Coronary Artery Disease: De Backer G

Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL, Anonymous00206, Anonymous00207. · European Society of Cardiology · G Ital Cardiol (Rome). · Pubmed #18383763 No free full text.

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De Winter O, Velghe A, Van de Veire N, De Bondt P, De Buyzere M, Van De Wiele C, De Backer G, Gillebert TC, Dierckx RA, De Sutter J. · Nuclear Medicine Division, Ghent University Hospital, Ghent, Belgium. · J Nucl Cardiol. · Pubmed #16344228 No free full text.

Abstract: BACKGROUND: Perfusion and functional data obtained during gated single photon emission computed tomography (SPECT) have proven prognostic value in the middle-aged patient population. The aim of this study was to investigate whether perfusion and functional cardiac gated SPECT data have prognostic value in patients aged 75 years or older. METHODS AND RESULTS: We studied clinical and gated SPECT predictors of cardiac and all-cause death in 294 patients aged 75 years or older with known or suspected coronary artery disease who were referred for tetrofosmin cardiac gated SPECT imaging. Summed perfusion scores were calculated in a 17-segment model by use of commercially available software (4D-MSPECT). Left ventricular functional data were calculated by use of QGS gated SPECT software. The median age of the study population was 78 years (range, 75-91 years). There were 160 men (54%) and 134 women (46%). During a median follow-up of 25.9 months (range, 1.8-36 months), 47 patients (16%) died (27 cardiac deaths). In a multivariate Cox proportional hazards regression analysis, the summed rest score (chi2 gain = 8.0, P = .009), transient ischemic dilatation index (chi2 gain = 6.3, P = .012), and resting left ventricular ejection fraction (chi2 gain = 7.0, P = .030) were independent predictors of all-cause death. The summed rest score (chi2 gain = 8.2, P = .004) and resting end-systolic volume (chi2 gain = 13.7, P = .005) were independent predictors of cardiac death. CONCLUSIONS: This study showed that gated SPECT left ventricular functional data assessed during myocardial gated SPECT provide independent and incremental information above clinical and perfusion SPECT data for the prediction of cardiac and all-cause death in patients aged 75 years or older referred for myocardial SPECT imaging.

De Sutter J, Tavernier R, De Buyzere M, Jordaens L, De Backer G. · Department of Cardiology, University Hospital Ghent, Belgium. · J Am Coll Cardiol. · Pubmed #10987597 No free full text.

Abstract: OBJECTIVES: To evaluate a possible effect of lipid lowering drugs on recurrences of ventricular arrhythmias (VA) after implantable cardioverter defibrillator (ICD) implantation. BACKGROUND: In patients with coronary artery disease (CAD), lipid lowering drugs reduce total and sudden cardiac death. Because the mechanism is not completely understood, we studied whether these drugs have a favorable influence on the occurrence of life-threatening VA in patients with CAD and ICD implants. METHODS: We conducted an observational study in 78 patients with CAD and life-threatening VA, treated with an ICD. After ICD implantation, 27 patients were on treatment with lipid lowering drugs (group I) and 51 were not (group II). Patients were studied for the following end points: recurrences of VA requiring ICD intervention, cardiac death and hospitalization. RESULTS: After a mean follow-up of 490 +/- 319 days, 35 patients (45%) had recurrences of VA requiring ICD intervention. In multivariate analysis, the use of lipid lowering drugs (chi-square 6.33, p = 0.012) and poorly tolerated sustained monomorphic ventricular tachycardia as initial presentation (chi-square 4.84, p = 0.028) remained as independent predictors of recurrences of VA. Patients in groups I and II had similar baseline clinical characteristics, but patients in group I had a lower incidence of recurrences of VA (6/27 or 22% vs. 29/51 or 57%, p = 0.004) and of the combined end points of cardiac death and hospitalization (4/27 or 15% vs. 23/51 or 45%, p = 0.015) compared with patients in group II. CONCLUSIONS: This is the first observation that the use of lipid lowering drugs is associated with a reduction of recurrences of VA in patients with CAD and ICD implants. These data require confirmation in a prospective randomized trial.

Tiret L, Gerdes C, Murphy MJ, Dallongeville J, Nicaud V, O'Reilly DS, Beisiegel U, De Backer G. · INSERM U525, Paris, France. · Eur J Clin Invest. · Pubmed #10886297 No free full text.

