Content uploaded by Andreas Leiherer
Author content
All content in this area was uploaded by Andreas Leiherer on Jan 11, 2016
Content may be subject to copyright.
Obesity: lowering risk 143
P712 | SPOTLIGHT 2013
Does adiponectin protect against the cardiovascular dysfunction
associated with central adiposity in young women with polycystic
ovary syndrome?
E. Rees1, R. Hocking2,F.Dunstan
3,M.Lewis
2, K. Tunstall2,J.P.Halcox
2,
A.G. Fraser2,D.A.Rees
2.
1
Swansea University, College of Human and Health
Sciences, Swansea, United Kingdom;
2
Cardiff University, School of Medicine,
Inst. of Molecular and Experimental Medicine, Cardiff, United Kingdom;
3
Cardiff
University, Institute of Primary Care and Public Health, Cardiff, United Kingdom
Purpose: To investigate the relationships between regional adiposity, adiponectin
(APN), insulin resistance and cardiovascular function in young women with poly-
cystic ovary syndrome (PCOS).
Methods: We studied 180 women aged 16-45y (85 with PCOS, 95 healthy con-
trols) free from overt cardiovascular disease or treated diabetes. Biochemical as-
says included high molecular weight APN, insulin resistance (HOMA-IR), and glu-
cose and insulin area under the curve (AUC) following oral glucose tolerance test.
Regional fat and lean mass were assessed by dual energy x-ray absorptiometry
and computed tomography (total, subcutaneous and visceral fat area). Systolic
and diastolic function measures included tissue Doppler velocities from echo-
cardiography. Arterial stiffness was assessed using central pulse wave velocity
(PWV) from applanation tonometry.
Results: After adjusting for age and body mass index (BMI), PCOS subjects had
higher glucose AUC, insulin AUC, HOMA-IR, testosterone (p-values all <.005)
and, unexpectedly, APN (p=.02). There were no between group differences in
cardiovascular measures following adjustment. APN was negatively associated
with lean leg mass (r=-.620) and visceral fat (r=-.523) in PCOS subjects (both
p<.001) but not in controls, while it was negatively associated with subcutaneous
fat in both groups (PCOS r=-.387 [p<.001], controls r=-.244 [p=.022]). In con-
trols, visceral fat (β=.206, p=.036) and age (β=.530, p<.001) were independent
predictors of PWV; visceral fat (β=-.274, p=.003), age (β=-.586, p<.001) and in-
sulin AUC (β=-.178, p=.039) were independent predictors of diastolic function.
In contrast, there were no independent predictors of PWV in a similar model of
PCOS subjects and age was the only independent predictor of diastolic function
(β=-.488, p=.001).
Conclusion: Despite having a worse metabolic profile, these young women with
PCOS had similar cardiovascular function to control subjects of the same age
and BMI. APN is a secretory protein which may have a cardio-protective effect.
It has an inverse relationship with adiposity, and plasma levels are usually lower
in insulin resistant states. APN levels were unexpectedly higher in PCOS sub-
jects when age and BMI were controlled; the association with regional adiposity
was different between the groups. Central adiposity was associated with arterial
stiffness and diastolic dysfunction in control subjects but not in those with PCOS.
Young women with PCOS may be protected against the effects of central obesity
on arterial stiffness and diastolic function by a compensatory increase in APN.
P713 | BEDSIDE
Analysis of the obesity paradoxic according to the sex: relation
between body mass index and mortality in the first year after an
acute coronary syndrome
S. Raposeiras Roubin, E. Abu Assi, N. Bouzas Cruz, A. Lopez Lopez,
M. Castineiras Busto, E. Pereira Lopez, S. Gestal Romari, J.M. Garcia Acuna,
J.R. Gonzalez Juanatey.
University Clinical Hospital of Santiago de Compostela,
Santiago de Compostela, Spain
Introduction: Obesity is considered a global epidemic, with alarming prevalence
and incidence. The aim was to investigate the relationship between obesity (in
terms of body mass index, BMI) and the prognosis of patients with acute coronary
syndrome (ACS).
