Hypercholesterolemia: Pitsavos C

Panagiotakos DB, Pitsavos C, Chrysohoou C, Bratsas A, Toutouzas P, Stefanadis C. · Cardiology Department, School of Medicine, University of Athens, Greece. · Acta Cardiol. · Pubmed #15368799 No free full text.

Abstract: OBJECTIVE: In this work we assessed a risk score for developing a first event of acute coronary syndrome (ACS) based on the family history of the cardiovascular risk factors. METHODS AND RESULTS: The studied population consisted of 848 randomly selected middle-aged patients with first event of ACS and 1078 sex-age-region matched controls admitted to the same hospitals for minor operations and without any clinical suspicion of cardiovascular disease in their life. A Family History Score (FHS) was developed based on the presence of coronary heart disease, hypertension, hypercholesterolaemia and diabetes mellitus, among first-degree relatives of the participants after adjusting for the family size. The evaluation of FHS was based on conditional logistic regression analysis, after controlling for demographic variables as well as for the mutual confounding effects of other risk factors. Family history of CHD, hypercholesterolaemia and diabetes was highly associated with the development of the disease. The introduced FHS was also highly associated with the development of ACS among participants who had no family history of CHD (odds ratio = 10.9, p < 0.001), whereas it was not associated with the development of the disease among participants who had a family history of CHD (odds ratio = 1.41, p = 0.543). CONCLUSIONS: The suggested FHS could be a useful tool in the primary prevention of ACS, as well as in detecting and understanding associations between genetic vulnerability and cardiovascular risk factors.

Chrysohoou C, Panagiotakos DB, Pitsavos C, Kokkinos P, Marinakis N, Stefanadis C, Toutouzas PK. · Section of Preventive Cardiology, Cardiology Department, School of Medicine, University of Athens, Greece. · Prev Cardiol. · Pubmed #12732792 No free full text.

Abstract: Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3+/-8 vs. 59.7+/-10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.

Charakida M, Tousoulis D, Skoumas I, Pitsavos C, Vasiliadou C, Stefanadi E, Antoniades C, Latsios G, Siasos G, Stefanadis C. · Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece. · Atherosclerosis. · Pubmed #19004443 No free full text.

Abstract: BACKGROUND: Evidence suggests that children with familial hypercholesterolemia (FH) have endothelial dysfunction. Inflammatory and haemostatic abnormalities are associated with advanced atherosclerosis and increased cardiovascular events. However, it is unknown whether these abnormalities present in FH children and contribute to their vascular dysfunction. METHODS AND RESULTS: We studied 38 children with FH (19 males, 19 females aged 14.8+/-0.9 years mean+/-S.E.) and 41 healthy children (controls; 22 males, 19 females aged 15.4+/-0.7 years). Endothelium-dependent reactive hyperemia (RH%) and endothelium-independent nitrate hyperemia dilatation (NH%) were measured by strain gauge plethysmography. Inflammatory and haemostatic parameters were assessed by ELISA. RH% and NH% were significantly reduced in FH compared to controls (91.3+/-9.3% vs. 120.4+/-10.6% and 53.6+/-3.8% vs. 74.5+/-7.4%, p<0.05 for both). Total cholesterol and lipoprotein (a) were increased in FH children compared to controls (282.3+/-8.8 mg/dl vs. 163.8+/-4.6 mg/dl and 11.0[4.6, 30.7]mg/dl vs. 5.24[2.63, 11.0]mg/dl median [IQR] respectively; p<0.001 for both). Intercellular cell adhesion molecule (ICAM-1) and interleukin 1 beta (IL-1 beta) serum levels were increased in FH compared to controls (p<0.05 and <0.001, respectively). Plasminogen activator inhibitor 1 (PAI-1) levels were also higher in FH children (p<0.001). Multivariate analysis revealed that reactive hyperemia was independently associated with nitrate-dependent reactive hyperemia (beta=0.597(0.199), p<0.01), PAI-1(beta=-6.78(2.65), p<0.05), log IL-1 beta (beta=-102.8 (30.2), p<0.01), age (beta=-5.06 (2.35), p<0.05) and FH status (beta=-25.2(10.6), p<0.05) (R(2) for the model: 0.63, p=0.001). CONCLUSIONS: Inflammatory and haemostatic abnormalities are present in FH children and contribute to the endothelial dysfunction observed in these children.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, Stefanadis C. · Department of Nutrition Science - Dietetics, Harokopio University, Athens, Greece. · Public Health Nutr. · Pubmed #18616850 No free full text.