Abstract: BACKGROUND: The European Atherosclerosis Research Study (EARS) I had shown that fasting plasma concentrations of apolipoprotein B (apo B) and triglycerides were the most discriminant variables between offspring with a paternal history of coronary heart disease (CHD) and controls. The EARS II study was undertaken to investigate whether a paternal history of CHD was associated with differences in postprandial lipemia. DESIGN: Male subjects with a paternal history of CHD (cases, n = 407) and age-matched male controls (n = 415) were recruited from 14 European universities. All subjects had an oral fat tolerance test. RESULTS: In the sample as a whole, the postprandial triglyceride responses did not significantly differ between the two groups. However, in the upper tertile of fasting triglycerides, cases displayed a higher area under the curve (5.71 vs. 4.49 mmol.h L-1, P < 0.001), a higher peak (1.76 vs. 1.43 mmol L-1, P < 0.001) and a more delayed time to peak (3.15 vs. 2.91 h, P < 0.05) than controls. In the upper tertile, fasting apo B levels (P < 0.05) and triglyceride area under the curve (P = 0.002) significantly discriminated cases from controls in a multivariate analysis. Cases had also higher Lp C-III:B levels at 4 h than controls (11.2 vs. 9.9 mg dL-1, P < 0.01) and this difference remained significant after adjustment for apo B and triglyceride levels. CONCLUSIONS: These results indicate that in subjects with a moderate elevation of fasting triglycerides, an impaired postprandial response to a fat load constitutes an early biological expression of a paternal history of premature CHD.

Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U, Anonymous00065. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. · Lancet. · Pubmed #19286092 No free full text.

Abstract: BACKGROUND: The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice. METHODS: EUROASPIRE I, II, and III were designed as cross-sectional studies and included the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, and Slovenia. Consecutive patients (men and women </=70 years) were identified after coronary artery bypass graft or percutaneous coronary intervention, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. FINDINGS: 3180 patients were interviewed in the first survey, 2975 in the second, and 2392 in the third. Overall, the proportion of patients who smoke has remained nearly the same (20.3% in EUROASPIRE I, 21.2% in II, and 18.2% in III; comparison of all surveys p=0.64), but the proportion of women smokers aged less than 50 years has increased. The frequency of obesity (body-mass index >/=30 kg/m(2)) increased from 25.0% in EUROASPIRE I, to 32.6% in II, and 38.0% in III (p=0.0006). The proportion of patients with raised blood pressure (>/=140/90 mm Hg in patients without diabetes or >/=130/80 mm Hg in patients with diabetes) was similar (58.1% in EUROASPIRE I, 58.3% in II, and 60.9% in III; p=0.49), whereas the proportion with raised total cholesterol (>/=4.5 mmol/L) decreased, from 94.5% in EUROASPIRE I to 76.7% in II, and 46.2% in III (p<0.0001). The frequency of self-reported diabetes mellitus increased, from 17.4%, to 20.1%, and 28.0% (p=0.004). INTERPRETATION: These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease. Despite a substantial increase in antihypertensive and lipid-lowering drugs, blood pressure management remained unchanged, and almost half of all patients remain above the recommended lipid targets. To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention.

Vlayen J, De Backer G, Peers J, Moldenaers I, Debruyne H, Simoens S. · Deloitte, Diegem, Belgium. · Cardiovasc Drugs Ther. · Pubmed #18792772 No free full text.

Abstract: PURPOSE: This study aims to quantify costs of atherosclerotic cardiovascular diseases in Belgium in 2004. METHODS: Costs were estimated using data on prevalence, healthcare resource utilization and unit costs. Healthcare costs included expenditure on ambulatory care, hospital inpatient care, emergency care, and medications. Costs of prevention campaigns and costs of productivity loss were also included. RESULTS: Costs amounted to 3.5 billion euros in Belgium in 2004. Total costs consisted of 80 million euros related to prevention and screening, 1.3 billion euros related to pre-clinical disease, and 2.2 billion euros related to established disease. These costs were incurred by the Belgian third-party payer (58% of costs), patients (10%) and third parties (i.e. employers and supplementary health insurance) (32%). CONCLUSIONS: Atherosclerotic cardiovascular diseases impose a significant economic burden on Belgian society.

De Winter O, Van De Veire N, De Bondt P, Van De Wiele C, De Buyzere M, De Backer G, Gillebert TC, Dierckx RA, De Sutter J. · Nuclear Medicine Division, Ghent University Hospital Ghent, Belgium. · Q J Nucl Med Mol Imaging. · Pubmed #17220816 links to  free full text

Abstract: AIM: The aim of this study was to investigate the prognostic value of myocardial perfusion and function SPECT imaging in patients with coronary artery disease (CAD) and poor left ventricular (LV) function. METHODS: We studied 261 patients (231 men, age 66+/-10 years) with CAD and a resting LV ejection fraction (LVEF) <or= 40% assessed during myocardial gated SPECT. Perfusion defect extent was calculated using 4D-MSPECT software (Michigan University). Ischemia scoring was performed visually. Considered end points were: 1) major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction or late revascularization), 2) MACE or the need for hospitalization due to heart failure (MACE-HF) and 3) cardiac death or non-fatal myocardial infarction. RESULTS: During a median follow-up of 31 months, 52 patients (20%) died (35 cardiac deaths), 50 (19%) developed a MACE and 69 (26%) a MACE-HF. In a clinical model, diabetes and angina status were the only predictors of MACE (chi-squared=19.3; P<0.001). By multivariate analysis, poststress LVEF (chi-squared-gain of 6.4; P=0.008) and presence of ischemia (chi-squared-gain of 5.8; P=0.018) were predictive of MACE. Similarly, diabetes mellitus (chi-squared=12.1; P<0.001), poststress LVEF (chi-squared-gain of 5.5; P=0.019) and presence of ischemia (chi-squared-gain of 4.3; P=0.044) were independent predictors of MACE-HF. Diabetes mellitus (chi-squared=17.8; P<0.001), presence of angina complaints (chi-squared-gain of 6.8; P=0.028) and poststress LVEF (chi-squared-gain of 6.3; P=0.008) were independent predictors of cardiac death or non-fatal myocardial infarction. CONCLUSION: In patients with impaired LV function and CAD, poststress LVEF is an independent predictor of future cardiac events.

