TY - JOUR
AB - Thursday, 03 May 2012, 14:00–18:00 Location: Poster Area P62 Obesity paradox in patients undergoing coronary artery bypass grafting: myth or reality L Velicki1, B Mihajlovic1, N Cemerlic-Adjic1, M Jevtic2, R Velicki2, S Nicin1 1Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia, 2Institute of Public Health, Novi Sad, Serbia Obesity (Prevention & Epidemiology) Purpose It had been suggested that elevated body mass index (BMI) is beneficial and a preventive factor when it comes to outcome for patients undergoing coronary artery bypass grafting (CABG). At the same time, obesity is strongly associated with coronary artery disease development. We sought to determine the significance of the “obesity paradox” in patients referred for coronary artery bypass grafting and to examine if a relationship exists between obesity and severity of coronary artery involvement. Methods Analysis examined 791 consecutive patients who had undergone isolated coronary artery bypass grafting over one year period (2010). Average age was 62.33 ± 8.12 years and involved 568 (71.8%) male and 223 (28.2%) female patients, while the mean logistic EuroSCORE was 3.42%. Patients were categorized into three distinct groups based on their body mass index: I - BMI < 25; II - BMI 25.1-30 (overweight); III - BMI > 30.1 (obese). We compared 30-day mortality rate, prevalence of significant left main disease (>50%) and 3-vessel coronary disease between the groups. Regression analysis was conducted to determine whether body mass index was an independent predictor of morbidity and mortality after coronary artery bypass grafting. Results Majority of the cohort could be categorized as overweight (48.8%) or obese (30%). There was no association between body mass index and gender (p = 0.258). Overall 30-day mortality for all 3 groups combined was 2.15% and 1.82% in group I, 2.12% in group II and 2.59% in group III (p = 0.869). Univariate analysis showed that obesity can not be regarded as an independent risk factor for 30-day mortality following coronary artery bypass grafting (Odds ratio 1.021, 95% Confidence interval 0.910-1.145, p = 0.724). However, increased body mass index was strongly associated with the presence of left main disease (p = 0.007), but not with triple vessel coronary disease (p = 0.654). Duration of in-hospital period following the surgery is comparable within body mass index groups (p = 0.424). Conclusions Compared to non-obese patients, overweight and obese individuals have similar 30-day mortality rate following coronary artery bypass grafting. Patients referred for coronary artery bypass grafting with body mass index higher than normal are more likely to have significant left main disease. This study can not substantiate the presence of “obesity paradox”. Further research is needed to confirm the validity of these findings and delineate potential underlying mechanisms. P63 The association of rs9939609 FTO polymorphism and overweight and obesity. The final results of Polish WOBASZ study. WOBASZ investigators, A Aleksandra Piwonska1, W Piotrowski1, R Ploski2 1Institute of Cardiology, Warsaw, Poland, 2Medical University of Warsaw, Warsaw, Poland Obesity (Prevention & Epidemiology) Purpose Obesity is both a huge healthy problem in developed countries as well as one of cardiovascular diseases risk factors. Genetic factors play an important role in the obesity origination. We investigated the association between the rs9939609 polymorphism in the FTO gene (fat mass and obesity associated gene) and anthropometric variables (body weight, waist circumference), body mass index, WHR, overweight and obesity in Polish WOBASZ study. Methods presented results are based on genotypes of 3000 persons previously examined in the WOBASZ study. Results The A allele were found in 32,4% of men and 32,9% of women. 19,3% of men has AA, 47,5% AT and 33,2% TT genotype (in women respectively: 19,8%, 53,2% and 27,0%). The frequency of AA genotype increased from 13,6% in underweight men to 25,0% in men with BMI ≥ 40kg/m2 (in women respectively: from 16,6% to 25,5%). Simultaneously decreased the frequency of TT genotype from 40,6% to 8,3% in men and from 31,6% to 17,0% in women. The presence of at least one A allele (AA and AT genotypes) was associated, but only in men, with 1,5-fold increase in prevalence of overweight (from 31,2% to 46,3%) and 3-fold increase in prevalence of 3rd degree obesity (from 0,5% to 1,9%) compared to men with TT genotype. Men with AA genotype were characterized by significantly higher mean body weight, WHR, body mass index and longer waist circumference than those with AT or TT genotype. In women the significant association was observed only between genotype and body mass index and waist circumference. In the logistic regression analysis we found the significant association between AA genotype and overweight and obesity after adjustment for age, smoking, diet and diabetes in men (in women only between AA genotype and overweight) Conclusions The prevalence of A allele in Polish population was like in other European countries. About 1/5 both men and women has AA genotype the most unfavorable in relation to the obesity. The significant relation was found between genotype and body weight, WHR, body mass index and waist circumference. The AA genotype were significantly and independently of age, smoking, diet and diabetes associated with overweight and obesity. P64 Prognostic value of leptin in abdominal obesity patients with arterial hypertension I Iuliia Myloslavska1 1Academy of postgraduated medical education, Zaporozhye, Ukraine Obesity (Prevention & Epidemiology) Recently it has been documented that increase of leptin plasma level tightly relate with severity of abdominal obesity and blood pressure elevation. However, prognostic power of leptin levels in predicting clinical outcomes regarding mentioned above has been hampered by inconsistent results. Aim of the study was to investigate the predictive value of leptin in obesity patients with mild-to-moderate arterial hypertension (AH). Methods 120 subjects with mild-to-moderate arterial hypertension aged 18-68 years (mean age 46.7 ± 11.4 years) with abdominal obesity (accordingly IDF criteria (2005) and 30 healthy volunteers (men and women the same aging) were enrolled to the study. All patients had written informed consent for participation of the study and were randomized into two groups depends on treatment strategy. Contemporary antihypertensive treatment included ACE inhibitor ramipril in high doses (5-10 mg daily, 1st group) or low doses (2-4 mg daily, 2nd group) doses respectively with indapamide (2.5-5.0 mg daily). Period of observation was 36 weeks. Conventional transthoracic echocardiography and high-resolution sonolocation of carotids arteries with measurement of intima-media thickness (IMT) were performed at baseline and at the end of the study. Leptin plasma level was detected by ELISA. The primary end points were the occurrence of transient ischaemic attack, stroke, newly diagnostic heart failure, hospitalization due to any non-fatal cardiovascular events, and all-cause death. Results Analysis of obtained outcomes have been shown that mean, leptin concentration in AH patents (9.4 ± 1.2 ng/ml) was superior in comparison to healthy subjects (6.3 ± 1.9 ng/ml) and correlated well with body mass index (r = 0.52; P < 0.01), waist/hip circumflex ratio (r = 0.50; P < 0.05), mass of left ventricle (r = 0.44; P < 0.02), intima-media thickness (r = 0.40; P < 0.001), blood pressure at baseline (r = 0.42; P < 0.05), the primary end point occurrence (r = 0.40; P < 0.001; RR = 2.26; 95% CI = 1.08-4.16; P = 0.02). Tendency to decrease of leptin plasma level during all observation period was more pronounced in 2nd group patients only but references level of healthy subjects were not achieved. Conclusion Leptin plasma level elevation can be considered as predictor of high risk occurrence of primary end points included transient ischaemic attack, stroke, newly diagnostic heart failure, hospitalization due to any non-fatal cardiovascular events, and all-cause death in mild-to-moderate AH patients. P65 Effects of the school-based intervention programme JuvenTUM 3 on physical fitness, physical activity, and the prevalence of overweight M Siegrist1, H Hanssen2, C Lammel1, M Halle1 1Technical University of Munich, Department of Prevention and Sports Medicine, Munich, Germany, 2University of Basel, Institute of Exercise and Health Sciences, Basel, Switzerland Obesity (Prevention & Epidemiology) Purpose JuvenTUM 3 aims to implement a comprehensive randomized, controlled school- and family-based lifestyle-intervention trial (RCT) in secondary schools to analyse and improve cardio-metabolic risk factors of children aged 10 to 11 years over a period of 18 months by increasing physical activity and physical fitness, psychological well-being, and the motivation to exercise. Methods Fifteen secondary schools in Southern Germany were randomized in 8 intervention schools (IS) (n = 242 children) and 7 control schools (CS) (n = 192 children). The main components are weekly lifestyle-lessons for children, 6-8 meetings for teachers with information about health-related topics and worksheets for children, and 3-4 parents' trainings. Anthropometric data, physical fitness level and physical activity were examined in 11/12 2008 and in 6/7 2010. Results In IS 3.5% of normal weight children became overweight (CS 5.6%), and 14.2% of overweight children normalized their body weight (CS 12.8%). Physical fitness improved more in IS (1.4 ± 3.8 points) than in CS (0.6 ± 3.9 points, between-group-difference p < 0.040) and physical activity in school increased in IS from 2.9 ± 1.1 to 3.3 ± 1.1 h/week (CS: 2.9 ± 0.9 to 3.0 ± 0.9 h/week, between-group-difference p < 0.003). Conclusions: The JuvenTUM 3 programme with weekly lifestyle-lessons for pupils combined with teachers and parents' training has the potential to improve physical fitness as well as physical activity in school, and reduce the prevalence of overweight. P66 The effect of lifestyle advice on physical activity characteristics and cardiovascular risk factors in healthy police employees with multiple cardiovascular risk factors: the UP-LIFT study. V A Veronique Cornelissen1, H Kiers2, R Peeters2, H Wittink2, L Vanhees1 1Catholic University of Leuven, Leuven, Belgium, 2Utrecht University of Applied Sciences, Utrecht, Netherlands Obesity (Prevention & Epidemiology) Objective High blood pressure, abdominal obesity, dyslipidemia and low levels of physical activity are all associated with increased risk of cardiovascular morbidity and mortality. Our primary aim was to investigate the effect of lifestyle advice on physical activity behaviour and some other cardiovascular risk factors in a working cohort of the Utrecht Police Lifestyle Intervention Fitness and Training study (UP-LIFT). As secondary objective we aimed to examine the association between changes in physical activity characteristics and changes in other cardiovascular risk factors. Methods A sample of 494 healthy police employees (407 men, mean age 44 yrs (range 19-60) with at least two cardiovascular disease risk factors of the UP-LIFT study underwent measurements of anthropometric characteristics, blood pressure, total cholesterol and physical activity (SQUASH questionnaire) at baseline and at a median follow-up of 2.3 yrs. After baseline assessment, all participants were given a simple advice on lifestyle changes. Results Lifestyle advice increased physical activity characteristics, although not significantly. That is, total volume of habitual physical activity (+2.9 METhours; p = 0.10), total duration of habitual physical activity (+0.50 hrs; p = 0.17) and average intensity of habitual physical activity (+ 0.07 MET; p = 0.07) were all higher at follow-up. Compared to baseline, participants had a significantly lower blood pressure (−3.2 mmHg/−1.4;mmHg; p < 0.001), total cholesterol (−0.10mmol/L; p < 0.05) and body mass index (−0.27 kg/m2; p < 0.05) at follow-up. Changes in physical activity intensity and physical activity volume were negatively associated with changes in body mass index and waist circumference (p < 0.001 for both). Conversely, changes in blood pressure and total cholesterol were not significantly related to changes in physical activity characteristics. Conclusions Lifestyle advice exerted a positive effect on blood pressure, total cholesterol and body mass index and resulted in a small but non-significant increase in physical activity behavior in this group of healthy police employees. P67 The role of thoracic fat in coronary artery disease A C Ana Catarina Faustino1, R Providencia1, L Paiva1, P Mota1, S Barra1, P Gomes1, F Caetano1, I Almeida1, M Costa1, A Leitao-Marques1 1Hospital Center of Coimbra, Coimbra, Portugal Obesity (Prevention & Epidemiology) Purpose The body mass index (BMI) is an adiposity measure commonly used. The pathogenic value of visceral fat deposits has been highlighted in numerous studies and many quantifiers have been investigated in this regard. This study aims to assess the relationship of body mass index, different kinds of thoracic fat with the cardiovascular risk (CVR) and the prevalence of coronary atherosclerosis (AT) and significant coronary artery disease (sCAD). Methods A retrospective study of 148 consecutive patients (P) who underwent cardiac MDCT (Phillips Brilliance, 16-slices): 37.8% men, 62 ± 13 years, 23.6% diabetics, 73.6% hypertensive, 51.4% with dyslipidaemia and 12.2% smokers. Thoracic fat volumes (cm3) were measured with an Aquarius 3D - TeraRecon workstation: pericardial fat (PF: adipose tissue located within the pericardial sac), intrathoracic extra-pericardial fat (IF: adipose tissue located within the chest outside the pericardial sac) and chest fat (CF: adipose tissue upper the rib cage). The relationship between these values, body mass index, AT and sCAD (identified by MDCT) was evaluated. P were then separated into 2 groups: IF+ (IF ≥ 67.7cm3) e IF− (IF < 67.7cm3), which were compared regarding analytical parameters, CVR factors (CRF) and scores (CRS), the calcium score (CS) and the presence of AT and sCAD. Results The receiver operating characteristics curve analysis identified the IF as the measure of adiposity best related to sCAD: AUC 0.63, CI95%, p = 0.046 (vs PF: AUC 0.58, pns; CF: AUC 0.42, pns; BMI: 0,49, pns). It also identified the best threshold for this association: 67,7cm3 (sensibility 77%, specificity 52%). The P IF+ were mostly male (48.8 vs 25.4, p = 0.004), older (67 ± 10 vs 57 ± 14, p < 0.001), had higher BMI (30 ± 4.8 vs 28 ± 4.0Kg/m2, p = 0.002), prevalence of diabetes (32.0 vs 16.7%, p = 0.035), hypertension (HT: 89.6 vs 66.2%, p = 0.001) and renal dysfunction (GFR (MDRD): 78 ± 25 vs 90 ± 24mL/min/1.73m2, p = 0.016). The CRS were higher for IF+ (Framingham: 15 ± 7.5 vs 13 ± 6%, p < 0.001; SCORE 3.4 ± 3.2 vs 1.4 ± 1.2%, p < 0.001) as well as the CS: 350 ± 837 vs 178 ± 75, p = 0.01. The group IF+ had also a higher prevalence of AT (75 versus 47.7%, p = 0.01) and sCAD (21.3 versus 7.5%, p = 0.020). By multivariable regression only the male gender was an independent predictor of sCAD (OR 3.38, CI95%, p = 0.019). Conclusions According to these data, IF was related with sCAD. This association was found in a context of higher CVR, which was identified by a value of IF ≥ 67.7cm3. It was not an independent predictor of sCAD, which suggests its value as a marker of metabolic risk, similar to the abdominal fat. P68 The impact of changing trends in obesity on cardiovascular disease in ten Eastern European countries T Tim Marsh1, L Webber1, K Mcpherson2, M Brown1, K Rtveladze1 1National Heart Forum, London, United Kingdom, 2University of Oxford, Oxford, United Kingdom Obesity (Prevention & Epidemiology) Purpose The obesity epidemic affects both high and low-middle income countries placing a burden on health systems, including those of Eastern Europe. Understanding how the obesity epidemic will unfold and its impact upon cardiovasculardisease incidence is important if policies that aim to halt rising obesity rates are to be well thought out and effective. Methods We used a microsimulation model to project future body mass index trends and disease incidence in eleven Eastern European countries that had adequate body mass index data (Bulgaria, Croatia, Czech Republic, Estonia, Latvia, Lithuania, Poland, Romania, Serbia and Slovenia). Incidence, mortality and survival data for coronary heart disease, stroke and incidence data for type 2 diabetes from each country were collected. The results were simulated from three separate scenarios: no body mass index reduction, 1% reduction, 5% reduction. Results Overweight and obesity was largely projected to increase. The highest rates were seen in Latvia and Bulgaria. Lithuania showed marked decreases in overweight and obesity to 2050 in males and females. Conclusion The obesity epidemic is an acute and relevant public health challenge. Knowing how these trends will change over the coming decades is important if resources are to be allocated appropriately and policies put in place to ameliorate rising rates of cardiovascular disease. P69 Mother's but not father's age at birth is inversely associated with body mass index increase between late adolescence and early middle age: a 22 years follow-up study of 4,442 young men A Andreas Rosenblad1, G Nilsson1, J Leppert1 1Center for Clinical Research, Västerås, Sweden Obesity (Prevention & Epidemiology) Purpose To examine if parents' age at childbirth is associated with increase in the child's body mass index between late adolescence and early middle age. Methods In 1989, it was decided that all men and women in the county of Västmanland, Sweden, turning 40 or 50 years old during the years 1990-1999 should be invited to a free health examination for risk factors for cardiovascular diseases. A total of 34,385 persons (participation rate: 60.3%) attended the examination, which included measures of e.g. body mass index. Through record linkages with the Swedish population and conscription examination registers, information was obtained about parents' birth dates, body mass index at the time of conscription examination and confounding variables for 4,442 men aged 17-22 years at the conscription examination an 39-41 years at the health examination. The association between body mass index increase and parents' age were examined by linear regression with body mass index increase as outcome and mother's and father's ages at childbirth, birth place and body mass index, IQ, education, blood pressure, heart rate and age at conscription examination as predictors. P-values <0.05 were considered statistically significant. Results The mean (SD) age at childbirth was 30.7 (6.5) years for fathers and 27.4 (5.9) for mothers. Between an age of 18.1 (0.72) years at conscription examination and 39.7 (0.49) at the health examination, a follow-up time of 21.6 (0.82) years, body mass index increased with 4.4 (2.7) kg/m2, from 21.4 (2.7) kg/m2 to 25.8 (3.4) kg/m2. The adjusted slope coefficients per 10 years were −0.24 kg/m2 (p = 0.027) for mother's age and 0.01 kg/m2 (p = 0.896) for father's age. The Figure illustrates the association for mothers. Conclusions Mother's but not father's age at childbirth is inversely related to men's body mass index increase between late adolescence and early middle age. Open in new tabDownload slide P70 Metabolic improvements in young obese patients following a supervised weight loss management programme C Avram1, AM Rusu2, M Iurciuc2, LM Craciun2, D Stancila3, D Gaita2 1West University of Timisoara, Timisoara, Romania, 2Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 3St. James's Hospital, Dublin, Ireland Obesity (Prevention & Epidemiology) Purpose This study is aiming to demonstrate the benefit of a supervised weight loss management programme, based on moderate caloric restriction and interval exercise training (IET), on resting and effort metabolism, in young obese patients. Methods We conduct a 6 months prospective study on 53 voluntary young obese patients (mean age 23.3 ± 3.1 years; body mass index 34.5 ± 6.6kg/m2). All patients were evaluated through a maximal cardiopulmonary exercise test in order to determine the maximal fat oxidation rate (MFOR) and provide optimal recommendation for exercise intensity. A multi-frequency bioelectrical impedance analysis method was used in order to evaluate the skeletal muscle mass (SMM) along with indirect calorimetry assessment of resting metabolic rate (RMR) at baseline and after 6 months of study. The patients benefit from an intensive IET program supervised and guided by physical therapists. Exercise training consisted in 50 minutes sessions, 3 times per week, at intensive endurance training zone (in the range of anaerobic threshold), completed by 1 minute interval in the range between anaerobic threshold and respiratory compensation point, for every 5 minutes of training. We pursue a exercise caloric consumption of 2500 kcal/week. For monitoring exercise intensity and caloric consumption we used Polar RS 800 heart rate monitors. We also provide dietary recommendations to the patients in order to improve the nutritional habits and achieve a dietary restriction of 500 Kcal/day. Data were compared using paired t test. Results After 6 months of study we noticed a significant (p < 0.001) decrease of weight (4.2 kg) and MFOR (from 16.8 ± 7.7 to 21.8 ± 7.5 g/h) along with an increase of RMR (from 2066 ± 325 to 2147 ± 367 Kcal/day, p < 0.001), but also a minor decrease of SMM (from 27.7 ± 6.1 to 27.5 ± 5.8 kg, p = 0.812). Conclusions The results of our study show that 6 months of supervised weight loss management program improves exercise-induced fat oxidation and resting metabolic rate in young obese patients, in spite of a slightly decrease in muscle mass. The decrease in SMM is probably due to moderate dietary restriction. A randomized controlled trial is needed in order to verify these results. P71 Continental region of residence and female sex as possible risk factors for presence of hypertension and central obesity among Croatian hospitalized coronary heart disease patients H Vrazic1, J Sikic2, T Lucijanic3, I Rajcan Spoljaric1, A Romic4, S Polic4, D Trsinski4, J Mirat2, B Starcevic1, M Bergovec1 1University Hospital Dubrava, Department of Internal Medicine, Division of Cardiology, Zagreb, Croatia, 2University Hospital Sv. Duh, Department of Internal Medicine, Division of Cardiology, Zagreb, Croatia, 3University Hospital Dubrava, Department of Internal Medicine, Zagreb, Croatia, 4University of Zagreb School of Medicine, Zagreb, Croatia Obesity (Prevention & Epidemiology) Purpose The aim of this study was to measure the exposure of Croatian hospitalized coronary heart disease (CHD) patients to interim cardiovascular risk factors (hypertension, overweight and obesity) and to try to find differences between two principal geographical regions of Croatia: continental and Mediterranean. Methods A total of 1.298 hospitalized coronary heart disease patients (acute or chronic) between 2007 and 2009 from seven hospitals in continental region and five hospitals in Mediterranean region participated in this study. Results Prevalences of interim risk factors in surveyed patient population were high: 70.1% of participants had hypertension; 48.2% of participants were overweight and 28.6% were obese according to their body-mass index; and measured through waist-to-hip ratio 54.5% of participants were centrally obese. Hypertension was more frequent in continental region (72.1% versus 66.8%, p = 0.044). Mean body-mass index and waist-to-hip ratio were significantly higher in continental region (p < 0.001 and p = 0.020), prevalence of overweight measured through body-mass index was significantly more frequent in Mediterranean region (51.0% versus 46.6%, p < 0.001), prevalence of obesity measured through body-mass index was significantly more frequent in continental region (33.6% versus 21.1%, p < 0.001), and prevalence of central obesity measured through waist-to-hip ratio was significantly more frequent in continental region (60.0% versus 46.5%, p < 0.001). Female coronary heart disease patients were as much as 5.12 times more likely to be centrally obese than men (OR = 5.12, 95% CI 3.47-7.55, p < 0.001), and also had 62% greater odds to have hypertension than men (OR = 1.62, 95% CI 1.10-2.39, p = 0.014). Conclusions Prevalence of hypertension among Croatian hospitalized coronary heart disease patients is unacceptably high with seven out of ten patients being hypertensive, while at the same time half of Croatian hospitalized coronary heart disease patients are overweight and centrally obese. Furthermore, women seem to be much more affected than men, and also patients living in continental region seem to be much more affected than those living in the Mediterranean region. These findings indicate that more effective hypertension prevention efforts, as well as weight management strategies are needed those groups of patients. P72 Assessing the risk for cardiovascular diseases using PROCAM/HeartScore in obese patients S Hossain1, F Van Buuren1, M Vlachojannis1, J Gilis-Januszewski1, B Koerber1, A Fruend2, D Horstkotte1, KP Mellwig1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany, 2Dept of Physiotherapy, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Obesity (Prevention & Epidemiology) Purpose Obesity has long been identified as important risk factor for a number of health problems. Body Mass Index (BMI) is the most frequently used measure to determine levels of body fat, provides a proxy measure of total adiposity (the amount of fat around the body). The aim of the present project is to apply the PROCAM and HeartScore for association of adiposity with morbidity and mortality of cardiovascular diseases. Methods 384 employees of 5 different companies were investigated between May - October 2011. The cardiovascular risk was determined using the PROCAM score (allows the early detection of the risk of contracting a disease thereby providing the possibility of a timely prevention, especially in high risk groups whose disorders have not manifested clinically yet) and HeartScore (The tool for predicting and managing the risk of heart attack in Europe). Results We examined 136 women and 248 men (age 40 ± 10.82 years). 