FATTORI DI RISCHIO PER LO SVILUPPO DI SINDROME CORONARICA ACUTA

[SEX DIFFERENCES IN CARDIOVASCULAR RISK FACTORS AND THE IMPACT OF SEX ON THE OCCURRENCE OF AN ACUTE CORONARY EVENT. A CASE-CONTROL STUDY. Eur J Cardiovasc Nurs 2008; 7:S12-S13]

ABSTRACT
INTRODUCTION The role of sex on the development of atherosclerosis has long been recognized. In this work we aimed to evaluate the extent to which cardiovascular risk factors can explain the sex difference in coronary heart disease (CHD) risk.
METHODS During 2000-01, we randomly selected from all Greek regions 848 hospitalised patients with a first event of an acute coronary syndrome and 1078 paired, by sex, age, and region controls, without any suspicious for CHD. All participants were evaluated through a rather detailed questionnaire in which demographic, athropometric, life-style habits; social, psychometric, nutritional and clinical factors were recorded.
RESULTS Women patients were significantly older than men (65.3 ± 8 vs. 59.7 ± 10 years old, p < 0.01). The frequency ratio of males÷females patients was 4÷1. The effect of the family history of premature CHD and hypercholesterolemia, on the risk of developing acute coronary syndromes, seems to be related more consistent in males, while the presence of hypertension affects more significantly females. The higher education level as well as the adoption of Mediterranean diet seems to be more protective in females, while, depression is associated with higher risk of developing ACS in women.
CONCLUSION Lifestyle characteristics as well as several clinical symptoms and laboratory measurements seem to play significant role in the distinction of the risk factors profile between sexes. However, much remains to be learned about the mechanisms that relate CHD risk and sex.

[FISH CONSUMPTION AND THE RISK OF DEVELOPING ACUTE CORONARY SYNDROMES: A CASE-CONTROL STUDY. Eur J Cardiovasc Nurs 2008; 7:S11-S12]

ABSTRACT
OBJECTIVE Diet has been recognized to have an important role on the development, as well as, the progression of atherosclerosis The aim of this work was to investigate the association between fish consumption and the development of non-fatal acute coronary syndromes, in a Mediterranean population.
METHODS During 2000-01, we randomly and stratified selected, from all Greek regions, 848 hospitalised patients (695 males, 58 ± 10 years old and 153 females, 65 ± 9 years old) who had a first event of acute coronary syndromes (ACS) and 1078 paired, by region-sex-age, controls without any clinical symptoms or signs of coronary heart disease.
RESULTS On multivariate logistic regression analysis, and after controlling for several potential confounders, we found that fish consumption less than 150 g/wk was associated with 38% lower odds of developing ACS as compared to no consumption (odds ratio = 0.62, P -value < 0.05). In contrast, moderate (150-300 g/wk) and high (> 300 g/wk) fish consumption was not associated with the developing of the disease (odds ratios = 1.10 and 1.01, respectively, P -value > 0.1). The benefits from low fish consumption were also significant even amongst current smokers and diabetics.
CONCLUSION Moderate fish consumption was independently associated with a significant reduction in the odds of developing ACS. The strength and consistency of this finding has implications for public health and should be explored further.

[THE IMPACT OF PHYSICAL ACTIVITY ON THE RISK OF DEVELOPMENT AN ACUTE CORONARY SYNDROME, IN HYPERTENSIVE SUBJECTS. Eur J Cardiovasc Nurs 2008; 7:S13]

ABSTRACT
INTRODUCTION The level of blood pressure is known to determinate the cardiovascular risk. In this work we aimed to evaluate the effect of physical exercise on the coronary risk, in different groups of hypertensives.
METHODS During 2000-01, we randomly selected 848 hospitalised patients (695 males, 58 ± 10-153 females, 65 ± 9 years old) with a first event of coronary heart disease (CHD) and 1078 paired, by sex-age, hospitalised controls without CHD. Physically active was defined as those who reported non-occupational physical activity > 1/week. The rest were considered physically inactive.
RESULTS 418 (49%) of the patients and 303 (28%) of the controls were hypertensive. Of them 21 (5%) patients-36 (12%) controls were unaware of their condition, 94 (22%)-34 (11%) were untreated, 148 (35%)-111 (36%) were uncontrolled and 155 (38%)-122 (41%) were controlled (P - < 0.01). Two hundred eighty-eight (34%) of the patients and 453 (42%) controls were assigned to light (13% vs. 17%, respectively, P < 0.01), moderate (7% vs. 13%, P < 0.01) and vigorous physical activity level (14% vs. 12%, P = 0.078). The adoption of moderate physical activity reduced by 21% the coronary risk in controlled hypertensive subjects (OR = 0.79, P < 0.01), by 13% (OR = 0.87, P < 0.05) in uncontrolled and by 7% (OR = 0.93, P < 0.05) in unaware of their condition, after adjusting for age, sex, educational and financial level and the conventional cardiovascular risk factors.
CONCLUSION The adoption of physical activity is associated with reduction of the coronary risk in hypertensives. Non-habitual exercise seems to prevent approximately, one fourth of the acute coronary events due to hypertension, in controlled hypertensive subjects.