Van de Veire NR, Van Laethem C, Philippé J, De Winter O, De Backer G, Vanderheyden M, De Sutter J. · Department of Cardiology, Ghent University, Gent, Belgium. · Eur J Cardiovasc Prev Rehabil. · Pubmed #17143123 No free full text.

Abstract: BACKGROUND: Peak exercise oxygen uptake (peakVO2) is a widely used prognosticator. Novel spirometric parameters, less affected by submaximal performance, such as the rate of increase of minute ventilation per unit decrease of carbon dioxide production (VE/VCO2 slope) and the oxygen uptake efficiency slope (OUES) have recently been introduced. AIM: To evaluate the discriminative value of OUES, as compared to VE/VCO2 slope in patients with coronary artery disease (CAD) and intermediate peakVO2 values. METHODS AND RESULTS: Bicycle spiroergometry was applied in 214 patients with CAD (age 67+/-8 years, 85% men). OUES was strongly related to peakVO2 (r=0.79). New York Heart Association (NYHA) class, 6-min walking distance, N-terminal pro-brain natriuretic peptide (NT-proBNP), inflammatory markers, left ventricular (LV) volumes and ejection fraction were evaluated. NT-proBNP levels predicted independently VE/VCO2-slope and OUES. Patients with intermediate peakVO2 (12-18 ml/kg per min) and increased VE/VCO2-slope (> or = 35) had higher NYHA class, lower walking distance, higher NT-proBNP levels and higher LV volumes as compared to patients with a similar peakVO2 but lower VE/VCO2-slope. Similar findings were found for patients with intermediate peakVO2 and high OUES/kg (median value>15.3). CONCLUSION: In CAD patients, OUES was strongly correlated with peakVO2. Both VE/VCO2 slope and OUES were independently associated with NT-proBNP levels. Both VE/VCO2 slope and OUES/kg were able to identify a subgroup of patients with an intermediate peakVO2 that was characterized by advanced remodelling and a higher degree of neurohumoral activation.

Van Laethem C, Van de Veire N, De Sutter J, Bartunek J, De Backer G, Goethals M, Vanderheyden M. · Department of Cardiology, University Hospital Gent, Belgium. · Am Heart J. · Pubmed #16875913 No free full text.

Abstract: BACKGROUND: The purpose of this study was to evaluate the oxygen uptake efficiency slope (OUES) as a predictor of peak oxygen consumption (VO2) in aged patients with coronary artery disease (CAD) and to compare its predictive value to that of ventilatory anaerobic threshold (VAT). METHODS: A total of 160 aged (>60 years) patients with stable CAD performed a maximal cardiopulmonary exercise test. The equations were computed by using data of 85 randomly selected patients and were validated in the remaining 75 patients. Bland-Altman (BA) analysis was used to assess the agreement between measured and predicted peak VO2. RESULTS: In the first 85 patients, peak VO2 correlated best with VAT and OUES per kilogram (P < .001). The linear regression to predict peak VO2 for OUES per kilogram was peak VO2 = 4.591 + 0.64 x OUES/kg (SEE = 2.61 mL kg(-1) min(-1)). The BA 95% limits of agreement were -29% and +30% of the predicted value. For VAT, the linear regression to predict peak VO2 was peak VO2 = 2.995 + 1.251 x VAT (SEE = 2.26 mL kg(-1) min(-1)). The BA 95% limits of agreement were -23% and +33% of the predicted value. Cross-tabulation analysis in 3 subgroups with different exercise capacities showed significant relationship between predicted and measured peak VO2 (all P < .001). OUES per kilogram showed the best measure of agreement with measured peak VO2, resulting in high sensitivity and specificity scores. CONCLUSION: OUES is not able to acceptably predict peak VO2 in aged patients with CAD but is at least as performant as VAT in categorizing patients into subgroups with different exercise capacities. Therefore, the objectively measurable OUES is the preferred submaximal predictor of functional capacity in the assessment of aged patients with CAD.

De Sutter J, Tavernier R, De Bacquer D, De Buyzere M, Van de Veire NR, Jordaens L, Matthys K, Bernard D, Langlois M, De Backer G. · Department of Cardiology, University Hospital Gent, De Pintelaan 185, 9000 Gent, Belgium. · Int J Cardiol. · Pubmed #16316699 No free full text.