56 employees (14.58%) had body mass index values above 30 kg/m2. The PROCAM-Score was ≥ 20 in 2 employees of the adiposity group (3.6%) and in 4 of the non-adiposity group (1.2%). HeartScore was ≥ 5 in 6 patients (10.7%) of the adiposity group and in 16 patients (4.9%) of the non-adiposity group. Conclusion Although there was only a small percentage of obese employees (∼15%), the significant higher risk for cardiovascular disease was apparent in both score systems (more than double). Therefore extensive diagnostic measures in prevention are required. Group A (BMI > 30) Group B (BMI < 30) Total number 56/384 = 14.58% 328/384 = 85.42% BMI (kg/m2) 33.6 ± 4.31/30-47.9 24.04 ± 3.15/16.6-29.9 Heart Score total number 6/56 = 10.71% 16/328 = 4.88% Procam total number 2/56 = 3.57% 4/328 = 1.22% Heart Score (mw/range) 1.88 ± 2.02/1-10 1.57 ± 1.60/1-14 Procam (mw/range) 4.52 ± 5.52/0-25.4 2.69 ± 4.69/0-45 Group A (BMI > 30) Group B (BMI < 30) Total number 56/384 = 14.58% 328/384 = 85.42% BMI (kg/m2) 33.6 ± 4.31/30-47.9 24.04 ± 3.15/16.6-29.9 Heart Score total number 6/56 = 10.71% 16/328 = 4.88% Procam total number 2/56 = 3.57% 4/328 = 1.22% Heart Score (mw/range) 1.88 ± 2.02/1-10 1.57 ± 1.60/1-14 Procam (mw/range) 4.52 ± 5.52/0-25.4 2.69 ± 4.69/0-45 Open in new tab Group A (BMI > 30) Group B (BMI < 30) Total number 56/384 = 14.58% 328/384 = 85.42% BMI (kg/m2) 33.6 ± 4.31/30-47.9 24.04 ± 3.15/16.6-29.9 Heart Score total number 6/56 = 10.71% 16/328 = 4.88% Procam total number 2/56 = 3.57% 4/328 = 1.22% Heart Score (mw/range) 1.88 ± 2.02/1-10 1.57 ± 1.60/1-14 Procam (mw/range) 4.52 ± 5.52/0-25.4 2.69 ± 4.69/0-45 Group A (BMI > 30) Group B (BMI < 30) Total number 56/384 = 14.58% 328/384 = 85.42% BMI (kg/m2) 33.6 ± 4.31/30-47.9 24.04 ± 3.15/16.6-29.9 Heart Score total number 6/56 = 10.71% 16/328 = 4.88% Procam total number 2/56 = 3.57% 4/328 = 1.22% Heart Score (mw/range) 1.88 ± 2.02/1-10 1.57 ± 1.60/1-14 Procam (mw/range) 4.52 ± 5.52/0-25.4 2.69 ± 4.69/0-45 Open in new tab P73 Reducing lifestyle-related risk factors in an obese population - findings from a community-based vascular disease prevention programme in the West of Ireland C Kerins1, I Gibson1, AM Walsh1, J Windle1, C Costello1, J Jones2, S Connolly3, G Flaherty4, J Crowley5 1Croí, West of Ireland Cardiac Foundation, Galway, Ireland, 2Imperial College London, London, United Kingdom, 3Imperial College Healthcare NHS Trust, London, United Kingdom, 4National University of Ireland, Galway, Ireland, 5University College Hospital Galway, Galway, Ireland Obesity (Prevention & Epidemiology) Purpose The aim of this study was to investigate the impact of a community-based, vascular disease prevention programme on lifestyle-related cardiovascular risk factors in obese patients at high multifactorial risk. Methods Patients with a Heart SCORE ≥ 5% were enrolled on a 16-week intensive lifestyle programme delivered by a multidisciplinary team in a community setting. Body mass index (BMI), waist circumference and other lifestyle risk factors such as dietary habits and physical activity levels were assessed at baseline and at end of the programme (EOP). To calculate the Mediterranean diet score a food habit questionnaire was administered, with the use of a photographic food atlas to estimate portion sizes. Individuals also completed a Chester Step Test, a sub-maximal exercise assessment which determined an estimate of their maximal aerobic capacity. Results Data on 439 patients and their family members or partners were analysed. Conclusions Obesity is a growing epidemic in Ireland and these results demonstrate that significant weight loss is achievable along with reductions in other lifestyle risk factors in those who are at high risk from cardiovascular disease. Summary of outcomes Patients IA (n = 296) Patients EOP (n = 296) Partners IA (n = 143) Partners EOP (n = 143) Mean (SD) BMI (kg/m2) 33.3 (7.2) 31.8 (6.4), p < 0.001 30.0 (5.5) 29.0(5.2), p < 0.001 Mean (SD) Waist Circumference (cm) Men 116 (15) 111(15), p < 0.001 113 (14) 108(14), p < 0.001 Mean (SD) Waist Circumference (cm) Women 108 (16) 103(16), p < 0.001 95 (15) 94(15), p < 0.001 Mean (SD) Mediterranean Diet Score 4.1 (2.2) 8.2 (2.3), p < 0.001 4.3 (2.0) 8.6(2.3), p < 0.001 % Achieving fruit & vegetable targets (>400g/day) 10.9 37.9, p < 0.001 17.6 38.0, p < 0.001 % Achieving fish target (>20g/day) 57.8 82.3, p < 0.001 52.1 80.3, p < 0.001 % Achieving salt target (not added to food or cooking) 32.1 74.4, p < 0.001 29.1 71.6, p < 0.001 % Achieving physical activity targets 11.1 62.2, p < 0.001 20.1 61.1, p < 0.001 Mean Estimated METs Maximum 7.5 (1.6) 9.2 (2.0), p < 0.001 7.9 (1.6) 9.4 (1.8), p < 0.001 Patients IA (n = 296) Patients EOP (n = 296) Partners IA (n = 143) Partners EOP (n = 143) Mean (SD) BMI (kg/m2) 33.3 (7.2) 31.8 (6.4), p < 0.001 30.0 (5.5) 29.0(5.2), p < 0.001 Mean (SD) Waist Circumference (cm) Men 116 (15) 111(15), p < 0.001 113 (14) 108(14), p < 0.001 Mean (SD) Waist Circumference (cm) Women 108 (16) 103(16), p < 0.001 95 (15) 94(15), p < 0.001 Mean (SD) Mediterranean Diet Score 4.1 (2.2) 8.2 (2.3), p < 0.001 4.3 (2.0) 8.6(2.3), p < 0.001 % Achieving fruit & vegetable targets (>400g/day) 10.9 37.9, p < 0.001 17.6 38.0, p < 0.001 % Achieving fish target (>20g/day) 57.8 82.3, p < 0.001 52.1 80.3, p < 0.001 % Achieving salt target (not added to food or cooking) 32.1 74.4, p < 0.001 29.1 71.6, p < 0.001 % Achieving physical activity targets 11.1 62.2, p < 0.001 20.1 61.1, p < 0.001 Mean Estimated METs Maximum 7.5 (1.6) 9.2 (2.0), p < 0.001 7.9 (1.6) 9.4 (1.8), p < 0.001 Open in new tab Summary of outcomes Patients IA (n = 296) Patients EOP (n = 296) Partners IA (n = 143) Partners EOP (n = 143) Mean (SD) BMI (kg/m2) 33.3 (7.2) 31.8 (6.4), p < 0.001 30.0 (5.5) 29.0(5.2), p < 0.001 Mean (SD) Waist Circumference (cm) Men 116 (15) 111(15), p < 0.001 113 (14) 108(14), p < 0.001 Mean (SD) Waist Circumference (cm) Women 108 (16) 103(16), p < 0.001 95 (15) 94(15), p < 0.001 Mean (SD) Mediterranean Diet Score 4.1 (2.2) 8.2 (2.3), p < 0.001 4.3 (2.0) 8.6(2.3), p < 0.001 % Achieving fruit & vegetable targets (>400g/day) 10.9 37.9, p < 0.001 17.6 38.0, p < 0.001 % Achieving fish target (>20g/day) 57.8 82.3, p < 0.001 52.1 80.3, p < 0.001 % Achieving salt target (not added to food or cooking) 32.1 74.4, p < 0.001 29.1 71.6, p < 0.001 % Achieving physical activity targets 11.1 62.2, p < 0.001 20.1 61.1, p < 0.001 Mean Estimated METs Maximum 7.5 (1.6) 9.2 (2.0), p < 0.001 7.9 (1.6) 9.4 (1.8), p < 0.001 Patients IA (n = 296) Patients EOP (n = 296) Partners IA (n = 143) Partners EOP (n = 143) Mean (SD) BMI (kg/m2) 33.3 (7.2) 31.8 (6.4), p < 0.001 30.0 (5.5) 29.0(5.2), p < 0.001 Mean (SD) Waist Circumference (cm) Men 116 (15) 111(15), p < 0.001 113 (14) 108(14), p < 0.001 Mean (SD) Waist Circumference (cm) Women 108 (16) 103(16), p < 0.001 95 (15) 94(15), p < 0.001 Mean (SD) Mediterranean Diet Score 4.1 (2.2) 8.2 (2.3), p < 0.001 4.3 (2.0) 8.6(2.3), p < 0.001 % Achieving fruit & vegetable targets (>400g/day) 10.9 37.9, p < 0.001 17.6 38.0, p < 0.001 % Achieving fish target (>20g/day) 57.8 82.3, p < 0.001 52.1 80.3, p < 0.001 % Achieving salt target (not added to food or cooking) 32.1 74.4, p < 0.001 29.1 71.6, p < 0.001 % Achieving physical activity targets 11.1 62.2, p < 0.001 20.1 61.1, p < 0.001 Mean Estimated METs Maximum 7.5 (1.6) 9.2 (2.0), p < 0.001 7.9 (1.6) 9.4 (1.8), p < 0.001 Open in new tab P74 Predictive impact of visceral adiposity on new-onset of metabolic syndrome components in healthy japanese population: Metabolic syndrome and visceral obesity (MERLOT study) YM Nakao1, S Yasuno2, T Miyawaki3, K Nakao1, S Tanaka2, A Fujimoto2, M Kasahara2, K Ueshima2, K Nakao1 1Kyoto University Graduate School of Medicine, Department of Medicine and Clinical Science, Kyoto, Japan, 2Kyoto University Graduate School of Medicine, EBM Research Center, Kyoto, Japan, 3Health Administration Center, NTT WEST Kyoto Hospital, Kyoto, Japan Obesity (Prevention & Epidemiology) Purpose The objective of this study is to examine the association between abdominal adiposity and new-onset of metabolic syndrome components in healthy Japanese population. Methods We conducted a longitudinal study using complete medical checkup data of NTT WEST Kyoto Hospital (Kyoto, Japan) from 1994 to 2010, the metabolic syndrome and visceral obesity (MERLOT) study. Of 25,255 subjects, we examined 1,380 subjects (1,053 men and 327 women), who underwent computed tomography (CT) to measure visceral fat area (VFA) and did not have any of metabolic syndrome components defined by the Examination Committee of Criteria for the Metabolic Syndrome in Japan (blood pressure < 130/80 mmHg, triglyceride <150g/dl, HDL-cholesterol ≥ 40 g/dl, fasting glucose < 110 g/dl, or treated) at baseline. The endpoint was the onset of any of metabolic syndrome components. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the multiple Cox regression analysis adjusted for possible confounders. Results During 4.9 years of mean follow-up, the endpoint occurred in 58.4% of men and 41.9% of women. Of three metabolic syndrome components, high blood pressure is more prevalent (37.5% in men, 24.2% in women) than dyslipidemia (31.5% in men, 18.0% in women) and hyperglycemia (13.7% in men, 11.0% in women). The multiple Cox regression analysis showed that body mass index (BMI), VFA, and subcutaneous fat area (SFA) are significantly associated with the risk of new-onset of metabolic syndrome components (BMI, HR: 1.05 per 1 kg/m2, 95%CI: 1.02-1.08; VFA, HR: 1.05 per 10 cm2, 95%CI: 1.03-1.05; SFA, HR: 1.02 per 10 cm2, 95%CI: 1.01-1.04). After further adjusting for BMI, VFA was still significantly associated with the risk, but SFA was not. Conclusions This large-number, long-term follow-up longitudinal cohort study disclosed that VFA measured by computed tomography was an independent predictor of new-onset of metabolic syndrome components in healthy population. P75 Measured parental weight status and familial socio-economic status correlates with childhood overweight and obesity at age 9 E Keane1, R Layte2, J Harrington1, P Kearney1, I Perry1 1University College Cork, Cork, Ireland, 2The Economic and Social Research Institute, Dublin, Ireland Obesity (Prevention & Epidemiology) Purpose Childhood obesity is a predictor for cardiovascular disease in adulthood. Parental obesity is a predominant risk factor for child obesity. Moreover, familial socio-economic factors play a role in determining parent weight. The aim of this study is to examine the association between familial socio-economic factors, measured parental weight status and risk of childhood obesity. Methods Cross sectional analysis of the first wave (2008) of the Growing Up in Ireland (GUI) study. GUI is a nationally representative study of 9 year old children (N = 8,568). Children were recruited from schools (response rate 82%) and age eligible children (response rate 57%) were invited to participate. Parents and children had anthropometric measurements taken using standard methods. Data were re-weighted to account for sampling design. Multinomial logistic regression was conducted to determine the risk of childhood overweight and obesity (based on International Obesity Taskforce definitions). Results One quarter of children were either overweight (19.3%) or obese (6.6%). Parental obesity was a significant predictor of child obesity. Where both parents were obese almost half (49%) of children were overweight (32%) or obese (17%). The relationship between child obesity and parent obesity was stronger for mothers than for fathers. There was a near linear relationship between child obesity and social class. Adjusted regression indicates that children with two obese parents have 22 times the odds of being obese (95% CI, 9.5-50.3) than those with two normal weight parents. Conclusions Childhood obesity prevention policies and interventions should be more family focussed. Due to the apparent graded relationship between child weight and social class, actions to tackle obesity are more urgently required in lower social class families. P76 Assessing real-world European patient profiles in the Helping Evaluate Reduction in Obesity (HERO) study JB Dixon1, N Nancy Dreyer2, EA Finkelstein3, Z Su2, D Globe4, T Okerson5 1Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 2Outcome, Cambridge, United States of America, 3Duke-NUS Graduate Medical School Singapore, Singapore, Singapore, 4Allergan, Inc., Irvine, United States of America, 5University of California, Irvine School of Medicine, Irvine, United States of America Obesity (Prevention & Epidemiology) Purpose Optimum management of obese patients requires a coordinated effort by the healthcare provider and the patient. Deciding upon a bariatric surgical option involves consideration of many factors which may vary between patients and geographic regions. The HERO Study was developed to evaluate the characteristics of patients who choose to undergo LAP-BAND AP® (LBAP) adjustable gastric banding in Europe, Canada, the US, and Australia. This real world effectiveness study will provide information that will help inform patient choice and treatment strategies and guide practice standards to achieve optimal outcomes. Methods This prospective, multi-national study enrolled patients upon their decision to have LBAP implanted. Evaluations are recorded at baseline (pre-surgery), peri-surgery, 3 months, 6 months, 1 year and annually thereafter until 5 years. Data collected include medical history, adverse events, if any, and effectiveness including clinical, humanistic, direct medical, and productivity outcomes. Descriptive statistics were assessed for baseline characteristics categorized by patients enrolled in centres in Europe (EU) and those outside of Europe (OEU). Results A total of 1123 patients were enrolled into the study; 293 (26%) in EU and 830 (74%) OEU. The majority of patients are female (79%), with a mean age of 42 in EU and 44 OEU (range 18-76). Mean body mass index at baseline was nearly identical for EU and OEU at ∼45kg/m2. Europeans have a lower prevalence of comorbidities compared with others, including type 2 diabetes (14.0% v 24.9%, p < 0.001), hypertension (34.1% v 46.1%, p < 0.001), and a trend in cardiovascular disease (2.1% v 3.5%, p = 0.33) for EU and OEU, respectively. Males from EU have more comorbidities than females, including type 2 diabetes (21.3% v 12.1%), hypertension (41.0% v 32.3%), and cardiovascular disease (4.9% v 1.3%). All EU males treated their diabetes with oral medication while one male (7.7%) and 9 females (32.1%) also used insulin; More OEU males (18, 32.1%) used insulin, but this trend was not seen in OEU females (38, 25.7%). Conclusions This first multi-national study for weight loss through banding has successfully reached target recruitment. Interestingly, although bariatric surgery often leads to improvement or remission of the comorbidities of obesity, EU patients had lower rates of comorbidity at the time of surgery compared with other regions. Future analyses will describe any regional differences in weight loss, remission/improvement in comorbidities, and resultant variability in utilization of healthcare resources, and may suggest improved strategies for more effective intervention. P77 Obesity and body fat classification in the metabolic syndrome: impact on cardiometabolic risk CM Phillips1, JA Lovegrove2, CA Drevon3, C Defoort4, EE Blaak5, J Lopez-Miranda6, A Dembinska-Kiec7, U Riserus8, HM Roche9 1University College Cork, Cork, Ireland, 2University of Reading, Reading, United Kingdom, 3Oslo University Hospital & University of Oslo, Oslo, Norway, 4University of the Mediterranean, Marseille, France, 5Maastricht University, NUTRIM School for Nutrition, Toxicology and Metabolism, Dept of Epidemiology, Maastricht, Netherlands, 6University Hospital Reina Sofia, Cordoba, Spain, 7Jagiellonian University Medical College, Department of Clinical Biochemistry, Krakow, Poland, 8Uppsala University, Department of Public Health and Caring Science, Uppsala, Sweden, 9University College Dublin, School of Public Health, Physiotherapy & Population Science, Dublin, Ireland Obesity (Prevention & Epidemiology) Purpose Obesity is a key causal factor in the development of the metabolic syndrome (MetS), a common condition which is associated with increased cardiometabolic risk. Whether obesity classification influences cardiometabolic risk in the MetS is unknown. The objective of this study is to investigate whether obesity classification by body mass index (BMI) and body fat percentage (BF%) influences a comprehensive panel of cardiometabolic risk factors and dietary responsiveness in MetS individuals, by comparing those classified as non-obese by body mass index and obese by BF% (NOO) to subjects classified as obese by both tools (OO). Methods Anthropometric measures, markers of inflammation and glucose metabolism, lipid profiles, adhesion molecules and haemostatic factors were determined at baseline and after 12 weeks of 4 different isoenergetic dietary interventions (high-saturated fat, high-monounsaturated fat, low-fat and low-fat-high-n3 polyunsaturated fat) in 486 MetS subjects. Results 39% of the subjects classified as normal weight (BMI 18.5-24.99 kg/m2) and 87% classified as overweight (BMI 25-29.99 kg/m2) were obese according to their BF% (≥ 25% in men and ≥ 35% in women). This misclassification was higher for women. Individuals classified as obese by both body mass index (≥ 30 kg/m2) and BF% (OO, n = 284) had larger waist and hip measurements, higher body mass index and were heavier (P < 0.001) than those classified as non-obese by body mass index but with BF% in the obese range (NOO, n = 92). OO individuals displayed a more pro-inflammatory (higher C reactive protein and leptin levels), pro-thrombotic (higher plasminogen activator inhibitor-1 concentration), pro-atherogenic (higher leptin/adiponectin ratio) and more insulin resistant profile (lower insulin sensitivity index, higher HOMA-IR) relative to the NOO group (P < 0.001). Interestingly, NOO individuals demonstrated greater dietary responsiveness with a significant reduction in tumour necrosis factor alpha concentrations post-intervention compared to the OO individuals (P < 0.001). Conclusions This data suggests body mass index underestimates obesity defined as BF%, particularly in overweight MetS subjects. The use of both BF% and body mass index has the potential to detect individuals at greater cardiometabolic risk than body mass index alone. P78 Obesity is associated with increased risk of heart failure among coronary heart disease patients M Benderly1, U Goldbourt2, M Haim3 1Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel, 2Tel-Aviv University, Sackler School of Medicine, Department of Epidemiology and Preventive Medicine, Tel Aviv, Israel, 3Cardiology department, Rabin Medical Center, Petach Tikva, Israel Obesity (Prevention & Epidemiology) Purpose To examine if obesity, recently identified as a risk-factor for heart failure (HF) in the general population is associated with increased HF risk among patients with already established coronary heart disease (CHD). Methods 2945 of 3122 coronary heart disease patients included in the Bezafibrate Infarction Prevention (BIP) study, free of HF at baseline with body mass index (BMI) 18.5 kg/m2, were classified as: normal-weight (BMI: 18.5-24.9; N = 704), overweight (25.0-29.9;N = 1630), or obese (≥ 30; N = 407). Results: Obese patients were younger (mean age: 59.1 ± 6.5) compared to their normal weight (60.4 ± 6.8) and overweight (60.0 ± 6.8) counterparts and included a higher percent of women. Hypertension (53% versus 46% and 35% among over- and normal weight respectively; p < 0.0001), and diabetes (12% compared to 9% of either normal or over-weight patients) were more prevalent among obese patients who also had higher glucose, HOMA, or triglycerides levels and lower mean HDL-cholesterol as well as higher CRP levels (geometric mean: 4.5 mg/dl versus 3.0, 3.6 in normal- and over-weight; p < 0.0001). Treatment with beta-blockers, nitrites, calcium antagonists, diuretics and ACE inhibitors was more frequent among obese. Over 8 follow-up years, 510 patients developed HF. Obese patients had higher cumulative incidence of HF compared to normal or over-weight counterparts (Figure). Accounting for the competing risk of death, age adjusted hazard ration (HR) in obese was 1.68 compared to normal-weight (95% confidence interval (CI):1.17-2.42). Further adjustment for sex, diabetes, HDL-C, glucose, HOMA, smoking, hypertension, pulse pressure, education and CRP attenuated HR to 1.53 (1.05-2.24). Conclusion Obesity is associated with increased HF risk among coronary heart disease patients. Open in new tabDownload slide P79 VITABalance-MED Project - Pilot Study (Phase II) IIIES, A R Antonio Rui Leal1, N Vilar2, R Santos1 1Foundation SANITUS, Sta Maria da Feira, Portugal, 2University of Santiago de Compostela, Santiago de Compostela, Spain Obesity (Prevention & Epidemiology) VITABalance-MED is an innovative project, with the intent of disseminating to children in school age a new and comprehensive teaching concept of cardiovascular, obesity and Diabetes Mellitus type 2 prevention. Was started in 2005, is planed in 5 phases and is based on behavioral adhesion to an appropriate balance, between healthy alimentation, regular physical exercise, healthy life style, with cardiovascular risk factors control and respect for the eco-system, in a scientifically correct and articulated way (five pyramids connected by the EU-R-EKO = a role model children), This transmission is made by prepared teachers in schools, in an conception that regards to costs, to sustainability (net-work), and is visually based (poster). After the Conceptual Phase (Phase I), during 4 years, the project was developed and targeted to Families, trough Basic Schools and their 8 years students, giving to Teachers one global tool to teach correct cardiovascular prevention concepts, in a attractive and easy way. This Pilot-Project (Phase II), performed between 2009-2011 involved a convenience case-control study in 3 groups of elementary schools, with 475 students and 26 teachers, of the 3th year. An anthropometric and knowledge evaluation was performed to all students at initial point, at 6 and 18 months by a foreign University. In the intervention group (16 teachers + 293 students), teachers were submitted to a 25 h course, along with the mission to transmit correct concepts, during 10h in class. The control group (10 teachers + 185 students) were only exposed to the poster. Initial results revealed 19% overweight + 27% obese children. After 6 months, this project revealed an increase of knowledge in the five (pyramids) areas: 1 - Nutrition (42,4 => 50,2%); 2 - Exercise (46,5% => 60,2%); 3 - Behavior (41,5 => 52,7%); 4 - Medical (38,0 => 50,3%); Ecological (41,3 => 52,7%); There was also to a significant reduction of HR (82.5 ± 12.6 =  > 80.1 ± 10.7), diastolic blood pressure (65.3 ± 9,6 => 64.1 ± 8.7), along with an increase in body mass index (18.1 ± 3.1 => 18.5 ± 3.1) and Waist circumference (61.9 ± 8.1 => 62.8 ± 8.3). Interestingly, the control group revealed and increase in the knowledge of about 13% (36,3 => 49,8%), although with an inferior starting level. The final and completed 18 months results, are under statistical analysis. We could conclude the poster alone is and interesting and potent tool to transmit CV knowledge and reduce some of the CVRF but perhaps not Obesity. So, we are currently in Phase III (District level), with a new formative model, involving 10 groups of Schools, 1500 Students, Parents and 47 Teachers. P80 Overweight and obesity: still high in Bulgaria B Borislav Georgiev1, N Gotcheva1 1National Heart Hospital, Sofia, Bulgaria Obesity (Prevention & Epidemiology) Despite accumulated evidence that overweight and obesity is significantly associated with elevated risk for cardiovascular conditions, their prevalence has reached epidemic levels in the general population and among patients with established coronary heart disease (CHD). The patients with excess body weight may have higher prevalence of established cardiovascular risk factors. Aim The aim of the study was to analyse the distribution of the overweight and obesity among coronary heart disease and high-risk patients, included in the Bulgarian cohort of EUROASPIRE III (European Action on Secondary and Primary Prevention by Intervention to Reduce Events III). Methods Data collection was conducted by trained research staff, who reviewed patient medical records, interviewed and examined the patients. Personal and demographic details were recorded and risk factors monitored. Each subject was specifically asked if he/she had been offered any personal advice about weight reduction and, if yes, if he/she had attempted to lose weight and how. Height and weight were measured, body mass index (BMI) was calculated, overweight and obesity was defined. Waist circumference was recorded and abdominal overweight was defined. Results We found overweight and obesity in 79.2% of coronary heart disease patients (obesity in 30.3%); the mean waist circumference was 98.1 cm. After the index event 87.2% of the patients attempted to reduce the fats, 54.3% - to reduce the calories intake. We found an increased consumption of fruits and vegetables after the hospital discharge, 63.3% decreased the sugar intake. Only 37.9% followed the diet and 15.3% had regular physical activity. In the high-risk patients group we found in 92.9% body mass index ≥ 25 kg/m2 (obesity in 65.3%). The mean waist circumference was 102.9 cm, central obesity was found in 81%. 25% was attempted to reduce their weight. 51.2% from the obese patients never been told to be overweight. 