Methods: We studied a total of 3436 consecutive ACS patients. This cohort was
divided into 4 groups according to BMI: normal weight (BMI <25 kg/m2), over-
weight (BMI 25 to 29.9 kg/m2), obesity grade I (BMI 30 to 34.9 kg/m2) and grade
II obesity (BMI 35 to 39.9 kg/m2. Patients with BMI <18.5 kg/m2(underweight)
(n = 19) or ≥40 kg/m2(morbid obesity) (n = 17) were excluded from analysis
since the low number of patients belonging to each group (it did not allow precise
analysis or comparison). The primary end-point was 1-year mortality.
Results: After 1 year of follow up, 189 patients (5.5%) died. Patients with normal
weight compared with those with BMI >25 kg/m2had higher mortality (8.0% vs
4.9%, P = 0.002), in both NSTEMI (8.5% vs. 5, 7, p = 0.024) and STEMI (6.8% vs
Figure 1
3.2%, p = 0.017). For the different BMI groups, patients with BMI between 30 and
35 kg/m2were those with lower mortality, with statistically significant differences
compared to patients with normal weight (3.2% vs. 8.0%, p <0.001). These differ-
ences remained statistically significant only in men, not in women (Figure). After
adjusting for the predictors of one year mortality in univariate analysis, BMI was
inversely associated with mortality in men (HR 0.950, 95% CI 0.903 to 1.000, p =
0.049), but not in women (HR 0.996, 95% CI 0.936 to 1.059, p = 0.894).
Conclusion: The main clinical finding of our study, based on its clinical implica-
tion, is that BMI was inversely associated with mortality in the first year after ACS
in men, but not in women.
P714 | BEDSIDE
Despite a mixed reactivity to antiplatelet agents, obese patients
have no benefit of platelet function monitoring: insight from the
ARCTIC study
E. Van Belle1, J.P. Collet2, S. O’Connor2, J. Abtan2, C. Saint-Etienne3,
M. Kerneis2, H. Rousseau4,J.Sylvain
2,E.Vicaut
4, G. Montalescot2on behalf
of ARCTIC investigators.
1
Hospital Regional University of Lille - Cardiological
Hospital, Lille, France;
2
AP-HP - Hospital Pitie-Salpetriere, Department of
Cardiology, Paris, France;
3
Tours Regional University Hospital, Hospital
Trousseau, Department of Cardiology, Tours, France;
4
AP-HP - Hospital
Lariboisiere, Clinical Research Unit, Paris, France
Background: Obese patients have been shown to have a "paradoxical" good
outcome after PCI despite more frequent poor response to antiplatelet agents.
In the ARCTIC study, which failed to demonstrate any clinical benefit of platelet
function testing with drug adjustment before stent PCI, obese patients was a pre-
specified subgroup. We therefore sought to address the relation between platelet
response, obesity and clinical outcome after PCI.
Results: Of the 2440 patients randomized in the ARCTIC study, 533 were obese
(BMI>30 kg/m2, 22%) of whom 274 were randomized in the "conventional" group
(without bedside platelet function monitoring) and 259 in the "monitoring" group
(with bedside platelet function monitoring). Compared to non-obese patients (me-
dian BMI=25.4 [23.7-27.5]), obese patients (median BMI=32.5[31.1-34.5]) were
younger (median 61[55-69] vs 64[56-71], p=.0001), had more frequently hyper-
tension (72.5% v.58.1%, p=0.0001), dyslipidemia (75.1% vs 65.9%; p=0.0001)
and diabetes mellitus (51.8% vs 32.0%, p=0.0001).
At the time of stent implantation, high on-aspirin platelet reactivity was more fre-
quent in obese than in non-obese patients (11.2% versus 6.4%, p=0.01) whereas
and unexpectedly, there was no difference in the rate of high on-thienopyridine
platelet reactivity (37.8% versus 33.5%, respectively, p=0.20). As a consequence,
in the "monitoring" group, intensification of antiplatelet therapy using aspirin
reloading (10% versus 5.4%, p=0.01) was more frequently performed in obese
than in non-obese patients while clopidogrel reloading was similar in obese and
non-obese patients (23.6% versus 25.4%, p=0.99).
In obese patients the risk of primary end point (any death, MI, stent thrombosis,
stroke, TIA or urgent revascularization) at one-year follow-up was not reduced in
the "monitoring" group compared to the "conventional" group (28.6% vs 32.1%,
p=0.42). The same was true for the main secondary endpoint ([stent thrombosis
or urgent revascularization], 5.1% vs 5.5%, p=0.96).
