Risk Factor Profile Of Patients Research Articles

Modalités thérapeutiques du syndrome d’apnées-hypopnées obstructives du sommeil de l’adulte en dehors de la pression positive continue

Oral appliance therapy (OAT) is the main therapeutic alternative to continuous positive airway pressure (CPAP). OAT has been recommended as an appropriate first-line treatment option for moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients without severe cardiovascular comorbidity. The lower efficacy of OAT in reducing sleep-disordered breathing could be offset by a higher compliance relative to CPAP, resulting in similar health outcomes in terms of sleepiness, neurobehavioral functioning, quality of life and blood pressure. Electrical stimulation of the hypoglossal nerve is a promising treatment approach for moderate to severe OSAHS. Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing. There are currently no medications to treat OSAHS effectively. At least fifty percent of OSAHS patients are affected by central obesity and related metabolic disorders. To date, there is no evidence that treating OSAHS may improve comorbid metabolic disorders. Weight-loss intervention is a central component of the strategies used to improve the cardiovascular risk-factor profile in patients with OSAHS and obesity.

Intake of key micronutrients and food groups in patients with late-stage age-related macular degeneration compared with age–sex-matched controls

BackgroundKnowledge of the risk factor profile of patients presenting with late-stage age-related macular degeneration (AMD) could help identify the most frequent modifiable AMD precursors among people who are referred for...

Relation between cardiovascular disease risk factors and epicardial adipose tissue density on cardiac computed tomography in patients at high risk of cardiovascular events.

Background The radiodensity of epicardial adipose tissue may provide information on cardiovascular risk in addition to epicardial adipose tissue volume. The aim of this study was to quantify the relation between cardiovascular risk factors and the radiodensity of epicardial adipose tissue in patients at high risk of cardiovascular disease. Design This was a cross-sectional study in 140 patients at high risk of cardiovascular disease. Methods Patients from the Secondary Manifestations of ARTerial disease (SMART) cohort study were invited to undergo cardiac computed tomography angiography. The radiodensity (in Hounsfield units; HU) and volume (in cm3) of epicardial adipose tissue were quantified semi-automatically. Multivariable linear regression was used to quantify the relation between cardiovascular risk factors and the radiodensity of epicardial adipose tissue. Results The cardiovascular risk factors most strongly associated with epicardial adipose tissue density were sex, body mass index and visceral fat, with a lower adipose tissue attenuation of 3.5 HU (95% confidence interval (CI) 2.0-5.0 HU) for female sex, 1.6 HU (95%CI 0.2-2.9 HU) for body mass index >25 kg/m2 and 1.3 HU (95% CI 0.6-2.0 HU) for a one standard deviation higher quantity of visceral fat, adjusted for age, sex, coronary artery bypass graft history and epicardial adipose tissue volume. Conclusion Low epicardial adipose tissue computed tomography attenuation is associated with an adverse cardiovascular risk factor profile in patients at high risk of cardiovascular disease, independent of the volume of epicardial adipose tissue and waist circumference. These findings support the potential role for epicardial adipose tissue radiodensity as a valid biomarker of cardiovascular risk. Adipose tissue radiodensity may be a more sensitive marker than epicardial adipose tissue volume with which to study the contribution of epicardial adipose tissue to the coronary atheromatous disease process.

Metabolic risk factor-profile in patients on treatment with second generation antipsychotics.