23.6% followed dietary recommendations and 2.4% tried to reduce the weight. Conclusions The patients with coronary heart disease are doing more efforts to reduce their weight and have better results in the body weight control than the high risk individuals. We need national and international strategies for weight control in the general population, as well as in the cohort of coronary heart disease and high-risk patients. P81 In younger people body mass index just below overweight threshold is associated with presence of components of increased cardiometabolic risk MV Konnov1, LM Dobordzhginidze1, NA Gratsiansky1 1Institute of Physico-Chemical Medicine, Moscow, Russian Federation Obesity (Prevention & Epidemiology) Purpose To elucidate whether “high normal” (HN) body mass index (BMI) is associated with worse risk factor profile than smaller body mass index. Methods. Among members of families of patients with premature coronary heart disease (PCHD) examined by us there were 223 persons (66 spouses, 157 children) without overt coronary heart disease with body mass index 18.5-<25.0 kg/m2. Parameters analysed included conventional risk factors. High blood pressure was defined as prehypertension/hypertension (NHBPEP 4 on blood pressure in adolescents or JNC 7). Triglycerides (TG) ≥ 1.7, glucose ≥ 5.55 mmol/l were defined high, high density lipoprotein cholesterol (HDLC) <1.0 (men), <1.3 mmol/l (women) - low. Top tertile of body mass index (22.6-<25.0 kg/m2) was considered HNBMI. For persons ≥ 30 years Framingham global risk was calculated. Logistic regression univariate analysis and Spearman correlation with age and sex adjustment were used to assess relation of HNBMI to presence of some metabolic characteristics and global risk ≥ 5%. Subjects were grouped by median age: 16-25 (112 children), 26-60 years (66 spouses, 45 children). Results Persons with HNBMI in younger but not in older group had higher risk to have low HDLC and high blood pressure (significant), high TG (tendency) than those with smaller body mass index (table). Conclusion In young adults with parental PCHD body mass index just below overweight threshold (22.6-<25 kg/m2) was associated with higher probability to have components of increased cardiometabolic risk. Relation between HNBMI and risk factors OR 95% confidence interval P RSpearman PSpearman 16-25 years, n = 112, 29 (25.9%) with HNBMI Low HDLC 4.07 1.47-11.3 0.007 0.262 0.006 High blood pressure 3.00 1.17-7.67 0.022 0.226 0.018 High TG 7.77 0.69-87.0 0.096 0.192 0.044 High glucose 1.77 0.27-11.8 0.554 0.057 0.555 26-60 years, n = 111, 50 (45.1%) with HNBMI High glucose 0.70 0.19-2.68 0.606 −0.049 0.612 Low HDLC 1.24 0.52-2.94 0.633 0.045 0.641 High blood pressure 1.09 0.46-2.58 0.848 0.019 0.848 High TG 1.05 0.13-8.55 0.967 0.004 0.970 30-60 years (HNBMI, 42/87) Global risk ≥ 5% 1.57 0.44-5.58 0.490 0.076 0.496 OR 95% confidence interval P RSpearman PSpearman 16-25 years, n = 112, 29 (25.9%) with HNBMI Low HDLC 4.07 1.47-11.3 0.007 0.262 0.006 High blood pressure 3.00 1.17-7.67 0.022 0.226 0.018 High TG 7.77 0.69-87.0 0.096 0.192 0.044 High glucose 1.77 0.27-11.8 0.554 0.057 0.555 26-60 years, n = 111, 50 (45.1%) with HNBMI High glucose 0.70 0.19-2.68 0.606 −0.049 0.612 Low HDLC 1.24 0.52-2.94 0.633 0.045 0.641 High blood pressure 1.09 0.46-2.58 0.848 0.019 0.848 High TG 1.05 0.13-8.55 0.967 0.004 0.970 30-60 years (HNBMI, 42/87) Global risk ≥ 5% 1.57 0.44-5.58 0.490 0.076 0.496 Open in new tab Relation between HNBMI and risk factors OR 95% confidence interval P RSpearman PSpearman 16-25 years, n = 112, 29 (25.9%) with HNBMI Low HDLC 4.07 1.47-11.3 0.007 0.262 0.006 High blood pressure 3.00 1.17-7.67 0.022 0.226 0.018 High TG 7.77 0.69-87.0 0.096 0.192 0.044 High glucose 1.77 0.27-11.8 0.554 0.057 0.555 26-60 years, n = 111, 50 (45.1%) with HNBMI High glucose 0.70 0.19-2.68 0.606 −0.049 0.612 Low HDLC 1.24 0.52-2.94 0.633 0.045 0.641 High blood pressure 1.09 0.46-2.58 0.848 0.019 0.848 High TG 1.05 0.13-8.55 0.967 0.004 0.970 30-60 years (HNBMI, 42/87) Global risk ≥ 5% 1.57 0.44-5.58 0.490 0.076 0.496 OR 95% confidence interval P RSpearman PSpearman 16-25 years, n = 112, 29 (25.9%) with HNBMI Low HDLC 4.07 1.47-11.3 0.007 0.262 0.006 High blood pressure 3.00 1.17-7.67 0.022 0.226 0.018 High TG 7.77 0.69-87.0 0.096 0.192 0.044 High glucose 1.77 0.27-11.8 0.554 0.057 0.555 26-60 years, n = 111, 50 (45.1%) with HNBMI High glucose 0.70 0.19-2.68 0.606 −0.049 0.612 Low HDLC 1.24 0.52-2.94 0.633 0.045 0.641 High blood pressure 1.09 0.46-2.58 0.848 0.019 0.848 High TG 1.05 0.13-8.55 0.967 0.004 0.970 30-60 years (HNBMI, 42/87) Global risk ≥ 5% 1.57 0.44-5.58 0.490 0.076 0.496 Open in new tab P82 Risk factors for abdominal obesity in adolescents E Egle Silva1, JJ Villasmil1, M Bracho1, M Munoz1, A Gonzalez1, V Romero1, G Bermudez1 1INSTITUTO REGIONAL DE INVESTIGACION Y ESTUDIOS DE ENFERMEDADES CARDIOVASCULARES, UNIVERSIDAD DEL ZUL, Maracaibo, Venezuela Obesity (Prevention & Epidemiology) Introduction Increased visceral fat in adolescents is associated with cardiovascular and metabolic diseases, but the prevalence and the factors associated with abdominal obesity (AO) occurrence are unknown in Hispanic adolescents. Objective To determine the main risk factors for abdominal obesity (AO) in adolescents from Venezuela. Methods: This study was conducted in 3140 adolescents, aged 12-19 years, who were randomly selected of high schools, in Maracaibo, Venezuela. Participants were 1371 males and 1769 females; and completed a demographic questionnaire. Also, the waist circumference (WC) was measured using a steel measuring tape to the nearest 0.1 cm at the high point of the iliac crest when the subject was in a standing position. Percentiles for WC were calculated by gender and age; the adolescents with WC above 90th percentile for their age and gender were considered as AO. Odds ratios (OR) and 95% Confidence Intervals (CIs) were calculated using logistic regression to determine AO risks factors. Results: The AO prevalence was 23.7% in all adolescents, 23.6% in males and 23.7% in females (p: NS). The logistic regression detected that hypertension (OR = 5.720; 95% CIs = 4.130-7.923), smoking (OR = 2.860; 95% CIs = 1.094-7.476), prehypertension (OR = 2.365; 95% CIs = 1.949-2.868), liquor ingestion (OR = 1.891; 95% CIs = 1.335-2.679) and non physical activity (OR = 1.791; 95% CIs = 1.418-2.262) were the AO risk factors statistically significant. Likewise, the analysis applied by gender showed that smoking (OR = 6.773; 95% CIs = 1.963-23.364) in males, and liquor ingestion (OR = 3.097; 95% CIs = 1.704-5.629) in females were the main AO risk factors. Conclusions The AO prevalence is high in adolescents, being similar in both genders. High blood pressure and smoking and alcoholic habits are most important AO risk factors in adolescents. Thus, it is necessary to identify these risk conditions in adolescents, and then, it can be applied interventions more intensive to reduce the AO. P83 Prognostic impact of body mass index on a size of myocardial impairment area, percutaneous coronary intervention outcome and in-hospital mortality in patients with acute coronary syndrome J Gilis-Januszewski1, K-P Mellwig1, F Van Buuren1, T Gilis-Januszewski2, M Moellenberg1, G Koenig1, B Koerber1, A Raethling1, B Brockmeier1, D Horstkotte1 1Heart and Diabetes Center NRW, Ruhr-University of Bochum, Department of Cardiology, Bad Oeynhausen, Germany, 2Heart and Diabetes Center NRW, Ruhr-University of Bochum, Clinic for Thoracic & Cardiovasc. Surgery, Bad Oeynhausen, Germany Obesity (Prevention & Epidemiology) Purpose We investigated the impact of pre-existing body mass index (BMI) on percutaneous coronary intervention outcome defined as TIMI flow after initial percutaneous coronary intervention, infarct size defined as cardiac TnI peak release and in-hospital mortality in patients with acute coronary syndrome (ACS). Methods 1038 consecutive pts with acute coronary syndrome from 2007-2010 (398 pts with ST-elevation myocardial infarction and 640 pts with non ST-elevation myocardial infarction) were enrolled in this study. Depending on body mass index three groups were separated (BMI ≤ 25 normal weight, 25 < BMI < 30 overweight, BMI ≥ 30 adiposities). In-hospital mortality, TIMI flow after percutaneous coronary intervention, inguinal hematomas and cardiac TnI peak release were evaluated with respect to overall outcome. Results The in-hospital mortality of the all pts was 1.54%, TIMI flow III after initial percutaneous coronary intervention was seen in 91.53% and prevalence of inguinal hematomas in 9.94%. The group of 288 pts (28%) with normal weight (BMI ≤ 25) experienced an in hospital mortality of 0.48%. Prevalence of inguinal hematomas after percutaneous coronary intervention was 2.2% and 25% of pts presented TIMI flow III after initial percutaneous coronary intervention. Cardiac TnI peak release was 49.5 ± 77.8 µg/ml. The second group of 475 overweighed pts (46%) with 25 < BMI < 30 experienced an in hospital mortality of 0.67%. Prevalence of inguinal hematomas after percutaneous coronary intervention was 4.7% and 44% of pts presented TIMI flow III after initial percutaneous coronary intervention. Cardiac TnI peak release was 53.3 ± 112.4 µg/ml. The third group of 275 adipose pts (26%) with BMI ≥ 30 experienced an in hospital mortality of 0.39%. Prevalence of inguinal hematomas after percutaneous coronary intervention was 3% and 23% of pts presented TIMI flow III after initial percutaneous coronary intervention. Cardiac TnI peak release was 44.4 ± 67.5 µg/ml. We did not see significant differences regarding the body mass index on the in hospital mortality, infarct size, percutaneous coronary intervention outcome and inguinal hematomas after initial percutaneous coronary intervention between the groups (p > 0.05). Conclusion body mass index seems not to have an influence on a size of myocardial impairment area, percutaneous coronary intervention outcome and in-hospital mortality in patients with acute coronary syndrome. P84 Waist circumference and cardio metabolic risk indicators in an obese population S Silva1, SJ Otto1 1Erasmus Medical Center, department Public Health, Rotterdam, Netherlands Obesity (Prevention & Epidemiology) Purpose Abdominal obesity is associated with an increased risk of cardiovascular disease (CVD). Cardiovascular disease risk can be estimated using the Framingham or SCORE risk function, under the assumption that the risk factors occur independently. Metabolic syndrome (MetS), a cluster of cardiometabolic factors that are partly included in the risk functions, is also associated with high cardiovascular disease risk. Studies have shown that MetS does not improve cardiovascular disease risk prediction compared to Framingham in the general population. In this study the association between the extent of abdominal obesity and a SCORE score >=5% and MetS are compared in an abdominal obese population in order to evaluate the predictive value of these risk indicators. Methods Cross-sectional data of participants in a diabetes screening trial were used, after excluding those with existing cardiovascular disease, diabetes, family history of diabetes or missing value for WC. Chi square tests were used for comparison of proportions by WC categories and Spearman correlation, adjusted for age & smoking, for testing the interdependence of waist circumference (WC), SCORE risk & MetS. Results In both males (n = 1407; mean age 57.2 yrs) and females (n = 1667; mean age 55.9 yrs), WC was positively correlated with MetS, while there was a tendency of negative correlation with SCORE >=5% at higher WC categories (See Figure). Within this abdominal obese population, no correlation was found between the two indicators after adjustment for age and smoking (rho in men: 0.043, and women: 0.011, p-value>0.05). Conclusion In contrast to MetS, the SCORE function seems to have no additional value in the prediction of cardiovascular disease at extreme abdominal obesity. This lack of correlation between the indicators leads to two independent groups with elevated risk. Open in new tabDownload slide P85 Model of prediction of the long-term success of the weight reduction in obese individuals D Avramovic1, J Marinkovic2, V Stojanov3, B Beleslin3, J Jorga1 1University of Belgrade, School of Medicine, Belgrade, Serbia, 2Zemun Medical Centre, Belgrade, Serbia, 3Clinical Center of Serbia, Clinic for Cardiology - Belgrade Medical School, Belgrade, Serbia Obesity (Prevention & Epidemiology) Purpose To investigate if there exist set of parameters that can predict the long-term success in weight-reduction. Methods In total 99 (86 f, 13 m) adult obese subjects were included, and examined at the beginning of the therapy, at the end of the therapy, and at follow-up after average 33 (30-36) months. We collected data on personal and family medical history, initial age of onset and duration of obesity, anthropometric measures (body height, body weight), calculated body fat percentage, measured systolic and diastolic arterial blood pressure. Participants filled out three-factor eating questionnaire. Participants were counseled with weight reduction therapy, moderate balanced hypocaloric diet was recommended, with daily energy deficit range from 600 up to 1000 kCal, (total daily energy intake of any participant was not less than 1200 kCal), with or without concomitant oral lipase inhibitor use. Short term success, comparing to baseline body weight of participant, was defined as 5% weight reduction after three months of therapy or 10% weight reduction after 6 months of therapy. Long term success was defined as weight at the end of therapy increased at maximum up to 3% at control examination (min.2 years after). Results At baseline mean values for: age was 39 (+−11y), body weight was 95.2kg (+−16.9kg), body mass index was 34.2kg/m2 (+−5.5), and body fat percent 40.2%(+−6.5). According to pre-defined success, all participants were grouped as following: (1) short term and long term successful, (2) short term unsuccessful and long term successful, (3) short term successful and long term unsuccessful, (4) short term and long term unsuccessful. Conclusions Results of our study indicate that factors which can predict long term successful weight reduction in obese person are: younger age and lower grade of obesity at beginning of therapy, shorter duration of obesity, absence of comorbidities, continuation of diet therapy after final visit to health care practitioner, acceptance of lifestyle changes, regular daily recreational activity, and higher degree of the cognitive-restrained eating. P86 Waist circumference as a selection tool for cardiovascular risk factors in an obese population S Sonja Silva1 1Erasmus Medical Center, Rotterdam, Netherlands Obesity (Prevention & Epidemiology) Purpose Abdominal obesity is associated with diabetes and cardiovascular disease (CVD). Studies have shown that measures of abdominal obesity do not add to risk prediction beyond traditional risk factors. Cardiovascular prevention in primary care (Netherlands) has recently introduced a risk questionnaire (Prevention Consult) to select a high risk group for a consultation. In this study the predictive ability of waist circumference (WC) to detect dyslipidemia is compared to the questionnaire. Methods Cross-sectional data from a obese population has been used after excluding subjects with pre-existing cardiovascular disease and family history of diabetes. Receiver operating characteristics curves were used to analyse the predictive ability. Results In males (n = 1407, mean age 57.2 yrs, WC > 93cm) and females (n = 1667; mean age 55.9 yrs, WC > 79 cm) WC (AUC 0.537) was a beter predictor of dyslipidemia compared to the questionnaire (AUC 0.500). In smokers the predictive ability of WC (AUC 0.629) improved. Conclusion:The predictive ability to detect lipid disorders in this obese population is low with either selection tool. WC alone selected more dyslipidemia compared to the risk questionnaire in both males and females. Table 1 AUC values Total Smoker non smoker PC Q 0.500 0.500 0.500 WC 0.537 0.629 0.513 Age 0.435 0.374 0.461 Total Smoker non smoker PC Q 0.500 0.500 0.500 WC 0.537 0.629 0.513 Age 0.435 0.374 0.461 Abbreviations: PC Q: Prevention Consult Questionnaire; WC: Waist circumference. Open in new tab Table 1 AUC values Total Smoker non smoker PC Q 0.500 0.500 0.500 WC 0.537 0.629 0.513 Age 0.435 0.374 0.461 Total Smoker non smoker PC Q 0.500 0.500 0.500 WC 0.537 0.629 0.513 Age 0.435 0.374 0.461 Abbreviations: PC Q: Prevention Consult Questionnaire; WC: Waist circumference. Open in new tab Open in new tabDownload slide P87 The role of night-time administration of angiotensin-converting enzyme inhibitor on nocturnal non-dipping blood pressure in asymptomatic patients with hypertension - initial experience analysis KJ Voon1, MT Ledwidge1, R O' Hanlon1, KM Mc Donald1 1St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland Hypertension (Prevention & Epidemiology) Purpose Non-dipping nocturnal blood pressure (BP) (“non-dipping”) is an emerging risk factor for progressive left ventricular dysfunction in patients with hypertension (HTN) and diabetes (DM). Non-dipping as defined as a failure of nocturnal blood pressure to fall by 10% has been shown to persist independent of the effects of conventional blood pressure lowering strategies targeted at daytime blood pressure. It remains unknown the effects of additional night-time administration of angiotensin-converting enzyme inhibition on non-dipping profile and overall 24-hour blood pressure control. Methods This ongoing prospective randomized study aims to assess the impact of additional night-time administered perindopril (2.5-5mg/day) (n = 25) versus conventional therapy (n = 25) on non-dipping nocturnal blood pressure in a cohort of 50 asymptomatic patients with optimally treated daytime blood pressure with or without diabetes mellitus. Patients will be assessed with B-type natriuretic peptide (BNP), 24-hour ambulatory blood pressure monitor and Doppler-echocardiography at baseline (T0) and follow-up at 3 months (T1). Unpaired t-testing was performed to assess differences in continuous variables. Results were expressed as mean ± SD or median (interquartile range). Results Preliminary analysis was performed on 37 patients [age 66 ± 10 years, male 57%, diabetes mellitus 49%, average daytime systolic blood pressure (SBP) 128 ± 9, diastolic blood pressure (DBP) 72 ± 8 mmHg, follow-up duration 3.3 ± 0.9 months, BNP 26.2 (15.9,51.9) pg/mL, Creatinine 72 ± 20 mmol/L, left-ventricular ejection fraction 68 ± 7%]. At T1, the perindopril intervention group (n = 18) showed significant improvements of night SBP and DBP, day DBP and 24-hour SBP (all p < 0.05). The control group (n = 19) also showed significant reduction in night SBP but no change in other parameters. Despite that, non-dipping persisted and there were no significant differences between both groups. Conclusion Early evidence show that additional short-term nocturnal administration of perindopril improves night-, day-, and 24-hour blood pressure control in patients with treated HTN and non-dipping profiles. While awaiting the study completion, current findings support ongoing evidence that restoring diurnal blood pressure rhythm in such patients may play a crucial role in future blood pressure management. P88 Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland P Marques-Vidal1, F Paccaud1 1University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland Hypertension (Prevention & Epidemiology) Objectives Compare the screening and management of cardiovascular risk factors between the different Swiss regions. Methods Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed. Results After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09-1.42]. Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions. Conclusions in Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved. CV risk factor prevalence and management Results in % Leman Mittelland Northwest Zurich East Central Ticino Switzerland p-value Smokers 27.6 26.5 26.7 29.2 29.1 27.4 26.8 27.5 <0.05 Tried to quit smoking 24.5 24.6 25.9 25.7 29.0 31.8 19.0 25.9 <0.001 Hypertension 25.3 27.6 30.0 26.7 26.2 24.3 27.4 26.8 <0.001 Antihypertensive tr. 65.6 65.1 63.4 63.7 57.3 64.7 66.3 64.0 NS Dyslipidaemia 21.9 19.1 19.2 19.2 16.2 18.1 22.9 19.5 <0.001 Hypolipidemic tr. 47.1 46.1 38.5 37.1 34.1 33.7 47.8 41.8 <0.001 Diabetes 5.8 5.9 6.1 5.7 4.6 4.0 5.3 5.4 <0.05 Results in % Leman Mittelland Northwest Zurich East Central Ticino Switzerland p-value Smokers 27.6 26.5 26.7 29.2 29.1 27.4 26.8 27.5 <0.05 Tried to quit smoking 24.5 24.6 25.9 25.7 29.0 31.8 19.0 25.9 <0.001 Hypertension 25.3 27.6 30.0 26.7 26.2 24.3 27.4 26.8 <0.001 Antihypertensive tr. 65.6 65.1 63.4 63.7 57.3 64.7 66.3 64.0 NS Dyslipidaemia 21.9 19.1 19.2 19.2 16.2 18.1 22.9 19.5 <0.001 Hypolipidemic tr. 47.1 46.1 38.5 37.1 34.1 33.7 47.8 41.8 <0.001 Diabetes 5.8 5.9 6.1 5.7 4.6 4.0 5.3 5.4 <0.05 Results are expressed as %. Statistical analysis by chi-square. Open in new tab CV risk factor prevalence and management Results in % Leman Mittelland Northwest Zurich East Central Ticino Switzerland p-value Smokers 27.6 26.5 26.7 29.2 29.1 27.4 26.8 27.5 <0.05 Tried to quit smoking 24.5 24.6 25.9 25.7 29.0 31.8 19.0 25.9 <0.001 Hypertension 25.3 27.6 30.0 26.7 26.2 24.3 27.4 26.8 <0.001 Antihypertensive tr. 65.6 65.1 63.4 63.7 57.3 64.7 66.3 64.0 NS Dyslipidaemia 21.9 19.1 19.2 19.2 16.2 18.1 22.9 19.5 <0.001 Hypolipidemic tr. 47.1 46.1 38.5 37.1 34.1 33.7 47.8 41.8 <0.001 Diabetes 5.8 5.9 6.1 5.7 4.6 4.0 5.3 5.4 <0.05 Results in % Leman Mittelland Northwest Zurich East Central Ticino Switzerland p-value Smokers 27.6 26.5 26.7 29.2 29.1 27.4 26.8 27.5 <0.05 Tried to quit smoking 24.5 24.6 25.9 25.7 29.0 31.8 19.0 25.9 <0.001 Hypertension 25.3 27.6 30.0 26.7 26.2 24.3 27.4 26.8 <0.001 Antihypertensive tr. 65.6 65.1 63.4 63.7 57.3 64.7 66.3 64.0 NS Dyslipidaemia 21.9 19.1 19.2 19.2 16.2 18.1 22.9 19.5 <0.001 Hypolipidemic tr. 47.1 46.1 38.5 37.1 34.1 33.7 47.8 41.8 <0.001 Diabetes 5.8 5.9 6.1 5.7 4.6 4.0 5.3 5.4 <0.05 Results are expressed as %. Statistical analysis by chi-square. Open in new tab P89 Dynamics of cardiovascular diseases risk factors in children and adolescents A Alexandr Alexandrov1, E Zvolinskaya1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Hypertension (Prevention & Epidemiology) Aim to evaluate time- and age-specific dynamics of risk factors (RF) in order to substantiate the necessity of early prevention of cardiovascular diseases. Methods the sample of 12-13 year-olds (both sexes) residing in one of Moscow districts was examined. Investigation included blood pressure (BP) (thrice, by mercurial sphygmomanometer according to standard procedure) and blood lipids spectrum measurement, anthropometry. Harmful habits were brought to light by means of questionnaire. 315 examinees were evaluated nine times. Results the prevalence of arterial hypertension (AH) in males increased from 2.5-3% in 13 year-olds to 35% in 35 year-olds and from 1.5-4% to 9% in females accordingly. Risk of AH in adults for adolescents with elevated blood pressure for males and females was 2.3 and 2.9 times higher accordingly than for their peers with normal blood pressure. For the combination of elevated blood pressure and excessive body mass the risk of AH increased 7.5 and 5 times in males and females accordingly as compared to their peers without these RF. 37% and 43% (males and females accordingly) of 13 year-olds with elevated blood pressure had elevated blood pressure as 33-35 year-olds. Every 5th male and every 3th female with AH were characterized by elevated blood pressure in adolescence. Multiple regression analysis shows that predictive value of these parameters for systolic blood pressure after 22 years does not exceed 20%. The prevalence of excessive body mass and obesity was 11.8 and 13.7% in 12-13 year-olds (boys and girls accordingly) as compared to 52.5 and 34.9% in 35 year-olds (male and female accordingly) and the prevalence of hypercholesterinemia - from 11.6 and 18.7% to 44 and 40% accordingly. Before 16 years of age hypercholesterinemia was more prevalent in females, after that - in males. Every 5th male and every 3th female suffered hypercholesterinemia in childhood. Males significantly more often had low level of high density lipoproteins (<1,03 mmol/l). The prevalence of smoking was 7.4 and less than 1% in boys and girls accordingly and 52 and 18.4% in adults. One half of examinees with excessive body mass and obesity in adolescence has them in adulthood too. The number of examinees without RF decreased from 49.9 and 60.9% to 16.4 and 35% in males and females accordingly. Conclusion The prevalence of RF of cardiovascular diseases due to atherosclerosis sharply rises in adolescence and very often continues in adulthood. Elevated blood pressure in adolescence in combination with excessive body mass and obesity are the most significant predictors of AH in adulthood. P90 Elevated cardiac Troponin I as predictor of adverse outcomes in hypertensive patients A Antonio Ramirez Moreno1, JR Siles-Rubio1, C Pera-Rojas1, JC Salas-Serantes1, J Munoz-Bellido1, T Gil2, L Fernandez2, C Medina2, FJ Martinez2 1Cardiology Department. Hospiten,, Estepona, Spain, 2Hospital Costa del Sol, Marbella, Spain Hypertension (Prevention & Epidemiology) Purpose Myocardial damage detected as elevated serum cardiac troponin I (cTnI) indicates increased risk for future cardiac events in patients with chronic heart failure. Whether elevated cTnI is associated with adverse outcomes in patients with hypertension (HT) without left ventricular (LV) systolic dysfunction is unknown. Methods: We measured cTnI levels in 194 patients with essential HT without left ventricular systolic dysfunction (left ventricle ejection fraction ≤ 55%), renal failure, and prior cardiovascular or cerebrovascular diseases and 48 normal controls. Results: Levels of cTnI were elevated (≥ 0.1 ng/mL) in 19 (10%) of the patients with HT and in 0 (0%) of the normal controls (P = 0.04). The rate of diabetes mellitus (DM), the cardiothoracic ratio, plasma B-type natriuretic peptide (BNP) value, and left ventricle mass index were significantly higher in patients with than without elevated cTnI (DM, 9/19 versus 31/175, P = 0.004; cardiothoracic ratio, 58.5 ± 4.2 versus 51.2 ± 5.6%, P = 0.04; BNP, 101.2 ± 138.6 versus 37.2 ± 48.6 pg/mL, P = 0.04; left ventricle mass index, 232 ± 82 versus 148 ± 61 g/m2, P = 0.0001). Kaplan-Meier analysis demonstrated that significantly fewer (P < 0.00001) patients with, than without elevated cTnI remained free of events (hospitalization due to cardiovascular or cerebrovascular disease). Conclusion: cTnI is a novel and useful predictor of future cardiovascular or cerebrovascular events in hypertensive patients. P91 Tackling hypertension in primary care in the west and northwest of Ireland R Regina Kiernan1 1HSE West, Galway, Ireland Hypertension (Prevention & Epidemiology) Purpose This project was a pilot initiative in the west and north west of Ireland to introduce evidence based guidelines for the management of hypertension into primary care. Methods Fourteen GP practices were selected. The 2006 BHS Hypertension guidelines were chosen. A computerized audit tool was developed and integrated into existing patient management software. Management of patients with hypertension over a 1 - 2 week period was audited before and after the introduction of the guidelines and an educational programme. Results Fourteen practices completed the first audit (n = 146) and 13 practices completed the second audit (n = 332). Patients in the second audit had a higher average risk of a cardiac event (10.3% vs 8.8%, p = 0.013). Management The performance of electrocardiograms increased from 46% to 55% (p = 0.07) and of urinalysis increased from 57% to 69% (p = 0.012). Use of a cholesterol lowering agent increased from 42% to 50% (p = 0.110) and the use of aspirin increased from 37% to 50% (p = 0.012). The percentage on two or more anti-hypertensives increased from 56% to 60% (p = 0.338). Of the approximate 30% of patients that were on a single anti-hypertensive agent in the second audit, 32% of patients aged under 55 years were not on the recommended BHS step 1 treatment i.e. either an ACE Inhibitor or an angiotensin-II receptor blocker- a small reduction from 33% in the first audit; and 68% of those aged 55 years and older were not on the recommended treatment i.e. either a calcium channel blocker or a diuretic - the figure was 64% in the first audit. The most common anti-hypertensive treatment used among all age groups was an ACE Inhibitor (43.8% in the first and 43.5% in the second audit). Conclusion The introduction of the BHS hypertension guidelines in these primary care practices led to some improvements in rates for assessing target organ damage, but these rates were low. There was also some improvement in prescribing rates for cholesterol lowering agent and aspirin, but again the rates were low. There was little change in the prescribing pattern for anti-hypertensive agents, though the proportion on two or more agents increased. It was felt that the absence of nationally agreed guidance leads to inconsistent management approaches. The following recommendations were made to improve the management of hypertension: Select and implement a nationally agreed guideline for the management of hypertension in primary care in Ireland. This should be accompained by an audit tool. Formalise training and education for GPs and practice nurses in the national guideline P92 Cholesterol efflux capacity and arterial stiffness in healthy subjects: data from the Brisighella Heart Study Brisighella Heart Study Group, A Arrigo Cicero1, E Favari2, N Ronda2, P Salvi1, MP Adorni2, F Zimetti2, F Bernini2, C Borghi2 1Sant'Orsola-Malpighi Polyclinic, Department of Internal Medicine, Bologna, Italy, 2Pharmacological and Biological Sciences and Applied Chemistries Dept., Parma, Italy Hypertension (Prevention & Epidemiology) Purpose Serum capacity to promote cholesterol efflux from macrophages correlates inversely with carotid intima-media thickness and the likelihood of angiographic coronary artery disease, independently of the high density lipoprotein (HDL) level. We investigated the relationship between serum cholesterol efflux capacity and Pulse Wave Velocity (PWV), as an indicator of arterial stiffness, in healthy subjects. Methods: 99 subjects (40 males, 59 females) were selected from the Brisighella Heart Study cohort for being non-smokers, non-diabetics, untreated with antihypertensive, lipid-lowering or antidiabetic drugs, and without echographically detectable carotid atherosclerotic plaques. Serum cholesterol efflux capacity was measured as aqueous diffusion, total cholesterol efflux and adenosine triphosphate binding cassette A1 (ABCA1)-dependent