is significantly associated with a decreased FVC (p = 0.008) and an increased ratio of FEV1/FVC (p = 0.031) after adjustment for the covariates of the basal model. The association between BMI and spirometric parameters reaches borderline significance only with the ratio of FEV1/FVC (p = 0.052). ConclusionsWe suggest measuring both BMI and WC to assess the risk of future respiratory impairment.

Plasma creatinine levels, estimated glomerular filtration rate and carotid intima media thickness in middle-aged women: A population based cohort study

Background and aimThe relationships between high Creatinine (Cr) levels or low estimated Glomerular Filtration Rate (eGFR) and common carotid Intima Media thickness (IMT) have been evaluated in a population-based cohort study in women, aged 30–69 (Progetto ATENA). Methods and resultsSerum Cr and eGFR were measured in 310 women, as a part of 5.062. In this group carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Women were classified by Cr levels >1 mg/dL or eGFR < 56 ml/min.Women with Cr > 1 mg/dL (90th percentile of creatinine distribution) or eGFR less than 56 ml/min (5th percentile of eGFR distribution) had relatively more carotid plaques as compared to the rest of the cohort.Multivariate logistic analysis, after adjustment for age, demonstrated a significant association between Cr (>1 mg/dL) and IMT (≥1.2 mm): OR 4.12 (C.I 1.22–13.86), p = 0.022; or eGFR (<56 ml/min) and IMT (≥1.2 mm): OR 4.31 (C.I 1.27–14.66), p = 0.019. ConclusionsThese findings on an independent relationship between Cr and common carotid plaques in this population of middle aged women, independently of age, suggest the value of screening for early carotid disease in asymptomatic middle aged-women with mild renal insufficiency, in order to predict those at relatively higher risk for future cardiovascular events.

Association of thyroid stimulating hormone levels with subclinical carotid atherosclerosis in a Mediterranean female population

Objective To determine whether thyroid stimulating hormone (TSH) levels, an index of thyroid function, are associated with signs of carotid atherosclerosis. Participants and methods We examined 310 women from Southern Italy, aged 30–69 years, recruited for a prospective study, currently ongoing, on the etiology of cardiovascular disease and cancer in the female population (Progetto ATENA). All participants underwent cardiovascular risk factor assessment and high-resolution B-mode ultrasound to measure intima-media thickness (IMT) of carotid arteries. The occurrence and the number of atherosclerotic plaques (intima-media thickness>1.2 mm) were also evaluated. Results Women in the upper TSH decile (n=30; TSH>3.13 mU/l) had a significantly higher prevalence of diabetes mellitus and hypertriglyceridemia compared with women in the other TSH deciles. In a multivariate analysis, women in the upper TSH decile had a thicker carotid intima-media complex than those in the other deciles (0.92±0.02 vs. 0.86±0.01 mm; P=0.037) after adjustment for covariates. Furthermore, the number of carotid plaques was significantly associated with higher TSH levels (2.3±0.3 vs. 1.7±0.1; P=0.025). Conclusion In a cohort of women, higher TSH levels were associated with subclinical atherosclerotic changes of the carotid artery wall.

Relation of body mass index with carotid intima-media thickness and diameter is independent of metabolic syndrome in postmenopausal Mediterranean women

The aim of this study was to evaluate whether overweight and obesity are associated with arterial abnormalities in postmenopausal women and the contribution of the metabolic syndrome. A total of 390 postmenopausal women (mean age, 63.1 ± 7.7 y) living in the metropolitan area of Naples, Southern Italy, and participating in a population-based cohort study (Progetto Atena) were offered an ultrasound examination of the carotid arteries; 370 women accepted. Blood pressure, serum high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin, apolipoprotein B, and high-sensitivity C-reactive protein were measured in all participants. Women in the second and third tertiles of body mass index showed a greater common carotid intima-media thickness compared with those in the first tertile (tertile II vs I, odds ratio, 2.15; P = 0.013; tertile III vs I, odds ratio, 2.24; P = 0.018), adjusted for age and metabolic syndrome. Obese and overweight postmenopausal women showed greater common carotid lumen diameters as compared with lean postmenopausal women (mean ± SD, 6.36 ± 0.86, 6.16 ± 0.65, and 5.96 ± 0.59 mm, respectively; P < 0.001 [obese vs lean] and P = 0.04 [overweight vs lean]); no statistical difference in carotid lumen diameter was found between obese and overweight postmenopausal women. The statistical significance between obese and lean postmenopausal women was retained even after adding the components of the metabolic syndrome as covariates. These findings indicate an association between overweight, obesity, and preclinical carotid artery abnormalities, independently of the metabolic syndrome, in a population of postmenopausal women.