The second generation antipsychotic agents, although exhibit superior safety profile, is associated with metabolic adverse effects including weight gain, diabetes mellitus and hyperlipidaemia. These adverse effects are not only the risk factors for cardiovascular disease and diabetes mellitus but may also impair patient's adherence to treatment. However, different member of second generation antipsychotics differ. in their extent of metabolic adverse effects. The aim of the study was to evaluate the association between olanzapine, risperidone or quetiapine treatment and body mass index, blood pressure, diabetes mellitus and hyperlipidaemia in patients with Schizophrenia and Bipolar Disorder. Forty-four cases of Schizophrenia and Bipolar Disorder diagnosed with DSM-IV criteria were selected according to inclusion and exclusion criteria. Body weight, body mass index and blood pressure were measured at baseline, at the end of 4th, 8th and 12th weeks of treatment. Blood samples were collected to measure blood glucose and serum lipid profile at baseline and at the end of 4th, 8th and 12th weeks in the study group receiving treatment (olanzapine 20-30 mg/day, risperidone 4-16 mg/day and quetiapine 300-800 mg/day) after overnight fasting. Therapeutic use of olanzapine and risperidone in Schizophrenia and Bipolar Disorder for a period of 4th, 8th and 12th weeks was associated with significant increase in body weight and body mass index. Quetiapine did not cause significant changes in body weight and body mass index after 4 and 8 weeks. However, after 12 weeks treatment, body mass index increased significantly. Olanzapine, risperidone and quetiapine increased the blood glucose level significantly after 8 and 12 weeks treatment. Olanzapine and risperidone elevated the serum cholesterol, triglyceride and low density lipoprotein levels significantly after 4, 8 and 12 weeks. But quetiapine showed no significant change in lipid profile. However, olanzapine and risperidone significantly increased triglyceride level after 8 and 12 weeks. Amongst three drugs, quetiapine treatment increased high density lipoprotein level. Our study revealed that quetiapine treatment is associated with less risk of dyslipidaemia.

Risk Factor Profile of Patients Sustaining Femoral Vascular Complications in a Tertiary Referral Cardiac Catheterisation Laboratory

Risk Factor Profile of Patients Sustaining Femoral Vascular Complications in a Tertiary Referral Cardiac Catheterisation Laboratory

Gender Difference in Risk Factor Profiles in Patients Referred for Coronary Angiogram

AbstractBackground & ObjectiveCoronary artery disease (CAD) is a leading cause of death of women and men worldwide. Expected burden of athero-thrombotic CAD in India will surpass other regions of the world by the year 2020. It is better to control the risk factors for CAD to prevent this crisis. So, we want to study the gender difference in risk factor profiles in patients referred for coronary angiogram (CAG).Materials & MethodsWe did is a prospective observational study for risk factors profile in patients referred for CAG over 24 months (2013 to 2015) to the Nizam's institute of medical sciences. We collected the demographic, clinical and lab parameters including CAG finding in these patients.ResultsWe analyzed the data of 3232 patients who undergone CAG during the study period. F: M::1081: 2151. 706 (65.3%) of female patients and 1312 (60.9%) of males patients had hypertension (HTN). 496 (45.9%) of females and 950 (44.1%) of males had Diabetes mellitus (DM). More males were presented with ACS (Acute coronary syndrome) whereas more females were presented with CSA (chronic stable angina). 203 (18.8%) female patients and 673 (31.3%) had lv dysfunction. Serum creatinine and Hemoglobin was low in females than males which were statistically significant. Total cholesterol was significantly higher in female CAD patients than male CAD patients (p=0.03). Both atherogenic (LDL) and protective (HDL) cholesterol were more in females than males with normal coronaries, but this difference was seen in patients with CAD in both sexes.543 females and 551 males had normal coronaries. Overall prevalence of normal coronaries is more in females (p=0.00). Prevalence of diabetes showed a tendency more in females with normal coronaries than with males (p=0.063). Overall prevalence of risk factors in patients with normal coronaries is more in females compared to males (p=0.03). 782 (48.87%) males and 301(55.94%) females with CAD had diabetes. Prevalence of HTN (p=0.00) and DM (p=0.005) is more in females with CAD than males (p=0.00). Both DM & HTN was present in 647 (40.43%) of males and 273 (50.74%) of females, which is also is statistically significant.ConclusionOverall prevalence of normal coronaries is significantly more in females than males (p=0.00). Incidence of ACS is significantly more in males whereas CSA incidence more in females. Even though statistically significant more prevalence HTN in females, there was no statistical significant difference in prevalence of DM & HTN in between both sexes in patients with normal coronaries. But there was significantly high prevalence of DM & HTN in females with CAD compared to males.

Cerebellar cortical infarct cavities and vertebral artery disease.

Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50% from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. Sixteen out of 46 (35%) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI.