cholesterol efflux (reflecting mainly high-density lipoprotein function). Carotid-femoral PWV was measured with a high-fidelity tonometer. Results: In the unadjusted model, PWV relates directly with basal aqueous cholesterol diffusion (R = 0.224, P = 0.034) and indirectly with ABCA1-dependent cholesterol efflux (R =  −0.215, P = 0.042). PWV does not correlate with total cholesterol efflux (R = 0.023, P = 0.830). In a stepwise multivariate analysis including age, body mass index, mean arterial pressure, serum low density lipoprotein level serum high-density lipoprotein level, ABCA1-dependent cholesterol efflux, aqueous diffusion, the best PWV predictors were mean arterial pressure (B = 0.83, 95%CI 0.058-0,108), age (B = 0.051, 95%CI 0.028-0.073) and ABCA1-dependent cholesterol efflux (B = −0.298, 95%CI −0.531- −0.066). Conclusions: ABCA1-dependent cholesterol efflux capacity, but not total serum high-density lipoprotein, is a significant predictor of PWV in healthy subjects. This finding points to the relevance of high-density lipoprotein function in vascular modeling and arterial stiffness prevention along life P93 Incident antihypertensive treatment in statin treated subjects: a pharmacoepidemiological report A Arrigo Cicero1, S Saragoni2, L Degli Esposti2, C Borghi1 1Sant'Orsola-Malpighi Polyclinic, Department of Internal Medicine, Bologna, Italy, 2Clin. Com. S.r.l., Ravenna, Italy Hypertension (Prevention & Epidemiology) Purpose Several lines of evidence support that statins may exert a mild, but clinically relevant, antihypertensive effect. The aim of the study was to evaluate the association between low-density lipoprotein cholesterol (LDL-C) level and the incidence of antihypertensive treatment (AHT) in a large population sample. Methods: A population-based cohort of 23,849 subjects from 2 italian Local Health Units (LHU) aged 18 years or older with at least 1 LDL-C measurement and free of AHT at baseline was followed from the LDL-C date until death or December 31, 2009. The cohort was subdivided into two groups (LDL-C < target, LDL-C ≥ target) in which patients were allocated according to guidelines criteria: low-density lipoprotein target value of 100 mg/dL for the diabetes or patients with CV disease and 130 mg/dL for the remaining patients. The incidence of AHT was defined as the presence of at least 1 prescription of the following classes of drugs: ATC: C02 - other AHTs, C03 - diuretics, C07 - beta-blockers, C08 - calcium channel blockers, and C09 - agents that act on the renin-angiotensin system. Results: During the mean follow-up of 1.3 years, 10.4% (n = 1,382) of patients with LDL-C < target and 13.6% (n = 1,442) of patients with LDL-C ≥ target started AHT. Compared with the LDL-C < target group, the LDL-C ≥ target group showed a higher overall incidence rate (7.59 vs 10.78 per 100 person-years, P < 0.001) as well as statistically significant higher rates for the age group category ≤ 45, gender, cardiopathy and for the groups with absence of diabetes, CV disease and statin treatment. In the multivariable Cox regression analysis, compared with LDL-C ≥ target group, the hazard ratio (HR) of AHT was reduced among those with LDL-C < target (HR =  0.91; 95%CI: 0.84-0.98). Other indipendent predictors of incidence of AHT were age, diabetes and CV disease. Conclusions: Cholesterolemia control seems to be associated to a significantly lower incidence of new ATH, and consequently of hypertension, in a large cohort of general population. P94 Relationship between blood pressure, cholesterolemia and serum apolipoprotein B in a large population sample: the Brisighella Heart Study Brisighella Heart Study, A Arrigo Cicero1, S D'addato1, M Rosticci1, F Santi1, M Veronesi1, C Borghi1 1Sant'Orsola-Malpighi Polyclinic, Department of Internal Medicine, Bologna, Italy Hypertension (Prevention & Epidemiology) Purpose An increasing body of evidence support the epidemiological and physiopathological link between hypercholesterolemia and hypertension. Our aim was to evaluate the relationship between cholesterolemia, serum apolipoprotein B (apoB) level and blood pressure in a large sample of general population. Methods: The Brisighella Heart Study (BHS) is a prospective, population-based longitudinal epidemiological investigation. For this study, we analysed the data sampled in the 2008 Brisighella Heart Study population survey, excluding those subjects treated with antihypertensive and/or lipid lowering drugs (M: 1134, W: 1339). The association between blood pressure, LDL-C and apoB has been evaluated by multiple linear regression analysis. Results: In a sex, body mass index, smoking habit, physical activity level and serum creatinine adjusted model, LDL-C appears to significantly related to SBP (B = 0.077, p < 0.001), DBP (B = 0.014, p = 0.026), and PP (B = 0.063, p < 0.001). In subjects aged less than 52 years, LDL-C was significantly associated to SBP and DBP (B = 0.062, 95%CInbsp;= 0.044-0.081, p < 0.001), but not PP. In a sex, body mass index, smoking habit, physical activity level and serum creatinine adjusted model, apoB appears to be mildly but significantly related to SBP (B = 0.166, p < 0.001), DBP (B = 0.071, p < 0.001), and PP (B = 0.095, 95%CI = 0.068-0.123, p < 0.001). In subjects aged less than 52 years, apoB was significantly associated to SBP (B = 0.179, p < 0.001), DBP (B = 0.127, p < 0.001), and PP (B = 0.052, p < 0.001). In subjects aged 52 or more, nor LDL-C neither apoB were significantly associated to neither SBP, DBP or PP. Including in the same model LDL-C and apoB, apoB excluded the predicting role of LDL-C as it regards the SBP, DBP, and PP either in the whole population sample and in the younger subjects. Conclusion: On the basis of our observation, either serum LDL-C and apoB are significantly related to the blood pressure level in a large sample of subjects untreated with antihypertensive and lipid-lowering drugs. This association is stronger in younger subjects than in elderly. ApoB seems to be a stronger predictor of either SBP, DBP and PP than LDL-C. P95 Lifestyle and haemodynamic parameters in high risk asymptomatic patients S Stela Iurciuc1, C Avram2, M Iurciuc1, D Gaita1, L Craciun1, A Avram3, S Ursoniu1, D Berceanu-Vaduva1, S Mancas1 1University of Medicine, Timisoara, Romania, 2West University of Timisoara, Timisoara, Romania, 3Medicover Clinic, timisoara, Romania Hypertension (Prevention & Epidemiology) Introduction The surveys EUROASPIRE I and II indicated a high prevalence of unhealthy lifestyle, cardiovascular risk factors (cv RF) and their inadequate treatment. Objectives The main purpose of this study is to determine the prevalence of cv RF in asymptomatic high-risk patients from Romania. We aimed also to assess and to improve the implementation of ESC 2007 Prevention Guideline into current practice through lifestyle changes and drug therapy optimization. Material and methods we enrolled 325 patients (55,91 ± 9 years, 38% men). Inclusion criteria: high risk asymptomatic patients with antihypertensive and/or hypolipemiant and/or antidiabetic drugs from EUROASPIRE III Romania Primary Care Arm, aged less than 80, without documented atherosclerotic diseases. The patients were followed-up for 18 months by their general practitioners (GP), previously trained by cardiologists; at every 6 month, the GP's reinforced lifestyle changes, optimized drug therapy in order to reach the reccomended targets. At baseline and after 18 month we measured abdominal waist, sistolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), lipids profile, fasting glucose and HbA1. Results The reduction of blood pressure (BP) and pulse pressure is explained both by lifestyle intervention and optimal recommendation of anti-hypertensive drugs. (Table 1) If to the lower blood pressure achieved we apply the weight loss correction for the patients in the group, the blood pressure reduction is approximately 7.2 mmHg (PP reduction is 1.8 mmHg). In hypertensive patients SBP value was significantly reduced in patients who have increased levels of physical activity (p = 0.044), in patients who have applied measures to reduce fat consumption (p = 0.028), in patients who have reduced excessive alcohol intake (p = 0.008). Conclusion: Prevention programmes focused on lifestyle changes are easy to conduct in primary care by GPs, even before drug therapy initiation. Necesity to find practical ways to improve lifestyle interventions has at least the same importance as cardiovascular drugs prescription. Trend of blood pressure parameters Parameters Visit I Visit IV p SBP (mmHg) 146 ± 18.3 136.9 ± 11.7 <0.001 DBP (mmHg) 86.19 ± 11.7 77.76 ± 7,6 <0.001 PP (mmHg) 61.12 ± 13.7 58.67 ± 11.3 0.013 Parameters Visit I Visit IV p SBP (mmHg) 146 ± 18.3 136.9 ± 11.7 <0.001 DBP (mmHg) 86.19 ± 11.7 77.76 ± 7,6 <0.001 PP (mmHg) 61.12 ± 13.7 58.67 ± 11.3 0.013 Values are presented as mean ± standard deviation Open in new tab Trend of blood pressure parameters Parameters Visit I Visit IV p SBP (mmHg) 146 ± 18.3 136.9 ± 11.7 <0.001 DBP (mmHg) 86.19 ± 11.7 77.76 ± 7,6 <0.001 PP (mmHg) 61.12 ± 13.7 58.67 ± 11.3 0.013 Parameters Visit I Visit IV p SBP (mmHg) 146 ± 18.3 136.9 ± 11.7 <0.001 DBP (mmHg) 86.19 ± 11.7 77.76 ± 7,6 <0.001 PP (mmHg) 61.12 ± 13.7 58.67 ± 11.3 0.013 Values are presented as mean ± standard deviation Open in new tab P96 The use of fixed dose combination of ace inhibitor and calcium channel blocker in patients with hypertension discharged for NSTEACS is associated with a favourable prognosis M A Miguel Angel Ramirez-Marrero1, I Vegas-Vegas1, D Gaitan-Roman1, JL Delgado-Prieto1, G Ballesteros-Derbenti1, M De Mora-Martin1 1Regional Hospital Carlos Haya, Malaga, Spain Hypertension (Prevention & Epidemiology) Introduction The use of fixed combinations in the treatment of patients with hypertension has several benefits. One of the most notable is the better adherence to pharmacological treatment. The aim of this study was to analyse the impact of the use of fixed dose combination of ACE inhibitor and calcium channel blocker (dihydropyridine) on the prognosis of hypertensive patients discharged from hospital for an episode of non-ST-segment-elevation acute coronary syndrome (NSTEACS) Methods Prospective analysis of all hypertensive patients consecutively discharged for an episode of NSTEACS, from July 2008 to December 2009. We studied clinical and epidemiological variables, establishing a prognostic analysis based on the use of fixed combination compared with conventional treatment. We completed a median follow-up of 23 months in 100% of cases. Results We included 417 patients, 65.2% men. The mean age was 68 ± 10.4 years. 45.3% of patients were diabetic, 58.5% dyslipidemic and 79.1% the reason for prior admission was unstable angina. They showed a Charlson comorbidity index 2.4 ± 2.1 and a TIMI Risk score of 3 ± 1.4. We found left ventricular systolic dysfunction in 22% of cases. 124 patients (29.7%) were treated with fixed combination of ACEI and calcium channel blocker, and had higher percentage of adherence to treatment compared with patients receiving conventional treatment (88.7% versus 77.8%, p = 0.03), lower cardiovascular death rate after long term-up follow-up (1.6% versus 6.8%, p = 0.02), admission for heart failure (HF) (5.6% versus 11.9%, p = 0.03), admission for a new episode of acute coronary syndrome (ACS) (13.7% versus 21.8%, p = 0.03) and major adverse cardiovascular events (MACE) (17.7% versus 29.4%, p = 0.01). After adjustment, the use of fixed combination predicted lower risk of developing heart failure (OR 0.39, 95% CI, 0.16 to 0.94), acute coronary syndrome (OR 0.55, 95% CI, 0.30 to 0.98) and MACE (OR 0.5, 95% CI, 0.29 to 0.86). Conclusions The use of fixed combination of ACEI and calcium channel blocker (dihydropyridine) in patients with hypertension and history of NSTEACS was associated with a more favorable prognosis. This seems justified by the greater adherence to treatment. P97 Physicians Observational Work on patient Education according to their vascular Risk - POWER Study POWER Study group, G Guy De Backer1 1Ghent University, Ghent, Belgium Hypertension (Prevention & Epidemiology) Introduction The POWER study is a 6-month duration, multicentre, open-label, non-comparative and observational study of hypertensive subjects treated with eprosartan. Objectives: The objectives were to assess the systolic blood pressure (SBP) and the total cardiovascular (CV) risk reduction in a large hypertensive study population under an eprosartan-based therapy. Methods The study was conducted in 16 countries worldwide. The dosage of eprosartan tablets was 600 mg once daily. Three study visits were scheduled: at baseline (V1), then 1 to 3 months (V2) and 6 months (V3) after starting eprosartan therapy. Blood pressure was evaluated at each visit by measuring twice the sitting SBP and the diastolic blood pressure (DBP) over a period of 5 minutes. The total CV risk was assessed at each visit through the SCOREÒ (for all countries except Canada) and Framingham® (for Canada only) risk score systems. Suspected Adverse Drug Reactions (SADR) and heart rate (HR) were recorded. Results The results presented were obtained on an ITT population of 26,192 hypertensive patients. At V1, mean(sd) age was 61.3 ± 12.2 years and mean SBP/DBP were respectively 160.4 ± 14.3/93.6 ± 9.7 mmHg. The main co-morbidities were diabetes (22.6% of patients), left ventricular hypertrophy (19.4%) and atherosclerotic cardiovascular disease (19.3%). The mean change in SBP and DBP between V1 and V3 was respectively of −25.8 ± 14.4 mmHg and −12.6 ± 9.5 mmHg (p < 0.0001). Blood pressure normalization (SBP < 140 mmHg and DBP < 90 mmHg) was achieved in 62.8% of patients. Between V1 and V3, the calculated SCORE® and Framingham® risk decreased of at least one class in 55.9% and 41.0% of patients, respectively. An absolute change in SCOREÓ value was observed in both genders and all age classes, but was more marked in men and older patients (p < 0.001). Significant absolute changes in other risk factors were also observed at V3: reduction of body mass index −0.4 ± 1.2 kg/m2 (p < 0.0001), reduction of total cholesterol −17.1 ± 28.9 mg/dl (p < 0.0001); 6.1% (all countries except Canada) and 5.2% (Canada) smokers stopped smoking. No safety issue was reported after treatment and mean HR remained within clinically acceptable limits throughout the study. Conclusion Control of hypertension within the general framework of total cardiovascular risk management proved to be feasible in daily practice. This study of 6 months duration has confirmed in a large non-selected population the ability to reduce blood pressure, especially its systolic component and, as a result, to decrease the total CV risk. P98 Parity as emerging risk factor for hypertension in perimenopausal women E Elisa Giubertoni1, Y Bartolacelli1, L Bertelli1, G Origliani1, R Rossi1, MG Modena1 1University of Modena & Reggio Emilia, Department of Cardiology, Modena, Italy Hypertension (Prevention & Epidemiology) Purpose The prevalence of hypertension among women steeply increases after menopause, so that at or beyond 60 years of age, women reach higher blood pressure (BP) than men. Whether this increase in blood pressure is related to menopause itself or to other confounding effects, especially age and body mass index (BMI), is still debated. The aim of our study is to investigate if hypertension shows an independent correlation with parity, age at menopause and a series of potential cardiovascular risk factors. Methods We analysed a total of 1000 perimenopausal women, aged 55.2 ± 5.4 years. The median follow-up period was 63.0 months (25°-75° percentiles: 42.7-104.0 months). The study sample consisted of patients who self-referred, between november 1998 and february 2009, to the benessere donna clinic, which is dedicated to menopause-related disorders. Results 360 women (36.0%) had a history of hypertension at baseline. After follow-up, the prevalence of hypertension was 44.8%, diagnosed at a mean age of 52.6 ± 8.4 years. Parity resulted significantly higher among hypertensive patients (1.6 ± 0.9 versus 1.4 ± 0.8; p < 0.001), as well as age (55.9 ± 5.6 versus 54.7 ± 5.2; p = 0.001) and body mass index (27.7 ± 5.1 versus 25.2 ± 4.2; p < 0.001). Conversely, comparisons of hypertensive versus normotensive women revealed no differences in age at menopause (49.9 ± 4.7 versus 49.5 ± 4.5; p = 0.258). Indeed, the multivariate analysis showed that parity (odds ratio [OR]: 1.381; 95% confidence interval [CI]: 1.100-1.734; p = 0.005), age (OR: 1.049; 95% CI: 1.012-1.086; p = 0.008), BMI (OR: 1.125; 95% CI: 1.077-1.174; p < 0.001) and family history of hypertension (OR: 3.235; 95% CI: 2.192-4.773; p < 0.001) were independently related to hypertension. A subanalysis showed that women with an earlier onset of hypertension (<53 years) experienced menopause 2.3 years before their counterparts (48.6 ± 4.6 versus 50.9 ± 4.6; p < 0.001) and had higher prevalence of metabolic syndrome (MS) [82 (40.0%) versus 66 (29.6%); p = 0.026] and family history of hypertension [174 (84.8%) versus 152 (68.2%); p < 0.001]. Conclusions Our study highlights the role of parity as emerging risk factor for hypertension in perimenopausal women. Moreover, it supports the hypothesis that the rise in blood pressure after menopause is due to aging and increased body mass index. Contrariwise, age at menopause gains relevance when hypertension develops early and is part of a dismetabolic frame, represented primarily by a higher prevalence of the metabolic syndrome. P99 The prevalence of coronary heart disease and its major risk factors among the male population of Zagatala region of Azerbaijan N R Natavan Ismayilova1 1Azerbaijan State Doctor's Advanced Training Institute, Baku, Azerbaijan Hypertension (Prevention & Epidemiology) Every year around the world die of cardiovascular disease (CVD) of more than 17 million people, more than half of them - patients with coronary heart disease (CHD) [D'Agostino RB et al., 2000]. Despite advances in diagnosis and treatment tool, coronary heart disease remains the most common disease among people of working age, leading to high morbidity and mortality. Out of this situation, only one - to prevent the development of most diseases by intensive exposure to the cause, its formative, i.e. implementation of measures for primary prevention. Objective To study the prevalence of coronary heart disease and its major risk factors in population-based study of a random sample of the male population in a mountainous area of Azerbaijan Republic. Material and methods 1295 men in the age 20-59 years were surveyed. The examination included filling in the questionnaire for revealing principal chronic no infection diseases, levels of physical activity, presences of a habit of smoking and alcohol consumption, anthropometry with calculation of a biomass index (BMI), an electrocardiogram-research in 12 leads, doppler-echocardiografic research with detection diastolic function of left ventricle, measurement of blood pressure on the right hand twice with calculation of an average arithmetic mean, definition of the average concentration of lipids in blood plasma. Results The study found that the prevalence of coronary heart disease in this population was 7.18 ± 0.7%. Hypertension was detected in 40.3 ± 1.4% of all surveyed. Alcohol consumption was recorded at 71.5 ± 1.3%, and smokers were 54.9% of all surveyed. Overweight and/or obesity was observed in 40.9 ± 1.4%, dyslipidemia in 59 ± 2.8%, and low physical activity 29.0 ± 1.3%. In the absence of coronary heart disease at least one risk factor were 94.09% of the patients, and in the presence of coronary heart disease 97.71%. Conclusions Examined population characterized by a very high prevalence of major risk factors for coronary heart disease. This indicates an unfavorable prognostic epidemiological situation dictates the need for primary prevention of coronary heart disease. P100 The age at which diastolic blood pressure begins to fall occurs much earlier than indicated by Framingham. DW Armstrong1, D Brouillard1, M Murray Matangi1 1Kingston Heart Clinic, Kingston, Canada Hypertension (Prevention & Epidemiology) Purpose The Framingham data regarding the change in blood pressure with age indicates a progressive and linear increase in systolic blood pressure with advancing age. The change in diastolic blood pressure with age is quite different. The diastolic blood pressure gradually increases until age 55 years and then progressively falls in a curvilinear manner. The purpose of our investigation was to see if this data could be reproduced in the current era. Methods Our cardiology database was searched for all 24hr ambulatory blood pressure monitors (ABPM). A scattergram of age versus both systolic and diastolic blood pressure was produced for 18,987 ABPMs. Linear regression was performed for the systolic blood pressure data points and 2nd to 4th order polynomial regression was performed for the diastolic blood pressure data points. The inflection point was calculated using differential calculus. This is the point on the diastolic polynomial regression curve where the curvature sign changes. This inflection point corresponds to the age at which diastolic blood pressure begins to decrease. Results See Figure 1. The inflection point as described above was calculated as 42 years. Conclusions Our data indicates that the age at which diastolic blood pressure begins to fall occurs much earlier than is generally accepted. In fact 13 years sooner than indicated by the Framingham data. The reasons for this difference are unknown at this time but could be related to the fact that the Framingham data is a population based community study and our population are patients referred for investigation of suspected hypertension, suspected white coat hypertension or assessment of hypertension control. It is possible that increased arterial stiffness may be occurring earlier in our predominantly hypertensive population than in the general Framingham population, many of whom were normotensive. Open in new tabDownload slide P101 Efficient use of home blood pressure measurement MAJ Niessen1, BJH Van Den Born2, CK Van Kalken1, RA Kraaijenhagen1 1NIPED, Amsterdam, Netherlands, 2Academic Medical Center, Department of Vascular Medicine, Amsterdam, Netherlands Hypertension (Prevention & Epidemiology) Purpose Home blood pressure (BP) measurement is an easy accessible, cost-effective tool to monitor blood pressure without interference of the white coat effect. Home blood pressure measurement is better correlated with daytime ambulatory blood pressure than office blood pressure. Data concerning the use of home blood pressure measurement as a screening tool for hypertension is limited. We assessed the performance of home blood pressure measurement as a screening tool for hypertension and validated cut-off values in a large worksite health promotion program. Method From March 13th 2011 until September 23rd 2011 a total of 1479 employees (from 16 Dutch companies) completed a series of home blood pressure measurements. Six double measurements were collected during 3 consecutive days. Attendees who completed the program before the 13th of April 2011 were assigned to the derivation cohort (n = 945). Receiver operating characteristics (ROC) analysis was used to determine cut off values. A validation cohort at high (n = 233) and low (n = 298) cardiometabolic risk was composed from attendees who completed the program between April 13th 2011 and September 23th 2011. False negatives were analysed using the SCORE risk function. Results Cut off values were chosen with the intent of limiting the percentage of false negatives at 5%. Lower limit cut off values for the 1st (DIA ≥ 80 and SYS ≥ 135) and 2nd (DIA ≥ 80 and SYS ≥ 130) double blood pressure measurement were chosen to rule out hypertension. Upper limit cut off values were chosen for the 1st (DIA ≥ 110 and SYS ≥ 155) and 2nd (DIA ≥ 95 and SYS ≥ 160) double measurements to diagnose hypertension. Two double measurements were sufficient to classify 72% of the individuals from the low risk validation cohort with 3,6% false negatives. For 59% of the individuals from the high risk validation cohort, two double measurements were sufficient to either rule out or diagnose hypertension with 6,6% false negatives. Two false negatives (2,2%) had an indication for cardiovascular risk treatment (SCORE ≥ 5). Discussion The current study demonstrates that home blood pressure can be used as a swift and reliable tool for diagnosing hypertension in a working population at high and low cardiovascular risk. P102 Awareness about hypertension and compliance in Russian bank employers OP Oxana Rotar1, LS Korostovtseva1, VV Ivanenko1, KT Kitalaeva1, SB Anokhin1, VN Solntsev1, AO Konradi1, EV Shlyakhto1 1Almazov Federal Center of heart, blood and endocrinology, Saint Petersburg, Russian Federation Hypertension (Prevention & Epidemiology) Purpose The aim of the study to appreciate the awareness about elevated blood pressure level and compliance to antihypertensive drug intake in bank employers with mental work. This population is well-educated, has regular physical checking and should take self care about health. Methods 1600 bank office workers with age from 20 to 59 years were screened at their working places in 5 bank offices in St. Petersburg in June-August 2008. The responding rate was 86%. The informed consent was obtained from all participants. Antihypertensive medication (yes or no) and its character were registered specially. All subjects were interviewed with special questionnaire which included personal data, life style risk factors, medical history. Blood pressure (BP) was measured on right arm in the sitting position after 5 minute rest tree times with an interval of 2 minutes. The mean value of the second and third blood pressure measurement was calculated. Results see table Conclusions The prevalence of hypertension is high, especially in males in spite of predominantly females are working in bank offices. Males have better awareness about hypertension and worse compliance to antihypertensive drug intake. Some people (10%) regulary take antihypertensive therapy and consider them healthy without hypertension (HTN). Control of hypertension was poor in both group independently of gender in spite of good intellectual level in mentally working people. Prevalence of HTN and complaince parameter all (n = 1561) males (n = 338) females (n = 1223) p BP>140/90 mm Hg 364 (23,3%) 153 (45,3%) 211 (17,3%) <0,0001 Awareness of HTN 366 (23,4%) 111 (32,8%) 311 (25,4%) <0,0001 Awareness of HTN and no antihypertensive therapy 237 (65%) 82 (73,8%) 155 (60,7%) <0,005 No awareness and antihypertensive therapy 14 (10,5%) 3 (10%) 11 (10,5%) 0,82 Intake of antihypertensive therapy 133 (8,5%) 30 (8,9%) 103 (8,4%) 0,79 Therapy and BP < 140/90 mm Hg 29 (1,9%) 5 (1,5%) 24 (2,0%) 0,56 parameter all (n = 1561) males (n = 338) females (n = 1223) p BP>140/90 mm Hg 364 (23,3%) 153 (45,3%) 211 (17,3%) <0,0001 Awareness of HTN 366 (23,4%) 111 (32,8%) 311 (25,4%) <0,0001 Awareness of HTN and no antihypertensive therapy 237 (65%) 82 (73,8%) 155 (60,7%) <0,005 No awareness and antihypertensive therapy 14 (10,5%) 3 (10%) 11 (10,5%) 0,82 Intake of antihypertensive therapy 133 (8,5%) 30 (8,9%) 103 (8,4%) 0,79 Therapy and BP < 140/90 mm Hg 29 (1,9%) 5 (1,5%) 24 (2,0%) 0,56 Open in new tab Prevalence of HTN and complaince parameter all (n = 1561) males (n = 338) females (n = 1223) p BP>140/90 mm Hg 364 (23,3%) 153 (45,3%) 211 (17,3%) <0,0001 Awareness of HTN 366 (23,4%) 111 (32,8%) 311 (25,4%) <0,0001 Awareness of HTN and no antihypertensive therapy 