Hyperlipidemias: Stefanadis C

Antoniades C, Tousoulis D, Tentolouris C, Toutouzas P, Stefanadis C. · Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece. · Herz. · Pubmed #14689123 No free full text.

Abstract: Oxidative stress is involved in the pathogenesis of atherosclerosis, while a variety of antioxidants has been used in clinical studies, during the past few years, for the prevention and treatment of atherosclerosis. In small clinical studies it was found that both vitamins C and E may improve endothelial function in patients with risk factors for atherosclerosis such as diabetes mellitus, smoking, hypertension, or hypercholesterolemia. However, the initial, hopeful reports regarding the beneficial role of antioxidant vitamins against atherosclerosis, derived from purely observational studies, were followed by the negative results of almost all large randomized trials. Therefore, treatment with antioxidant vitamins C and E should not be recommended for the prevention or treatment of coronary atherosclerosis. New antioxidant strategies are needed to clarify the exact role of antioxidant treatment in coronary atherosclerosis.

Tentolouris C, Tousoulis D, Goumas G, Stefanadis C, Davies G, Toutouzas P. · Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece. · Int J Cardiol. · Pubmed #11077122 No free full text.

Abstract: Nitric oxide is formed from the N-guanido terminal of the amino acid L-arginine and from molecular oxygen by nitric oxide synthase enzymes. L-arginine administration improves the coronary blood flow response to acetylcholine in patients with normal coronary arteries and hypercholesterolemia, reverses the defective endothelium-dependent vasodilation associated with an elevated plasma low-density lipoprotein level or hypercholesterolemia, dilates coronary epicardial arteries and stenoses, enhances nitric oxide generation, and inhibits lesion formation after balloon angioplasty. Stimulation of endogenous nitric oxide production could inhibit atherogenesis, and therefore may be of benefit in patients with risk factors for atherosclerosis.

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.

Tentolouris C, Tousoulis D, Davies G, Stefanadis C, Trikas A, Goumas G, Toutouzas P. · Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece. · Cardiology. · Pubmed #11111141 No free full text.

Abstract: We assessed the impact of systematic risk factors on the vasomotor effects of inhibition of nitric oxide synthesis. N(G)-monomethyl-L-arginine (LNMMA) was infused intracoronarily at 4, 8 and 16 micromol/min followed by intracoronary bolus administration of 250 microg nitroglycerin. Computerized angiography was used to assess the changes in the diameter of coronary segments. During the LNMMA infusions there was no significant difference in LNMMA response between smokers and non-smokers (-5.5+/-0.8 and -6.6+/-0.6%, respectively) or between hypertensives and normotensives (-6.4+/-1.1 and -6.1+/-0.6%, respectively), but the response was less in hypercholesterolaemic patients (-4.5+/-0.7 vs. -8.0+/-0.6%, p<0.05). Thus, the reduced nitric oxide activity is related to hypercholesterolaemia but not to smoking and hypertension.

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.

Pitsavos C, Skoumas I, Masoura C, Aznaouridis K, Papadimitriou L, Chrysohoou C, Giotsas N, Toutouza M, Stefanadis C. · 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. · Atherosclerosis. · Pubmed #18164018 No free full text.

Abstract: BACKGROUND: Familial combined hyperlipidaemia (FCH) is an inherited dyslipidaemia that is related to a high risk of coronary artery disease (CAD). We evaluated the prevalence of CAD in a large FCH population and the association of risk factors with CAD according to gender. METHODS: In this single-center, observational study, lipid and lipoprotein variables were measured in untreated patients with FCH (565 males and 302 females). CAD was defined as a documented history of myocardial infarction or coronary revascularization, or an abnormal coronary angiogram (stenosis of >50% in an epicardial coronary artery), or angina plus abnormal imaging stress test. RESULTS: Males had higher triglyceride level (P<0.001) but lower total cholesterol (P<0.001) and HDL-cholesterol level (P<0.001) compared to women. The prevalence of CAD was 22.2% in men and 4.6% in women (P<0.001). In logistic regression analysis, male gender was associated with a higher risk of CAD independent of lipid parameters and other risk factors (adjusted ORs for CAD 9.4, P<0.001). In gender-specific analysis, age (OR=1.06 per 1-year increase, P<0.001), diabetes (OR=2.42, P<0.01) and Lp(a) (OR=1.09 per 1-mg/dL increase, P<0.01) were independent predictors of CAD in men. In women, age (OR=1.24, P<0.01), total cholesterol (OR=1.022 per 1-mg/dL increase, P<0.05) and fasting glucose (OR=1.031 per 1-mg/dL increase, P<0.05) were independently associated with CAD. CONCLUSIONS: In FCH patients, the prevalence of CAD is higher in males than in females, independent of lipidaemic profile and other risk factors. Among lipid variables, Lp(a) and cholesterol level are predictors of CAD in males and females respectively.

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, 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.

Skoumas J, Papadimitriou L, Pitsavos C, Masoura C, Giotsas N, Chrysohoou C, Toutouza M, Panagiotakos D, Stefanadis C. · First Cardiology Department, School of Medicine, University of Athens, Athens 11527, Greece. · Metabolism. · Pubmed #17161236 No free full text.