Abstract: BACKGROUND: The aims of the present work were to investigate whether dietary habits are associated with socio-economic status (SES), and if they modify the relationship between SES and CVD risk factors, in a sample of men and women free from known CVD. METHODS: This population-based study was carried out in the province of Attica, where Athens is a major metropolis. During 2001-2002, information from 1,528 men (18-87 years old) and 1,514 women (18-89 years old) was collected (75 % participation rate). Among several sociodemographic, clinical and biological factors, adherence to the Mediterranean diet was assessed by a special diet score (Mediterranean Diet Score, MDS) that incorporated the inherent characteristics of this traditional diet. CVD risk factors were examined across the participants' educational level and annual income that defined their SES. RESULTS: Low SES groups exhibited higher prevalence of CVD risk factors, such as obesity, hypertension, diabetes mellitus and hypercholesterolaemia (all P < 0.001). Low SES groups also showed less adherence to the Mediterranean diet than high SES groups (MDS: 23.6 (sd 8.1) v. 25.6 (sd 5.6), P < 0.001). Higher SES index was associated with lower likelihood of having hypercholesterolaemia (OR = 0.91; 95 % CI 0.83, 1.00) and diabetes (OR = 0.83; 95 % CI 0.72, 0.95), after adjusting for various potential confounders. However, the previously mentioned inverse relationship observed between SES and prevalence of CVD risk factors was mainly explained by the dietary habits of the participants. CONCLUSIONS: Low SES groups showed less adherence to the Mediterranean diet compared with high SES groups. This finding may, in part, explain the higher CVD risk factors profile observed among low SES participants.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. · Department of Dietetics-Nutrition, Harokopio University, Greece. · Angiology. · Pubmed #18388034 No free full text.

Abstract: During 2000 to 2002, 700 men (59 +/- 10 years) and 148 women (65 +/- 9 years) patients with first event of an ACS were randomly selected from cardiology clinics of Greek regions. Afterwards, 1078 population-based, age-matched and sex-matched controls were randomly selected from the same hospitals. The frequency ratio between men and women in the case series of patients was about 4:1, in both south and north Greek areas. Hierarchical classification analysis showed that for north Greek areas family history of coronary heart disease, hypercholesterolemia, hypertension, diabetes (explained variability 35%), and less significantly, dietary habits, smoking, body mass index, and physical activity status (explained variability 4%) were associated with the development of ACS, whereas for south Greek areas hypercholesterolemia, family history of coronary heart disease, diabetes, smoking, hypertension, dietary habits, physical activity (explained variability 34%), and less significantly body mass index (explained variability <1%), were associated with the development of the disease.

Panagiotakos DB, Pitsavos C, Skoumas Y, Lentzas Y, Papadimitriou L, Chrysohoou C, Stefanadis C. · Department of Dietetics - Nutrition, Harokopio University, Athens, Greece. · Lipids Health Dis. · Pubmed #18377643 links to  free full text

Abstract: OBJECTIVE: In this work we evaluated the 5-year incidence of hypercholesterolemia, in a sample of cardiovascular disease free adult men and women from Greece. We also evaluated the association of several socio-demographic, dietary and lifestyle habits on the incidence of this disorder. METHODS: 1514 men and 1528 women (>18 y) without any clinical evidence of cardiovascular disease, living in Attica area, Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multi-stage, and included information about various socio-demographic, lifestyle (diet, exercise, smoking etc), biological (lipids, and inflammatory markers), and clinical characteristics of the participants. In 2006, a group of experts performed the 5-year follow-up through telephone calls or personal visits (941 of the 3042 (31%) participants were lost to follow-up). Hypercholesterolemia, among people who had normal blood lipids at initial examination, was defined as fasting total cholesterol levels > 200 mg/dl or use of lipids lowering agents (NCEP ATPIII). RESULTS: The 5-year incidence of hypercholesterolemia was 23.7% (n = 127) in men and 17.7% (n = 110) in women (p for gender differences < 0.001). Multi-adjusted logistic regression analysis which revealed that increased age (odds ratio = 1.05, p < 0.001), waist circumference (odds ratio = 1.02, p = 0.03), fasting blood glucose (odds ratio = 1.01, p = 0.08) and apolipoprotein B (odds ratio = 1.02, p = 0.001) levels, were the most significant baseline predictors of developing hypercholesterolemia within a 5-year period. CONCLUSION: Incidence of hypercholesterolemia was high in both genders, emphasizing the burden of this disorder at population level. Aging, increased waist circumference, fasting blood glucose and apolipoprotein B levels were the most significant baseline predictors of hypercholesterolemia.

Yannakoulia M, Panagiotakos D, Pitsavos C, Lentzas Y, Chrysohoou C, Skoumas I, Stefanadis C. · Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, Athens 17671, Greece. · Public Health Nutr. · Pubmed #18325138 No free full text.

