Risk in vulnerable groups 963

Risk in vulnerable groups
963
on MACEs. A total of 56,607 subjects were included, of whom 23,530 (41.6%) had
concomitant OA. The crude MACE rates were significantly higher in hypertensive
patients with OA than those without OA, except for ESRD (all p < 0.05). After adjusting the birth year and sex, the adjusted ORs (95% confidence interval (CI) and
p-values) for MACE in patients with both OA and HTN were all significantly higher
with 3.09 (2.69-3.54) in MI; 2.47 (2.22-2.75) in stroke; 2.40 (2.06-2.79) in CHF;
1.75 (1.48-2.08) in ESRD and 4.77 (4.38-5.19) in PVD (all p <0.0001), respectively. In the prospective study, when compared with controls and after adjusting
the birth year and sex, the adjusted HRs of cases with OA for total MACEs, hospitalized MI, stroke, CHF, PVD and ESRD with dialysis were 2.13 (2.02-2.25), 2.11
(1.86-2.40), 2.07 (1.94-2.20), 2.34 (2.12-2.58), 2.72 (2.41-3.06) and 1.78 (1.542.04) (all p< 0.0001), respectively.In addition, the risks for developing traditional
CV risk factors including hypertension, DM and dyslipidemia (all p <0.00001)
were also significantly increased in OA patients.
Conclusion: Results from this study highlight the risks for developing composite
and each MACE (MI, stroke, CHF, ESRD and PVD) rates were significantly higher
in patients with OA.
Figure 1
P5174 | BEDSIDE
The effect of LP(a) in patients with heterozygous familial
hypercholesterolemia on coronary plaque burden and calcium
score determined by CT
S. Bos 1 , G.-J.R. Ten Kate 2 , E.J.G. Sijbrands 1 , M.T. Mulder 1 , J.E. Roeters Van
Lennep 1 . 1 Erasmus Medical Center, Dpt Internal Medicine, Div. of Pharmacology,
Vascular & Metabolic Diseases, Rotterdam, Netherlands; 2 Erasmus Medical
Center, Department of Radiology, Rotterdam, Netherlands
P5172 | BEDSIDE
Maternal hypercholesterolemia during pregnancy is associated
with severity of myocardial infarction in young adults
Rationale: People with heterozygous familial hypercholesterolemia (FH) have a
genetic predisposition for developing premature cardiovascular disease (CVD).
However the clinical phenotype of FH has a high variability which is due to
metabolic and environmental factors. One of the metabolic factors that increase
the risk for pre-mature CVD might be Lp(a). Previous studies have identified Lp(a)
as an independent risk factor for cardiovascular disease. The goal of our study
was to analyze the association between calcium scores and coronary plaque burden in relation with plasma Lp(a) levels in patients with FH and to study whether
this association was similar in men and women.
Methods and results: From February 2008 until June 2011 145 (93 men, age
52±8) patients with a clinical diagnosis of FH visiting the outpatient clinic for
lipid disorders in the Medical Centre were included. These patients underwent
a CT coronary angiography to determine the coronary plaque burden and calcium score. From 131 (84 men, age 53±8) of these patients blood was collected
and Lp(a) levels were measured. Lp(a) levels were subsequently related to total
coronary calcium score(TCS) and coronary plaque burden. Coronary plaque burden is described as diseased coronary segment score per patient (DSS). DDS
and TCS were analyzed in a group with low Lp(a) <0,300 g/L and with high Lp(a)
>1,000 g/L levels, adjusted for sex, using the Mann-Whitney U test. In men no
significant differences in DSS (p=0,960) and TCS (p=0,400) were found if Lp(a)
was determined. In women significantly higher DSS (p=0,022) and TCS (p=0,004)
were found in the high-Lp(a) group.
Conclusion: Our data show a higher amount of DSS and TCS in women with high
Lp(a) levels in comparison with women with a low Lp(a). In men no difference in
DSS and TCS is found between high and low Lp(a) groups. We show that serum
levels of Lp(a) is associated with disease severity in FH women and not in FH
men.
Clinical relevance: High LP(a) levels in FH women are associated with advanced
subclinical atherosclerosis. Therefore, we can identify a high risk subgroup in
which we should attain an even more strict cardiovascular risk reduction.