237 (65%) 82 (73,8%) 155 (60,7%) <0,005 No awareness and antihypertensive therapy 14 (10,5%) 3 (10%) 11 (10,5%) 0,82 Intake of antihypertensive therapy 133 (8,5%) 30 (8,9%) 103 (8,4%) 0,79 Therapy and BP < 140/90 mm Hg 29 (1,9%) 5 (1,5%) 24 (2,0%) 0,56 parameter all (n = 1561) males (n = 338) females (n = 1223) p BP>140/90 mm Hg 364 (23,3%) 153 (45,3%) 211 (17,3%) <0,0001 Awareness of HTN 366 (23,4%) 111 (32,8%) 311 (25,4%) <0,0001 Awareness of HTN and no antihypertensive therapy 237 (65%) 82 (73,8%) 155 (60,7%) <0,005 No awareness and antihypertensive therapy 14 (10,5%) 3 (10%) 11 (10,5%) 0,82 Intake of antihypertensive therapy 133 (8,5%) 30 (8,9%) 103 (8,4%) 0,79 Therapy and BP < 140/90 mm Hg 29 (1,9%) 5 (1,5%) 24 (2,0%) 0,56 Open in new tab P103 Reduction of cardiovascular risk with a nutraceutical combination based on Orthosiphon, Berberine, Red Yeast Rice, and Coenzyme Q10 in patients with high-normal pressure A Macchi1, I Franzoni2, F Buzzetti3, I Rosa2, MC Pedrigi2, LM Fuse'1, L Cattaneo1, C Benvenuti4 1Busto Arsizio Hospital, Department of Cardiology, Busto Arsizio (VA), Italy, 2San Raffaele Hospital, Department of Cardiology, Milan, Italy, 3Foundation Macchi-Varese, Varese, Italy, 4Medical Department, Rottapharm|Madaus, Monza, Italy Hypertension (Prevention & Epidemiology) Purpose The European Guidelines define high-normal pressure (HNP) as systolic blood pressure (SBP) between 130 and 139 mmHg or diastolic blood pressure (DBP) between 85 and 89 mmHg. Many studies demonstrated that HNP correlates with other cardiovascular (CV) risk factors, presence of subclinical organ damage, development of hypertension and finally with an increase of global CV risk. Aim of this pilot study was to evaluate the efficacy and tolerability of a patented nutraceutical combination on blood pressure and on lipid profile in pts with HNP, investigate the presence of other CV risk factors and subclinical organ damage, calculate CV risk before and after treatment. Methods 45 Caucasian subjects (SBJ) with HNP (38 males, 34 ± 7.1 years) underwent to CV screening through physical examination, transthoracic echocardiography, carotid duplex sonography, albuminuria. After the enrolement, we treated them with Orthosiphon stamineus 300 mg, berberine 500 mg, red yeast rice 60 mg, policosanol 10 mg, coenzyme Q10 15 mg and folic acid 0.2 mg for 6 weeks. At baseline and after 6 weeks, we evaluated SBP and DBP in office and with 24h-monitoring; total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, uricemia and calculated Framingham 10-years CV risk (FCV). Results 62% SBJ were smokers, 41% overweight (BMI 28,6 ± 1.5 kg/m2; abdominal circumference 91,7 ± 4.1 cm), 37% had intimal media thickening, 12% carotid plaques, 24% ventricular hypertrophy and 1% albuminuria. After 6-weeks we observed a significant reduction in SBP (136 ± 5,1 vs 122 ± 1,6 mmHg; p < 0,01) and DBP (86 ± 4,5 vs 73,4 ± 3,2 mmHg; p < 0,01) in office; SBP (138 ± 3 vs 119 ± 2,1 mmHg; p < 0,01) and DBP (87 ± 2,5 vs 71,1 ± 1,3 mmHg; p < 0,01) during 24h monitoring. We observed a significant reduction in total cholesterol (201 ± 1.8 vs 186 ± 2.1 mg/dl, p < 0,01), low-density lipoprotein (133 ± 3.7 vs 113 ± 1.5 mg/dl, p < 0.01), triglycerides (162 ± 1.6 vs 141 ± 2.4, p < 0.01), glucose (108 ± 3,2 vs 99 ± 1,11 mg/dl; p < 0,01), uricemia (8,6 ± 2,1 vs 5,3 ± 3,1; p < 0,01) and a significant increase of high-density lipoprotein (36 ± 3.1 vs 45 ± 1.4 mg/dl, p < 0.01). FCV was significantly reduced (7 ± 2,1 vs 2 ± 1,8%; p < 0,01). The supplement combination was well tolerated with no side effects. Conclusions The combination of Orthosiphon stamineus, berberine, red yeast rice and coenzyme Q10 significantly reduces SBP and DBP and levels of total cholesterol, low-density lipoprotein, triglycerides and increases high-density lipoprotein with consequent reduction of CV Risk in a short period without additional side effects in SBJ with HBP. P104 The role of elevated pulse pressure in the field of primary prevention as an early sign to predict electrocardiogram alterations caused by left ventricular hypertrophy M E Marcus Etienne Moellenberg1, F Van Buuren1, J Gilis-Januszewski1, A Raethling1, M Vlachojannis1, S Hossain1, B Koerber1, D Horstkotte1, KP Mellwig1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Hypertension (Prevention & Epidemiology) Purpose: Puplse pressure (pp) is a stronger predictor for cardiovascular risk than systolic (sbp) or diastolic bp (dbp) alone, which has already be shown for people above 60 years. We analysed the impact of pp over 50 mmHG on the R-/ S-amplitude, ST-segment and T-wave to clarify if pathological pp elevation caused electrocardiogram alterations which predict a beginning left ventricular hypertrophy in primary prevention. Methods In 181 basically ethnic German employees, common cardiovascular risk factors were obtained including blood samples and an automatically analysed electrocardiogram (CardioLine®) (tab 1). We found 133 (74%) pts. with pp over 50 mmHG and correlated them to the amplitude of R- and S-spike in precordial leads (V5 or V6 and V1 or V2) according to the the Sokolow-Lyon-Index, to the ST-segment in I, aVL, V5 and V6 (80 ms after J-point), and to the T-wave in the previously mentioned leads. Results 78% of patient without any remarkable cardiovascular medical history had a total cardiovascular risk level (Heart Score) ≤ 2%, 11% a risk level of 3-4%, and 11% a risk level of 5-10%. According to Spearman's rank correlation (rs) it was not possible to provide evidence of a relationship between elevated pp and electrocardiogram alterations neither to the R-/S-amplitude (rs = −0.102, p > 0.05) and ST-segment (rs = −0.209, p = 0.016) nor to the T-wave (rs = −0.243, p = 0.005) morphology. Conclusions Pp is not an appropriate parameter to detect early electrocardiogram alterations related to a beginning left ventricular dysfunction or hypertrophy. Nevertheless we found about 74% of participants with the mean age of 42 years with elevated pp as a predictor for cardiovascular risk. Over the years this collective is supposed to develop severe cardiovascular diseases and should be followed up. Tab. 1 mean ± SD range Age years 42 ± 11 19 - 61 Gender female/male (%) 38/95 (29/71) – LDL/HDL ratio 2.6 ± 1.1 0.8-7.4 BMI kg/m2 28 ± 6 18 - 48 Pulse pressure mmHG 63 ± 9 50-98 HbA1C (DCCT) % 5.5 ± 0.4 4.7-6.8 Heart Score % 2.1 ± 2.1 1-10 mean ± SD range Age years 42 ± 11 19 - 61 Gender female/male (%) 38/95 (29/71) – LDL/HDL ratio 2.6 ± 1.1 0.8-7.4 BMI kg/m2 28 ± 6 18 - 48 Pulse pressure mmHG 63 ± 9 50-98 HbA1C (DCCT) % 5.5 ± 0.4 4.7-6.8 Heart Score % 2.1 ± 2.1 1-10 Baseline data in 133 pts. with pp > 50 mmHG Open in new tab Tab. 1 mean ± SD range Age years 42 ± 11 19 - 61 Gender female/male (%) 38/95 (29/71) – LDL/HDL ratio 2.6 ± 1.1 0.8-7.4 BMI kg/m2 28 ± 6 18 - 48 Pulse pressure mmHG 63 ± 9 50-98 HbA1C (DCCT) % 5.5 ± 0.4 4.7-6.8 Heart Score % 2.1 ± 2.1 1-10 mean ± SD range Age years 42 ± 11 19 - 61 Gender female/male (%) 38/95 (29/71) – LDL/HDL ratio 2.6 ± 1.1 0.8-7.4 BMI kg/m2 28 ± 6 18 - 48 Pulse pressure mmHG 63 ± 9 50-98 HbA1C (DCCT) % 5.5 ± 0.4 4.7-6.8 Heart Score % 2.1 ± 2.1 1-10 Baseline data in 133 pts. with pp > 50 mmHG Open in new tab P105 Application of primary prevention is inferior to secondary prevention management of hypertension in a community based population at heightened cardiovascular risk. Data from the STOP HF study. The STOP HF investigators, CM Conlon1, CC Kelleher1, IR Dawkins2, E Tallon2, L Mc Donald3, M Ledwidge2, K Mc Donald2 1University College Dublin, School of Public Health, Physiotherapy & Population Science, Dublin, Ireland, 2St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland, 3University College Dublin, Dublin, Ireland Hypertension (Prevention & Epidemiology) Purpose Management of hypertension in primary care in Ireland has received much focus and support in recent times via the application of structured forms of care such as the Heartwatch programme for secondary prevention and risk assessment tools such as SCORE for primary prevention. These rigorous approaches to cardiovascular (cv) risk management should result in increased application of cardio-protective therapies and improved control of global cv risk. We sought to examine the blood pressure health of an Irish primary care population at heightened cv risk. Methods Analysing the data of the STOP HF study; a community based cohort of adults >40 years of age with ≥ 1 cv risk factor; we observed hypertension in terms of diagnostic prevalence and clinical blood pressure readings at the baseline study visit. We calculated SCORE (Systematic Coronary Risk Evaluation) risk on all participants. We dichotomised the participants into those getting primary or secondary prevention management of cv risk (secondary prevention was defined by having coronary disease, arrhythmia and or diabetes). Using t-tests, comparisons were made between these groups. Results The entire secondary prevention group (n = 470) were classified as having a SCORE risk ≥ 5% while 31% of the primary prevention group (n = 570) had a SCORE risk ≥ 5%. The secondary prevention group were older with fewer smokers (both p < .0001) and did not differ in terms of diagnosis of hypertension. Beta blocker and ACE inhibitor therapy were more frequently applied in the secondary prevention group (both p < .001), but there was no difference in the application of other blood-pressure lowering therapies. Comparing those on treatment for hypertension, 75% of males and 65% of females were sub-optimally controlled. Comparing those with SCORE ≥ 5% across both groups; mean systolic and diastolic blood pressure was significantly higher in the primary prevention group (145mmHg versus 155mmHg and 78mmHg versus 85mmHg respectively, both p < .001). Conclusion This data suggests that management of hypertension in secondary prevention cohorts is superior to that in primary prevention, despite older age and heightened cv co-morbidity. This is likely due to increased vigilance in this setting via programmes such as Heartwatch and specialist out-patient clinics. Increased attention is warranted in the primary prevention of cv disease, particularly in the setting of heightened SCORE risk. P106 Value of routine potassium measurement for the detection of hypokalemia in uncontrolled hypertensive patients on diuretic therapy. K Konstantinos Farsalinos1, I Trikilis1, A Kostopoulou1, A Spyrou1, E Livanis1, V Voudris1 1Onassis Cardiac Surgery Center, 2nd Department of Cardiology, Athens, Greece Hypertension (Prevention & Epidemiology) Purpose Hypokalemia is a known side effect of diuretic therapy in hypertensive patients. There are reports that it lowers the benefit of blood pressure reduction on heart disease prevention and may contribute to inadequate hypertension control. The purpose of this study was to examine the prevalence of hypokalemia and to estimate the effect of low potassium levels on blood pressure levels in uncontrolled hypertensive patients treated with diuretics. Methods This was a prospective observational study. Consecutive patients with known hypertension, treated with medications including a diuretic, who presented to the emergency department with uncontrolled hypertension, were enrolled. Chronic renal failure, abnormal serum creatinine levels and hypertensive emergency were exclusion criteria. Blood pressure, serum creatinine and potassium levels were measured in all patients. They were also asked to report any recent change in antihypertensive medications dosage or addition of a new agent and time since last measurement of serum potassium levels. Results One-hundred and seventy patients (112 males) participated in the study. Thirteen (7.6%) were treated with diuretic monotherapy (thiazides or loop diuretics). The rest were on combination of 2 or more antihypertensives that included inhibitors of renin-angiotensin system in 67.1%, calcium-channel blockers in 37.6%, β-blockers in 22.9%, and potassium-sparing diuretics in 11.8% of the patients. Hypokalemia (serum potassium<3.5mEq/l) was found in 24 (14.1%) of the patients. They had similar systolic (170 ± 13 mmHg vs 167 ± 11 mmHg, p = 0.241) and diastolic (88 ± 11 mmHg vs 88 ± 9 mmHg, p = 0.805) blood pressure and serum creatinine levels (1.02 ± 0.13 mg/dl vs 1.02 ± 0.16 mg/dl). No correlation was found between blood pressure and serum potassium levels. In multivariate analysis, age (OR = 1.08, 95% CI = 1.01-1.14, p = 0.025), recent change in medications (OR = 5.1, 95% CI = 1.65-15.77, p = 0.005), and more than 6 months since last serum potassium measurement (OR = 6.45, 95% CI = 1.96-21.27, p = 0.002) were independently associated with hypokalemia. Monotherapy with diuretics was also marginally associated with hypokalemia (OR = 5.74, 95% CI = 1.06-31.14, p = 0.043). Conclusions There is a significant prevalence of hypokalemia in hypertensive patients receiving diuretic therapy that present with uncontrolled hypertension. It is important to routinely evaluate potassium levels in this population, especially in older patients and those with recent modifications in antihypertensive therapy and long time since last potassium level monitoring. P107 Studies of blood pressure measurement in community pharmacy K Karen Rossi1, M Henman1 1Trinity College Dublin, Dublin, Ireland Hypertension (Prevention & Epidemiology) Hypertension is a leading risk factor for premature cardiovascular morbidity which affects nearly 852,000 adults in Ireland. Despite the wide range of drug treatments blood pressure control can be difficult to achieve in patients. This study investigated the pharmacist's role in the measurement of blood pressure control in patients attending a community pharmacy. In particular the study set out to evaluate the feasibility of providing an ambulatory blood pressure monitoring service in a group of community pharmacies. This study incorporated a number of different methodologies: a study was conducted to offer a free blood pressure measurement to all customers collecting anti-hypertensive medication in the pharmacy over the course of a month. An ambulatory blood pressure monitoring service was established on a pilot six month basis in 7 community pharmacies and the uptake of the service was evaluated. The views of customers, pharmacists and pharmacy staff who provided the service was assessed through an anonymous questionnaire. Responses were coded and analysed using SPSS v. 16. 231 customers in seven pharmacies were offered a free blood pressure check during the one month study period. Out of these 88 eligible customers accepted the offer. Of the customers who had obtained the measurement 42% had uncontrolled blood pressure (a reading of > or = 140/90mmHg). During the two month period of assessment of the ambulatory blood pressure monitoring service 13 customers received the service, these all took place in one pharmacy and 54% were referred to receive the ambulatory service by their general practitioner. The ambulatory blood pressure measurements identified six cases of nocturnal hypertension, one case of white coat hypertension and four cases of white coat effect. The study identified a large proportion of customers who are attending a pharmacy on a regular basis to collect anti-hypertensive medication and who are not receiving the optimal treatment and care to manage their hypertension. It was recognised that there are difficulties in achieving this blood pressure control in individual patients and that pharmacists can provide services to evaluate blood pressure measurements. Providing an ambulatory blood pressure monitoring service in community pharmacy is feasible and appeared to have a high dependence on local general practitioners views of the service. P108 Detection of subclinical target organ damage for improved risk prediction in hypertensive patients M Marta German-Sallo1, P Kikeli1, D Szentendrey1, Z Preg1, L Farkas1, G Dosa1, M Hubatsch1, A Bocicor1, M Szabo1 1University of Medicine & Pharmacy, Targu Mures, Romania Hypertension (Prevention & Epidemiology) Hypertension leads to cardiovascular events and death through intermediate stages, which are represented by asymptomatic alterations of the cardiovascular system and the kidney. Thorough assessment of target organ damage is essential in risk profile evaluation. Purpose The aim of this study was the evaluation of presence of preclinical organ damage in hypertensive patients and whether they together with SCORE improve the selection of apparently healthy subjects for primary prevention. Methods We included 93 patients with essential hypertension without known cardiovascular or renal disease and without symptoms. The study was prospective, and was conducted in an ambulatory cardiology clinical setting. We calculated the 10 year risk of cardiovascular death using the SCORE risk chart for a high risk population. We assessed the presence of target organ damage in the heart, blood vessels and kidney determining creatinin level, microalbuminuria and estimated glomerular filtration rate, ankle-brachial index, and performing electrocardiogram, echocardiography and carotid artery ultrasound. Results 56 (60%) were male and 37 (40%) female. Mean age was 60,29 year. According to SCORE chart 14 (15%) patients had moderate risk, 37 (40%) patients had high risk and 42(45%) had very high risk. Heart was affected in 77 (82%) patients (left ventricular hypertrophy, silent ischaemia, atrial fibrillation). 78 (83,87%) patients had kidney dysfunction. Vessels showed signs of subclinical atherosclerosis in 63 (67,74%) patients. Overall 89 (96%) patients had early signs of target organ damage. In 63 (67,7%) patients this could be diagnosed simply by determining the creatinin level and calculating the glomerular filtration rate, this number increased to 67 (72%) when electrocardiogram was added, to 85 (91,4%) by measuring ankle-brachial index and microalbuminuria, cardiac and carotid ultrasound detecting the remaining 4 cases. Performing these additional diagnostic tests besides calculating the SCORE risk led to a substantial reclassification of risk, 15% of patients with moderate risk being shifted to high and very high risk category. Conclusions Prevalence of subclinical target organ damage was very high in our study. Most of these could be detected with the minimum work -up recommended by the guidelines. The combined used of SCORE and all these tests led to improved risk prediction especially in the intermediate category, having major influence on risk stratification and recommendations on primary prevention. P109 Screening for hypertension among healthy adult volunteer blood donors S Stephen Eason1, S Goudar1, J Centilli1, MH Sayers2 1Carter BloodCare, Bedford, United States of America, 2University of Texas Southwestern Medical Center, Dallas, United States of America Hypertension (Prevention & Epidemiology) Purpose Hypertension is a major contributor to cardiovascular disease, which is the leading cause of death in Europe and the United States. Since hypertension progresses asymptomatically over a period of time, early screening and identification of individuals at risk is essential. The volunteer blood donor setting offers a community based opportunity to provide such screening. We decided to use this setting to compare the prevalence of hypertension in different groups of adults according to their gender, age, and ethnicity. Methods Blood pressure was measured using automated equipment on 56,470 volunteer blood donors aged 18 or older. Hypertension was defined as a systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg. Results Hypertension occurred more often in males than females and increased with age in all ethnicities. The risk for hypertension was greatest in blacks. Conclusion Blood donor screening provides the opportunity to identify hypertension in an ostensibly healthy subset of the population. Although hypertension was detected across all age groups, genders, and ethnicities, this scrutiny could be of particular value to the younger population, who are the least likely to have regular screening. Since many volunteers donate frequently, the blood donor setting is also an opportunity to monitor individuals' risks for hypertension over time. Percentage of Hypertensive Blood Donors Age 18-39 40-64 ≥ 65 Gender M F Total M F Total M F Total Black n = 2,710 16.4% 5.3% 10.9% 28.7% 21.1% 25.1% 38.4% 32.7% 38.4% Caucasian n = 48,802 13.1% 4.0% 8.3% 21.5% 11.9% 17.1% 31.5% 25.8% 29.3% Hispanic n = 4,958 13.1% 3.9% 7.9% 20.1% 12.3% 13.3% 40.0% 22.5% 31.3% Age 18-39 40-64 ≥ 65 Gender M F Total M F Total M F Total Black n = 2,710 16.4% 5.3% 10.9% 28.7% 21.1% 25.1% 38.4% 32.7% 38.4% Caucasian n = 48,802 13.1% 4.0% 8.3% 21.5% 11.9% 17.1% 31.5% 25.8% 29.3% Hispanic n = 4,958 13.1% 3.9% 7.9% 20.1% 12.3% 13.3% 40.0% 22.5% 31.3% Open in new tab Percentage of Hypertensive Blood Donors Age 18-39 40-64 ≥ 65 Gender M F Total M F Total M F Total Black n = 2,710 16.4% 5.3% 10.9% 28.7% 21.1% 25.1% 38.4% 32.7% 38.4% Caucasian n = 48,802 13.1% 4.0% 8.3% 21.5% 11.9% 17.1% 31.5% 25.8% 29.3% Hispanic n = 4,958 13.1% 3.9% 7.9% 20.1% 12.3% 13.3% 40.0% 22.5% 31.3% Age 18-39 40-64 ≥ 65 Gender M F Total M F Total M F Total Black n = 2,710 16.4% 5.3% 10.9% 28.7% 21.1% 25.1% 38.4% 32.7% 38.4% Caucasian n = 48,802 13.1% 4.0% 8.3% 21.5% 11.9% 17.1% 31.5% 25.8% 29.3% Hispanic n = 4,958 13.1% 3.9% 7.9% 20.1% 12.3% 13.3% 40.0% 22.5% 31.3% Open in new tab P110 The prevalence and risk factors of prehypertension with impaired fasting glucose among local residents aged 45 or over in Chuncheon city, Korea Hallym Aging Study, H H Choi1, KS Hong1, DH Yoon1 1Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon, Korea, Republic of Hypertension (Prevention & Epidemiology) Both prediabetes and impaired fasting glucose (IFG) have been strongly associated with cardiovascular disease. But there have been few studies of the epidemiology and risk factors of prehypertension with IFG. By analysing cross-sectional cohort data from total 918 individuals aged 45 or over (men 384, women 534) who live in Chuncheon city, Korea, we evaluated the prevalence and risk factors of prehypertension with IFG among local residents. The prehypertension was defined as systolic blood pressure is from 120 to 139 mmHg, and/or diastolic blood pressure is from 80 to 89 mmHg. The IFG was defined as fasting serum glucose concentration is from 100 to 125 mg/dl. The prevalence of prehypertension with IFG was 6.3% (58 of total 918, men 29, women 29). The prevalence of normotension with normoglycemia was 11.9% (109 of total 918, men 41, women 68). An univariate analysis showed body mass index, waist circumference, gamma-glutamyltransferase, uric acid, total cholesterol, triglyceride were significantly higher in prehypertension with IFG group than normotension with normoglycemia group. A multivariate analysis showed only serum triglyceride concentration was significantly associated with coexisting prehypertension and IFG group (OR 3.24, 95% confidence interval 1.532 - 6.909. p-value 0.002). These data suggested that the prevalence of prehypertension with IFG was high, and high serum triglyceride concentration was independent risk factor of prehypertension with IFG among local residents men aged 45 or over in Chuncheon city, Korea. Table 1 baseline characteristics Prehypertension with IFG n = 58 Normotension with normoglycemida n = 109 p-Value Age, years 68.1 ± 7.3 66.5 ± 10.9 0.236 Male, n(%) 29(50.0%) 41(37.6%) 0.122 Waist circumference, cm 87.4 ± 7.5 82.1 ± 7.8 <0.0001 Body mass index, kg/m2 25.6 ± 2.9 23.6 ± 3.2 <0.0001 Gamma-glutamyltransferase, IU/L 47.2 ± 63.4 25.9 ± 37.3 0.007 Uric acid, mg/dl 5.2 ± 1.3 4.4 ± 1.5 0.001 Total cholesterol, mg/dl 201.4 ± 33.7 193.7 ± 37.1 0.191 LDL-cholesterol, mg/dl 113.3 ± 33.5 115.3 ± 32.0 0.706 HDL-cholesterol, mg/dl 51.2 ± 15.3 52.0 ± 17.4 0.759 Triglyceride, mg/dl 184.2 ± 94.4 131.6 ± 66.9 <0.0001 Prehypertension with IFG n = 58 Normotension with normoglycemida n = 109 p-Value Age, years 68.1 ± 7.3 66.5 ± 10.9 0.236 Male, n(%) 29(50.0%) 41(37.6%) 0.122 Waist circumference, cm 87.4 ± 7.5 82.1 ± 7.8 <0.0001 Body mass index, kg/m2 25.6 ± 2.9 23.6 ± 3.2 <0.0001 Gamma-glutamyltransferase, IU/L 47.2 ± 63.4 25.9 ± 37.3 0.007 Uric acid, mg/dl 5.2 ± 1.3 4.4 ± 1.5 0.001 Total cholesterol, mg/dl 201.4 ± 33.7 193.7 ± 37.1 0.191 LDL-cholesterol, mg/dl 113.3 ± 33.5 115.3 ± 32.0 0.706 HDL-cholesterol, mg/dl 51.2 ± 15.3 52.0 ± 17.4 0.759 Triglyceride, mg/dl 184.2 ± 94.4 131.6 ± 66.9 <0.0001 Open in new tab Table 1 baseline characteristics Prehypertension with IFG n = 58 Normotension with normoglycemida n = 109 p-Value Age, years 68.1 ± 7.3 66.5 ± 10.9 0.236 Male, n(%) 29(50.0%) 41(37.6%) 0.122 Waist circumference, cm 87.4 ± 7.5 82.1 ± 7.8 <0.0001 Body mass index, kg/m2 25.6 ± 2.9 23.6 ± 3.2 <0.0001 Gamma-glutamyltransferase, IU/L 47.2 ± 63.4 25.9 ± 37.3 0.007 Uric acid, mg/dl 5.2 ± 1.3 4.4 ± 1.5 0.001 Total cholesterol, mg/dl 201.4 ± 33.7 193.7 ± 37.1 0.191 LDL-cholesterol, mg/dl 113.3 ± 33.5 115.3 ± 32.0 0.706 HDL-cholesterol, mg/dl 51.2 ± 15.3 52.0 ± 17.4 0.759 Triglyceride, mg/dl 184.2 ± 94.4 131.6 ± 66.9 <0.0001 Prehypertension with IFG n = 58 Normotension with normoglycemida n = 109 p-Value Age, years 68.1 ± 7.3 66.5 ± 10.9 0.236 Male, n(%) 29(50.0%) 41(37.6%) 0.122 Waist circumference, cm 87.4 ± 7.5 82.1 ± 7.8 <0.0001 Body mass index, kg/m2 25.6 ± 2.9 23.6 ± 3.2 <0.0001 Gamma-glutamyltransferase, IU/L 47.2 ± 63.4 25.9 ± 37.3 0.007 Uric acid, mg/dl 5.2 ± 1.3 4.4 ± 1.5 0.001 Total cholesterol, mg/dl 201.4 ± 33.7 193.7 ± 37.1 0.191 LDL-cholesterol, mg/dl 113.3 ± 33.5 115.3 ± 32.0 0.706 HDL-cholesterol, mg/dl 51.2 ± 15.3 52.0 ± 17.4 0.759 Triglyceride, mg/dl 184.2 ± 94.4 131.6 ± 66.9 <0.0001 Open in new tab P111 Lipid profile and lipid control in high-risk patients in Bulgaria B Borislav Georgiev1, N Gotcheva1 1National Heart Hospital, Sofia, Bulgaria Hypertension (Prevention & Epidemiology) The European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey has had the goal to determine whether the Joint European Societies' guidelines on cardiovascular prevention were followed in everyday clinical practice and to describe the lifestyle, risk factors and therapeutic management in high-risk patients and in patients with coronary heart disease in Europe. For the first time a cohort of Bulgarian patients was included in this survey. The aim of this study was to determine the level of the dyslipidaemia control in the high risk cohort of Bulgarian patients and also to determine whether the Bulgarian doctors kept the European guidelines. Methods All patients included in this study were interviewed by using a standard validated questionnaire for every EUROASPIRE III participating country. Centralized laboratory for all participating countries measured the blood values of the total cholesterol (TC), LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) as well as the triglycerides (TG). Results 378 high-risk patients were selected and 327 participated in the interview. 12.8% were with diabetes, 12.5% - with diabetes and hypertension and 69.7% - with hypertension as primary criteria for inclusion into the study. The mean values of the TC was 5.69 mmol/L, the mean values of LDL-C - 3.54 mmol/L, the mean values of HDL-C for men was 1.13 mmol/L and for women - 1.30 mmol/L and the mean TG values were 1.7 mmol/L. The TC was higher than 5 mmol/L in 72.3% of patients, in 85.5% - TC was higher than 4.5 mmol/l. In 70% out of all patients the LDL-C values were >3 mmol/L and in 88.1% - >2.5 mmol/L. High TG levels (>1.7 mmol/L) were found in 50% of all studied patients. The lipid lowering drugs were used by 4.3% out of all patients. Conclusions Our data showed that the high-risk patients in Bulgaria had bad control of the lipid levels. 