Abstract: OBJECTIVES: To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals. METHODS: Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work. RESULTS: The 5-year incidence of obesity was 21.8 % in men and 11.9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1.6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals. CONCLUSIONS: Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.

Panagiotakos DB, Pitsavos C, Lentzas Y, Skoumas Y, Papadimitriou L, Zeimbekis A, Stefanadis C. · Department of Nutrition Science-Dietetics, Harokopio University, Greece. · Ann Epidemiol. · Pubmed #18083543 No free full text.

Abstract: OBJECTIVE: We sought to evaluate factors that are associated with physical activity changes among adults within a 5-year period. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age-gender distribution of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration, and intensity of sports-related physical activity. During 2006, the 5-year follow-up was performed in 1955 participants, which included, among others, current physical activity status. RESULTS: A total of 587 (61%) men and 673 (68%) women were classified as physically inactive at baseline, whereas 661 (69%) men and 728 (73%) women were classified as physically inactive at follow-up; thus, a 13% increase in physical inactivity rate was observed in men and a 7% in women during the follow-up period (p < 0.01). Multivariate analysis revealed that male gender, being a nonsmoker, healthy eating, better self-reported quality-of-life, and lower prevalence of hypercholesterolemia and incidence of cardiovascular disease were the characteristics of people that remained physically active; advanced age, anxiety and depression, overweight, and low quality-of-life were the baseline predictors of physical inactivity among initially active participants, which also had a greater incidence of cardiovascular disease. CONCLUSIONS: Gender, aging, psychological disorders, body mass, smoking, dietary habits, perceived health status, and quality-of-life were the most important discriminating factors of physical activity changes.

Vlachopoulos C, Aznaouridis K, Dagre A, Vasiliadou C, Masoura C, Stefanadi E, Skoumas J, Pitsavos C, Stefanadis C. · Peripheral Vessels and Hypertension Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Vas. Sofias avenue 114, Athens 11528, Greece. · Eur Heart J. · Pubmed #17597050 links to  free full text

Abstract: AIMS: Recent studies suggest an association between acute inflammation and deterioration of arterial function. The effect of acute inflammation on endothelial function and the role of treatment with statins have not been investigated in subjects with dyslipidaemia. METHODS AND RESULTS: In this randomized, placebo-controlled, double-blind study, we generated a transient systemic inflammation by Salmonella typhi vaccination in 50 volunteers with mild hypercholesterolaemia after 4 days of treatment with atorvastatin 40 mg or placebo once daily. Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery and circulating levels of endothelial and inflammatory markers were measured before and 8 h after the vaccine. Vaccination produced a decline on FMD at 8 h (absolute decrease of 2.55%, P = 0.001), indicating an unfavourable effect on endothelial function. In contrast, in atorvastatin-treated subjects, FMD was preserved after vaccination (decrease of 0.15%, P = 0.005 vs. placebo). The vaccination-induced decline in plasma level of nitric oxide metabolites (by 6.0 micromol/L, P = 0.007) and antioxidant capacity (by 20.6 micromol/L, P = 0.001) in the placebo group were completely abolished by atorvastatin (P = 0.038 and P = 0.005, respectively, vs. placebo). In contrast, atorvastatin had no significant effect on cytokine levels. CONCLUSION: Acute inflammation is aetiologically associated with the deterioration of vasomotor and systemic endothelial function in hypercholesterolaemic patients. Atorvastatin effectively abrogates these deleterious effects.

Kontogianni MD, Panagiotakos DB, Chrysohoou C, Pitsavos C, Zampelas A, Stefanadis C. · Department of Nutrition & Dietetics, Harokopio University of Athens, Athens, Greece. · Clin Cardiol. · Pubmed #17385704 No free full text.

Abstract: BACKGROUND: According to epidemiological and metabolic studies monounsaturated fatty acids (MUFAs) seem to exert a protection against coronary heart disease (CHD) risk. The aim of the present study was to evaluate the association between the pattern of edible oils and fats consumption and the prevalence of a first, nonfatal event of an acute coronary syndrome (ACS) in a Greek sample. METHODS: Seven hundred males and 148 females patients with first event of an ACS and 1078 population-based controls, age and sex matched, were randomly selected. Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semi-quantitative food-frequency questionnaire and use of oils in daily cooking or preparation of food was also recorded. Multiple logistic regression analysis estimated the odds ratio (OR) of having ACS by types of oil used, after taking into account the effect of several confounders. RESULTS: Exclusive use of olive oil was associated with 47% (95% confidence interval (CI) 0.4-0.71) lower likelihood of having ACS, compared to nonuse, after adjusting for BMI, smoking, physical activity level, educational status, the presence of family history of CHD, as well as hypertension, hypercholesterolemia and diabetes. Consumption of olive oil in combination with other oils or fats was not significantly associated with lower odds of ACS compared to no olive oil consumption (p=0.14). CONCLUSIONS: Exclusive use of olive oil during food preparation seems to offer significant protection against CHD, irrespective of various clinical, lifestyle and other characteristics of the participants.

Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C. · Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. · J Am Coll Nutr. · Pubmed #17353581 links to  free full text

Abstract: OBJECTIVE: We investigated the association between adherence to Mediterranean diet and fasting indices of glucose homoeostasis, in a Greek adult population. METHODS: During 2001-2002 we randomly enrolled 1514 men and 1528 women (18-89 years old) without history of CVD, from the Attica area. Diabetes mellitus (type 2) and impaired fasting glucose (IFG) were defined according to the established ADA criteria. Insulin resistance was evaluated by HOMA-IR. Dietary habits were assessed through a validated food frequency questionnaire and a diet score (range 0-55) was developed (higher values means greater adherence to the Mediterranean diet). RESULTS: The overall prevalence of diabetes type 2 was 7.9% in men and 6.0% in women (P = 0.05). Mean diet score was 26.3 +/- 6.8 in normoglycemic, 25.7 +/- 6.4 in IFG and 22.2 +/- 5.8 in diabetic subjects (p < 0.001). In normoglycemic subjects who were in the upper tertile of the diet score we observed 7% lower glucose (p < 0.05), 5% lower insulin (p < 0.05) and 15% lower HOMA-IR (p < 0.01) levels compared to subjects in the lower tertile of the diet score. Additionally, in diabetic/IFG participants who where in the upper tertile of the diet score we observed 15% lower glucose (p < 0.05), 15% lower insulin (p < 0.05) and 27% lower HOMA-IR (p < 0.01) levels compared to those in the lower tertile. However, multiple regression analysis, adjusted for age, sex, BMI, waist-to-hip ratio, physical activity, smoking status, and presence of hypertension and hypercholesterolemia, confirmed the previous associations in normoglycemic, but not in diabetic/IFG people. CONCLUSION: An inverse association was observed between adherence to Mediterranean diet and indices of glucose homeostasis, only in normoglycemic people.

Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C. · Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. · Prev Med. · Pubmed #17350085 No free full text.

Abstract: OBJECTIVE: We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity. METHODS: A diet score (range 0-55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants (n=3042, enrolment 2001-02 in Athens metropolitan area, aged 18-89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too. RESULTS: The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%-48%), 46% (95% CI 44%-49%), 12% (95% CI 11%-14%) and 33% (95% CI 30%-35%), while the negative predictive values are 86% (95% CI 85%-88%), 71% (95% CI 69%-74%), 98% (95% CI 97%-99%) and 97% (95% CI 96%-98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (+/-0.1%, p<0.001). CONCLUSION: The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease.

Skoumas I, Masoura C, Pitsavos C, Tousoulis D, Papadimitriou L, Aznaouridis K, Chrysohoou C, Giotsas N, Toutouza M, Tentolouris C, Antoniades C, Stefanadis C. · 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, 69 S. Karagiorga, Glifada, Athens, Greece. · Int J Cardiol. · Pubmed #17188767 No free full text.

Abstract: BACKGROUND: Heterozygous familial hypercholesterolemia (hFH) and familial combined hyperlipidemia (FCH) have been associated with increased risk for coronary artery disease (CAD), but the impact of traditional risk factors to the incidence of CAD in these patients remains unknown. The present study evaluates the contribution of such risk factors to the development of CAD in these two dyslipidemic populations. METHODS: This cross-sectional study enrolled a total 1306 subjects; 600 individuals with hFH (mean age 41+/-13 years, 261 males and 339 females), and 706 individuals with FCH (mean age 49+/-11 years, 463 males and 243 females). Blood samples were collected after 12 hours fasting period, and serum lipids were determined. Multivariate logistic regression models were used to estimate the odds ratios of CAD based on the type of hyperlipidemia, after adjustment for demographic characteristics and risk factors. RESULTS: Subjects with FCH were older (P<0.001), and they had a significantly increased prevalence of hypertension, diabetes and metabolic syndrome (40 vs. 10%, 13 vs. 2% and 41 vs. 6% respectively, all P<0.001) compared to the hFH group. Total cholesterol, LDL-cholesterol, and apolipoprotein B levels were higher (all P<0.001) in hFH subjects. Although in multivariate analysis lipid abnormalities found in hFH were associated with increased risk of CAD (P<0.001) compared with lipid abnormalities of FCH, the overall prevalence of CAD was similar between the two groups (16.7 vs. 15.3%, P=NS). CONCLUSIONS: Despite the high atherogenic potential of altered lipid metabolism found in hFH, the prevalence of CAD is similarly increased in patients with hFH or FCH. This may be related to the clustering of non-lipid cardiovascular risk factors, such as diabetes mellitus, observed in patients with FCH.