A. Liguori 1 , G. Bruzzese 1 , F. Cacciatore 2 , F. De Nigris 3 , P. Abete 4 ,
L. Sommese 5 , W. Palinski 6 , C. Napoli 3 . 1 ASL NA1, Pellegrini Hospital,
Department of Cardiology-UTIC, Naples, Italy; 2 Salvatore Maugeri Foundation,
IRCCS, Department of Cardiac Rehabilitation, Telese Terme, Italy; 3 Second
University of Naples, School of Medicine, Dept of Gen Pathol, Excellence
Centre on CVD, Naples, Italy; 4 University of Naples Federico II, Dpt of Clinical
Medicine, Cardiovascular & Immunological Science, Naples, Italy; 5 UOC of
Immunohematology and Transplantation, Second University of Naples, Naples,
Italy; 6 University of California, San Diego, Department of Medicine, San Diego,
United States of America
Background: Elevated Maternal Cholesterol during Pregnancy (MCP) enhances
atherogenesis in childhood, but its impact on acute myocardial infarction (AMI) in
adults is unknown.
Methods: 89 AMI patients meeting narrow criteria (born after 1945, typical chest
pain, transmural infarction Q-waves, elevated creatinine kinase, no cerebrovascular or terminal disease) were identified among patients admitted to coronary
care unit in Naples, Italy. Patients were classified by MI severity (severe=involving
3 arteries, left ventricle ejection fraction ≤35, CK-peak >1200 mg/dl, or CK-MB
>200 mg/dl). The association of MCP with AMI severity was tested by linear and
multiple regression analysis that included conventional cardiovascular risk factors, gender, age, and treatment. Associations of MCP with BMI was assessed by
linear correlation.
Results: MCP correlated with four measures of AMI severity: number of vessels
(β=0.382, p=0.001), ejection fraction (β=-0.315, p=0.003), CK (β=0.260, p=0.014)
and CK-MB (β=0.334, p=0.001), as well as survival time (β=-0.252, p=0.031). In
multivariate analysis of patients stratified by AMI severity, MCP predicted AMI
severity independently of age, gender, and CHD risk factors (OR=1.304, 95% CI
1.107-1.559; p=0.004). Screening for point mutations ruled out that this was due
to certain inherited differences in lipid metabolism. Survival was affected mainly
by AMI severity.
Conclusions: MCP is associated with adult BMI, atherosclerosis-related risk and
severity of AMI.
P5173 | BENCH
Osteoarthritis is an independent risk factor for major adverse
cardiovascular events-nationwide case-control studies
K.-H. Cheng, C.-S. Chu, K.-T. Lee, Y.-H. Yang, W.-C. Tsai, W.-H. Tang,
S.-H. Sheu, W.-T. Lai. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Purpose: The impact of osteoarthritis (OA) on major adverse cardiovascular
events (MACEs) remains unclear. We examined the total and each risk of MACEs
associated with OA in a nation-wide study.
Methods: A retrospective, case-control study was designed among middle-aged
patients (aged 30-60 years) with essential hypertension to alleviate the fundamental issue of hypertension relevant MACEs raised by the use of nonsteroidal
anti-inflammatory drugs (NSAIDs) and/or COX-2 selective inhibitor (coxibs). After
that, a further prospective study could be designed to test the causality of OA to
MACEs (MI, stroke, CHF, ESRD and PVD)
Results: In the first retrosepective study, patients with hypertension, on at least
3 visits, without pre-defined MACEs at the first year (in 1996) were retrieved from
Taiwan National Health Insurance Research Dataset to test the concomitant OA
P5175 | BEDSIDE
Albuminuria significantly predicts cardiovascular events in
patients with type 2 diabetes independently from the baseline
coronary artery state
P. Rein 1 , C.H. Saely 1 , D. Zanolin 2 , A. Vonbank 3 , H. Drexel 4 . 1 Academic
Teaching Hospital, Department of Internal Medicine, Fedlkirch, Austria;
2
VIVIT Institute, Feldkirch, Austria; 3 Private University of the Principality of
Liechtenstein, Triesen, Liechtenstein; 4 Drexel University College of Medicine,
Philadelphia, United States of America
Purpose: Albuminuria is an important indicator of cardiovascular risk. We have
recently shown that it is also associated with angiographically determined coronary artery disease (CAD). Whether albuminuria predicts cardiovascular events
independently of the baseline coronary artery state in patients with type 2 diabetes (T2DM) has not been investigated yet.
Methods: We measured urinary albumin and creatinine concentrations in 211
consecutive patients with T2DM undergoing coronary angiography for the evaluation of suspected or established stable CAD. Albuminuria was defined as a
urinary albumin to creatinine ratio (ACR) of 30 μg/mg or greater. Prospectively,
we recorded vascular events over 3.2±1.4 years.
Results: During follow up, 24.6% of our patients suffered cardiovascular events.