Conclusion: Compared to non-obese, obese patients display a 2-fold increase
in the rate of high on-aspirin platelet reactivity but no difference in the rate of
high on-thienopyridine platelet reactivity. As a consequence, no thienopyridine
dose adjustment is needed and no difference in clinical outcome is observed.
This finding reinforces the hypothesis that high platelet reactivity, although a good
marker of risk, is not a modifiable risk factor.
P715 | BEDSIDE
Serum omentin significantly predicts cardiovascular events both in
patients with the metabolic syndrome and in subjects who do not
have the metabolic syndrome
C.H. Saely1, A. Leiherer2, A. Muendlein 2, A. Vonbank3, D. Zanolin2, K. Geiger2,
H. Drexel4.
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: Some recent smal l cross-sectional studies have described associ ations
of the novel adipocytokine omentin with atherosclerosis. However, no prospective
data on the power of omentin to predict cardiovascular events are available.
Methods: We therefore measured serum omentin in a series of 297 patients
undergoing coronary angiography for the evaluation of established or suspected
stable CAD; the metabolic syndrome (MetS) was defined according to national
cholesterol education programme adult treatment panel III criteria; cardiovascular
events were recorded over a mean follow-up period of 3.2 years.
Results: During the follow-up per iod, 18.4% of our patients suffered cardiovascu-
lar events, corresponding to an annual event rate of 5.8%. In the total study pop-
ulation, serum omentin significantly predicted cardiovascular events both univari-
ately (standardized adjusted HR 1.47 [1.21-1.78]; p <0.001) and after adjustment
for age, gender, BMI, diabetes, hypertension, LDL cholesterol, HDL cholesterol
and smoking (HR 1.49 [1.21-1.82]; p<0.001). From our patients, 98 had the MetS
and 199 did not have the MetS. In both of these patient subgroups serum omentin
by guest on October 21, 2015http://eurheartj.oxfordjournals.org/Downloaded from
144 Obesity: lowering risk
strongly predicted cardiovascular events both univariately (HRs 1.51 [1.15-2.00];
p=0.003 and 1.41 [1.08-1.84]; p=0. 011, respectively) and after adjustment for age,
gender, BMI, diabetes, hypertension, LDL cholesterol, HDL cholesterol and smok-
ing (1.56 [1.09-2.25]; p=0.016 and 1.48 [1.12-1.97]; p=0.006, respectively).
Conclusions: From this first prospective evaluation of the cardiovascular risk as-
sociated with serum omentin we conclude that elevated serum omentin is a strong
predictor of cardiovascular events both among patients with the MetS and among
subjects who do not have the MetS.
P716 | BENCH
Association of current carotid elastic modulus and prior body
mass index in elderly people - results from the SAPALDIA cohort
study
S. Caviezel1,J.Dratva
2, E. Schaffner 2, C. Schindler2, N. Kuenzli 2,
J.M. Gaspoz3, T. Rochat4, N. Probst-Hensch 2, A. Schmidt-Trucksaess1.
1
University of Basel, Institute of Exercise and Health Sciences, Division of
Sports Medicine, Basel, Switzerland;
2
Swiss Tropical and Public Health Institute
- University of Basel, Basel, Switzerland;
3
University Hospitals of Geneva,
Department of Community Medicine and Primary Care, Geneva, Switzerland;
4
University Hospitals of Geneva, Division of Pulmonary Medicine, Geneva,
Switzerland
Purpose: Cardiovascular mortality has a close association with body mass index
(BMI). A subclinical vascular biomarker for atherosclerosis is the elastic modu-
lus introduced by Peterson (EP). However, whether BMI is associated with EP
has not been investigated. Therefore, the aim of the study was to investigate the
association of prior BMI and current EP examined by ultrasound device in partic-
ipants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases
In Adults (SAPALDIA).
Methods: BMI [kg/m2] was measured in 8047 participants of the first follow up
of SAPALDIA (SAP2) in 2002 and classified as normal weight (18.5-24.9 BMI),
overweight (25-29.9 BMI) and obese (>30 BMI). Further, age, sex, smoking sta-
tus, brachial systolic (sBP) and diastolic blood pressure (dBP), total cholesterol
(TC) and high-density cholesterol (HDL) were examined.