Dedoussis GV, Maumus S, Choumerianou DM, Skoumas J, Pitsavos C, Stefanadis C, Visvikis-Siest S. · Laboratory of Molecular Biology, Department of Science of Dietetics-Nutrition, Harokopio University of Athens, Kallithea-Athens, Greece. · Genet Test. · Pubmed #17020471 No free full text.

Abstract: Familial Hypercholesterolemia (FH) is a genetic disorder characterized by high low-density lipoprotein cholesterol (LDL-C) concentrations that frequently gives rise to premature coronary artery disease. The clinical expression of FH is highly variable, even in patients carrying the same LDL receptor gene mutation. This variability may be due to environmental and other genetic factors. We investigated the effect of APOCIII T1100C, FV Gln506Arg, ADRB2 Glu27Gln, SELE Ser128Arg, SELE Leu554Phe, and ENaCa Ala663Thr polymorphisms on the HDL-C variations in 84 patients with FH. For ApoCIII T1100C, subjects with the TT genotype presented higher HDL-C levels than the other genotype groups (p = 0.046). Similarly the presence of the Gln allele in ADRB2 27 Glu/Gln heterozygotes and ADRB2 27 Gln/Gln homozygotes was associated with higher HDL-C levels (p = 0.014). Among the other polymorphisms tested, none of them were associated with variations in HDL-C levels. The influence of each polymorphism on lipid concentrations was evaluated with linear regression analyses after adjustment for age and sex. Among the variables studied including total cholesterol, LDL-C, high-density lipoprotein (HDL)-C, triglycerides, apolipoprotein A (Apo-A) and B (Apo-B), and lipoprotein alpha (LP alpha), HDL-C concentration was significantly different in models applied for polymorphisms ApoCIII T1100C, FV Gln506Arg, and ADRB2 Glu27Gln (p = 0.01, p = 0.018, p = 0.04, respectively). These results suggest that HDL-C levels in FH heterozygotes may be affected by several different genetic variants.

Pitsavos C, Milias GA, Panagiotakos DB, Xenaki D, Panagopoulos G, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Greece. · BMC Public Health. · Pubmed #16904009 links to  free full text

Abstract: BACKGROUND: Hypertension leads to many degenerative diseases, the most common being cardiovascular in origin. This study has been designed to estimate the prevalence of self-reported hypertension in a random nationwide sample of adult Greek population, while focus was set to the assessment of participants' nutritional habits in relation to their hypertension status. METHODS: A random-digit dialed telephone survey. Based on a multistage, stratified sampling, 5003 adults (18 - 74 yr) participated (men: 48.8%, women: 51.2%). All participants were interviewed via telephone by trained personnel who used a standard questionnaire. The questionnaire included demographic and socioeconomic characteristics, medical history, lifestyle habits and nutritional assessment. RESULTS: The prevalence of self-reported hypertension was 13.3% in men and 17.7% in women (P < 0.001). Furthermore, women reported higher values of systolic blood pressure (180 +/- 27 mmHg) than men (169 +/- 24 mmHg). Positive relationships were found between hypertension status and the prevalence of the rest investigated health conditions (i.e. hypercholesterolaemia, diabetes mellitus, renal failure and obesity). Nutritional assessment showed that consumption of fish, fruits and juices, cereals, and low fat milk and yogurt was significantly higher among hypertensive subjects while the opposite was observed for food items as red meat, pork, egg, pasta and rice, full fat dairy products and desserts. CONCLUSION: Hypertension seems to be a serious public health problem in Greece. It is encouraging that hypertensives may have started adopting some more healthy nutritional behaviour compared to normotensive ones. However, they can gain significant benefits regarding to blood pressure control, if they increase the level of compliance with dietary recommendations.

Yannakoulia M, Panagiotakos DB, Pitsavos C, Stefanadis C. · Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, Athens 17671, Greece. · Obesity (Silver Spring). · Pubmed #16855199 No free full text.