[THE ROLE OF PHYSICAL ACTIVITY ON THE DEVELOPMENT OF ACUTE CORONARY SYNDROMES IN DIABETIC PATIENTS. A CASE-CONTROL STUDY. Eur J Cardiovasc Nurs 2008; 7:S12]

ABSTRACT
BACKGROUND Epidemiological data suggest that the prevalence of type-2 diabetes is increasing dramatically, especially, during the past years. This increase is primarily being driven by environmental factors, like dietary and exercise habits. In this study we investigated the effect of physical activity on coronary risk, in diabetic patients, an issue that has not been adequately studied so far.
METHODS We studied demographic, lifestyle, dietary and clinical information in 216 hospitalized diabetic patients (171 men, 63 ± 9 years old and 45 women, 67 ± 5 years old) with a first event of an acute coronary syndrome (ACS) and 196 frequency matched (by age and sex) diabetic controls (154 men, 64 ± 11 years old and 42 women, 66 ± 6 years old) without any clinical evidence of CHD (from the CARDIO2000 II study). Diabetes mellitus was defined according to the established ADA criteria. Physically active were considered those who reported non-occupational physical activity > 1 time/week (at least 30 min/time). The rest were considered physically inactive. Physical activity was evaluated according to the Kcal/min expended and the weekly frequency of exercise.
RESULTS Seventy-eight (36%) of 216 patients and 110 (56%) of 196 controls were classified as physically active (p < 0.001). Multivariate conditional logistic regression analysis revealed that the odds ratio for developing an acute coronary event in diabetic subjects who reported moderate level of physical activity was 0.22 (95% CI 0.12-0.47), while the odds ratio in diabetics who reported high level was 0.33 (95% CI 0.21-0.59), after adjusting for age, sex, and the conventional cardiovascular risk factors.
CONCLUSIONS Physical activity (moderate and high level) seems to be associated with a lower coronary risk in the investigated group of diabetic subjects. Light physical activity does not seem to confer any protective effect.

GRASSO EPICARDICO PERICORONARICO E CALCIFICAZIONE CORONARICA

[PERI-CORONARY EPICARDIAL ADIPOSE TISSUE IS RELATED TO CARDIOVASCULAR RISK FACTORS AND CORONARY ARTERY CALCIFICATION IN POST-MENOPAUSAL WOMEN . Eur Heart J 2008; 29:777-783]

ABSTRACT
AIMS To determine whether peri-coronary epicardial adipose tissue (EAT) is associated with vascular risk factors and coronary atherosclerosis.
METHODS AND RESULTS In this study, 573 healthy post-menopausal women underwent a cardiac CT scan to assess coronary calcification. Peri-coronary EAT thickness was measured in the areas of right coronary artery (RCA), left anterior descending (LAD) artery, and left circumflex (LCX) coronary artery. Average EAT thickness was 16.5 ± 4.3 mm (range 5.9-34.6) in the RCA area, 6.4 ± 2.2 mm (range 2.0-14.0) in the LAD area, and 10.8 ± 3.0 mm (range 2.8-29.1) in the LCX area. Overall average thickness was 11.2 ± 2.2 mm (range 5.4-19.1). EAT was positively related to age (P = 0.002). In age-adjusted linear regression models, EAT was positively related to weight (P< 0.001), waist circumference (P< 0.001), waist-to-hip ratio (P< 0.001), body mass index (P< 0.001), glucose (P< 0.001), triglycerides (P = 0.001), use of anti-hypertensive drugs (P = 0.007), and systolic blood pressure (P = 0.034), and inversely to HDL cholesterol (P = 0.005). In multivariable models, age, weight, waist circumference, smoking, and glucose were the main determinants of EAT. EAT showed a graded relation with coronary calcification (P = 0.026).
CONCLUSION EAT is strongly related to vascular risk factors and coronary calcification. Our findings support the hypothesis that EAT affects coronary atherosclerosis and possibly coronary risk.