The cardiovascular event rate was significantly higher in patients with albuminuria (n=85) than in those with normoalbuminuria (35.3 vs. 17.5%; p=0.003). Cox
regression analysis adjusting for age, gender, BMI, smoking, systolic and dias-
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Conclusions: Low levels of eGFR, females, and the presence of ulcer-like projection, but not the Stanford classification were predictive of long-term outcomes
in patients with intensive medical treatment for acute aortic dissection.
964
Risk in vulnerable groups / Streaming the management of STEMI
tolic blood pressure, LDL cholesterol, HDL cholesterol, eGFR, and use of ace
inhibitors/angiotensin II antagonists confirmed that albuminuria significantly predicted cardiovascular events independently from conventional risk factors (adjusted HR 1.96 [1.11-3.46]; p=0.021). Further adjustment for the angiographically
determined presence of CAD at baseline did not significantly attenuate the predictive power of the ACR (HR 1.84 [1.04-3.27]; p=0.037). Similar results were
obtained when the ACR was entered into the final regression model as a continuous variable (standardized adjusted HR 1.30 [1.02-1.65]; p=0.037).
Conclusions: Albuminuria significantly predicts cardiovascular events in patients
with T2DM independently of established cardiovascular risk factors and of the
baseline coronary artery state.
STREAMING THE MANAGEMENT OF STEMI
P5308 | BEDSIDE
Leptin predicts independently a first-ever STEMI in men, data from
a large prospective nested case-referent study
S. Soderberg 1 , M. Eriksson 2 , P. Wennberg 3 , G. Hallmans 4 , L. Weinehall 5 ,
T. Olsson 2 , J.H. Jansson 2 . 1 Umea University, Department of Public Health
and Clinical Medicine, Cardiology, and Heart Centre, Umea, Sweden; 2 Umea
University, Department of Public Health and Clinical Medicine, Medicine, Umea,
Sweden; 3 Umea University, Department of Public Health and Clinical Medicine,
Family Medicine, Umea, Sweden; 4 Umea University, Department of Public
Health and Clinical Medicine, Nutritional Research, Umea, Sweden; 5 Umea
University, Department of Public Health and Clinical Medicine, Epidemiology,
Umea, Sweden
P5309 | BEDSIDE
Comparison of infarct size and left ventricular ejection fraction as
surrogate endpoints for STEMI trials: evaluating the strength of the
evidence
P5310 | BEDSIDE
Increased 3-year-mortality after acute myocardial infarction in
patients with newly diagnosed diabetes - results of SWEETHEART
A.K. Gitt 1 , F. Towae 2 , A. Papp 2 , U. Zeymer 1 , R. Zahn 2 , S. Schneider 3 ,
O. Schnell 4 , D. Tschoepe 5 , J. Senges 3 on behalf of SWEETHEART Study
Group. 1 Herzzentrum Ludwigshafen, Med. Klinik B, Kardiologie + Institut
f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany;
2 Herzzentrum Ludwigshafen, Med. Klinik B, Kardiologie, Ludwigshafen am
Rhein, Germany; 3 Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen
am Rhein, Germany; 4 Diabetes Research Institute, Munich, Germany; 5 Heart
and Diabetes Center NRW, Bad Oeynhausen, Germany
Background: Many patients (pts) with coronary artery disease (CAD) suffer from
diabetes. Joint guidelines of the ESC and the EASD recommend testing for diabetes using OGTT in pts with established CAD and without known diabetes.
Methods: 2,767 consecutive pts with STEMI/NSTEMI were enrolled into the
SWEETHEART-registry to identify abnormal glucose metabolism. In pts without
diabetes, oral glucose tolerance test (OGTT) was performed at day 4 after the
MI. We examined the impact of known and newly diagnosed diabetes, impaired
fasting glucose (IFG) and impaired glucose tolerance (IGT) on 3-year-mortality.
Results: 689 pts (27.4%) had known diabetes. OGTT detected 417 pts with IFG
(16.6%), 182 with IGT (7.2%) and 461 with new diabetes (18.3%). The relative risk
for death and MACCE was increased in pts with diabetes (adjusted HR of 1.77
(95% CI 1.21-2.59) and 1.68 (95% CI 1.26-2.25) respectively). Pts with newly
diagnosed diabetes had significantly increased 3-year-mortality as compared pts
with IGT/IFG only or pts without any disturbances in glucose metabolism.
Age (years, mean)
Female gender
STEMI
NSTEMI
Prior MI
Prior PCI
Prior CABG
Renal failure
Periph. art. dis.