Abstract: OBJECTIVE: The aim of this study was to investigate correlates of misreporting in BMI, based on self-reported weight and height, in a randomly selected population sample of Greek adults and to evaluate the effect of obesity status misclassification on the associations between obesity and disease. RESEARCH METHODS AND PROCEDURES: During 2001 to 2002, we randomly enrolled 1514 men (18 to 87 years old) and 1528 women (18 to 89 years old) from the Attica area, Greece; the sampling was stratified by the age-sex distribution of the region. Various sociodemographic, clinical, and psychological characteristics were self-reported, and weight and height were measured and recorded in all participants. RESULTS: The proportions of true positives and true negatives for correct obesity status identification were 62% and 97%, respectively. Women were 9 times more likely to be under-reporters than men, whereas men were 7.5 times more likely to be over-reporters. A 10-year increase in age was associated with a 48% higher likelihood of being an under-reporter and 26% lower likelihood of being an over-reporter, irrespective of sex and other characteristics of the participants. Clinical status, such as the presence of hypertension and diabetes, was associated with under-reporting of body weight. Furthermore, the use of self-reported data may substantially exaggerate associations between obesity and obesity-related diseases, such as diabetes, hypercholesterolemia, and hypertension. DISCUSSION: The study indicates that, apart from age and sex, disease status may be another factor that influences misreporting of obesity status, with diabetic and hypertensive people to be more likely to under-report their overweight. Use of self-reported data may bias obesity-disease associations.

Choumerianou DM, Maumus S, Skoumas J, Pitsavos C, Stefanadis C, Visvikis-Siest S, Dedoussis GV. · Laboratory of Molecular Biology, Department of Science of Dietetics-Nutrition, Harokopio University of Athens, Athens, Greece. · Clin Chem Lab Med. · Pubmed #16776623 No free full text.

Abstract: BACKGROUND: Familial hypercholesterolemia (FH) is a genetic disorder characterized by high low-density lipoprotein-cholesterol (LDL-C) concentrations, which frequently gives rise to premature coronary artery disease. The clinical expression of FH is highly variable, even in patients carrying the same LDL receptor (LDLR) gene mutation. This variability may be due to environmental and other genetic factors. METHODS: We investigated paraoxonase 2 (PON 2) Ser311Cys, lipoprotein lipase (LPL) Asn291Ser, plasminogen activator inhibitor-1 (PAI-1) T11053G, beta-fibrinogen (FGB) -455 G>A and nitric oxide synthase gene (NOS) -922 A>G polymorphisms in 84 patients with FH. The effect of polymorphisms as independent factors of high lipid values was evaluated. RESULTS: The PON 2 Cys311 allele was correlated with high total cholesterol and LDL-C and apolipoprotein B levels, while LPL Asn291, PAI-1 T11053, FGB -455 G and NOS -922 A alleles were correlated with high apolipoprotein B levels. CONCLUSIONS: These results suggest that apolipoprotein B levels in FH heterozygotes may be affected by several different genetic variants.

Dedoussis GV, Maumus S, Skoumas J, Choumerianou DM, Pitsavos C, Stefanadis C, Visvikis-Siest S. · Laboratory of Molecular Biology, Department of Dietetics and Nutrition, Harokopio University of Athens, Athens, Greece. · J Clin Lab Anal. · Pubmed #16721833 No free full text.

Abstract: Atrial natriuretic peptide (ANP or NPPA) is the precursor protein of the form of amyloidosis called isolated atrial amyloid (IAA), which is related to the increased incidence of cardiac pathological conditions with age. Familial hypercholesterolemia (FH) patients are characterized by high concentrations of low-density lipoprotein cholesterol (LDL-C), which frequently gives rise to premature coronary artery disease (CAD). However, not all FH patients have the same clinical phenotype. The aim of the present study was to assess the relationship between ANP polymorphisms and apolipoprotein (Apo) A1 levels and CAD risk in FH patients. Transition T2238C, which leads to ANP with two additional arginines, and G664A (Val7Met) were investigated with lipid values and clinical phenotype in 83 FH patients. ApoA1 and HDL cholesterol levels were lower in GA patients compared to GG homozygotes for the G664A polymorphism. No association was found between the G664A polymorphism and CAD in our population. Moreover, ApoA1 and high-density lipoprotein cholesterol (HDL-C) levels did not differ among the different genotypes of the T2238C polymorphism, even after adjusting for age and sex. The 664A allele of the ANP polymorphism is associated with lower levels of ApoA1 and HDL-C in FH patients, but not with CAD risk. Concerning the T2238C polymorphism, no effect was found on lipid parameters or CAD incidence.