Abstract: BACKGROUND: The internal cardioverter defibrillator (ICD) is increasingly used to treat ventricular tachyarrhythmias in patients with coronary artery disease (CAD). The burden of coronary risk factors and inflammation is however not well studied in these high risk patients. STUDY AIMS: The aim of the present study was to describe the prevalence of coronary risk factors (including lipid values) and inflammation (including high sensitive-C-reactive protein, hs-CRP) in patients with CAD and ICD implants. METHODS: Baseline clinical characteristics and laboratory results of all eligible patients for the Cholesterol Lowering and Arrhythmias Recurrences after Internal Defibrillator Implantation trial (CLARIDI trial) were used. All patients had documented CAD, an ICD implant and were not yet treated with statins. Coronary risk factors, lipid values, glycated haemoglobin (HbA(1c)) and hs-CRP levels were determined. RESULTS: In the 110 included patients (mean age 68+/-9 years, LVEF 40+/-17%, NYHA class II-III in 47%), a high prevalence of coronary risk factors was documented: current smoking in 18%, body mass index > or =30 kg/m(2) in 16%, blood pressure > or =140/90 mm Hg in 40%, history of diabetes in 12%, and HbA(1c) > or =6% in 16% of patients not known with diabetes. A total cholesterol >175 mg/dl was found in 76% of patients and an LDL cholesterol >100 mg/dl in 83%. Finally, median hs-CRP was 4.8 mg/l (interquartile range 2.5-13.9 mg/l). Hs-CRP values > or =2 mg/l were noted in 83% of all patients and in 68% of patients who had an ICD implant more than 6 months before inclusion. CONCLUSION: In CAD patients with ICD implants, the burden of coronary risk factors is high, often unrecognized and/or under-treated. Persistent inflammation is found in the majority of these patients.

De Sutter J, De Bacquer D, Cuypers S, Delanghe J, De Buyzere M, Kornitzer M, De Backer G. · Department of Cardiology 8K12 IE, University Hospital Ghent, Belgium. · Eur Heart J. · Pubmed #16204267 links to  free full text

Abstract: AIMS: Increased levels of neurohormonal markers, including the N-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP), have been shown to be of prognostic significance in patients with heart failure or coronary heart disease (CHD). The aim of this study was to study the predictive value of NT-pro-BNP for coronary events in a middle-aged population of men at work. METHODS AND RESULTS: A nested case-control study was performed in a large cohort of over 10 000 men at work (aged 35-59) after a median follow-up of 2.66 years. In total, 66 individuals who developed coronary events were matched on a 3-to-1 basis to 198 controls free of coronary events during follow-up. Besides clinical characteristics and conventional cardiac risk factors, NT-pro-BNP (electrochemiluminiscence assay, Roche diagnostics) and serum creatinine levels were determined. In univariable analysis, cases were more frequently current smokers and diabetics, had more frequently a history of CHD, and had higher levels of total cholesterol and systolic blood pressure (SBP), and lower levels of HDL cholesterol. A highly significant difference (P < 0.0001) was noted for NT-pro-BNP levels between cases (median 48.5 pg/mL, interquartile range 26.4-116.6 pg/mL) and controls (30.0 pg/mL, 19.5-47.6 pg/mL). In multivariable conditional logistic regression analysis, NT-pro-BNP remained strongly associated with risk for coronary events [third vs. first tertile, odds ratio (95% CI) 3.24 (1.18-8.85)], independent of body mass index, smoking, diabetes, SBP, total and HDL cholesterol, creatinine, and previous CHD. CONCLUSION: NT-pro-BNP is a strong predictor of coronary events in men at work after a relatively short period, even after adjustment for conventional risk factors.

Verdaet D, Dendale P, De Bacquer D, Delanghe J, Block P, De Backer G. · Department of Cardiology, Hospital of the Free University of Brussels (AZ-VUB), Cardiac Rehabilitation, Laarbeeklaan 101, 1090 Brussels, Belgium. · Atherosclerosis. · Pubmed #15380453 No free full text.