Abstract: Familial combined hyperlipidemia (FCH) is closely related with metabolic syndrome (MetSyn), and coronary artery disease (CAD) is positively associated to MetSyn and FCH. In this study, we evaluated the prevalence of MetSyn and its components between patients with FCH and a control group. We also investigated the role of MetSyn and diabetes mellitus (DM) on the incidence of CAD within the FCH group. Our study population consisted of 463 male and 243 female patients with FCH who were not receiving any hypolipidemic treatment, and 1128 men and 1154 women who came from the same geographical region. The prevalence of MetSyn was 42% and 19.8% among FCH subjects and controls, respectively, whereas MetSyn increased with age in both groups. The prevalence of CAD was 15.3% in the FCH group. Moreover, after dividing FCH patients into 3 subgroups, with and without MetSyn and with DM, CAD prevailed at a percentage of 15.2%, 11.1%, and 26.5%, respectively. However, statistically significant differences in the prevalence of CAD were observed only between FCH subjects with DM compared with the other 2 subgroups, even when an adjustment for age, sex, and smoking was conducted. People with FCH and MetSyn differed in several anthropometric, biochemical, and clinical characteristics, compared with the non-MetSyn subgroup of FCH. MetSyn is more prevalent in the FCH than in the control group. Among subjects with FCH, only DM was significantly associated with an increase in the prevalence of CAD in this subgroup compared with FCH individuals with or without MetSyn.

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.

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.

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.

Antoniades C, Tousoulis D, Vasiliadou C, Marinou K, Tentolouris C, Ntarladimas I, Stefanadis C. · Department of Cardiology, Athens University Medical School, Athens, Greece. · Am J Cardiol. · Pubmed #15518617 No free full text.

Abstract: The combined effects of smoking and hypercholesterolemia on the inflammatory process, the thrombosis/fibrinolysis system, and forearm hyperemic response were investigated. It was shown that smokers with hypercholesterolemia (n = 25) had a reduced and delayed forearm hyperemic response compared with healthy smokers (n = 24), patients with hypercholesterolemia (n = 26), and healthy controls (n = 75; p <0.01 for all). This phenomenon was associated with a respective increase in the inflammatory process and changes in the thrombosis/fibrinolysis system.

Dedoussis GV, Skoumas J, Pitsavos C, Choumerianou DM, Genschel J, Schmidt H, Stefanadis C. · Laboratory of Molecular Biology, Department of Science of Dietetics-Nutrition, Harokopio University of Athens, Athens, Greece. · Eur J Clin Invest. · Pubmed #15200491 No free full text.

Abstract: BACKGROUND: Familial hypercholesterolaemia (FH) is caused by mutations in the low-density lipoprotein receptor gene and the gene encoding apolipoprotein B-100, affecting one in 500 individuals. METHODS: One hundred and eighty-three Greek FH patients were screened for mutations on the LDLR and ApoB genes. RESULTS: We identified mutations in 67 probands and 11 relatives. Sixteen mutations located in eight different exons and the promoter of the LDLR were discovered. Among them 10 were missense mutations (C6W, S265R, A370T, Q363P, D365E, V408M, A410T, A517T, G528D, G571E), two were nonsense mutations (Q363X and C660X), three were splice defects (2140 + 5G-->A and 2140 + 9C-->T, 1706 - 10G-->A), and one was a nucleotide substitution (- 45delT) on the promoter. None of the subjects carried any apoB mutation. The detection rate of mutations in this study was 43%. From the above mutations, A410T, A519T and the splice site defects 2140 + 9C-->T were detected for the first time in the Greek population. Among them V408M, G528D, C6W and S265R account for 73% of heterozygous FH probands. V408M mutation is more common in Central West, while C6W is more common in Central East. Separating the patients into two groups (receptor defective and receptor negative) we found that the receptor negative group had higher levels of total cholesterol, low-density lipoprotein cholesterol and higher prevalence of tendon xanthomas compared with the receptor-defective group. DISCUSSION: The homogenous molecular basis of familial hypercholesterolaemia in Greece facilitates the application of a DNA diagnostic strategy based on the origin of the patient. The early mutation analysis would add valuable information on the severity of the disease.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. · Atherosclerosis. · Pubmed #15064113 No free full text.

Abstract: OBJECTIVE: In this work, we assessed the status and management of blood lipids in a sample of cardiovascular disease free adult men and women from Greece. We also evaluated the effect of several socio-demographic, dietary and lifestyle habits on lipid levels. METHODS: The ATTICA Study is a population-based cohort that has randomly enrolled 1128 men and 1154 women (aged >18 years old), stratified by age-gender, from the greater area of Athens, during 2001-2002. Adherence to Mediterranean diet was assessed through a diet score that was based on a validated food-frequency questionnaire. RESULTS: Forty-six percent of men and 40% of women had total serum cholesterol levels >200mg/dl. Of them, 40% of men and 30% of women were unaware of their condition. Twenty-one percent of men and 7% of women had HDL-cholesterol levels <35 mg/dl. Twenty-eight percent of men and 13% of women had triglyceride levels >150 mg/dl. Fifteen percent of men and 12% of women had LDL-cholesterol levels >160 mg/dl and 52% of men and 48% of women had LDL >130 mg/dl. Of those who had known blood lipid abnormalities, 36% of men and 33% of women followed a dietary medication, 31% of men and 20% of women were receiving a pharmaceutical treatment (mainly statin) and the rest were untreated. Participants who adopted the Mediterranean diet and received statin, had on average 9% lower total cholesterol (P = 0.04), 19% lower LDL-cholesterol levels (P = 0.02) and 32% lower oxidized LDL-cholesterol levels (P < 0.001) compared to those who were untreated and adopted a Westernized diet. CONCLUSIONS: We could speculate that about 3 million Greek adults had high total cholesterol levels. Adverse findings were also observed regarding the other investigated blood lipids. Mediterranean diet could be a complimentary mean to pharmaceutical treatment in reducing blood lipids.