Recurrent unipolar mania: A comparative, cross-sectional study

IntroductionA significant number of patients experience recurrent episodes of mania without depressive episodes. Evidence from the available literature suggests that these patients differ from typical “bipolar” or “manic–depressive” patients, but results have been inconsistent. The current study aims to add to this literature by comparing the demographic, clinical and risk factor profiles of patients with recurrent mania with and without depression. Methods66 patients with a diagnosis of bipolar I disorder were divided into “unipolar mania” (recurrent mania alone, MA) and “bipolar” (both mania and depression, MD) sub-groups. Comorbid diagnoses were assessed using the Mini International Neuropsychiatric Interview (MINI), and genetic and environmental risk factors were explored using the Diagnostic Interview for Genetic Studies (DIGS), Childhood Trauma Questionnaire (CTQ), and an additional questionnaire designed for the purpose of the study. Differences between the MA and MD groups in terms of demographic variables, clinical profile, comorbidities and antecedent risk factors were explored. ResultsPatients with both mania and depression had higher frequencies of lifetime suicide attempts, antidepressant treatment, and catatonic symptoms. There was some evidence of an association between overcrowding in childhood and the presence of depressive episodes. No other differences in demographic, clinical or risk factor variables could be found between the two groups. DiscussionOur results are consistent with the view that unipolar mania is not a distinctive disorder, or even a distinctive subtype of bipolar disorder. However, this conclusion is provisional as it is based only on clinical and demographic data.

Abstract 18655: Impact of New Guidelines on Atrial Fibrillation Pattern Classification: The Women’s Health Study

Background: Recent US guidelines have updated atrial fibrillation (AF) pattern definitions, reclassifying patients who undergo successful cardioversion within 7 days of AF onset as paroxysmal rather than persistent. The impact of this reclassification on AF pattern designation and risk factor profiles in patients with AF is unknown. Methods: We examined all participants with confirmed, new-onset AF among 34,636 women who were aged ≥45 years and free of AF and cardiovascular disease at baseline within the Women’s Health Study. All women were classified by AF type using both 2006 and 2014 ACC/AHA AF guideline definitions. AF type was classified as the most sustained form within 2 years of initial diagnosis. Risk factor profiles of patients reclassified by the 2014 guidelines were then compared to patients where AF pattern classification remained unchanged. Results: During a median follow-up of 19.2 years, 1493 women developed incident AF. Application of the 2006 AF guidelines identified 998, 313 and 182 women with paroxysmal, persistent and permanent AF, respectively. Using the 2014 AF guidelines, 107 women with persistent AF (34.2%) were reclassified to paroxysmal. Compared to women classified as persistent by both guidelines, those reclassified to paroxysmal by the 2014 guidelines were younger and had a lower prevalence of hypertension; but had similar weight and BMI (Table). Compared to women classified as paroxysmal by both guidelines, the women reclassified to paroxysmal were again younger but had a higher weight and BMI. Other cardiac risk factors did not differ significantly across AF patterns (Table). Conclusions: Using 2014 AF guidelines definitions, AF pattern was reclassified in a significant number of persistent AF patients. The risk factor profile of the reclassified women differed with respect to age, hypertension and BMI; known risk factors for AF progression. Selected AF pattern definition may influence results of future studies on AF progression.

Gait characteristics in older adults with diabetes and impaired fasting glucose: The Rotterdam Study

AimsTo investigate the association of diabetes mellitus and impaired fasting glucose with gait in the general middle-aged and elderly population. MethodsWe performed a cross-sectional study on 3019 participants from the population-based Rotterdam Study (aged >45years, 54% women). The presence of diabetes mellitus and impaired fasting glucose was evaluated by measuring serum glucose levels and by documenting anti-diabetic treatment. Participants underwent gait analysis using an electronic walkway. Thirty gait variables were summarized into five independent gait domains for normal walking (Rhythm, Variability, Phases, Pace and Base of Support), one for turning (Turning) and one for walking heel to toe (Tandem), which were averaged into Global Gait. Linear regression analyses were performed to determine the association of diabetes, impaired fasting glucose and continuous glucose levels within the normal range with gait. ResultsDiabetes mellitus was associated with worse Global Gait (Z-score difference −0.19, 95% confidence interval (CI) −0.30; −0.07), worse Pace (−0.20, 95% CI −0.30; −0.10) and worse Tandem (−0.21, 95% CI −0.33; −0.09), after adjusting for age, sex, height and weight. The association with Tandem remained significant after additional adjustment for cardiovascular risk factors. Impaired fasting glucose and continuous glucose levels within the normal range were not associated with any of the gait domains. ConclusionIn our population-based study diabetes mellitus was associated with worse Global Gait, which was mostly reflected in Pace and Tandem. These associations were partly driven by other cardiovascular risk factors, emphasizing the importance of optimal control of cardiovascular risk factor profiles in patients with diabetes.