Abstract: BACKGROUND: Some markers of chronic inflammation have been recognized as predictors of cardiovascular risk in apparently healthy subjects and in patients with coronary heart disease (CHD). High sensitivity C-reactive protein (CRP) appears to be the most useful marker in clinical settings. Several studies reported associations between inflammatory markers and other cardiovascular risk factors, such as age, obesity, cholesterol levels, the presence of diabetes mellitus, physical activity, social level and smoking habits. We focussed on the association between C-reactive protein, serum amyloid A (SAA), fibrinogen and leisure time physical activity (LTPA). METHODS: This report deals with the results observed in a sub-sample of the BELSTRESS study. 892 male subjects, free from clinical CHD and major ECG abnormalities, working in the same environment, aged 35-59 years, were selected. A questionnaire was used to estimate the level of leisure time physical activity. Associations between CRP, SAA, fibrinogen and leisure time physical activity were evaluated through univariate and multivariate methods. Subjects taking statins or other lipid lowering medication were excluded from the study. RESULTS: Regular leisure time physical activity is associated with reductions of several cardiovascular risk factors, such as body mass index (BMI), waist hip ratio and the lipid profile. Smokers and low educated subjects had a lower physical activity status. Age adjustment did not alter the means of inflammatory parameters according to the levels of leisure time physical activity. After correction for personal characteristics (BMI, current smoking status, educational level, presence of diabetes and alcohol consumption) no significant relation was found between leisure time physical activity and levels of inflammatory markers. The differences of CRP and fibrinogen according to the level of physical activity, found in bivariate analysis, seem to be explained by linked differences in BMI, or related to current smoking habits. Leisure time physical activity, as reported in this study, is not significantly related to C-reactive protein, serum amyloid A or fibrinogen levels, after correction for other cardiovascular risk factors. CONCLUSION: These data indicate that leisure time physical activity, as reported in our study, is not an independent predictor of C-reactive protein, serum amyloid A or fibrinogen levels. Possible interactions of physical activity and other cardiovascular risk factors might explain the (indirect) relation we found in the bivariate analysis.

De Winter O, De Bondt P, Van De Wiele C, De Backer G, Dierckx RA, De Sutter J. · Division of Nuclear Medicine, Ghent University Hospital, Belgium. · J Nucl Cardiol. · Pubmed #14752472 No free full text.

Abstract: BACKGROUND: Although myocardial gated single photon emission computed tomography (SPECT) is routinely used for functional measurements in patients with coronary artery disease (CAD) and heart failure, day-to-day variability of left ventricular ejection fraction (LVEF), left ventricular (LV) volumes, and global perfusion scoring has not yet been investigated. METHODS AND RESULTS: In 20 consecutive patients with CAD and an LVEF lower than 40% who routinely underwent a resting tetrofosmin gated SPECT study, we performed an additional gated SPECT study at rest 1 to 5 days later under the same circumstances. LV volumes and LVEF were calculated from the gated SPECT data by commercially available software (QGS). Myocardial perfusion was scored visually by use of a 20-segment, 5-point scoring method. For global LV function and perfusion, agreement between data was investigated by use of Bland-Altman plotting. The 95% limits of agreement found by Bland-Altman analysis were -0.9% +/- 6.0% for LVEF, 3 +/- 20 mL for LV end-diastolic volume, and 4 +/- 20 mL for LV end-systolic volume. CONCLUSION: In CAD patients with an LVEF lower than 40%, day-to-day variability of measurements of global myocardial function and perfusion is quite similar to interobserver and intraobserver variability. Day-to-day variability of global LV functional parameters obtained by gated cardiac SPECT is fairly small, which indicates that myocardial gated SPECT can be used in daily clinical practice to determine changes in global LV function and perfusion over time in patients with diminished LV function.

De Bacquer D, De Backer G, Ostör E, Simon J, Pyörälä K, Anonymous00517. · Department of Public Health, Ghent University, Belgium. · Eur J Cardiovasc Prev Rehabil. · Pubmed #14555885 No free full text.

Abstract: BACKGROUND: Both EUROASPIRE studies revealed the suboptimal management of coronary patients regarding lifestyle changes and prophylactic use of cardiovascular drugs. We report here on the mortality follow-up of the EUROASPIRE I cohort over a median period of 4.4 years. DESIGN AND METHODS: The EUROASPIRE I cohort consisted of a consecutive sample of patients aged < or =70 years from nine European countries, hospitalized because of coronary artery bypass graft, percutaneous transluminal coronary angioplasty, acute myocardial infarction or myocardial ischaemia. Baseline data, gathered in 1995-96 through standardized methods, were linked to cause-specific mortality as registered up to 1 April 2000 in 3343 patients. RESULTS: After adjustment for age, gender and diagnostic category according to Cox modelling, smoking, previous coronary heart disease and diabetes proved significant predictors of total, cardiovascular (CVD) and coronary heart disease (CHD) mortality. Obesity, low education, raised blood pressure, elevated total cholesterol and low HDL cholesterol, however, were not significantly associated with higher mortality rates. In multivariate analysis, smoking and diabetes emerged as the strongest predictors of CVD [risk ratios (RR) 2.2 and 2.5 respectively] and CHD mortality (RR 2.4 and 2.4 respectively). CONCLUSIONS: The results of the mortality follow-up of the EUROASPIRE I patients underline the importance of smoking and diabetes in the secondary prevention of CHD. Failure to find statistically significant associations between other classical risk factors, such as blood pressure and plasma lipid levels, and mortality may be related to the extensive use of antihypertensive and lipid-lowering drugs in this cohort.

Boersma E, Keil U, De Bacquer D, De Backer G, Pyörälä K, Poldermans D, Leprotti C, Pilotto L, de Swart E, Deckers JW, Heidrich J, Sans S, Kotseva K, Wood D, Ambrosio GB, Anonymous00016. · Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. · J Hypertens. · Pubmed #14508188 No free full text.