Obesity, overweight, and weight gain over adult life are main determinants of elevated hs-CRP in a cohort of Mediterranean women

Body mass index (BMI), waist circumference (WC), body weight modification, and rate of weight increase over 10 years were evaluated in relation to high-sensitive C-reactive protein (hs-CRP) to assess the association of cross-sectional or longitudinal estimates of obesity/overweight with levels of circulating CRP, a well established and standardized marker of low-grade inflammation, in relation to cardiovascular risk. This study included a subgroup of 390 menopausal women participating in a large currently ongoing epidemiological study (Progetto Atena; N=5062). At the final visit, women in the third tertile of BMI, compared with those in the first tertile, showed the following odds ratio (OR) of having high hs-CRP values: III vs I tertile OR, 3.55; 95% confidence interval, 1.94-6.49, P<0.001, adjusted for age, and metabolic syndrome. Similar results were obtained when we evaluated women in the third tertile of WC, or those in the highest group of estimated weight increase, relative to their weight at age 20 years or in the group of highest rate of weight increase over 10 years of observation (weight at the final visit-weight at the baseline visit divided by time in months between visits). The independent relations between different markers of overweight/obesity and elevated hs-CRP consistently indicate that high (above 1.5 mg l(-1), median) hs-CRP is a major biochemical counterpart of cross-sectional or longitudinal estimates of increased adipose tissue mass.

Menstrual cycle length, serum lipids and lipoproteins in a cohort of Italian Mediterranean women: Findings from Progetto ATENA

Background and aims Clinical studies suggest that menstrual irregularities are associated with metabolic and hormonal abnormalities, insulin resistance and a hyperestrogenic/hyperandrogenic imbalance, that may influence the risk of cardiovascular disease. Methods and results The association of these abnormalities with the metabolic syndrome suggests that information on lipid patterns at different menstrual cycle length may be of interest in identifying women at higher cardiovascular risk. The association of lipid patterns with menstrual cycle length was evaluated in a cohort of 5062 women participating in the Progetto ATENA Study. Questions were administered to the participants about their cycle lengths at different periods of time over their reproductive life. The period between 20 and 50 years was investigated: normal cycle length was defined as short (≤26 days), medium (between 27 and 29 days) or long (>30 days). Perimenopausal women were excluded and variables adjusted for age, BMI and menopausal status. In 4434 participants serum triglycerides were found to increase with an increased number of days in the menstrual cycle: 106 mg/dl in the short cycle pattern (21–26 days); 113 mg/dl in the medium cycle pattern (27–29 days); and 116 mg/dl in the long cycle pattern (30–31 days), whereas total and LDL cholesterol were found to be higher and HDL was lower in women with longer cycles, but the difference was not statistically significant. The results were very similar when the same adjusted analysis was restricted to a subgroup of 3823 women with a stable cycle length over the fourth and the fifth decade of life. Conclusions These results suggest that cycle length may be a marker of higher cardiovascular risk due to associated metabolic and hormonal patterns.

Small dense LDL particles and metabolic syndrome in a sample of middle-aged women. Findings from Progetto Atena

Metabolic Syndrome (MS) is highly prevalent in the general population. Recently, small dense LDL (sd-LDL) particles have been considered a risk marker in MS diagnosis. We analyzed cross-sectionally the association between sd-LDL and MS in a population-based sample of 210 middle-aged southern Italian women; among them 86 participants had MS (prevalence 40.9%). LDL particle separation was performed by Lipoprint System: seven LDL subfractions were obtained and LDL score (% of sd-LDL particles) calculated. Women with the MS diagnosis had significantly higher LDL score as compared to participants without MS diagnosis (median 0 vs. 3.6, p < 0.001 by Mann Whitney). The univariate analysis showed a positive and significant association between MS diagnosis (OR 4.80; 95% CI 2.29–10.18; p < 0.001 for MS diagnosis) and some MS components Triglycerides (TG), HDL Cholesterol (HDL-C), (OR 14.82; 95% CI 5.24–41.88; p < 0.001 for Ln TG); (OR 0.92; 95% CI 0.89–0.95; p < 0.001 for HDL-C) and LDL score. Apo B and insulin levels were also positively related to the presence of sd-LDL (OR 31.56; 95% CI 5.58–178.29; p < 0.001 for apo B); (OR 1.07; 95% CI 1.00–1.15; p < 0.05 for insulin). After controlling for age, insulin and apo B, MS diagnosis (OR 4.0; 95% CI 1.76–9.09; p < 0.001 for MS diagnosis) and MS components (TG, HDL-C) (OR 4.41; 95% CI 1.22–15.87; p = 0.023 for Ln TG); (OR 0.94; 95% CI 0.89–0.98; p = 0.009 for HDL-C) remained significantly associated with high LDL score (upper quintile). Our results suggest that sd-LDL particles could be a valuable marker for diagnosis and severity of the MS. Future prospective epidemiological studies are envisaged to explore the specific contribution of this marker on cardiovascular risk. LDL size measurement could be an useful tool for identifying a subsample patients with prominent lipoprotein abnormality, within the large population with the MS diagnosis, and who are candidates for intensive lipid-lowering interventions.