10 times lower was the prescription rate of lipid lowering drugs compared to the mean value for EUROASPIRE III. Even treated with any lipid lowering drug, they did not achieve the target lipid levels as being determined by the ESC Guidelines. P112 Healthy heart: a cardiovascular disease screening programme in community pharmacy MRB Burke1, M Henman1, A Codd1, C Bradley1 1Trinity College Dublin, Dublin, Ireland Hypertension (Prevention & Epidemiology) Purpose Cardiovascular disease is the most common cause of death in Ireland, accounting for 36% of all deaths. Early identification of both coronary heart disease and lifestyle risk factors can help to improve patient outcomes. The objective was to develop a cardiovascular disease screening programme. The programme was to include lifestyle assessment and measurements of blood pressure, waist circumference, body mass index, random glucose levels and cholesterol levels to examine the lifestyle risk factors and Coronary Heart Disease risk factors of participants. Methods A cardiovascular disease (CVD) screening programme, “Healthy Heart”, was launched in 2009 in 34 community pharmacies within one company across Ireland. Pharmacists were trained in the required protocols and documentation procedures with a focus on techniques and on providing individualised support and action planning for patients. Results Pharmacists documented the records of 2,350 participants in the service between January and August 2009 and of these, the usable records of 1,645 participants who consented were analysed. Just under two-thirds of participants were female (64.3%). Measurements demonstrated that 66.5% of patients surveyed had a body mass index above normal, with 23.6% having a body mass index in the obese range. One quarter (24.2%) of participants were assessed as at moderate to high risk of cardiovascular disease over the next 10 years. One in six participants stated that they took no exercise (16.9%) while a similar proportion were current smokers (16.8%) and 7.6% indicated that they consumed in excess of the recommended weekly alcohol limits in Ireland. In 54.8% of cases the pharmacist provided individualised advice to the patient on how they could decrease their risk of cardiovascular disease. Participants accepted both the lifestyle and clinical service components. Conclusion For those who availed of the “Healthy Heart” screening programme substantial proportions of patients were found to have lifestyle and/or clinical risk factors, from this it appears that those in need, not just the ‘worried well’, utilized this programme. This screening programme demonstrates that lifestyle assessment, as well as physiological measurements, is an important aspect of cardiovascular screening programmes. P113 The role of pharmacy-based health promotion programs in combating hypertension; The experience of a large community-based pharmacy in Greece E Papadakis1, R Sharma2, V Panoulas3, A Strimbouli1, A Doudoulakis1, S Kournidaki1, E Marinaki4, M Papadakis5 1E Papadaki Community Pharmacy, Chania, Greece, 2London School of Pharmacy, London, United Kingdom, 3Hammersmith Hospital, Imperial College London, NHLI, London, United Kingdom, 4Addenbrooke's Hospital, Cambridge, United Kingdom, 5St George's University of London, Division of Cardiac and Vascular Sciences, London, United Kingdom Hypertension (Prevention & Epidemiology) Purpose Hypertension is a well-established risk factor for cardiovascular morbidity and mortality and the control of blood pressure (BP) is crucial in the prevention of adverse outcomes. Current epidemiological studies suggest that up to a third of the adult population is hypertensive and the majority of the individuals treated do not achieve satisfactory control. In an attempt to improve blood pressure control the World Health Organization recommends a partnership between primary health care professionals with the pharmacist having a pivotal role. Our study aimed to assess the potential benefits of a pharmacy-based health promotion program in hypertension control. Methods Patients were recruited from a large community based pharmacy where a hypertension health promotion program has been in place since 2006. Patients on established hypertension treatment were invited for a blood pressure measurement and further education as necessary, on each occasion they visited the pharmacy. Of the 115 patients consented, 97 were included in the analysis based on a >6 months follow-up period and ≥ 6 blood pressure recordings. Patients with frequent consultations ≥ 4 per year (42) formed the intervention group, while those that attended on ≤ 2 occasions per year (55) formed the control group. The initial and final blood pressure values were calculated based on the average of the first 3 and last 3, respectively, blood pressure recordings, at least 2 weeks apart. Results Both the intervention and control groups were of similar gender (43% versus 45% male gender, p = 0.84) and age (66.3 ± 11.6 versus 63.4 ± 11.0 years, p = 0.21). The intervention group exhibited a significant reduction of both the systolic and diastolic blood pressure with a mean reduction of 5.0 ± 14.5mmHg (p = 0.03) and 3.8 ± 9.6mmHg (p = 0.01), respectively. On the contrary, in the control group neither the systolic (0.4 ± 12.0mmHg, p = 0.79), nor the diastolic (−0.4 ± 7.1mmHg, p = 0.66) blood pressure exhibited a significant variation. Comparison of blood pressure difference between the intervention and control groups revealed a trend towards significance for the systolic blood pressure reduction (4.6 ± 2.7mmHg, p = 0.09) and a significant reduction for the diastolic blood pressure (4.3 ± 1.7mmHg, p = 0.01) in the intervention group. Conclusions Pharmacy-based health promotion programs improve blood pressure control in hypertensive patients on established treatment. Future studies on large populations with long follow-up are required to assess the long-term clinical impact of such programs. P114 Changes in blood pressure values over a 10 year period in school children R Karan1, D Nikolic2, N Kovacevic-Kostic1, B Obrenovic-Kircanski3, S Simeunovic4, I Novakovic4 1Clinical Center of Serbia, Clinic for Anesthesiology and Reanimathology, Belgrade, Serbia, 2University Children's Hospital, Belgrade, Serbia, 3University of Belgrade, School of Medicine, CCS, Institute for Cardiovascular Diseases, Belgrade, Serbia, 4University of Belgrade, School of Medicine, Belgrade, Serbia Hypertension (Prevention & Epidemiology) Purpose The aim of our study was to evaluate changes of blood pressure values over a 10-year period in school children. Methods We have evaluated 1292 participants from YUSAD study, of which 738 females and 554 males. The population was examined at the age of 10 and repeated examination was performed at the age of 19-20 years. We assessed systolic and diastolic blood pressure separately, where diastolic blood pressure was defined as disappearing of a sound. We separately analysed two groups: Group with normal blood pressure and Group with hypertension. Results More than half of male (65.0%) and female (69.7%) participants remained with normal systolic blood pressure values, while 12.0% of males and 11.4% of females developed systolic hypertension. Those with established systolic hypertension during the first examination remained unchanged during the second examination in 2.3% of male population and 2.0% of female population, while 11.5% males and 9.0% females changed to normal systolic blood pressure values. Less than half of male (48.1%) and female (47.2%) participants remained with normal diastolic blood pressure values, while 32.4% of males and 34.1% of females developed diastolic hypertension. Those with established diastolic hypertension during the first examination remained unchanged during the second examination in 4.7% of male population and 5.0% of female population, while 8.6% males and 7.1% females changed to normal diastolic blood pressure values. Conclusions We have demonstrated that the age of participants has more influence on diastolic blood pressure values for both genders, where we found that diastolic hypertension developed more than twice as systolic hypertension. P115 ADMA and endothelial function in white coat hypertension E E Elena Emilia Babes1, VV Babes1, MI Popescu1, M Rus1 1Faculty of Medicine, Oradea, Romania Hypertension (Prevention & Epidemiology) Introduction Elevated plasma levels of asymmetric dimethylarginine (ADMA) have been demonstrated in patients with hypertension (HT) and contribute to endothelial dysfunction. The aim of this study was evaluation of endothelial function based on flow-mediated dilation (FMD) and ADMA levels in patients with white coat hypertension (WCHT). Methods The study was performed on 72 patients with mild to moderate HT and no previous antihypertensive treatment. Patients with: coronary and cerebrovascular disease, diabetes, smokers, dyslipidemia, body mass index >30 kg/m2, creatinine >1,5 mg/dl and target organ damage owing to HT were excluded. A total of 31 patients remained in the study and underwent blood pressure Holter monitoring for 24 hours. They were classified in two groups: 17 patients with sustained hypertension (SHT) and 14 patients with WCHT. Fourteen healthy subjects were also included (normotension = NT). Flow mediated dilatation and ADMA were determined in all three groups. Results: There were no significant differences between the three groups regarding age, sex, body mass index, mean values for lipids, glucose, brachial artery basal diameter. Flow mediated dilatation was 10, 49 ± 3, 99% in patients with SHT and 11 ± 2, 73% in patients with WCHT (p = NS). Flow mediated dilatation was significantly greater in subjects with NT 25, 33 ± 4, 23% (p < 0, 0001). ADMA was 3, 45 ± 0, 48 µmol/l in patients with WCHT, significantly greater versus 2, 6 ± 0, 43 µmol/l in NT subjects (p = 0,005) and significantly lower versus patients with SHT 4, 13 ± 0, 35 µmol/l (p = 0, 0017). There is a strong inverse correlation between ADMA and flow mediated dilatation in WCHT (p < 0, 0001, r = −0, 86) and in SHT (p < 0, 0001, r = −0, 85) but no correlation was found in NT patients. In conclusion increased ADMA levels and decreased flow mediated dilatation shows the presence of endothelial dysfunction in patients with WCHT without other cardiovascular risk factors. Regarding endothelial function WCHT represents an intermediate group between NT and SHT. P116 Diabetes is related to higher central blood pressure P Jankowski1, D Debicka-Dabrowska1, M Kloch-Badelek1, J Wilinski1, M Brzozowska-Kiszka1, K Kawecka-Jaszcz1, D Czarnecka1 1Jagiellonian University Medical College, 1st Department of Cardiology and Hypertension, Krakow, Poland Hypertension (Prevention & Epidemiology) Background: Central blood pressure (BP) is directly related left ventricular overload as well as blood supply to the heart and brain. Several studies have shown closer correlation between end-organ damage and central composed to peripheral blood pressure. Central blood pressure was also shown to better predict cardiovascular (CV) risk as compared to brachial blood pressure. Diabetes is related to at least two-fold increas in CV risk. The influence of diabetes on central blood pressure values is unknown. Aim: To assess the independent influence of diabetes on the ascending aortic blood pressure values. Methods: blood pressure in the ascending aorta was measured using fluid-filled filter in 400 patients (200 with type 2 diabetes and 200 patients without diabetes matched for age and sex) undergoing non-emergency coronary angiography. Brachial blood pressure was measured using a sphygmomanometer. General regression model (age, sex, mean blood pressure, risk factors, left-ventricular ejection fraction, the extent of coronary atherosclerosis, creatinine level, and drugs were included into the model) was used to assess the independent influence of diabetes on blood pressure. Results: Systolic, diastolic, and mean brachial blood pressure did not differ between the study groups (138.8 ± 21.3 versus 133.7 ± 20.3 mmHg; p = 0.06; 83.4 ± 12.0 versus 82.6 ± 10.7 mmHg; p = 0.81; 101.9 ± 14.0 versus 99.6 ± 13.0 mmHg; p = 0.27 in diabetics and non-diabetics resp.) but brachial pulse pressure was higher in diabetics (55.4 ± 15.3 versus 51.1 ± 14.2; p = 0.02). Central blood pressure values are shown in the table. In multivariable analysis diabetes was related to higher ascending aortic systolic blood pressure by 2.7 (95% confidence intervals: 1.7-3.8) mmHg and pulse pressure by 4.1 (2.5-5.7) mmHg as well as higher brachial pulse pressure by 1.8 (0.2-3.3) mmHg. The differences in mean and diastolic (both brachial and central) blood pressure as well as brachial systolic blood pressure were not significant in multivariable analysis. Conclusions: Diabetes is independently related to higher values of systolic and pulse pressure in the ascending aorta. This may partly explain the higher CV risk in diabetics. Central blood pressure in diabetics and nondiabetics Non-diabetics N = 200 Diabetics N = 200 p Systolic blood pressure 136.0 ± 22.9 143.5 ± 23.6 0.008 Diastolic blood pressure 73.4 ± 12.3 72.3 ± 11.3 0.643 Mean blood pressure 94.0 ± 14.3 96.0 ± 14.2 0.204 Pulse pressure 62.5 ± 18.0 71.2 ± 19.6 <0.001 Non-diabetics N = 200 Diabetics N = 200 p Systolic blood pressure 136.0 ± 22.9 143.5 ± 23.6 0.008 Diastolic blood pressure 73.4 ± 12.3 72.3 ± 11.3 0.643 Mean blood pressure 94.0 ± 14.3 96.0 ± 14.2 0.204 Pulse pressure 62.5 ± 18.0 71.2 ± 19.6 <0.001 Open in new tab Central blood pressure in diabetics and nondiabetics Non-diabetics N = 200 Diabetics N = 200 p Systolic blood pressure 136.0 ± 22.9 143.5 ± 23.6 0.008 Diastolic blood pressure 73.4 ± 12.3 72.3 ± 11.3 0.643 Mean blood pressure 94.0 ± 14.3 96.0 ± 14.2 0.204 Pulse pressure 62.5 ± 18.0 71.2 ± 19.6 <0.001 Non-diabetics N = 200 Diabetics N = 200 p Systolic blood pressure 136.0 ± 22.9 143.5 ± 23.6 0.008 Diastolic blood pressure 73.4 ± 12.3 72.3 ± 11.3 0.643 Mean blood pressure 94.0 ± 14.3 96.0 ± 14.2 0.204 Pulse pressure 62.5 ± 18.0 71.2 ± 19.6 <0.001 Open in new tab P117 Blood pressure variability P Patricia Kearney1, V Mccarthy1, J Harrington1, AP Fitzgerald1, E Dolan2, E O'brien3, IJ Perry1 1University College Cork, Cork, Ireland, 2James Connolly Memorial Hospital, Dublin, Ireland, 3University College Dublin, Conway Institute, Dublin, Ireland Hypertension (Prevention & Epidemiology) In Ireland, diagnosis of hypertension is generally made based on clinic blood pressure readings. In 2011 the UK National Institute for Clinical Excellence recommended that diagnosis of hypertension should be based on ambulatory blood pressure monitoring (ABPM). The prevalence of hypertension using ABPM in Ireland is unknown. This study compares blood pressure levels at GP visit, study visit and using ABPM. The Mitchelstown cohort is a population based sample of 2047 middle aged Irish adults. Baseline assessment was completed in 2011 and included a general health questionnaire, physical health assessment and blood sampling. Study blood pressure was the average of the second and third readings from an omron syphgomomanometer obtained by a trained study nurse. Clinic blood pressure was based on previous blood pressure readings at GP visits which were available from electronic patient records. Ambulatory blood pressure (ABP) was measured over a 24 hour period using MEDITECH ABPM-05 monitors. Hypertension was defined as blood pressure ≥ 140/90 (≥ 135/90 for ambulatory readings) or on anti-hypertensive medications. The prevalence of hypertension was compared in participants with clinic, study and ambulatory blood pressure measurements. 1030 individuals had clinic, study and ambulatory measurements. Approximately 50% of individuals with hypertension based on previous GP readings and 44% of those with hypertension at the study visit had normal ambulatory blood pressure. However, 21% of those with normal clinic blood pressure and 20% of those with normal study blood pressure had hypertension according to ABPM. The prevalence of hypertension varied depending on the location and timing of the blood pressure measurements with almost half of those with hypertension according to standard methods having normal ambulatory blood pressure. The increased cost of ambulatory blood pressure monitoring may be outweighed by the potential benefit in terms of reducing the number of individuals who require treatment with anti-hypertensive medication. Blood pressure and Hypertension Setting Mean (SD) SBP Mean (SD) DBP Hypertension (%) BP ≥ 140/90 (≥ 135/90 for ABP) Hypertension (%) BP ≥ 140/90 or on meds Clinic 134 (15) 79 (9) 38.8 55.8 Study 135 (18) 83 (10) 44.2 60.3 Ambulatory (day) 131 (15) 77 (10) 42.2 61.4 Ambulatory (night) 110 (18) 61 (10) 29.8 37.9 Setting Mean (SD) SBP Mean (SD) DBP Hypertension (%) BP ≥ 140/90 (≥ 135/90 for ABP) Hypertension (%) BP ≥ 140/90 or on meds Clinic 134 (15) 79 (9) 38.8 55.8 Study 135 (18) 83 (10) 44.2 60.3 Ambulatory (day) 131 (15) 77 (10) 42.2 61.4 Ambulatory (night) 110 (18) 61 (10) 29.8 37.9 Open in new tab Blood pressure and Hypertension Setting Mean (SD) SBP Mean (SD) DBP Hypertension (%) BP ≥ 140/90 (≥ 135/90 for ABP) Hypertension (%) BP ≥ 140/90 or on meds Clinic 134 (15) 79 (9) 38.8 55.8 Study 135 (18) 83 (10) 44.2 60.3 Ambulatory (day) 131 (15) 77 (10) 42.2 61.4 Ambulatory (night) 110 (18) 61 (10) 29.8 37.9 Setting Mean (SD) SBP Mean (SD) DBP Hypertension (%) BP ≥ 140/90 (≥ 135/90 for ABP) Hypertension (%) BP ≥ 140/90 or on meds Clinic 134 (15) 79 (9) 38.8 55.8 Study 135 (18) 83 (10) 44.2 60.3 Ambulatory (day) 131 (15) 77 (10) 42.2 61.4 Ambulatory (night) 110 (18) 61 (10) 29.8 37.9 Open in new tab P118 Age-specific cardiovascular risk factors trends in the Czech population 1985 - 2007/8. Czech MONICA and post MONICA study. J Jan Bruthans1, R Cifkova1, Z Skodova1, V Adamkova1, Z Petrzilkova1, M Jozifova1, M Galovcova1, P Wohlfart1, D Bruthansova2, V Lanska1 1Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 2Institute for Labour and Social Affaires, Prague, Czech Republic Hypertension (Prevention & Epidemiology) Purpose: The aim of our study was to assess age-specific longitudinal trends in major cardiovascular (CV) risk factors in a representative population sample of the Czech Republic. Methods: Three cross-sectional surveys of CV risk factors were conducted within the WHO MONICA Project in six Czech districts in 1985 (n = 2,570), 1988 (n = 2,768) and 1992 (n = 2,343). In 1997, 2000/01 and 2007/8, another three screenings for CV risk factors (a 1% random sample, aged 25-64) were conducted in nine districts, including the six original districts (n = 1,990; 2,055 and 2,246 respectively). Linear time trends of risk factors in age decades were analysed and compared. Results: In the period 1985 to 2007/8 body mass index increased significantly (p < 0.001) in all male age decades and did not increase in any female age decade. Prevalence of obesity (BMI>30] increased in all male age decades, the increase was more pronounced with increasing age. It did not increase in any female age decade. Prevalence of smoking decreased in all male age decades, more significantly in the age 25-44 years, and in females 25-44 years old, but increased in females 45-64 years old. Systolic and diastolic blood pressure decreased significantly in males 45-64 years old and in all female age decades. Prevalence of hypertension decreased in males 25-54 years old and in all female age decades. Control of hypertension increased in all male and female age decades, more significantly in elder ones. Total and low-density lipoprotein cholesterol and triglycerides decreased significantly (p < 0.001) in all male and female age decades. Prevalence of dyslipidemia also decreased in all age decades. Diabetes mellitus prevalence did not change in any male or female age decade. Conclusions: despite considerably similar time trends of CV risk factors in population age decades, more favourable trends were found in younger age groups (25-44 years). This might herald futher improvement in population CV risk factors levels (and continuing CV mortality decrease) in the next 10 - 20 years. P119 Assessment of selected cardiovascular risk factors prevalence among women living in rural areas and big cities in Poland. Polish 400 Cities Project investigators, I Irina Mogilnaya1, T Zdrojewski1 1Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland Hypertension (Prevention & Epidemiology) In Poland are observed significant differences in cardiovascular disease morbidity and mortality, wich are dependent on gender, age, but also on the place of living. Analysis of mortality rates, prevalence of cardiovascular risk factors, and trends emerging over the past decades show that the worst epidemiological situation affects small-town and village communities, people with low social and economic status. Aim: To compare prevalence and control of arterial hypertension (AH) and other selected cardiovascular risk factors among female citizens of rural areas and big cities in Poland. Methods: Study was done as a part of Polish 400 Cities Project (P400CP) in years 2004-2007. All together, 1008 women from the 90 smallest Polish towns (<8.000 citizens) and surrounded areas and 277 women from the 8 biggest Polish cities aged between 18-60 years were examined. Blood pressure (tree independent visits), anthropometric measurements and questionnaire interviews were performed. Results: Every fifth woman in Poland in age before 60 has AH. We didn't find differences in AH prevalence among examined groups. Awareness of the disease was more frequent among women from small towns (Wst), but women living in big cities (Wbc) had significantly better control of AH. Overweight and abdominal obesity were more prevalent among Wst. Among Wst the rate of current smokers either ex-smokers was smaller. Differences on impact of education level, income and marital status on examined RSC factors were observed. Conclusions: Existing differences in education level, income and prevalence of cardiovascular disease risk factors between women from small and big cities should be taken into account in planning preventive action in Poland. P120 Hepatic steatosis is an independent predictor of increased exercise blood pressure. A Antonio Laurinavicius1, FC Nary1, RDO Conceicao1, JAM Carvalho1, RD Santos1 1Hospital Israelita Albert Einstein, Sao Paulo, Brazil Hypertension (Prevention & Epidemiology) Purpose: exercise blood pressure hyper-reactivity is associated with an increased risk of developing future systemic hypertension, as well as with an increased overall cardiovascular risk. Clinical predictors of hyper-reactive response (HRR) are related to traditional hypertension risk factors. However, key determinants of HRR were not conclusively defined. Recently, hepatic steatosis (HS) has been shown to be independently associated with systemic inflammation and higher cardiovascular risk. We hypothesizes that HS is also a key determinant of increased exercise blood pressure. Methods: We evaluated 7995 individuals (mean age: 41.7 years, 24.9% female) who underwent exercise test, abdominal ultrasound and an extensive clinical and laboratory evaluation as part of a check-up protocol between 2006 and 2009. We evaluated the association between HRR and the presence of HS detected by abdominal ultrasound. HRR was defined by the detection of a systolic blood pressure higher than 220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure. Results: The prevalence of HS was 28.4%. Overall, 7% of the study population presented HRR. Subjects with HS showed higher incidence of HRR than those without HS (12.7% versus 4.7%, OR 2.14, 95% CI 1.78 to 2.56, p < 0.001). Other variables associated with HRR were: Body Mass Index (BMI) > 25 (OR 2.49, 95% CI 2.01 to 3.08, p < 0.001); impaired fasting glucose (OR 1.69, CI 95% 1.34 to 2.14, p < 0.001); C-reactive protein > 2 mg/L (OR 1.40, 95% CI 1.15 to 1.70, p = 0.001); and low HDL-cholesterol levels (OR 1.22, 95% CI 1.02 to 1.46, p = 0.034). However, after multivariate adjustment only HS (OR 1.37) and BMI > 25 (OR 1.41) remained statistically significant and independent HRR predictors. Conclusions: HS is an independent predictor of HRR, presenting a stronger association than other variables classically related to hypertension. This association may partially explain cardiovascular risk excess observed in HS patients. P121 Trends in cardiovascular risk factors according to urban and rural residence in adolescents V Valeria Regecova1, P Simurka2, A Barakova3, E Kellerova1 1Institute of Normal and Pathological Physiology, Bratislava, Slovak Republic, 2Paediatric Clinic of the Faculty Hospital, Trencin, Slovak Republic, 3National Health Information Center Bratislava, Bratislava, Slovak Republic Hypertension (Prevention & Epidemiology) The aim: To examine 10-year trends in cardiovascular (CVD) risk factors among urban and rural adolescents aged 16 to 18 years. Methods: The data were collected at preventive health examinations by the out-patient units. The first survey (2001) consisted of 8838, the second (2010) of 2383 participants. Blood pressure was measured sphygmomanometrically, in line with the ESH recommendations. Overweight was evaluated by body mass index (BMI ≥ 25). Limits for normal blood pressure values and hypertension were set according to ESH (2009), cut of value for total cholesterol (Tchol) was>4.85 mmol/L. For the statistical evaluation the two-way ANOVA and Chi-Square tests were used. Results: Within a decade secular trend in body height was manifested. The mean systolic blood pressure in 2010 was higher (+3 mm Hg in boys, +2 mmHg in girls, p < 0.001. Diastolic blood pressure and Tchol levels did not change. Frequencies of overweight and high blood pressure values in girls were lower as compared with boys and remained the same over 10 years. In boys overweight increased by 5% (p < 0.01), the prevalence of prehypertension in boys was 67.4% (+ 5.5%), thereof in 7.5% was blood pressures ≥ 140 mmHg. Conclusions: Except of Tchol cardiovascular disease risk factors considerably increased in boys over past 10 years. This unfavorable trend was accentuated in urban communities. Open in new tabDownload slide P122 Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study M Majid Ali1, F Schifano1, P Robinson2, G Phillips3, A Sinclair4, S Dhillon1 1University of Hertfordshire, Hatfield, United Kingdom, 2Merck Sharp & Dohme Ltd, Hoddesdon, United Kingdom, 3Manor Pharmacy Group, Hertfordshire, United Kingdom, 4Bedfordshire and Hertfordshire Postgraduate Medical School, Bedfordshire, United Kingdom Diabetes Type 1/2 (Prevention & Epidemiology) Aim/objectives: To evaluate the impact of a pharmacist-led patient education and diabetes monitoring program on HbA1c and other cardiovascular risk factors in thecommunity setting. Methods: Patientswith Type 2 diabetes (n = 46) attending two community pharmacies in Hertfordshire, UK were randomized to one of two groups. The ‘intervention’ group (n = 23) received a program of education about diabetes, its treatment andassociated cardiovascular risk factors. They were seen formonitoring/counselling by community pharmacist on 6 occasions over a 12 monthperiod. Measures included HbA1c, body mass index, blood pressure, blood glucose and lipid profile. The ‘control’ group (n = 23) underwent these measurements at baseline and at 12months only, without specific counselling or education over and above usualcare. Results: HbA1c fellfrom 8.2 (65.55) to 6.6% (48.73mmol/mol) (p < 0.001) in the interventiongroup, compared with a fall from 8.1 (64.54) to 7.5% (58.76mmol/mol) in