Abstract: BACKGROUND: Elevated blood pressure is associated with an impaired prognosis in patients with established coronary heart disease. Adequate blood pressure control is therefore of utmost importance. We report on two successive European surveys that evaluated whether the goals given in recommendations on secondary prevention are achieved. METHODS: The first European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE I) survey was conducted during 1995-1996 in 21 hospitals in nine European countries. The second survey (EUROASPIRE II) was conducted during 1999-2000 in 47 hospitals (including 20 hospitals that participated in EUROASPIRE I) in 15 Europeans countries. Consecutive patients (aged < 71 years) were identified from hospital records after coronary artery bypass grafting, percutaneous coronary intervention, myocardial infarction, or myocardial ischaemia. Patients were invited for an interview and examination at least 6 months after hospitalization. During the interview, blood pressure was measured in a standardized fashion. Systolic blood pressure >/= 140 mmHg and/or a diastolic blood pressure >/= 90 mmHg were considered as elevated blood pressure. EUROASPIRE II provides a more comprehensive view on the actual management of patients with established coronary disease. Therefore, we decided to concentrate mainly on the EUROASPIRE II data, and to use EUROASPIRE I for the evaluation of time trends. RESULTS: In EUROASPIRE II, 5556 patients were interviewed, and 51% were diagnosed with elevated blood pressure. Large regional variations in the prevalence of elevated blood pressure were observed, with values ranging from 37 to 64%. Twenty-five per cent (1401) of patients were on a diet to reduce blood pressure, and among these 61% had elevated blood pressure. The prevalence of elevated blood pressure among the 4827 (87%) patients taking blood pressure-lowering medication (which was not necessarily taken as an antihypertensive treatment) was 51%. Patients with elevated blood pressure were more likely to be diabetic, hypercholesterolemic, and obese than normotensive patients. The proportion of patients who reported being aware of their hypertensive status was somewhat higher in EUROASPIRE II than in EUROASPIRE I (71 versus 67%), and the use of blood pressure-lowering medication was intensified (91 versus 85%). However, these changes were not accompanied by a decrease in the prevalence of elevated blood pressure (54 versus 55% in centres that participated in both surveys). CONCLUSION: During 1995-2000 the prevalence of elevated blood pressure in patients with established coronary heart disease remained at an unacceptably high level. Throughout Europe, still about half of coronary patients require more intensive blood pressure management.

De Sutter J, De Bacquer D, Kotseva K, Sans S, Pyörälä K, Wood D, De Backer G, Anonymous00125. · Department of Public Health, University Hospital, De Pintelaan 185, 9000, Gent, Belgium. · Eur Heart J. · Pubmed #12590902 links to  free full text

Abstract: AIMS: To determine whether the Joint European Societies' recommendations that first degree blood relatives of patients with premature coronary heart disease (CHD) should be screened for coronary risk factors is being followed and, if so, how effectively these relatives are being managed. METHODS AND RESULTS: Using a postal questionnaire, 3322 relatives (siblings and children >/=18 years of age) of 1289 index patients in the EUROASPIRE II survey who had suffered from premature CHD (men under 55 years and women under 65 years) were asked whether screening for coronary risk factors had occurred and, if so, how they were being managed in terms of lifestyle advice and drug therapies. Overall, screening for coronary risk factors because of CHD in the family was only performed in 11.1% of siblings and 5.6% of children. However, prevalences of different cardiac risk factors were high both in relatives and offspring and a clear familial clustering could be documented. Less than 50% of siblings and 25% of children were given some general lifestyle advice regarding cardiac risk factors. Moreover, active interventions such as starting antihypertensive or lipid lowering drugs were rarely carried out, particularly in children of patients with premature CHD. CONCLUSIONS: European physicians rarely screen family members of patients with premature CHD for cardiac risk factors. General lifestyle style advice or active treatment for these risk factors are also rarely given. However, since these family members have a high prevalence and familial clustering of cardiac risk factors, they form an ideal target population for primary prevention of CHD in high-risk patients.

Haddy N, De Bacquer D, Chemaly MM, Maurice M, Ehnholm C, Evans A, Sans S, Do Carmo Martins M, De Backer G, Siest G, Visvikis S. · INSERM U 525 Equipe 4, 30 rue Lionnois, 54000 Nancy, France. · Eur J Hum Genet. · Pubmed #12461692 links to  free full text

Abstract: Interindividual variation in the concentration of plasma lipids which are associated with coronary artery disease (CAD) risk is determined by a combination of genetic and environmental factors. This study investigates the effects of apoE genotype and plasma concentration on cholesterol and triglycerides (TG) levels in subjects from five countries: Finland, France, Northern Ireland, Portugal, and Spain. Age and sex significantly influenced serum cholesterol, TG and apoE concentrations. The age effect differs in males and females. The allele frequencies of the apoE gene, one of the most widely studied CAD susceptibility genes, were determined: the epsilon2 allele frequency and the apoE concentration showed a north-south increasing gradient while the epsilon4 allele frequency showed the reverse. ApoE plays an important role in lipid metabolism. Total cholesterol and TG concentrations were significantly dependent on apoE genotype in both sexes. These differences in lipids between genotypes were more pronounced when plasma apoE concentrations were taken into account.