Mo-P1:40 Menstrual cycle length, serum lipids and lipoproteins in a cohort of Italian Mediterranean women: Findings from progetto atena

Mo-P1:40 Menstrual cycle length, serum lipids and lipoproteins in a cohort of Italian Mediterranean women: Findings from progetto atena

Mo-P1:46 Body mass index and HS-CRP in a cohort of mediterranean women: Findings from progetto atena

Mo-P1:46 Body mass index and HS-CRP in a cohort of mediterranean women: Findings from progetto atena

Carotid Artery Remodeling in Middle-Aged Women With the Metabolic Syndrome (from the “Progetto ATENA” Study)

The prevalence of the metabolic syndrome (MS) is rapidly growing, especially in women. This analysis was designed to evaluate whether preclinical vascular changes are detectable in middle-aged women with the MS. Five thousand sixty-two women participated in a prospective study of the causes of cardiovascular disease in women (the "Progetto Atena" study). Three hundred ten women underwent high-resolution B-mode ultrasound examinations. Common carotid intima-media thickness (IMT) and internal and external diameters were measured using a computerized system. The National Cholesterol Education Program Adult Treatment Panel III criteria were used to classify participants as having the MS. Seventy-three subjects fulfilled the criteria for the MS. Women with the MS were slightly older and had greater serum total cholesterol and higher levels of serum insulin and lipid peroxidation compared with women without the MS. The group with the MS had a greater mean IMT (1.24 +/- 0.27 vs 1.10 +/- 0.20 mm, p <0.0001) and larger mean values for diameters (7.9 +/- 1.0 vs 7.4 +/- 0.7 mm, p <0.0001 for external diameter; 6.1 +/- 0.8 vs 5.8 +/- 0.6 mm, p <0.005 for internal diameter). The average increase in wall thickness was greater than in vessel diameter, as evidenced by the greater relative wall thickness in women with the MS (0.41 +/- 0.09 vs 0.38 +/- 0.07, p <0.005). In conclusion, carotid structural changes are noninvasively detectable in asymptomatic middle-aged women with the MS. These modifications indicate a dynamic process of arterial remodeling by which the vascular system responds to atherosclerotic stimuli.

W08-P-007 Central adiposity and HS-CRP in acohort of mediterranean women: Findings from progetto atena

W08-P-007 Central adiposity and HS-CRP in acohort of mediterranean women: Findings from progetto atena

58 Screening for familial combined hyperlipidemia criteria in a cohort of mediterranean women: Findings from progetto ATENA

58 Screening for familial combined hyperlipidemia criteria in a cohort of mediterranean women: Findings from progetto ATENA

Effect of high-density lipoprotein cholesterol levels on carotid artery geometry in a Mediterranean female population

Controversy remains on the relationship between high-density lipoprotein cholesterol (HDL-C) and atherosclerotic cerebrovascular disease. Over 5000 women living in the area of Naples, Southern Italy, were recruited for a prospective study on the etiology of cardiovascular disease in the female population (the 'Progetto ATENA' study). A sample of 310 participants underwent high-resolution B-mode ultrasound examination and the intima-media thickness and diameters of common carotid artery were measured. In addition to routine biochemical tests, these women also had oxidation markers determined. Women in the upper HDL-C quartile (HDL-C>1.89 mmol/L) had significantly lower body mass index and waist-to-hip ratio values, and triglycerides concentrations when compared with women in the first three quartiles. A linear negative association was found between HDL-C and carotid intima-media thickness (1.07+/-0.16 mm for the IV quartile versus 1.10+/-0.20 mm for the III quartile, 1.15+/-0.26 mm for the II quartile and 1.19+/-0.23 mm for the I quartile; P<0.01 by ANOVA). No difference was found between groups with regard to carotid diameters and oxidation markers. After adjustment for other cardiovascular risk factors, women in the highest quartile of HDL-C had a decreased risk of carotid intima-media thickening (OR 0.42, 95%CI 0.23-0.94). In asymptomatic middle-aged women, HDL-C levels were independently and negatively associated with preclinical atherosclerotic changes of the carotid artery wall.

The relationship between BMI and common carotid plaques or Apo B and bifurcation plaques are independent of hs-CPR concentration: findings from Progetto ATENA

The relationship between BMI and common carotid plaques or Apo B and bifurcation plaques are independent of hs-CPR concentration: findings from Progetto ATENA

Body mass index and hs-CRP in a cohort of mediterranean women: Findings from progetto ATENA

Body mass index and hs-CRP in a cohort of mediterranean women: Findings from progetto ATENA

W01.22 Insulin levels and HS-CRP in a group of mediterranean women: Findings from progetto atena

W01.22 Insulin levels and HS-CRP in a group of mediterranean women: Findings from progetto atena