Coronary artery calcification scores by peri-coronary epicardial adipose tissue quartile

[PERICARDIAL FAT, VISCERAL ABDOMINAL FAT, CARDIOVASCULAR DISEASE RISK FACTORS, AND VASCULAR CALCIFICATION IN A COMMUNITY-BASED SAMPLE: THE FRAMINGHAM HEART STUDY. Circulation 2008; 117:605-13]

ABSTRACT
BACKGROUND Pericardial fat may be an important mediator of metabolic risk. Correlations with cardiovascular disease risk factors and vascular calcification in a community-based sample are lacking. We sought to examine associations between pericardial fat, metabolic risk factors, and vascular calcification.
METHODS AND RESULTS Participants free of cardiovascular disease from the Framingham Heart Study (n=1155, mean age 63 years, 54.8% women) who were part of a multidetector computed tomography study underwent quantification of intrathoracic fat, pericardial fat, visceral abdominal fat (VAT), coronary artery calcification, and aortic artery calcification. Intrathoracic and pericardial fat volumes were examined in relation to body mass index, waist circumference, VAT, metabolic risk factors, coronary artery calcification, and abdominal aortic calcification. Intrathoracic and pericardial fat were directly correlated with body mass index (r=0.41 to 0.51, P<0.001), waist circumference (r=0.43 to 0.53, P<0.001), and VAT (r=0.62 to 0.76, P<0.001). Both intrathoracic and pericardial fat were associated with higher triglycerides (P<0.0001), lower high-density lipoprotein (P<0.0001), hypertension (P<0.0001 to 0.01), impaired fasting glucose (P<0.0001 to 0.001), diabetes mellitus (P=0.0005 to 0.009), and metabolic syndrome (P<0.0001) after multivariable adjustment. Associations generally persisted after additional adjustment for body mass index and waist circumference but not after adjustment for VAT (all P>0.05). Pericardial fat, but not intrathoracic fat, was associated with coronary artery calcification after multivariable and VAT adjustment (odds ratio 1.21, 95% confidence interval 1.005 to 1.46, P=0.04), whereas intrathoracic fat, but not pericardial fat, was associated with abdominal aortic calcification (odds ratio 1.32, 95% confidence interval 1.03 to 1.67, P=0.03).
CONCLUSIONS Pericardial fat is correlated with multiple measures of adiposity and cardiovascular disease risk factors, but VAT is a stronger correlate of most metabolic risk factors. However, intrathoracic and pericardial fat are associated with vascular calcification, which suggests that these fat depots may exert local toxic effects on the vasculature.

POLIMORFISMI E RISCHIO DI EVENTI CARDIOVASCOLARI

[POLYMORPHISMS ASSOCIATED WITH CHOLESTEROL AND RISK OF CARDIOVASCULAR EVENTS. N Engl J Med 2008 ; 358:1240-9]

ABSTRACT
BACKGROUND Common single-nucleotide polymorphisms (SNPs) that are associated with blood low-density lipoprotein (LDL) or high-density lipoprotein (HDL) cholesterol modestly affect lipid levels. We tested the hypothesis that a combination of such SNPs contributes to the risk of cardiovascular disease.
METHODS We studied SNPs at nine loci in 5414 subjects from the cardiovascular cohort of the Malmö Diet and Cancer Study. We first validated the association between SNPs and either LDL or HDL cholesterol and subsequently created a genotype score on the basis of the number of unfavorable alleles. We used Cox proportional-hazards models to determine the time to the first cardiovascular event in relation to the genotype score.
RESULTS All nine SNPs showed replication of an association with levels of either LDL or HDL cholesterol. With increasing genotype scores, the level of LDL cholesterol increased from 152 mg to 171 mg per deciliter (3.9 to 4.4 mmol per liter), whereas HDL cholesterol decreased from 60 mg to 51 mg per deciliter (1.6 to 1.3 mmol per liter). During follow-up (median, 10.6 years), 238 subjects had a first cardiovascular event. The genotype score was associated with incident cardiovascular disease in models adjusted for covariates including baseline lipid levels (P<0.001). The use of the genotype score did not improve the clinical risk prediction, as assessed by the C statistic. However, there was a significant improvement in risk classification with the use of models that included the genotype score, as compared with those that did not include the genotype score.
CONCLUSIONS A genotype score of nine validated SNPs that are associated with modulation in levels of LDL or HDL cholesterol was an independent risk factor for incident cardiovascular disease. The score did not improve risk discrimination but did modestly improve clinical risk reclassification for individual subjects beyond standard clinical factors.