De Backer TL, De Buyzere M, Segers P, Carlier S, De Sutter J, Van de Wiele C, De Backer G. · Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium. · Atherosclerosis. · Pubmed #12417289 No free full text.

Abstract: BACKGROUND: Impaired hemorheology has been demonstrated in atherosclerotic disease and has shown a relationship with classical risk factors. Blood viscosity (eta), being the ratio of shear stress over shear rate, is an important parameter of hemorheology. In women with premature coronary artery disease (CAD), the underlying risk factors are a matter of debate and the role of whole blood viscosity in its pathogenesis has not been documented. AIM: To investigate the association of whole blood viscosity with premature CAD in women, with complaints suggestive of angina pectoris. METHODS: Eighty-eight women (mean age 53 years) were divided into two groups, those with a high likelihood of CAD (LIKELI+) and those with a low likelihood of CAD (LIKELI-), based on medical history and technical investigations. Assessment of risk factors comprised smoking, diabetes mellitus, arterial hypertension, left ventricular hypertrophy (LVH), systolic and diastolic blood pressures, total low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol, triglycerides, body mass index, menopause, hormone replacement therapy, uric acid and creatinine, and predicted 10-year cardiovascular risk according to the Framingham study was calculated. Whole blood viscosity was determined at 37 degrees C using a rotational cone-and-plate viscosimeter. RESULTS: Baseline characteristics did not differ significantly between the groups except for antiplatelet therapy (P=0.001), prevalence of diabetes mellitus (P=0.002), predicted 10-year cardiovascular risk (P=0.007), essential hypertension (P=0.02), LVH (P=0.03) and smoking habits (P=0.04). LIKELI+ women had a significantly higher whole blood viscosity at all shear rates compared with LIKELI- women (P<0.05). All blood viscosities measured from 25 to 125 s(-1) were highly significantly (P<0.0001) correlated with eta(250s(-1)). Univariate correlates with eta(250s(-1)) comprised triglycerides (P=0.006) and haematocrit (P=0.026). Binary logistic multivariate regression analysis for high likelihood of CAD revealed that only presence of arterial hypertension (P<0.0001) was predictive. Multiple regression analysis demonstrated that haematocrit (P=0.001) and likelihood of CAD (P=0.01) were the only significant determinants of eta(250s(-1)). CONCLUSION: In this study, blood viscosity did not appear as an independent risk factor for the prediction of premature CAD in women. Viscosity may act as a marker of CAD or of classical risk factors.

De Sutter J, De Buyzere M, Gheeraert P, Van de Wiele C, Voet J, De Pauw M, Dierckx R, De Backer G, Taeymans Y. · Department of Cardiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. · Atherosclerosis. · Pubmed #11427220 No free full text.

Abstract: BACKGROUND: In acute myocardial infarction (AMI) treated conservatively or with thrombolysis, marked increases of C-reactive protein (CRP) and fibrinogen have been observed. No data are however available concerning a possible relation between CRP and fibrinogen levels on admission and markers of infarct size after obtaining thrombolysis in myocardial infarction (TIMI) flow III by primary angioplasty. METHODS: We studied 34 patients with a first AMI (29 men, mean age 54+/-11 years) who were treated with primary angioplasty (TIMI flow III in all patients, no concomitant treatment with glycoprotein IIb-IIIa antagonists) within 6 h of onset of pain. CRP and fibrinogen levels on admission were determined and related to the following markers of infarct size: peak creatine kinase MB (CKMB) levels, radionuclide left ventricular ejection fraction (LVEF) at discharge and thallium-201 single-photon emission computed tomography (SPECT) infarct size at 1 month. RESULTS: Median CRP levels were 0.4 mg/dl (range 0.09-3 mg/dl), median fibrinogen levels 412 mg/dl (range 198-679 mg/dl), mean CKMB was 178+/-151 U/l, mean LVEF 52+/-8% and mean thallium-201 infarct size 7+/-6%. Although CRP levels were related to fibrinogen levels on admission (r=0.56, P=0.002), only fibrinogen levels were related to markers of infarct size (r=0.58, P=0.001 for CKMB, r=-0.44, P=0.01 for LVEF and r=0.64, P=0.001 for thallium-201 infarct size). No relation was found between CRP or fibrinogen levels on admission and the extent of coronary artery disease or the myocardial area at risk. In multiple regression analysis, the relation between fibrinogen and markers of infarct size was independent of CRP levels and the duration of pain on admission. CONCLUSIONS: These findings indicate a relation between fibrinogen levels on admission and myocardial infarct size in patients treated with primary angioplasty for AMI. This relation seems to be independent of CRP levels and the duration of pain on admission. If confirmed in larger patient populations, fibrinogen levels on admission could have an important value for risk stratification and more aggressive reduction of infarct size in patients who are treated with primary angioplasty.