In the second follow up in 2010/11 (SAP3) ultrasound clips of the common carotid
artery were accomplished in 3490 participants. Lumen diameter (LD) was ana-
lyzed over a standardized 1cm segment proximal to the bifurcation over at least
one heart cycle. dBP and sBP was measured directly after ultrasound examina-
tion. EP was defined as (diastolic LD) ×(sBP – dBP)/(systolic LD – diastolic LD).
Overall, the study sample included 1815 participants (44.4% men, 55.6% women)
with complete measurements. The associations between log-transformed EP and
BMI categories were assessed using multiple linear regression analysis wi th addi-
tional adjustment for above mentioned prior cardiovascular risk factors and study
centers.
Results: Means and standard deviations in SAP2 were: 55.1 (8.1) years for age,
127.0 (18.8) mmHg for sBP, 80.1 (10.7) mmHg for dBP, 6.1 (1.1) mmol/l for TC
and 1.5 (0.4) mmol/l for HDL. In the sample, 48.8% were of normal weight, 38.2%
overweight and 13% obese. Means and standard deviations in SAP3 were 155.3
(75.0) kPa for EP, 135.1 (18.5) mmHg for sBP and 78.1 (9.4) mmHg for dBP.
Adjusted geometri c means with 95% confidence inter vals for EP [kPa] were 139.2
(136.2, 142.2) for normal weight, 145.7 (142.3, 149.2) for overweight, 147.7
(141.8, 153.9) for obese subjects. Overweight (p=0.013) and obese subjects
(p=0.023) differed significantly from normal weight subjects, but there was also
a significant difference of EP between overweight and obesity (p=0.018).
Conclusions: The results showed significantly higher EP values of the carotid
artery for each increase in BMI category. This indicates that prior overweight and
obesity is associated with current reduced vascular health status which indicates
a harmful long term effect of increased BMI.
P717 | BEDSIDE
Volume-rendered regional adipose tissue depots correlated with
circulating hs-CRP as an independent clinical predictor for left
atrial remodeling beyond BMI in asymptomatic population
Y.H. Lai1,C.H.Yun
2,J.Y.Kuo
1, T.C. Hung1,Y.J.Wu
1,H.I.Yeh
1, C.L. Hung1.
1
Mackay Memorial Hospital, Department of Internal Medicine, Division of
Cardiology, Taipei, Taiwan;
2
Mackay Memorial Hospital, Depar tment of
Radiology, Taipei, Taiwan
Purpose: The effect of body fat composition on left ventricular (LV) geometry has
been recently recognized. However, the relationship between regional fat deposits
and left atrium (LA) remodeling, especially of those adipose tissues surrounding
the heart or central ar teries, remains largely unexplored.
Methods: We consecutively studied 361 asymptomatic subjects who underwent
an annual health survey (age: 51.7±8.8, 31% female). LA diameter and volume
measurements were obtained by conventional echo method. Pericardial (PCF)
and thoracic periaortic adipose tissue (TAT) volumes were assessed by volume-
rendered multi-detector computed tomography (MDCT, Siemens Medical Solu-
tions, Germany).
Results: In multivariable models adjusted for age, gender, body mass index, LV
mass and medical histories, both increased PCF and VAT were independently
associated with maximal LA volume (all p<0.05) while borderlinely associated
with LA diameter in subjects with larger BMI (body-mass index). Hs-CRP-related
modification effects on LA diameter and volume were only observed with PCF
(interaction p=0.024).
Beta-coefficients between PCF and LA volume based on BMI terti les (kg/m2)
≤23.1 23.2∼25.7 ≥25.7 Adjusted R2
Bivariate Model 0.12 0.45†0.62†0.2
Multivariate Model 1 0.1 0.45†0.62†0.2
Multivariate Model 2 0.06 0.43†0.57†0.3
Multivariate Model 3 0.02 0.32†0.55†0.36
Model 3 + hs-CRP Interaction p: 0.024
Beta-coefficients between TAT and LA volume based on BMI tertiles (kg/m2)
≤23.1 23.2∼25.7 ≥25.7 Adjusted R2
Bivariate Model 0.13 0.43†0.45†0.14
Multivariate Model 1 0.1 0.43†0.46†0.14
Multivariate Model 2 0.07 0.41†0.44†0.27
Multivariate Model 3 0.05 0.4†0.35†0.33
Model 3 + hs-CRP Interaction p: 0.071
Model 1: adjusted for age; Model 2: adjusted for age, gender, BMI; Model 3: adjusted for age,
gender, BMI, LV mass, history of hypertension, diabetes, hyperlipidemia and coronar y artery
disease. †p<0.05.