4. Comparing risk factors profile in patients with Coronary Artery Disease who underwent cardiac catheterization with those revealed to have normal coronary arteries: A case-control study

Coronary Artery Disease (CAD) is one of the major causes of morbidity and a leading public health issue, comprising the death causes of millions of men and women worldwide. Most of prior studies in the region of the modifiable risk factors were cross-sectional studies. Study was conducted to compare those who revealed to have CAD after cardiac catheterization with those who shown to be free from CAD. The comparison planned based on the following variables: age, gender, Body Mass Index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus, and the presence or absence of family history of CAD, in order to identify significant risk factors of CAD in our population. Second objective was to identify the most important predictors for CAD, in order to help clinicians identifying main characteristics of a cardiac cath candidate in our population. A case-control study was conducted by extracting data of patients who underwent cardiac cath between 10th of June 2008 and 8 July 2013. Patients’ information was taken from King Abdulaziz Cardiac Center in Riyadh (KACC) catheterization lab with the following inclusion and exclusion criteria: Inclusion criteria: Age >18, both genders, suspected to have CAD and had at least one visit prior to catheterization. Exclusion criteria: other cardiac diseases including valvular disease, vacuities, congenital anomalies, and cath done not primarily to rule out CAD Sample size was calculated based on presence of family history with estimated proportion of 0.048 in controls, odd ratio of 3, 95% confidence level and 90% power to be 484 subjects in total (with a case to control ratio of 1:1, 242 for each group). The sample size then was maximized to include all patient who were found not having CAD after heart cath (total of 456 for control group), cases (those found to have CAD) were minimized to 456 subjects through computerized based simple random sampling technique. Data was recorded in data collection sheet based on subjects’ disease status (diseased, or not diseased), and their exposure to single or multiple factors. Total of 912 subjects included in the analysis, 456 for each group. The mean was 58.52 ± 13, and the mean BMI was 29.8 ± 6. Smoker were 25.5%, those with hypertension were 58%. Hyperlipidemia was experienced in 49%, diabetes in 50.7% of subjects. Family history of CAD presented in 4.8% of total subject who went for cardiac cath. All expected risk factors entered in the logistic regression analysis, and showed significantly different prevalence in patients with CAD compared to those without; gender (P < 0.001),diabetes (P < 0.001),age (P < 0.001), BMI (P < 0.001), dyslipidaemia (P < 0.001), smoking (P = 0.017), family history (P = 0.994) and hypertension with P < 0.001. The most important predictors of CAD in our population were age, gender, BMI, dyslipidaemia, diabetes mellitus and smoking. Whereas, family history was not recognized as predictor, this is may be due improper documentation of this variable in patient records.

Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit.

The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.

Abstract 152: Vascular Risk Factor Profiles Differ Between Subtypes of MRI Defined Younger Onset Lacunar Stroke