Milias GA, Panagiotakos DB, Pitsavos C, Xenaki D, Panagopoulos G, Stefanadis C. · Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. · Lipids Health Dis. · Pubmed #16529663 links to  free full text

Abstract: BACKGROUND: The strong causal role of hypercholesterolaemia on the progression of atherosclerosis and subsequently on the development of cardiovascular disease is well described. Main aim of this study was to evaluate the prevalence of self-reported hypercholesterolaemia and its relation to nutritional habits, in a representative nationwide sample of adult Greek population. METHODS: Cross sectional survey. Based on a multistage sampling, 5003 adults (18-74 yr) were enrolled (men: 48.8%, women: 51.2%). All participants were interviewed by trained personnel who used a standard questionnaire. The questionnaire included demographic and socioeconomic characteristics, medical history, lifestyle habits and nutritional assessment. RESULTS: The prevalence of self-reported hypercholesterolaemia was 16.4% in men and 21.8% in women (P < 0.001). Hypercholesterolaemic status was positively associated with the prevalence of hypertension, diabetes mellitus, renal failure, obesity and physical inactivity, and inversely with the prevalence of smoking. The analysis of reported food consumption patterns showed that consumption of fish, fruits and juices, cereals, and low fat milk and yogurt was significantly higher among hypercholesterolaemic participants while the opposite was observed for food items as red meat, pork, egg, full fat dairy products and desserts. CONCLUSION: Hypercholesterolaemia seems to affect a large part of Greek population. It is hopeful that hypercholesterolaemics may have started adopting some more healthy nutritional behaviour compared to normocholesterolaemic ones.

Pitsavos C, Choumerianou DM, Skoumas J, Maumus S, Stefanadis C, Dedoussis GV, Visvikis-Siest S. · Department of Cardiology, Hyperlipidemic Clinic, Hippocratio Hospital, Medical School of Athens, Greece. · Clin Exp Med. · Pubmed #16362800 No free full text.

Abstract: Familial hypercholesterolaemia is a genetic disorder characterised by high low-density lipoprotein (LDL) cholesterol concentrations, which frequently gives rise to premature coronary artery disease (CAD). The clinical expression of familial hypercholesterolaemia is highly variable even in patients carrying the same LDL receptor gene mutation. This variability may be due to environmental and other genetic factors. Apolipoprotein E (Apo-E) has been extensively studied for its effects on the phenotype of familial hypercholesterolaemia. In this study we examined the influence of Apo-E genotype on lipid parameters and the incidence of CAD in 93 Greek patients with familial hypercholesterolaemia. Apo-E E2, E3 and E4 allele frequencies were 0.06, 0.86 and 0.09 respectively. The levels of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoproteins A and B and lipoprotein alpha did not differ significantly among carriers and non-carriers of the E4 allele. The prevalence of CAD and hypertension did not differ either. Our results suggest that the E4 allele is not associated with lipid levels or with the prevalence of CAD among familial hypercholesterolaemia patients of the Greek population.

Tousoulis D, Antoniades C, Vassiliadou C, Toutouza M, Pitsavos C, Tentolouris C, Trikas A, Stefanadis C. · Cardiology Unit, Hippokration Hospital, Athens University Medical School, A Cardiology Department, Greece. · Eur J Heart Fail. · Pubmed #16051518 No free full text.

Abstract: BACKGROUND: Heart failure has been associated with impaired endothelial function, increased inflammatory process and elevated oxidative stress status. Both statins and vitamin E separately improve endothelial function in patients with hypercholesterolemia and/or advanced atherosclerosis. AIM: To evaluate the effect of atorvastatin alone or in combination with vitamin E on endothelial function and serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and vascular cells adhesion molecule (sVCAM-1) in patients with ischemic heart failure. METHODS: Thirty-eight male patients with ischemic cardiomyopathy were randomly divided into three groups and received either atorvastatin 10 mg/day (n = 14), a combination of atorvastatin 10 mg/day plus vitamin E 400 IU/day (n = 12), or no statin or antioxidant treatment (n=12, controls) for 4 weeks. Forearm blood flow (FBF) was measured using venous occlusion strain-gauge plethysmography. Forearm vasodilatory response to reactive hyperemia (RH%) or to nitrate (NTG%) was defined as the percent change of FBF from rest to the maximum flow during reactive hyperemia or after nitrate administration, respectively. RESULTS: RH% was significantly improved in both the atorvastatin-treated (p < 0.01) and atorvastatin plus vitamin E groups (p < 0.05), but the increase was significantly higher in the atorvastatin-treated group (p < 0.05). Serum levels of IL-6, TNF-alpha and sVCAM-1 were decreased in the atorvastatin-treated group (p < 0.05 for all), but remained unaffected in the other two groups (p = NS for all). CONCLUSIONS: Low dose atorvastatin treatment improves endothelial function and reduces the expression of proinflammatory cytokines and adhesion molecules in patients with ischemic heart failure, an effect partly depressed by vitamin E.