Conclusions: Accumulated regional adiposity in terms of pericardial fat may ex-
ert biological effects on left atrial remodeling, which may be partially mediated by
exaggerated systemic inflammation.
P718 | BENCH
Increased levels of circulating arginase I in adolescents with
overweight
C. Jung1, H.R. Figulla2, M. Lichtenauer2, M. Franz2, J. Pernow1.
1
Karolinska
Institutet, Stockholm, Sweden;
2
Friedrich-Schiller-University, Jena, Germany
Background and aims: Overweight and the metabolic syndrome have become
major problems, especially in children and adolescents. Obesity at young age in-
creases the risk for cardiovascular diseases and diabetes mellitus later in life. An
early event in the development of cardiovascular disease is endothelial dysfunc-
tion which is found in obese young individuals. Increased activity of the enzyme
arginase has been described as a central mechanism for endothelial dysfunction,
especially in patients with diabetes mellitus. The aim of the study was to deter-
mine plasma levels of arginase in overweigth adolescents.
Methods: Sixty-six male German adolescents (age: 15.2±1.1 years old) were
included. Thirty-one of them were overweight (>90th age specific weight per-
centile). Besides recording clinical data, anthropometrical measurements of obe-
sity were performed. Plasma arginase I and Tumor-Necrosis-Factor alpha (TNFα)
were determined.
Results: Overweight adolescents had a higher systolic blood pressure, lower
high-density lipoprotein and increased levels of high-sensitive CRP. Circulating
arginase I was elevated in overweight adolescents (95.8±68.2 ng/ml) compared
to normal weight adolescents (39.3±26.9 ng/ml, p<0.001) and correlated with
markers of obesity. There was no difference between the two groups regarding
TNFα.
Conclusions: We demonstrate that arginase I levels are increased in obese ado-
lescents. Knowing the important role for arginase in endothelial dysfunction, ele-
vated levels of arginase I may represent a link between obesity, endothelial dys-
function and related comorbidities.
P719 | BEDSIDE
Association between erectile dysfunction severity and major
adverse cardiovascular events in men with metabolic syndrome
A. Aggelakas, C. Vlachopoulos, I. Iona, N. Ioakeimidis, M. Abdelrasoul,
A. Aggelis, D. Terentes-Printzios, P. Pietri, S. Vaina, C. Stefanadis.
Hippokration
General Hospital, Athens, Greece
Purpose: Metabolic syndrome (MetS) is a risk factor for severe erectile dys-
function (ED). ED confers an independent cardiovascular risk in patients with
metabolic risk factors, such as hypertension and diabetes, however the predictive
role of ED severity in patients with MetS has not been investigated. Accordingly,
we sought to investigate whether ED severity predicts major adverse cardiovas-
cular events (MACE) in patients with MetS.
Methods: Three hundred and two ED patients (mean age 56 years) without a
previous history of cardiovascular disease were followed up. ED was assessed
by the International Index Erectile Function-5 questionnaire. Low score indicates
severe ED.
Results: During the mean follow-up period of 41 months, a total of 20 MACE
occurred. The prevalence of MetS between patients with and those without MACE
was not statistically significant (45% vs 35%; p=0.232). Kaplan–Meier survival
analysis revealed that severe ED is associated with a higher risk of MACE in
patients with MetS (n=136), but not in patients without MetS (p=0.004, by log-
rank test, figure). A Cox proportional hazard model showed that among men with
MetS, subjects with severe ED had an approximately 2.7-fold higher MACE risk
compared to those with mild and moderate ED after adjustment for age, MetS
components, smoking, antihypertensive therapy and use of statins (HR 2.7, 95%
CI 1.25 to 5.12, p=0.024).
by guest on October 21, 2015http://eurheartj.oxfordjournals.org/Downloaded from