Vanuzzo D, Pilotto L, Ambrosio GB, Pyörälä K, Lehto S, De Bacquer D, De Backer G, Wood D, Anonymous00100. · Centre for Cardiovascular Diseases, A.S.S. 4 Medio Friuli, Udine, Italy. · Atherosclerosis. · Pubmed #11164441 No free full text.

Abstract: We have examined the potential for cholesterol lowering in secondary prevention of coronary heart disease based on data from the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) study carried out in 1995-1996 in nine European centres (Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, Slovenia and Spain). Consecutive patients aged < or = 70 years in four diagnostic categories--coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without infarction--were identified from hospital records and invited for an interview and risk factor assessment at least 6 months after hospital admission. Plasma lipid measurements were carried out in a central laboratory. Combining patients from all centres and diagnostic categories (n = 2749) the medians (interquartile ranges) for plasma lipids were: total cholesterol 5.36 (4.76-6.03) mmol/l, high density lipoprotein (HDL) cholesterol 1.19 (1.01-1.42) mmol/l, triglycerides 1.55 (1.15-2.24) mmol/l, and low density lipoprotein (LDL) cholesterol 3.32 (2.76-3.91) mmol/l. Only 33% of the patients received lipid-lowering drugs. If the therapeutic goal given in the 1998 European recommendations, total cholesterol < 5.0 mmol/l, were applied, 67% of these patients would have needed an intensified cholesterol-lowering action, and with an even stricter goal, total cholesterol < 4.5 mmol/l, this proportion would have been as high as 84%.

Montaye M, De Bacquer D, De Backer G, Amouyel P. · INSERM U 508, Institut Pasteur de Lille, France. · Eur Heart J. · Pubmed #10781352 links to  free full text

Abstract: AIMS: To evaluate the management of overweight and obesity in coronary artery disease patients in Europe. METHODS AND RESULTS: The EUROASPIRE Study is a multicentre epidemiological study involving nine European countries. The major cardiovascular risk factors and their management were collected from hospital records and measured at least 6 months after hospitalization during a specific interview. A total of 4863 consecutive records from men and women with coronary artery disease, under 71 years of age, were reviewed. Interviews were obtained for 3569 (73%). Body mass index was computed from height and weight noted in the medical records and measured at interview. Management of overweight and obesity was recorded at interview. At least 6 months after hospitalization, 75% of women and 80% of men were overweight and 33% of women and 23% of men were obese. Height noted in medical records was over-estimated, inducing an under-estimation of obesity in 16% of men and 33% of women. Advice from a nutritionist was offered in less than 20% of obese patients. The same trends were observed in all participating countries. CONCLUSIONS: Prevalences of overweight and obesity are high in coronary artery disease patients in Europe. A systematic measurement of height and weight is a prerequisite to a better management of this common modifiable risk factor.

De Sutter J, Tavernier R, Van De Wiele C, De Backer J, Kazmierczak J, De Backer G, Dierckx R, Jordaens L. · Department of Cardiology, University Hospital Gent, De Pintelaan 185, 9000 Gent, Belgium. · Heart. · Pubmed #10212174 links to  free full text

Abstract: OBJECTIVE: To relate QT parameters to infarct size and inducibility during electrophysiological studies. DESIGN: Analysis of a prospective register. SETTING: University hospital. PATIENTS: 64 patients with coronary artery disease and documented life threatening ventricular arrhythmias. INTERVENTIONS: Measurements of QT-max, QTc-max, and QT dispersion (QT-d) on a simultaneous 12 lead ECG (50 mm/s). Estimation of myocardial infarct size with radionuclide left ventricular ejection fraction (LVEF), echocardiography (left ventricular end diastolic diameter, LVEDD), and a defect score based on a quantitative stress redistribution 201-thallium perfusion study. Electrophysiological study to assess inducibility. RESULTS: Mean (SD) QT parameters were: QT-max 440 (50) ms, QTc-max 475 (46) ms, and QT-d 47 (20) ms. Mean (SD) estimates of infarct size were: LVEF 34 (13)%, LVEDD 61 (9) mm, and defect score 18 (11). There was no significant correlation between any index of infarct size and QT parameters. QT parameters were not significantly different between patients with inducible (n = 57) and non-inducible arrhythmias (n = 7) (QT-max: 416 (30) v 443 (51) ms, p = 0.18; QTc-max 485 (34) v 473 (47) ms, p = 0.34; QT-d 47 (12) v 47 (21) ms, p = 0.73). Non-inducible patients had a significant lower defect score: 8 (9) v 19 (11), p = 0.02, but comparable LVEF: 38 (12)% v 34 (12)%, p = 0.58, and LVEDD: 54 (10) v 61 (8) mm, p = 0.13. CONCLUSIONS: QT parameters are not influenced by infarct size and do not predict inducibility during electrophysiological study in patients with coronary artery disease and malignant ventricular arrhythmias. In contrast, the amount of scar tissue determined by perfusion imaging is strongly correlated with inducibility.