Introduction: The pathogenesis of lacunar infarct is poorly understood. Two pathological and radiological subtypes have been suggested: isolated infarcts due to microatheroma and multiple smaller lacunar infarcts due to lipohyalinosis. The latter subtype has been associated with leukoaraiosis (LA) on MRI. Differing associations of vascular risk factors with lacunar infarct have been reported, which is likely due to heterogeneity in the classification of lacunar infarcts. Therefore we aimed to investigate the risk factor profile of lacunar infarction and subtypes in a MRI verified cohort of lacunar infarct patients. Methods: 1029 Caucasian patients with lacunar infarction, aged &lt;=70 years (mean age 56.7 (SD8.5), range 20-70), were recruited from 72 specialist stroke centres throughout the UK as part of the Young Lacunar Stroke DNA Resource. Risk factor profiles were compared with 1962 stroke-free population controls. Lacunar infarct was subdivided on MRI into isolated lacunar infarction without confluent LA (ILI) and multiple lacunar infarcts and/or confluent LA (MLI/LA). All MRI’s and clinical histories were reviewed centrally. Results: Lacunar infarct was associated with hypertension (OR 2.26 (95% CI 1.89-2.70)), diabetes (OR 2.13 (95% CI 1.63-2.79)), hyperlipidaemia (OR 1.79 (95% CI 1.50-2.12)) and smoking (OR 1.73 (95% CI 1.46-2.05)). The association with hypertension was stronger in women than in men (OR 3.65 (95% CI 2.63-5.07 and 1.83 (95% CI 1.48-2.26) respectively). Compared to ILI, the MLI/LA variant was associated with age (OR 1.04 (95% CI 1.02-1.05)), hypertension (OR 2.16 (95% CI 1.60-2.91)), smoking OR 1.48 (95%CI 1.11-1.96)) and lower estimated glomerular filtration rate (per 10 ml/min, OR 0.94 (95% CI 0.90-0.98)). Conclusion: In this younger onset lacunar stroke population we identified a distinct risk factor profile in patients compared to controls. This risk factor profile differed between lacunar infarct subtypes. The association of the MLI/IL subtype with more severe hypertension and renal impairment might reflect a diffuse small vessel arteriopathy.

A Study of the Cardiovascular Risk Factor Profile in Patients with Acute Coronary Syndrome with Particular Reference to Metabolic Syndrome

Objectives: Cardiovascular risk factors for acute coronary syndrome (ACS) are on rise in people of Indian origin. Moreover, the prevalence of metabolic syndrome (MS) is higher in populations with ACS than in the general population. Thus, the aim of the study was to evaluate the cardiovascular risk factor profile of patients presenting with acute coronary syndrome and to study the prevalence and impact of metabolic syndrome in patients with acute coronary syndrome by using South Asian modified National cholesterol Education Program Adult Treatment Panel III definition. Methods: This study was conducted between October, 2010 and March, 2011 at Government General Hospital, Kurnool, India. A total of 100 patients with ST or non-ST segment elevation ACS and who had clinical, electrocardiographic and biochemical diagnosis within the first 24 hrs of clinical onset were enrolled in the study. The enrolled subjects were divided into two groups: those with MS and those without MS. Cardiovascular risk factors defined by components of MS were evaluated. Analysis was performed using SPSS software. Results: Sixty patients had MS along with ACS and 40 patients had ACS without MS. The most prevalent component of MS was increased waist circumference (83.3%), followed by increased triglycerides (78.3%) and increased fasting blood sugar (76.7%). Majority of patients (58.3%) had presence of three components of MS. Conclusion: The MS is a highly prevalent condition among the patients with ACS and is associated with severe coronary artery disease. The identification of MS imparts a high risk status to the patient in developing cardiovascular disease but at the same time provides abundant opportunities for intervention. Hence it is of paramount importance to aim for stricter goals and lower cut offs for intervention at all levels of prevention: primordial, primary and secondary.