the control group (p = 0.03). Blood pressure fell from 146/87 to 126/81mmHg in the interventiongroup (p = 0.01) compared with no significant change in the control group (136/86to 139/82mmHg). Significant reductions in body mass index (30.8 to 27kg/m2, p < 0.001) and blood glucose (8.8 to 6.9mmol/l, p < 0.001) were also observed in the intervention group as compared to no significant changes in the control group. Lipid profile changes were mixed. Conclusions: Education and counselling by community pharmacists can result in favourable improvements to cardiovascular risk profile of patients with Type 2 diabetes. P123 The effect of exercise on the risk factors of the metabolic syndrome in metabolic syndrome patients: a meta-analysis of controlled trials N Nele Pattyn1, V Cornelissen1, SR Toghi Eshghi1, L Vanhees1 1Catholic University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors including abdominal obesity, hypertension, dyslipidemia and impaired glucose control. To date, 20-30% of the adult population is considered to have the MetS, and the prevalence is increasing. The first-line treatment of MetS includes regular exercise and weight loss. While numerous meta-analyses investigating the effect of dynamic aerobic endurance training have been conducted in different populations and for single risk factors, none have specifically focused on the MetS patients and the concomitant effect of exercise on all associated cardiometabolic risk factors. Methods: We conducted a systematic literature search and included (randomized) controlled trials investigating the effect of dynamic aerobic endurance exercise of at least 4 weeks duration in adults with the MetS and without established cardiovascular disease, published in a peer-reviewed journal up to March 2011. Primary outcome measures were changes in risk factors associated with the MetS: waist circumference, systolic and diastolic blood pressure, high-density lipoproteins, triglycerides and plasma glucose. VO2peak was a secondary outcome. Random and fixed effect models were used for analyses and data are reported as means and 95% confidence intervals (CI). Results: Seven trials were included, involving 9 study groups and 206 men and women with the MetS (128 exercise and 78 control). Exercise resulted in a significant reduction of waist circumference of −3.4 (95%CI −4.9 to −1.8; p < 0.0001) cm, a blood pressure reduction of −7.1 (−9.03 to −5.2; p < 0.0001) mmHg/−5.2 (−6.2 to −4.1; p < 0.0001) mmHg and an increase in high-density lipoproteins of 0.06 (+0.03 to +0.09; p < 0.0001) mmol/l, whereas plasma glucose levels [−0.31 (−0.64 to 0.01) p = 0.06] mmol/l and triglycerides [−0.05 (−0.20 to 0.09) p = 0.47] mmol/l remained statistically unaltered. In addition, VO2peak improved with 5.9 (+3.03 to +8.7; p < 0.0001) ml/kg/min or 19.3%. Conclusions: Data from 7 trials suggest that dynamic aerobic endurance exercise has a favourable effect on most of the cardiometabolic risk factors associated with the MetS, that is waist circumference, systolic and diastolic blood pressure and high-density lipoproteins. However, additional research is needed, including search for optimal training programs for improving total cardiovascular risk in individuals with the MetS. P124 Trends in the incidence of lower extremity amputations in individuals with and without diabetes in a five year period in Ireland C Claire Buckley1, A O'farrell2, R Cavanagh3, AD Lynch1, D De La Harpe2, C Bradley1, IJ Perry1 1University College Cork, Cork, Ireland, 2HSE - Dr Steevens Hospital, Dublin, Ireland, 3St Vincent's University Hospital, Dublin, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Background: Diabetic foot disease is a major health problem and lower extremity amputation remains a common outcome. Studies estimating the incidence of lower extremity amputation in Ireland are lacking. Purpose: The aims of this study are to describe trends in the incidence of non-traumatic amputations in individuals with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a nontraumatic amputation compared to an individual without diabetes. Methods: All adults who underwent a nontraumatic amputation in Ireland during 2005 to 2009 were identified using HIPE (Hospital In-patient Enquiry) data. Participants were classified as diabetic or non-diabetic. Incidence rates were calculated using the number of admissions for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Poisson rates were used for trend analysis. Results: Total diabetes-related amputation rates remained steady during the study period; 221.7 in 2005 and 193.1 in 2009 per 100,000 people with diabetes (p = 0.69). Total non-diabetes related amputation rates dropped non-significantly from 12.2 in 2005 to 8.8 in 2009 per 100,000 people without diabetes (p = 0.07). An individual with diabetes was 18.2 (95% CI 15.6-21.2) times more likely to undergo a nontraumatic amputation than an individual without diabetes in 2005 and this did not change significantly by 2009. Conclusions: This study provides the first national estimate of lower extremity amputation in Ireland. Diabetes-related amputation rates have remained steady despite an increase in people with diabetes. These estimates provide a base-line and will allow follow-up over time. P125 Incidence of diabetes in the Polish population. Results of the Multicentre Polish Population Health Status Study (WOBASZ) M Maria Polakowska1, W Piotrowski1 1Institute of Cardiology, Warsaw, Poland Diabetes Type 1/2 (Prevention & Epidemiology) Introdution. Incidence of diabetes is increasing at an alarming rate worldwide. It has been estimated that 2.2 to 2.5 million of Poles will be affected by this disease by 2030. Objectives: The aim of the study was to conduct an epidemiological analysis of the incidence of diabetes and impaired fasting glucose (IFG) in the Polish population. Patients and methods: A sample of 21,600 individuals (men and women) aged 20-74 years was randomly selected from the general Polish population. A total of 14,769 individuals took part in the study (6977 men and 7792 women). Diabetes was identified in individuals with fasting glucose equal to or exceeding 7 mmol/l and in those with previously diagnosed diabetes. IFG was identified in non treated individuals with fasting glucose between 5.6 and 6.9 mmol/l. Results: Diabetes was diagnosed in 1000 individuals (6.8%), including 518 men (7.4%) and 482 women (6.2%). IFG was detected in 1401 individuals (9.5%), including 864 men (12.4%) and 537 women (6.9%). Incidence of diabetes increases with age: in men from 0.7% in those aged 20-29 years to 16.3% in those aged >60 years; in women from 0.5% in the youngest age group to 17.8% in the oldest group. Incidence of diabetes in Poland varies between the provinces - from 5.3% to 9% among men and from 4.2% to 7.5% among women. There was no significant correlation between the incidence of diabetes and the size of a particular local district (commune). Similar territorial differences were observed for IFG, i.e., from 5.8% to 20.8% among men and from 2.8% to 11.7% among women. As with diabetes, the incidence of IFG was not associated with the size of a commune. Conclusions: Incidence of diabetes and IFG in the study population varies depending on age, sex, and region. Incidence of diabetes in Poland is comparable to the average values observed worldwide. P126 The effectiveness of podiatry services in preventing the occurrence of a lower extremity amputation in patients with diabetes: a systematic review C Claire Buckley1, P Kearney1, C Bradley1, IJ Perry1 1University College Cork, Cork, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Background: Diabetes is associated with a significant risk of lower extremity amputation. Amputation rates vary between communities (46-9600 per 100,000 people with diabetes) (1). With optimal management, amputation can be prevented. The management of diabetes involves many healthcare professionals; including podiatrists. Guidelines recommend that patients with diabetes and at risk of amputation should be reviewed by a podiatrist (2). Purpose: Previous Cochrane reviews have examined the effectiveness of complex interventions for preventing foot ulceration and patient education for preventing foot ulceration and amputation incidence (3), (4). However, the effect of podiatry services has not been reviewed. The aim of this study is to conduct a systematic review of international literature to determine the effect of podiatry services on the occurrence of lower extremity amputation in patients with diabetes. Methods: Published studies were identified through searches of PUBMED, CINAHL, EMBASE (Excerpta Medica), and Cochrane databases. Inclusion and exclusion criteria were pre-defined. Reference lists of all relevant papers were reviewed for additional eligible articles. Results: Five hundred and one records were retrieved. Twenty-one papers were considered after initial screening of titles and abstracts. Review of the full text articles of these studies identified five eligible studies (2 RCTs and 3 Cohort studies). The identified studies were heterogenous in design and included people with diabetes at both low and high baseline risk of amputation. The findings were conflicting; 2 of the 3 studies that provided a risk estimate suggested that podiatry has a protective effect. Conclusions: In conclusion, the available evidence suggests that podiatry may reduce the risk of amputation in people with diabetes However, high quality studies assessing the effect of podiatry on the lower extremity amputation in people with diabetes are required to determine the magnitude of the effect and to assess whether other factors such as the timing or intensity of the intervention have an impact. 1. Moxey P, Gogalniceanu P, Hinchliffe R, Loftus I, Jones K, Thompson M. Lower extremity amputations - a review of global variability in incidence. Diabetic Medicine. 2011. 2. SIGN. Management of diabetes. A national clinical guideline. March 2010. 3. Dorresteijn Johannes AN, Kriegsman Didi MW, Valk Gerlof D. Complex interventions for preventing diabetic foot ulceration. 4. Dorresteijn Johannes AN, Kriegsman Didi MW, Assendelft Willem JJ, Valk Gerlof D. Patient education for preventing diabetic foot ulceration. P127 Beneficial effects of nutraceutics on pathologic cardiac remodelling in patients with metabolic syndrome V Valentina Mercurio1, G Carlomagno1, V Fazio1, C Pirozzi1, A Ruvolo1, F Affuso1, S Fazio1 1University of Naples Federico II Dpt of Clinical Medicine, Cardiovascular and Immunologic Sciences, Naples, Italy Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: Prevalence of metabolic syndrome (MetS) is rapidly increasing, leading to an increased cardiovascular risk. An effective therapy is an urgent need. Aim of the study: to test the efficacy of a nutraceutical combination (NC) of berberine 500 mg, policosanol 10 mg and red yeast rice (monacolin K 3 mg) in reducing insulin resistance associated with MetS. Methods: 64 patients with MetS were randomly assigned to receive either placebo (P) or NC, in a prospective, double-blind, placebo-controlled study. Evaluations were performed at baseline and after 18 week treatment. The HOMA index was the primary endpoint. In addition, blood pressure (BP) and echocardiographic indices of left ventricular (LV) remodelling and diastolic function were assessed. Results: 59 patients completed the study, 2 withdrew for adverse effects. After 18 weeks there was a significant reduction of the HOMA index in NC compared to P (p < 0.05). A significant reduction of systolic blood pressure was observed in NC compared to P. Concerning the echocardiographic parameters, within-group analysis showed significant decreases in left ventricle mass index and increase in mitral Doppler E/A ratio in NC group (p < 0.05), while no change was observed in P, suggesting beneficial effects on left ventricle mass and diastolic function. Conclusions: This short-term study shows that NC has beneficial effects on insulin resistance, a main component of MetS. Echocardiographic results suggest also effects on pathologic cardiac remodelling in patients with MetS. Further research to explore these effects in a large and better defined population of MetS patients with persistent left ventricle remodelling despite optimal blood pressure control should be performed. Table 1 Nutraceutical combination Within-group differences vs baseline (p) Placebo Within-group differences vs baseline (p) Between- group comparison (p2) Baseline 18-weeks Baseline 18-weeks N (M/F) 29 (20/9) 30 (18/12) Age 53 ± 7 50 ± 12 Weight (Kg) 90 ± 13 88 ± 12 0.008 96 ± 18 95 ± 18 0.011 0.657 BMI (kg/m2) 32.2 ± 4.6 32.7 ± 4.4 0.013 34.7 ±  5.1 34.2 ±  5.1 0.008 0.805 HOMA index 3.2 ± 1.5 2.6 ± 1.3 0.019 2.8 ± 2.2 3.2 ± 2.6 0.259 0.023 Systolic blood pressure (mmHg) 125 ± 13 120 ± 9 0.037 125 ± 14 126 ± 12 0.585 0.047 Left ventricular mass indexed for height (g/m2.7) 44.4 ± 7.5 41.6 ± 7.4 0.005 45.2 ± 8.2 43.5 ± 7.8 0.08 0.515 Mitral doppler E/A ratio 1.00 ±  0.43 1.12 ±  0.30 0.004 1.06 ±  0.29 1.09 ±  0.28 0.442 0.082 Nutraceutical combination Within-group differences vs baseline (p) Placebo Within-group differences vs baseline (p) Between- group comparison (p2) Baseline 18-weeks Baseline 18-weeks N (M/F) 29 (20/9) 30 (18/12) Age 53 ± 7 50 ± 12 Weight (Kg) 90 ± 13 88 ± 12 0.008 96 ± 18 95 ± 18 0.011 0.657 BMI (kg/m2) 32.2 ± 4.6 32.7 ± 4.4 0.013 34.7 ±  5.1 34.2 ±  5.1 0.008 0.805 HOMA index 3.2 ± 1.5 2.6 ± 1.3 0.019 2.8 ± 2.2 3.2 ± 2.6 0.259 0.023 Systolic blood pressure (mmHg) 125 ± 13 120 ± 9 0.037 125 ± 14 126 ± 12 0.585 0.047 Left ventricular mass indexed for height (g/m2.7) 44.4 ± 7.5 41.6 ± 7.4 0.005 45.2 ± 8.2 43.5 ± 7.8 0.08 0.515 Mitral doppler E/A ratio 1.00 ±  0.43 1.12 ±  0.30 0.004 1.06 ±  0.29 1.09 ±  0.28 0.442 0.082 Open in new tab Table 1 Nutraceutical combination Within-group differences vs baseline (p) Placebo Within-group differences vs baseline (p) Between- group comparison (p2) Baseline 18-weeks Baseline 18-weeks N (M/F) 29 (20/9) 30 (18/12) Age 53 ± 7 50 ± 12 Weight (Kg) 90 ± 13 88 ± 12 0.008 96 ± 18 95 ± 18 0.011 0.657 BMI (kg/m2) 32.2 ± 4.6 32.7 ± 4.4 0.013 34.7 ±  5.1 34.2 ±  5.1 0.008 0.805 HOMA index 3.2 ± 1.5 2.6 ± 1.3 0.019 2.8 ± 2.2 3.2 ± 2.6 0.259 0.023 Systolic blood pressure (mmHg) 125 ± 13 120 ± 9 0.037 125 ± 14 126 ± 12 0.585 0.047 Left ventricular mass indexed for height (g/m2.7) 44.4 ± 7.5 41.6 ± 7.4 0.005 45.2 ± 8.2 43.5 ± 7.8 0.08 0.515 Mitral doppler E/A ratio 1.00 ±  0.43 1.12 ±  0.30 0.004 1.06 ±  0.29 1.09 ±  0.28 0.442 0.082 Nutraceutical combination Within-group differences vs baseline (p) Placebo Within-group differences vs baseline (p) Between- group comparison (p2) Baseline 18-weeks Baseline 18-weeks N (M/F) 29 (20/9) 30 (18/12) Age 53 ± 7 50 ± 12 Weight (Kg) 90 ± 13 88 ± 12 0.008 96 ± 18 95 ± 18 0.011 0.657 BMI (kg/m2) 32.2 ± 4.6 32.7 ± 4.4 0.013 34.7 ±  5.1 34.2 ±  5.1 0.008 0.805 HOMA index 3.2 ± 1.5 2.6 ± 1.3 0.019 2.8 ± 2.2 3.2 ± 2.6 0.259 0.023 Systolic blood pressure (mmHg) 125 ± 13 120 ± 9 0.037 125 ± 14 126 ± 12 0.585 0.047 Left ventricular mass indexed for height (g/m2.7) 44.4 ± 7.5 41.6 ± 7.4 0.005 45.2 ± 8.2 43.5 ± 7.8 0.08 0.515 Mitral doppler E/A ratio 1.00 ±  0.43 1.12 ±  0.30 0.004 1.06 ±  0.29 1.09 ±  0.28 0.442 0.082 Open in new tab P128 High prevalence of stage B heart failure in diabetics; from the STOP-HF study G Murtagh1, IR Dawkins1, C Conlon1, E Tallon1, C Watson1, R O' Hanlon1, M Ledwidge1, KM Mc Donald1 1St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Background: Diabetes mellitus (DM) is known to be an independent predictor of heart failure. The optimal approach to this problem involves identifying patients at risk early in the course of the condition. Previous studies have shown a high prevalence of left ventricular diastolic dysfunction in diabetic subjects. We set out to study the wider burden of structural and functional problems that could lead to heart failure. Methods and Results: The STOP-HF cohort consists of subjects over the age of 40 with at least one cardiovascular risk factor. Each participant had a Brain Natriuretic Peptide level and Doppler-Echocardiography performed. Stage B heart failure was defined as structural heart disease (consisting of ejection fraction <50%, left atrial volume index >34 ml/m2 and/or left ventricular mass >182g in females or >254g in males) in the absence of symptoms of heart failure. Of 906 total patients, 183 (20%) were documented as having diabetes mellitus. Prevalence of stage B heart failure was 25% in the total population, 34% in those with diabetes mellitus and 23% in the non-diabetic cohort (p = 0.001). Considering only those patients with BMI>30 kg/m2, 82 (27%) of the total of 303 had diabetes mellitus whilst prevalence of stage B was 32% overall, with 44% in those with diabetes mellitus compared to 28% in the non-diabetics (p = 0.013). Conclusions: There was a significantly higher prevalence of stage B HF in the diabetic population, particularly those with BMI>30 kg/m2. This identifies a cohort of patients requiring more intensive risk factor control to prevent progression to symptomatic heart failure. P129 Comprehensive cohort study in type 2 diabetes with high risk of cardiovascular disease in China (CCMR - CCDC Study) G Ning1, L Ji2, C Pan3, Y Mu3, G Li4, Y Zeng5, Z Zhang5, D Zhang5 1Ruijin Hospital of Shanghai Jiaotong University, Shanghai, China, People's Republic of, 2Peking University People's Hospital, Beijing, China, People's Republic of, 3China PLA General Hospital, Beijing, China, People's Republic of, 4Fuwai Hospital, Beijing, China, People's Republic of, 5VitalStrategic Research Institute, Shanghai, China, People's Republic of Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The incidence of diabetes has been rising rapidly in China in recent years, potentiating a surge of incidence of cardiovascular disease (CVD). Comprehensive Cohort Study in Type 2 Diabetes (T2D) with High Risk for Cardiovascular disease in China (CCDC Study) is a non-interventional prospective cohort study designed to assess the incidence of cardiovascular events and treatment pattern in T2D patients with high risk of cardiovascular disease or existing cardiovascular disease, after 12 month follow-up. CCDC is part of the China Cardiometabolic Registires (CCMR). Methods: About 800 patients receiving active anti-diabetic treatment were recruited from 17 major hospitals across China. Patients either had three or more risk factors for cardiovascular disease such as >65 years old, hypertension, dyslipidemia, or had existing or history of coronary artery disease. The primary outcome measurement was the incidence of cardiovascular events, including fatal and non-fatal acute coronary syndromes (AMI or unstable angina) at 12-month follow-up. Results: The study is still ongoing. We are reporting here the analysis of baseline data. The patient population had a mean age of 63.6 years (s.d. 10.4), with 56% being male, 41.4% having a history of smoking, 33.6% having been diagnosed of T2D for 10 years or more. The mean HbA1c was 8.34% (s.d. 2.15%). About 17% of patients had HbA1c lower than 6.5%. Logistical regression shows that diabetes history for 10 years or more (p < .05), and higher value of triglycerides (p < 0.01), were statistically significantly correlated with possibility of HbA1c greater than 6.5%, controlling for factors such as age and gender (Table 1). Conclusions: The glycemic control in most diabetic patients with high risk for cardiovascular disease in China is unsatisfactory. Patients with HbA1c greater than 6.5% are more likely than those having lower HbA1c to also have higher blood triglycerides. Comprehensive effort is needed to better prevent cardiovascular and other complications for T2D patients. Logistic regression for HbA1c > 6.5 Independent Variable Coefficient Std. Err. age>=65 −0.121 0.237 male −0.118 0.298 T2D diagnosed for 10 years or more −0.641* 0.259 Total Cholesterol 0.134 0.109 Triglycerides −0.423** 0.128 Independent Variable Coefficient Std. Err. age>=65 −0.121 0.237 male −0.118 0.298 T2D diagnosed for 10 years or more −0.641* 0.259 Total Cholesterol 0.134 0.109 Triglycerides −0.423** 0.128 * p < .05; **p < .01 Open in new tab Logistic regression for HbA1c > 6.5 Independent Variable Coefficient Std. Err. age>=65 −0.121 0.237 male −0.118 0.298 T2D diagnosed for 10 years or more −0.641* 0.259 Total Cholesterol 0.134 0.109 Triglycerides −0.423** 0.128 Independent Variable Coefficient Std. Err. age>=65 −0.121 0.237 male −0.118 0.298 T2D diagnosed for 10 years or more −0.641* 0.259 Total Cholesterol 0.134 0.109 Triglycerides −0.423** 0.128 * p < .05; **p < .01 Open in new tab P130 A workplace based lifestyle intervention programme: effect on anthropometric risk factors for cardiovascular disease and type 2 diabetes E M Di Battista1, M Williams2, S Rice2, J Stephens3, R M Bracken3, S D Mellalieu3 1Nutrition and Dietetics Dept. Prince Philip Hospital, Llanelli, United Kingdom, 2Diabetes Centre, Prince Philip Hospital, Llanelli, United Kingdom, 3College of Engineering, Swansea University, Swansea, United Kingdom Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: Over the past 30 years obesity rates have increased to pandemic proportions, dramatically influencing the rates of Type 2 Diabetes (T2D) and to a lesser extent Cardio-Vascular Disease (CVD). Programmes that detect those at high risk of developing T2D and cardiovascular disease are advocated by UK government bodies. Prosiect Sir Gâr (the Carmarthenshire Project) a multi-agency collaboration, was formed to provide risk assessment at the workplace of employees aged 40 years and over, in Carmarthenshire, South Wales. A lifestyle intervention programme (LIP) was developed as a component of Prosiect Sir Gâr with the aim of facilitating behaviour change as a part of the cardiovascular disease and T2D risk reduction strategy. Individuals identified with increased cardiovascular disease and T2D risk were offered access to the LIP. The purpose of this study was to evaluate the anthropometric variances following completion of the LIP. Methods: Employees received eight 75 minute sessions delivered at their workplace (at 1 of 2 hospital sites or a steel works) by a dietitian (7 sessions) and an exercise specialist (1 session) with an emphasis on education and motivation for behaviour change. Weight, body mass index and Waist Circumference (WC) were collected at programme commencement and completion. A maximum of 10 participants were enrolled on a LIP. Depending on their initial risk profile, employees were reassessed at 6 months, 12 months or 5 years. Results: To date, ten 8-week programmes have been evaluated and 38 participants have completed. Body mass index improved significantly (p < 0.001) across the sample with body mass index 33.7 ± 4.5 kg/m2 pre-LIP and body mass index 32.9 ± 4.3 kg/m2 (mean ± standard deviation) post-LIP, respectively. Twenty-nine participants reduced their weight, with body mass index 34.1 ± 4.3 kg/m2 pre-LIP and body mass index 33.1 ± 4.2 kg/m2 post-LIP, respectively (p < 0.001). Weight loss was 2.7 ± 2.1 kg (2.8 ± 2.2% body weight) over the 8 week LIP (n = 29, p < 0.001) with a reduction in WC of 3.9 ± 2.01 (n = 25, p < 0.001). Weight loss of 6.2 ± 3.8 kg (5.8 ± 3.5% body weight) was observed 1 year post-LIP in a cohort of 7 participants. Conclusions: Positive anthropometric results were observed following this workplace-based intervention. The results suggest a lifestyle intervention programme represents a positive start towards behaviour change. The 8-week period triggered initial weight loss which continued up to 1 year in a cohort of our sample. This behaviour change strategy implies weight loss can be maintained in a real-life workplace setting. As participants continue to be re-evaluated, examination of a greater sample may suggest an effective workplace-based strategy in cardiovascular disease and T2D risk reduction. P131 Preliminary results of the Italian health examination survey: trend of diabetes prevalence in Italy from 1998 to 2008 C Donfrancesco1, L Luigi Palmieri1, C Lo Noce1, F Dima1, S Vannucchi1, D Vanuzzo2, S Giampaoli1 1Istituto Superiore di Sanità, Rome, Italy, 2ASS4 “Medio Friuli”, Centre for Cardiovascular Prevention, Udine, Italy Diabetes Type 1/2 (Prevention & Epidemiology) Background: The WHO estimated an increase of diabetes prevalence at every age from 2,8% in 2000 to 4,4% in 2030 with particular increase among over 65 years old persons. Here are presented preliminary analyses aiming to estimate the trend of diabetes prevalence and the quality of diabetes treatments in Italian population aged 35-74 years from 1998 to 2008. Methods: Data collected during the ongoing Health Examination Survey (HES) started in 2008, were compared with data collected during the HES 1998-2002. Both samples were randomly selected by age and sex stratification and were screened using the same standardized procedures. Up to now the survey has been finalized in nine regions (3 in the North, 2 in the Centre and 4 in the South of Italy): 1740 men and 1738 women were examined and compared with 1874 men and 1798 women enrolled in the same regions during the 1998-2002 survey. Persons with fasting plasma glucose >=126 mg/dl or with diagnosis of diabetes were classified as diabetic; diabetic persons with fasting plasma glucose < 140 mg/dl were considered under control. Educational level was categorized in two groups: ‘primary/secondary school’ and ‘high school/university’. Differences between means and prevalence were tested using t-test and chi-squared test respectively. Results: In 1998, diabetes prevalence resulted 15% in men and 10% in women; in 2008, diabetes prevalence resulted 15% in men and 9% in women. In both surveys diabetes prevalence increases with age both in men and women. In 1998, 43% of diabetic men and 31% of diabetic women were unaware; in 2008, 41% and 35% respectively. In 1998, 24% of diabetic men and 28% of diabetic women were under control; in 2008, 30% and 26% respectively. Mean values of continuous cardiovascular risk factors were higher in diabetics in both surveys. An higher prevalence of smokers were found among diabetics, especially among women in 2008. Even though not statistically significant, diabetes prevalence seems to slightly increase in lower educational level group and decrease in elevated educational level class. Conclusions: No statistically significant differences of diabetes prevalence were found between the two surveys in both men and women. This results could suggest that the attention on diabetes prevention was not encouraged in spite of WHO recommendations. Further analyses including data from remaining Italian regions are needed to confirm diabetes trend in the Italian adult population. P132 Type 2 diabetes and cardiovascular drug therapy on the island of Ireland: do financial incentives change prescribing behaviour? N Naomh Gallagher1, D O'reilly1, K Bennett2 1UKCRN Centre of Excellence for Public Health (NI), Belfast, United Kingdom, 2St James's Hospital, Trinity Centre for Health Sciences, Department of Pharmacology and Therapeutics, Dublin, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The risk of mortality and morbidity related to cardiovascular disease (CVD) are known to be up to five times higher for individuals with type 2 diabetes mellitus compared to the general population. European guidelines recommend that cardiovascular drug therapy should be considered in those with diabetes, even those recently diagnosed or asymptomatic. Pay for performance incentives for primary care physicians currently exist in the UK through the Quality and Outcomes Framework (QOF) with three specific