Pitsavos C, Panagiotakos DB, Lentzas Y, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. · BMC Public Health. · Pubmed #15836794 links to  free full text

Abstract: BACKGROUND: We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) among adults in Greece, as well as its relationship with socio-demographic, lifestyle and clinical characteristics of these people. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women, without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age-gender distribution of (census 2001) of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration (in minutes) and intensity of sports related physical activity during a usual week. RESULTS: 53% of men and 48% of women were classified as physically active. Men were more likely to be active as compared to women (p < 0.05), while the lowest activity rates were observed in 40 to 49 years old participants (p < 0.01). Physically active people had higher occupation skills, were more likely to live in rural areas, to be unmarried, non smokers and they were devoted to a healthier dietary pattern, as compared to sedentary, irrespective of age and sex (all p < 0.05). In addition, the cumulative risk factors score of obesity, hypertension, hypercholesterolemia and diabetes, was inversely associated with activity status (p < 0.001). Finally, physically active men and women were less likely to report depressive symptoms (p < 0.01), after various adjustments were made. CONCLUSION: Half of the studied population reported physically inactive, indicating that sedentary lifestyle becomes a serious epidemic in Greece. High occupation skills, non-smoking, devotion to a healthier dietary pattern and a better cardiovascular risk factors profile were some of the determinants of physically active people.

Panagiotakos DB, Pitsavos C, Manios Y, Polychronopoulos E, Chrysohoou CA, Stefanadis C. · First Cardiology Department, School of Medicine, University of Athens, Athens, Greece. · Eur J Cardiovasc Prev Rehabil. · Pubmed #15703509 No free full text.

Abstract: BACKGROUND: Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. DESIGN: Cross-sectional survey. METHODS: During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. RESULTS: An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-alpha, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. CONCLUSIONS: An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C, Toutouzas P. · Department of dietetics and nutrition, Harokopio University, Athens, Greece. · East Mediterr Health J. · Pubmed #15603042 No free full text.

Abstract: We evaluated the role of a Mediterranean-style diet in preventing acute coronary syndromes (ACS). Data from CARDIO2000, a multi-centre retrospective case-control study investigating the association between ACS and demographic, nutritional, lifestyle and medical risk factors were used. We studied 661 patients hospitalized for a first ACS event and 661 matched controls without clinical suspicion of cardiovascular disease. The Mediterranean diet significantly reduced (by 16%) the risk of developing ACS. The association remained significant in the presence of hypertension, hypercholesterolaemia, sedentary lifestyle, diabetes mellitus or a combination of two of these cardiovascular risk factors. Our findings illustrate the importance of the Mediterranean diet in the primary prevention of acute coronary events.

Michaelides AP, Fourlas CA, Pitsavos C, Andrikopoulos GK, Skoumas I, Kartalis A, Katsaros A, Stougiannos P, Stefanadis CI. · Department of Cardiology Clinic, Medical School of Athens University, Athens, Greece. · Coron Artery Dis. · Pubmed #15585985 No free full text.

Abstract: OBJECTIVE: Familial hypercholesterolaemia (FH) is a frequent genetic disorder in Europe, affecting one in 500 people in its heterozygous form. Both homozygous and heterozygous forms are correlated with increased incidence of cardiovascular events. METHODS: We investigated clinical and biochemical parameters possibly associated with the results of exercise testing (ET) in asymptomatic patients with heterozygous FH. The study population was derived from outpatients of the Lipid Center in our department and consisted of 194 patients with heterozygous FH who had no medical history of coronary artery disease (CAD) or angina-like symptoms and who had agreed to undergo ET. RESULTS: Sex, body mass index, smoking status, diabetes mellitus, family history of CAD, presence of xanthomas and total cholesterol, triglyceride, low-density and high-density lipoprotein cholesterol, apolipoproteins A and B and lipoprotein (a) levels did not differ significantly between patients with positive and negative ET. Higher fibrinogen levels, arterial hypertension and family history of CAD were more frequent among patients with positive ET. However, in multivariate analysis adjusted for all the aforementioned variables, only high fibrinogen levels were significantly and independently associated with a positive result of ET. CONCLUSIONS: Lipid and coronary risk factor profiles do not seem to predict exercise-induced myocardial ischaemia in asymptomatic patients with heterozygous FH. However, in this high-risk population for cardiovascular events, fibrinogen levels are an independent predictor of positive ET. The adverse effects of FH on the cardiovascular system may be partly mediated by coagulability factors, whose role in the management of FH patients remains to be fully clarified.