Recent Surgery or Invasive Procedures and the Risk of Stroke

Background and Purpose: A recent surgery may be one of the trigger factors precipitating stroke and transient ischemic attack (TIA). While stroke in cardiac and carotid surgery has been well studied, less is known on stroke risk after surgery outside the heart and brain supplying arteries. We tested the hypothesis that preceding non-neurosurgical, non-cardiothoracic, and non-carotid surgery and other interventions temporarily increase the risk of stroke and transient ischemic attack (TIA) and investigated the risk related to different time periods between interventions and stroke/TIA. Methods: In the Ludwigshafen Stroke Study, a population-based stroke registry, we assessed surgery and other interventions within the year preceding stroke and TIA. The risk factor profiles of patients with and without prior intervention were compared and rate ratios (RR) were calculated for different time periods with 91-365 days before stroke and TIA serving as reference period. Results: In 2006 and 2007, 803 patients without and 116 patients with non-neurosurgical, non-cardiothoracic, and non-carotid intervention within the preceding year were identified. Elective (n = 21) and posttraumatic orthopedic (n = 14), eye (n = 14), and visceral surgery (n = 11) dominated. Interventions within 0-30 days (n = 34; RR 4.72; 95% confidence interval (CI) 2.70-8.26) but not within 31-60 or 61-90 days before stroke/TIA were observed more often than in the reference period. Interventions were more common within day 8-30 before stroke/TIA (RR 3.26; 95% CI 1.66-6.39), particularly common within the preceding week (RR 9.52; 95% CI 3.77-24.1) and most common in the preceding 2 days (RR 27.1; 95% CI 5.97-123) as compared to the reference period. Atrial fibrillation (AF) but not other risk factors was more common in patients with interventions within 30 days (n = 15; 44.1%) as compared to patients with more antecedent interventions (n = 19; 23.2%, p = 0.022) and those without surgery (n = 222; 27.6%, p = 0.031). Interventions within 30 days before stroke/TIA, were associated with total ischemic stroke (RR 6.11; 95% CI 3.32-11.2), first-ever in a lifetime ischemic stroke (RR 5.62; 95% CI 2.83-11.1) and recurrent ischemic stroke (RR 7.50; 95% CI 2.88-19.6). Conclusion: Recent non-cardiothoracic, non-carotid, and non-neurosurgical interventions are associated with an increased risk of stroke lasting for about 1 month and being particularly high within the first days. AF may be among the mechanisms linking interventions and stroke besides induction of a procoagulant state and interruption of medication.

An analysis of the risk factor profile of patients of established coronary artery disease

An analysis of the risk factor profile of patients of established coronary artery disease

Relationship among 25-hydroxyvitamin D concentrations, insulin action, and cardiovascular disease risk in patients with essential hypertension.

Although low plasma 25-hydroxyvitamin D (25(OH)D) concentrations have been shown to predict risk of hypertension and associated cardiovascular disease (CVD), vitamin D repletion has not consistently lowered blood pressure or decreased CVD. One possibility for this discrepancy is the presence of considerable metabolic heterogeneity in patients with hypertension. To evaluate this possibility, we quantified relationships among insulin resistance, 25(OH)D concentration, and CVD risk factor profile in patients with essential hypertension. Measurements were made of 25(OH)D concentrations, multiple CVD risk factors, and insulin resistance by the steady-state plasma glucose concentration during the insulin suppression test in 140 otherwise healthy patients with essential hypertension. As a group, the patients were overweight/obese and insulin resistant and had low 25(OH)D concentrations. The more insulin resistant the patients were, the worse the CVD risk profile was. In addition, the most insulin-resistant quartile had significantly lower 25(OH)D concentrations than the most insulin-sensitive quartile (20.3±1.4 vs. 25.8±1.4ng/ml; P = 0.005). In the entire group, 25(OH)D concentration significantly correlated with magnitude of insulin resistance (steady-state plasma glucose concentration; r = -0.20; P = 0.02). There was considerable metabolic heterogeneity and substantial difference in magnitude of conventional CVD risk factors in patients with similar degrees of blood pressure elevation. The most insulin-resistant quartile of subjects had the lowest 25(OH)D concentration and the most adverse CVD risk profile, and they may be the subset of patients with essential hypertension most likely to benefit from vitamin D repletion.

Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting

ObjectiveTo evaluate the relationships of lipoprotein(a) (Lp(a)) concentration and apolipoprotein(a) (apo(a)) phenotype to major adverse cardiovascular events after coronary artery bypass grafting (CABG) in long-term follow-up. MethodsThis single-center study included 356 patients with stable coronary heart disease (CHD) who underwent successful CABG. At baseline, we assessed the patient's risk factor profile for atherosclerosis, Lp(a) concentration and apo(a) phenotype. The primary endpoint was the composite of cardiovascular death and non-fatal myocardial infarction (MI). The secondary endpoint also included hospitalization for recurrent or unstable angina and repeat revascularization. ResultsOver a mean of 8.5 ± 3.5 years (range 0.9–15.0 years), the primary and secondary endpoints were registered in 46 (13%) and 107 (30%) patients, respectively. Patients with Lp(a) ≥30 mg/dL were at significantly greater risk for the primary endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76–5.03, p < 0.001) and secondary endpoint (HR 3.47, 95% CI 2.48–4.85, p < 0.001) than patients with Lp(a) values <30 mg/dL. The low molecular-weight apo(a) phenotype was also associated with higher risk of both primary and secondary endpoints (3.57 (1.87–6.82) and 3.05 (2.00–4.62), respectively; p < 0.001 for both), regardless of conventional risk factors and statins use. ConclusionIn stable CHD patients Lp(a) concentration and low molecular-weight apo(a) phenotype are independently associated with three-fold increase in risk of major adverse cardiovascular events within 15 years after CABG. Lp(a) levels may provide an additional information for postoperative cardiovascular risk assessment.

Temporal trends in clinical characteristics of patients without known cardiovascular disease with a first episode of myocardial infarction

Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI. In the American Heart Association's Get With The Guidelines-Coronary Artery Disease national registry, 100,884 patients without known cardiovascular disease presenting with acute MI from 408 hospitals were evaluated between 2002 and 2008. The time trends of the proportion of patients with cardiovascular risk factors (nonmodifiable: age >45 years for men or >55 years for women, male sex, modifiable: diabetes mellitus, hypertension, hyperlipidemia, tobacco use) were analyzed. Analyses were stratified by non-ST-segment elevation MI (NSTEMI) versus ST-segment elevation MI (STEMI). The proportion of patients with ≥3 of 6 traditional risk factors slightly decreased over time in the NSTEMI (69.5%-66.8%, P < .0001) and STEMI (68.9%-66.4%, P < .0001) cohorts. The proportion of patients with ≥2 of 4 modifiable risk factors increased from 52% to 59% and then declined to 52.1% (P < .0001) in the NSTEMI cohort but declined slightly in the STEMI cohort (50.9%-47.3%, P < .0001). After adjusting for age and gender, the time trend of proportion with diabetes mellitus, hypertension, and tobacco use declined in both cohorts. However, the proportion of patients with hyperlipidemia remained similar. Although risk factor profiles in patients presenting with first MI have shown improvements over time, the changes are modest.

221: Peripheral artery disease and description of risk factors profile in ambulatory patients with metabolic syndrome

The metabolic syndrome, a cluster of cardiovascular risk factors associated with insulin resistence and obesity has been associated with an increase in incidence of coronary artery disease, stroke and cardiovascular mortality. Less data are available on the relationship between the metabolic syndrome and incident lower extremity peripheral artery disease. Our aim is to evaluate the prevalence of peripheral artery disease (PAD) in ambulatory patients aged 45-65 years with metabolic syndrome (MS). We included in our study 400 ambulatory patients (200 men and 200 women) who fulfilled criteria of metabolic syndrome. The diagnosis of PAD was establighed if ankle-brachial index (ABI) was < 0.9. We analyzed risk factors profile in these patients: body mass index (BMI), physical inactivity, smoking, hypertension, dyslipidemia, abnormal glucose metabolism and subclinical inflammatory status. Smoking was found in 38% of males and 21% of females. Among these patients with MS, an HDL-Chol < 50 mg/dl was the most prevalent MS trait: 87% in males and 83% in females. This trait was followed by elevated BMI in 80% of males and 84% of females. Also, elevated blood pressure was found in 79% of males and 75% of females. Elevated triglycerides were present in 80% of males and 74% of females. Dysglycemia was found in 29% of males and 24% of females. Among patients with metabolic syndrome, the prevalence of PAD was of 12% in males and 6% in females, correlated with smoking (87.5% in males and 91.66% in females with PAD), physical inactivity (79.16% in males and 91.66% in females), dysglycemia (75% in males and 83.33% in females), age (66.66% in males aged >55 years and 83.33% in females aged >55 years, total cholesterol (79.16% in males and 83.33% in females) and high hs-CRP (70.83% in males and 75% in females). MS is associated with a risk of PAD, an important role playing smoking, dysglycemia, dyslypidemia and subclinical inflammation.