Coronary angio
PCI
Hospital Mortality
3-y-Mortality
3-y-MACCE
Known
diabetes
(n=689)
New
diabetes
(n=461)
IFG/IGT
(n=599)
Normal glucose
metabolism
(n=769)
p-value
71
30.9%
45.3%
54.7%
27.3%
25.6%
12.2%
27.0%
14.3%
91.0%
74.9%
2.9%
21.7%
28.6%
68
30.6%
53.8%
46.2%
12.8%
12.7%
6.3%
9.4%
7.2%
98.0%
87.0%
3.0%
12.4%
17.3%
64
21.0%
57.3%
42.7%
14.2%
14.7%
6.7%
9.0%
6.3%
96.8%
86.1%
0.5%
8.3%
13.8%
60
22.0%
61.9%
38.1%
13.6%
12.2%
4.6%
6.3%
6.6%
98.0%
86.8%
1.3%
6.1%
12.0%
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
J. Sackner-Bernstein, A. Pecora. NeoStem, New York, United States of America
Purpose: Acute mortality is declining following myocardial infarction, yet those
with ventricular dysfunction face substantial morbidity and mortality. We evaluated
the associations between treatment effects on infarct size (IS) and left ventricular
ejection fraction (EF) with treatment effects on survival after STEMI.
Methods: Literature was reviewed for randomized controlled trials of STEMI patients in which assessments of IS or LVEF were performed after study intervention and in which survival to at least 30-days was reported. For univariate
models, fixed effects and random effects meta-analyses were performed assum-
Conclusion: Oral glucose tolerance testing in the setting of acute MI identified
newly diagnosed pathologic glucose metabolism (diabetes mellitus/IGT/IFG) in
42.1% of consecutive MI-pts. Besides known diabetes, newly diagnosed diabetes
was a significant predictor of 3-year mortality.
Relationship of EF or IS to Mortality
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Purpose: The adipocyte derived hormone leptin could be a mediator between
obesity and increased risk for cardiovascular disease (CVD), as leptin has been
linked to the atherosclerotic process. We hypothesised that leptin predicted independently a myocardial infarction (MI).
Methods: A prospective nested case-referent study was set up within the framework of the Northern Sweden MONitoring of Trends and Determinants in CArdiovascular Diseases (MONICA) project, the Västerbotten Intervention Program
(VIP), and the Mammary Screening Program (MSP). Subjects (n=564, 40%
women) with a first-ever acute MI that had participated in one of these surveys
prior to the MI were selected. Age, sex, survey and location matched referents
(n=1082, 40% women) were selected within the surveys. Leptin was measured
in stored plasma. Conditional logistic regression was used to determine the risk
for MI. Type of MI (STEMI and NSTEMI) was classified according to Minnesota
codes.
Results: The time period between survey and event was 3.9 years (interquartile
range 3.6), and 51% of the cases had STEMI, 29% had NSTEMI, and 21% were
unclassified. Male and female cases had higher levels of leptin (5.0 vs. 4.1 ng/mL,
p<0.001 and 15.4 vs. 14.0 ng/mL, p=0.03), compared to referents. High leptin
levels predicted MI independently in men (OR 2.17 [1.32-3.54], ptrend<0.001),
but not in women (OR 1.10 [0.55-2.18], ptrend=0.05). The risk related to leptin in
men was seen for STEMI in particular.
Conclusions: High leptin predicts first–ever fatal and non–fatal MI, notably with
a gender and MI-type difference. Leptin may affect the atherosclerotic process
differentially in men and women and may promote plaque rupture and thrombus
formation in larger coronary vessels.
ing T-distribution random effects. Random-effects meta-regression models were
used to investigate the association between log odds ratios of mortality and mean
change in IS and EF.
Results: 10 and 17 STEMI trials met inclusion criteria for EF and IS, respectively. Treatment effect on EF correlated significantly with mortality; a 5% placebocorrected difference in EF was associated with odds ratio (OR) for mortality of
0.37 (95% CI: 0.19, 0.68; P=0.038; Figure 1A), reflecting 57.7% of the between
study variability in mortality. In contrast, the relationship between IS and mortality
was not statistically significant (OR=0.81 per 5% difference in IS; 95% CI: 0.55,
1.20; P=0.1; Figure 1B), and responsible for 14.7% of between study variability.
Conclusions: While infarct size has served as an acceptable surrogate endpoint
for mortality in STEMI in prior randomized trials, EF correlates more strongly with
mortality after STEMI, and may be useful as a surrogate endpoint in future STEMI
trials of therapies intended to improve ventricular function and mortality.
`