payments regarding management of cardiovascular disease in individuals with diabetes, yet there has been no conclusive evidence to show that financial incentives improve quality of care. We used population wide pharmacy claims datasets from two similar populations to assess (i) differences in prescribing of common preventative cardiovascular therapies, and (ii) whether financial incentives made a significant difference in quality of care. Methods: We obtained pharmacy claims data from Northern Ireland (NI; n = 1.4m) and the Republic of Ireland (ROI; n = 3.4m) on known and pharmacologically treated type 2 diabetes mellitus (T2DM) in individuals ≥ 16yrs, over a two year period 1st January 2009 - 31st December 2010. T2DM was defined as diabetes treated with oral anti-diabetic medication or a combination of oral medication and insulin. Rates of prescribing of preventive cardiovascular therapies (including anti-platelets, beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACE), lipid-lowering drugs (LLD)) were measured. Results: The 2009 & 2010 prevalence figures for treated T2dm were 3.6% & 4.1% in NI and 2.8% & 3.1% in ROI for individuals aged ≥ 16yrs respectively. There were comparable proportions of patients with T2DM being prescribed cardiovascular therapies across both countries, with slightly more prescribing of LLD in NI and higher prescribing of ACE in ROI. Prescribing was high for all cardiovascular disease medication at >92% for both countries. Conclusions: We found no significant difference in rates of prescribing of overall cardiovascular disease medication, antiplatelets and BB in patients with treated T2DM between the two populations. The financial incentives in place in NI do not seem to affect the quality of care in terms of cardiovascular disease prevention in patients with diabetes, which raises questions about the cost-effectiveness of such incentives. P133 Paraoxonase 1 Gene (Gln192-Arg) polymorphism and the risk of coronary artery disease in type II diabetes mellitus M F Mohamed Fahmy Elnoamany1, A Dawood1, A Azmy1, M Elnajjar1 1Menoufiya Faculty of Medicine, Shebeen El-Koom, Egypt Diabetes Type 1/2 (Prevention & Epidemiology) Background: Paraoxonase 1 (PON1) is reported to have an antioxidant & cardioprotective properties. Recently, an association of glutamine (Gln) or (type A)/arginine (Arg) or (type B) polymorphism at position 192 of PON1 gene has been suggested with coronary artery disease (CAD) among patients with diabetes mellitus (DM). However, conflicting results have also been reported. Objectives: To investigate relationship between of PON1 gene (Gln192-Arg) polymorphism & presence, extent & severity of CAD in type II diabetes mellitus. Methods: The study comprised 180 patients recruited from those undergoing coronary angiography for suspected CAD, divided according to presence or absence of CAD & diabetes mellitus into 4 groups; Group I (n = 40 patients) nondiabetic subjects without CAD, Group II (n = 45 patients) diabetic patients without CAD, Group III (n = 47 patients) non diabetic patients with CAD &Group IV (n = 48 patients) diabetic patients with CAD. PON1(Gln192-Arg) genotype was assessed using polymerase chain reaction (PCR) followed by AlwI digestion. Results: The frequency of Gln allele (Type A) was significantly higher in group I & group II compared to group III & group IV (62.5%, 60% versus 38.3, 31.25% respectively, p < 0.001) while the frequency of Arg allele (Type B + Type AB) was significantly higher in ischemic groups (III, IV) compared to non ischemic groups (I,II) (61.7%, 68.75% versus 37.5, 40% respectively, p < 0.001). Patients with CAD & diabetes mellitus (group IV) have significantly higher severity score & vessel score than those with CAD only (group III) (9.7 ± 2.97, 2.44 ± 0.56 versus 6.99 ± 3.71, 1.67 ± 0.89 respectively, p < 0.001) Patients with vessel score 3 had significantly higher severity score & higher Arg allele frequency than patients with vessel score 2, the latter group had also significantly higher severity score & Arg allele frequency than patients with vessel score 1 (8.9 ± 2.79 versus 5.21 ± 2.13 & 80.49% versus 67.86%), (5.21 ± 2.13 versus 3.11 ± 0.89 & 67.86% versus 53.85%), p < 0.001 for all. In multivariate regression analysis, age [OR 2.99, CI (1.11-10.5), P < 0.01], smoking [OR 4.13, CI (1.37-11.7), P < 0.001], low density lipoprotein (LDL) cholesterol > 100 mg/dL [OR 4.31, CI (1.25-12.5), P < 0.001], high density lipoprotein (HDL) cholesterol <40 mg/dL [OR 5.11, CI (1.79-16.33), P < 0.001] & PON1 192 Arg allele [OR 4.62, CI (1.79-13.57), P < 0.001] were significantly independent predictors of CAD. Conclusion: Arg allele of PON1 192 gene polymorphism is an independent risk factor for CAD & it is associated not only with the presence of CAD but also with its extent & severity and its impact is clearly more pronounced in diabetic patients. P134 Comorbidity in type 2 diabetes in ireland M O Shea1, M Teeling1, K Bennett1 1Trinity Centre for Health Sciences, St James's Hospital., Dublin, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Introduction: Diabetes Mellitus is associated with a range of comorbid conditions including those affecting the cardiovascular system (CVS). Few studies have investigated the prevalence or type of comorbidity present in the Irish population with type 2 diabetes mellitus (T2DM). Purpose: To investigate the prevalence and type of chronic comorbid conditions in an Irish adult population with and without T2DM in 2010 using a national pharmacy claims database. Methods: Data obtained from the Irish Health Service Executive Primary Care Reimbursement Service pharmacy claims database for 2010 was used to identify the study cohort aged 25-64 years. T2DM was identified using the prescription of oral anti-hyperglycaemic agents (ATC A10B). Chronic comorbidity was ascertained using a modified version of the RxRisk index, and included cardiovascular (CV) and other co-morbid conditions. The association between T2DM (present or not) and comorbid conditions was assessed using the chi sq test. Logistic regression was used to examine the relationship between comorbid conditions and T2DM, adjusting for age and gender. SAS version 9.1 was used for the analysis. Statistical significance at p < 0.05 was assumed. Results: A cohort of 21,877 from the study cohort of 695,903 individuals, were identified as having treated T2DM, representing a prevalence of 3.14% in this cohort. The median number of chronic comorbid conditions was higher in those with T2DM compared to those without (3 versus 0 conditions) (p < 0.0001). Individuals with T2DM were 7 times more likely to have >3 comorbidities compared to individuals without diabetes (OR = 7.2; 95%CI = 7.0, 7.4). Comorbid conditions associated with the CVS were shown to account for 66% of the comorbidity present in the cohort with T2DM. The most prevalent CV-related conditions/prescriptions in those with T2DM were hyperlipidemia (75%), antiplatelet therapy (60%) ischaemic heart disease (42.3%) and hypertension (23.4%). Removal of CV conditions from the analysis reduced the median number of comorbid conditions in the cohort with T2DM versus no T2DM (1 versus 0 conditions). Conditions unrelated to CVS were also more prevalent in those with T2DM (p < 0.0001). Conclusion: Individuals with T2DM were more likely to have a higher number of comorbid conditions overall compared with those without T2DM. CV-related comorbid conditions were highly prevalent in the cohort with T2DM. The high frequency of co-prescribing of anti-hypertensive and cholesterol reducing agents suggest appropriate prescribing practice by doctors caring for these patients, given the known increased risk of CV events in patients with T2DM. P135 HbA1c > 5.7% in non-diabetic patients: a risk class in acute myocardial infarction? F Francisca Caetano1, I Almeida1, J Silva1, L Seca1, A Botelho1, P Mota1, A Leitao Marques1 1Hospital Center of Coimbra, Coimbra, Portugal Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The American Diabetes Association has issued new recommendations in 2010 including HbA1c as a diagnostic criterion for diabetes mellitus (DM) and define a new risk class (HbA1c 5.7-6.4%). The purpose of this study was to compare two groups (G) of patients (P) with acute coronary syndromes (ACS) without diabetes mellitus, separated by HbA1c. Methods: From a population of 519 P consecutively admitted for acute coronary syndrome to a Coronary Unit, we studied 237 P (71.3% male, age 65 ± 14 years) without diabetes mellitus. P were separated in 2 groups: G1 - HbA1c <5.7% (n = 115) vs G2 - HbA1c 5.7-6.4% (n = 122). Clinical, analytical, echocardiographic, angiographic and adverse events were compared. Major adverse cardio and cerebrovascular events (MACCE) were assessed at follow-up (FU) (6.8 ± 5.1 months). Results: P in G2 were more often female (p = 0.044), older (62.0 ± 15.1 vs 67.7 ± 13.2; p = 0.002); had a higher incidence of high blood pressure (p = 0.025) and chronic heart failure (HF) (p = 0.008). At admission they presented with higher blood glucose levels (5.8 ± 1.3 vs 6.5 ± 2.4; p = 0.004) and NT-pro-BNP (p = 0.016), although with lower values of glomerular filtration rate (84.1 ± 23.4 vs 74.0 ± 26.3; p = 0.005). They had higher global registry of acute coronary events risk score (135 ± 39 vs 146 ± 45; p = 0.048) and increased risk of acute HF - Killip-Kimball ≥ 2 - (13% vs 26.2%; p = 0011). No differences were found between the two G in the type of acute coronary syndrome, in the incidence of coronariography or angioplasty. Regarding adverse events: the incidence of new-onset HF, the severity of coronary artery disease and in-hospital mortality did not differ between the G. However, G2 P had longer hospitalizations (4.7 ± 2.0 vs 5.9 ± 4.7; p = 0.011), higher incidence of cardio-renal syndrome (12.3% vs 22.3%; p = 0.043) and left ventricular dysfunction (p = 0.048). During FU more MACCE were observed in G2 (9.3% vs 21.7%; p = 0.011), with higher rates of re-infarction (0.9% vs 7.8%; p = 0.020) and a trend towards higher mortality (2.8% vs 8.7%; p = 0.059) and re-hospitalization for acute HF (0.9% vs 6.1%; p = 0.067). Conclusions: Non-diabetic patients with HbA1c 5.7-6.4% are a higher risk class in acute coronary syndrome, both in-hospital and during FU, reinforcing the need for optimization of medical therapy, with implementation of measures to prevent the progression to diabetes mellitus, avoiding an even grimmer prognosis. P136 VITABalance-MED project - District level (Phase III) IIIES, A R Antonio Rui Leal1, I Pinto2, M Rodrigues3 1Foundation SANITUS, Sta Maria da Feira, Portugal, 2Sao Joao Hospital, Department of Cardiology, Porto, Portugal, 3Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal Diabetes Type 1/2 (Prevention & Epidemiology) VITABalance-MED is an innovative project, with the intent of diffusing to children in school age a new and comprehensive teaching concept of Cardiovascular, Obesity and Diabetes Mellitus type 2 prevention model. Was started in 2005, is planed in 5 phases and is based on behavioral adhesion to an appropriate balance, between healthy alimentation, regular physical exercise, healthy life style, with cardiovascular risk factors control and respect for the eco-system, in a scientifically correct and articulated way (five pyramids connected by the EU-R-EKO = a role model children). This transmission is made by prepared teachers in schools, in an conception that regards to costs, to sustainability (net-work), and is visually based (poster). After the Conceptual Phase (Phase I), during 4 years and the Pilot-Project (Phase II), between 2009 - 2011 involving 475 students and 16 teachers, we are currently in Phase III (District level). This phase (Randomized Control Trial), will start October 2011 till June 2012, and involves 5 strategic partnerships (Foundation, City Hall, Clinic, Editor, Web-Enterprise), and 10 primary Schools (randomized to poster alone vs teachers course/parents), about 1500 students and their parents. The certified course, will be applied to 47 Teachers, is specific and modular, with a duration of 75h (=3CUs), and includes the delivery of a pedagogical kit (“VITA-Kit”: the 5 pyramids-Poster, a CD and several didactic and evaluating materials) permitting access to a web-page with a Forum for parents and teachers. To test a more realistic and practical approach, it's been also planed the execution of a Tridimensional model of the “EU-R-EKO”, along with practical sessions, with the support of Centers for “Live Science”. The Phase IV it will be at a National level, after this district validation of the interventional process. We will proceed after with Phase V, at the International level, along with the expansion of the Consortium for research and education in health - the IIIES Project. It is our purpose to present this project, their methodology and the preliminary results of the impact of the course in the teachers, trough knowledge questionnaires in the EuroPrevent congress. P137 Prevalence of diabetes in Ireland based on HbA1C P Patricia Kearney1, J Harrington1, IJ Perry1 1University College Cork, Cork, Ireland Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: To date estimates of the prevalence of diabetes in Ireland have been based on self-report measures. Since 2009 the International Expert Committee has recommended that the diagnosis of diabetes can be made on the basis of HbA1c levels. The purpose of this study is to estimate the prevalence of diabetes in Ireland based on levels of HbA1c. Methods: Estimates were based on the subsample of participants in the Survey of Lifestyles, Attitude and Nutrition (SLAN) 2007, a nationally representative study, who provided a blood sample at the physical examination. The diagnosis of diabetes was based on a HbA1C level ≥ 6.5% or self-report of occurrence of diabetes in past year or reporting of diabetes medications. Results: 1202 participants >45 years participated in the physical examination and blood was available from 1140. The overall prevalence of diabetes was 7.7% (95% CI 6.2-9.4). The prevalence of diabetes was more than twice as high among men than among women (11.2% [95% CI 8.6%-14.3%] versus 4.9% [95% CI 3.3%-6.8%]; p < 0.0001). The prevalence of diabetes increased with age in both men and women. Conclusions: The estimated prevalence of diabetes in Ireland which incorporates HbA1c is much higher than previous estimates based only on self-report. Despite efforts to increase awareness and screening for diabetes, many individuals with diabetes are undiagnosed or untreated. Increased efforts are required to improve detection of diabetes. Prevalence of diabetes by age and sex Men Women Age group N (%) N (%) p-value 45-64 33 (10.6) 18 (4) 0.0004 ≥ 65 23 (12.2) 13 (6.9) 0.08 Men Women Age group N (%) N (%) p-value 45-64 33 (10.6) 18 (4) 0.0004 ≥ 65 23 (12.2) 13 (6.9) 0.08 Open in new tab Prevalence of diabetes by age and sex Men Women Age group N (%) N (%) p-value 45-64 33 (10.6) 18 (4) 0.0004 ≥ 65 23 (12.2) 13 (6.9) 0.08 Men Women Age group N (%) N (%) p-value 45-64 33 (10.6) 18 (4) 0.0004 ≥ 65 23 (12.2) 13 (6.9) 0.08 Open in new tab P138 Diet quality, insulin resistance and risk of type 2 diabetes in middle-aged men and women: results from the cork and kerry diabetes and heart disease study J Harrington1, AP Fitzgerald1, PM Kearney1, DL Dahly2, VJC Mccarthy1, E Kennedy1, IJ Perry1 1University College Cork, Cork, Ireland, 2University of Leeds, Leeds, United Kingdom Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: Increasing levels of type 2 diabetes (T2D) pose a significant threat to population health worldwide. The aim of this study was to investigate the effect of diet quality on insulin resistance (IR) and risk of T2D. Methods: Cross-sectional and longitudinal analyses of data from a study of 1018 men and women in Ireland, born 1926-1951, recruited in 1998 (age 50 to 69 years) and re-screened in 2008 (Response rate at follow-up 57%, N = 346). Participants completed a physical examination including fasting blood samples for glucose, insulin and glycosylated haemoglobin and a questionnaire addressing health related behaviours, health status and sociodemographic attributes at baseline and follow-up. Diet quality was assessed using a standard Willet FFQ, from which a dietary score (Dietary Approaches to Stop Hypertension-DASH score) was constructed. The DASH score is a composite score weighted heavily on fruit and vegetable intake and low intake of sodium-rich and processed foods. High scores equate to healthy diets, lower scores less healthy diets. T2D was diagnosed on the basis of glycosylated haemoglobin >=6.5%. IR prevalence was estimated by the homeostasis model assessment (HOMA) and defined as HOMA-IR values above 4.65. Results: At baseline, obesity was predictive of IR (OR 12.5 95% CI[4.0-39.0] P < 0.00), physical activity was protective (OR 0.3 95% CI[0.1-1.0] P = 0.054). Though not significant there was a trend across dietary quality groups (DASH Score quintiles), poor quality diet increased the risk of IR (OR 3.1 95% CI [1.0-9.2]) compared to higher quality diets. At follow-up there was a 13% mortality rate (N = 136) and 30% (N = 374) loss to follow-up. Baseline characteristics between responders and those lost-to-follow-up were broadly similar. The prevalence T2D increased by 6% between baseline (2%) and 10-year follow-up (8%). Smoking (OR 8.2 95% CI [1.5-45.0] P = 0.016) and obesity (OR 11.3; 95% CI [2.1-60.9] P = 0.005) at baseline increased T2D risk at follow-up. There was a significantly lower risk of T2D for those with a high dietary quality at baseline (OR 0.2 95% CI [0.1-1.0] P = 0.045) in multivariate analyses adjusted for body mass index, smoking and other potential confounding factors. Conclusion: While calorie excess/obesity and physical inactivity are the major contributors to the emerging epidemic, dietary quality has a significant impact on the development of T2D. Social marketing and public policy focused on improving diet quality has the potential to mitigate current adverse trends in a developed country such as Ireland. P139 Target low-density lipoprotein cholesterol levels attainment among dyslipidemic individuals in the Levant region (Jordan and Lebanon) The CEPHEUS-Levant Survey Group, A Ayman Hammoudeh1, G Ghanem2, A Echtay3 1Istishari Hospital, Amman, Jordan, 2University Medical Center-Rizk Hospital, Beirut, Lebanon, 3Lebanese University Medical College, Beirut, Lebanon Lipid Disorders (Prevention & Epidemiology) Purpose: Cardiovascular disease (CVD) is the leading cause of death in the Middle East and dyslipidemia is one of the most common risk factors for this. It is largely unknown whether dyslipidemia is adequately treated to recommended cholesterol target levels or not. The CEPHEUS survey evaluated the use and efficacy of lipid lowering agents (LLA) in reducing low-density lipoprotein cholesterol (LDL-C) to reach target levels recommended by the American and European guidelines, and the predictive factors that influence reaching such target levels in the Levant region. Methods. A multi-centre, cross-sectional survey enrolled 1002 consecutive dyslipidemic patients in Jordan and Lebanon (August 2010-January 2011) who were on LLA for >3 months with stable doses for >6 weeks. Collection of clinical data and fasting blood samples were done over one visit. Physicians and patients filled out a dyslipidemia diagnosis and treatment questionnaire. LDL-C target levels were defined according to the US National Cholesterol Education Program Adult Treatment Panels (NCEP ATP III) and the Third Joint European Task Force (JETF) guidelines. Results. Full analysis of 992 patients (41% women) showed mean age of 58 + 11 years. Hypertension, diabetes mellitus (DM), and smoking were present in 66%, 50%, and 29%; respectively. History of coronary, peripheral, or cerebro-vascular disease was present in 52%, 5% and 3% respectively. LLA were prescribed for primary and secondary prevention and familial hypercholesterolemia in 46% and 53% and 1% respectively. Overall, 57%, and 64%of patients attained LDL-C goals recommended by the JETF and NCEP ATP III guidelines; respectively. However, according to the 2004 ATP III updated guidelines; only 25% of the very high risk group (53% of all patients) attained low-density lipoprotein goal of < 70 mg/dL. Smoking, diabetes mellitus, metabolic syndrome, cardiovascular disease history, increased waist circumference, and elevated pre-treatment LDL-C were all associated with not reaching LDL-C goals. Conclusion. Among dyslipidemic individuals using LLA in the Levant region, only 25% of the very high risk group achieved recommended LDL-C targets of < 70 mg/dl. Overall, about 60% of patients achieved the JETF and NCEP ATP III target levels. National strategies and aggressive awareness campaigns to effectively control LDL-C levels to recommended targets are urgently needed. P140 Apolipoprotein E genotype and metabolic syndrome in Lithuanian urban population DI Luksiene1, A Smalinskiene1, V Lesauskaite1, M Baceviciene1, A Tamosiunas1 1Institute of Cardiology of Lithuanian University of Health Sciences Medical Academy, Kaunas, Lithuania Lipid Disorders (Prevention & Epidemiology) The aim of the study was to assess the associations of Apolipoprotein E (ApoE) genotype with metabolic syndrome in Lithuanian population aged 45-72 years. Methods: Data from survey performed in the framework of the HAPIEE (Health, Alcohol, Psychosocial factors in Eastern Europe) study are presented. A random sample of Kaunas men and women aged 45-72 years, stratified by gender and age were randomly selected from Lithuanian population register. 7087 individuals were screened (3218 men and 3869 women). Response rate was 64.8%. 1021 individuals (525 men and 496 women) were genotyping and this data from were approved for statistical analysis. ApoE genotyping were performed using the real-time polymerase chain reaction method. Metabolic syndrome was defined using Adult Treatment Panel III definition. Age-adjusted odds ratios of metabolic syndrome by the ApoE genotype were calculated using logistic regression analysis. Results: In random sample of population aged 45-72 years the frequency of ApoE genotype 3/3 was 66.1%, 2/2 or 3/2 - 17.6%, and 4/3 or 4/4 - 16.3% and did not differ between men and women. The prevalence of metabolic syndrome was significantly higher in women than in men (36.6% versus 26.4%) (p < 0.001). In men group with metabolic syndrome the prevalence of men with ApoE genotype 4/3 or 4/4 was significantly higher than with ApoE genotype 2/2 or 3/2 (36.6% versus 24.0%) (p < 0.05) and it did not differ in women group. After adjustment for age, the odds ratios for metabolic syndrome among men with ApoE genotype 4/3 or 4/4 versus men with ApoE genotype 2/2 or 3/2 were 1.82 (95% CI 1.07-3.07) (p = 0.026). We did not found associations with ApoE genotype and metabolic syndrome in women. Conclusion: ApoE genotype 4/3 or 4/4 should be considered as possible genetic risk factor for metabolic syndrome in middle-aged and elderly Lithuanian men population. P141 Physical activity during an inpatient weight-loss programme, a pedometer sub-study of the LOGIC trial D C Desiree Wilks1, M Rank1, D Harl1, H Langhof2, M Siegrist1, M Halle1 1Technical University of Munich, Department of Prevention and Sports Medicine, Munich, Germany, 2Clinic Schoensicht, Berchtesgaden, Germany Obesity (Rehabilitation & Implementation) Background: Physical activity (PA) is an important part of weight-loss programmes for children, however objectively measured data are sparse. The aims of this study were firstly to quantify the PA volume of children and adolescents during an inpatient non-pharmacological weight-loss programme; secondly to examine whether both the amount of steps walked during leisure time and the structured exercise therapy is comparable amongst children; and thirdly to investigate whether daily steps were associated with weight-loss during the programme. Methods: During their inpatient stay at a weight-loss clinic 78 girls and 51 boys aged 14.2 ± 1.5 years, who participated in the LOGIC-trial, wore a pedometer all day and completed a PA diary. The weight-loss programme of the clinic is based on increasing PA, improving nutrition and health-related behaviours. Body weight was measured at the beginning and the end of the programme. Participants with PA data for at least three weekdays and one weekend day were included into the analysis. A day was defined as steps for ≥ 8h and ≥ 1.000 to ≤ 30.000 steps. To investigate comparability of the children's PA volumes, tertiles of the steps per day were created and mean steps during both leisure time and exercise therapy were calculated. Results: Girls and boys walked on average 10,315 ± 2,093 und 11,633 ± 3,069 steps per day, with 38% of the participants achieving the President's Council on Physical Fitness and Sports recommendations (11,000 and 14,000 steps/day for boys and girls). Tertile analyses indicated that the daily activity volume of the children differed significantly (group difference tertiles 1-3: p < 0.01): The girls and boys of the upper tertile walked on average 35% und 45% more steps than those of the lower tertile (girls: 8155 ± 1021 versus 12578 ± 1340 steps/day; boys: 8178 ± 1540 versus 14938 ± 1743 steps/day; p < 0.001). This was due to a large difference in the PA volume during leisure time (girls: 6329 ± 1435 versus P129 ± 1778 steps/day (+40%); boys: 6323 ± 1405 versus 12840 ± 1875 steps/day (+51%); p < 0.05), but not during the exercise therapy (p > 0.05), which can therefore be considered standardised regarding the PA volume. During the programme, mean body weight decreased on average from 89.6 ± 19kg to 80.0 ± 16kg (p < 0.001); the children's daily steps were not associated with the change in body weight (p > 0.05). Conclusion: To increase physical activity in an inpatient setting, leisure time PA is an important factor that should be considered. P142 Is there a need to redo many of the diagnoses of hypertension? JM Jose Marcos Thalenberg1, B Luna Filho1, MTN Bombig1, YA Francisco1, RMS Povoa1 1Unifesp - Federal University of São Paulo, São Paulo, Brazil Hypertension (Rehabilitation & Implementation) Purpose: Most of treated hypertensive subjects had their diagnosis performed solely by office measurements. The objective of this study is to redo the diagnosis of treated patients after drug withdrawal, new office measurements and ambulatory blood pressure monitoring (ABPM). Methods: This is a cross-sectional study conducted on a specialty clinic. Included were patients with mild-to-moderate office hypertension or taking anti-hypertensive drugs, no target-organ damages or diabetes. After drug withdrawal of 2-3 weeks, patients had office blood pressure (BP) measurements taken on two distinct visits. ABPM was performed in a blind fashion. Diagnostic criteria: hypertension if office B ≥ 140 (systolic) or 90 (diastolic) mmHg on the 2 visits and mean awake ABPM (MAA) ≥ 135/85 mm Hg; white-coat hypertension if the same office findings and MAA < 135/85 mm Hg; normotension if BP < 140/90 mmHg on both or the second visit and MAA < 135/85 mmHg; masked hypertension if the same office findings and MAA ≥ 135/85 mmHg. Results: One hundred and one subjects (70% women), mean age 51 ± 10 years. Mean office BP: 155 ± 18/97 ± 10 mm Hg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit). MAA of 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were classified as hypertensive, 28 (28%) as white-coat hypertension, 9 (9%) as normotension and none as masked hypertension. After ABPM, 37% of presumptively hypertensive patients did not fit in this category. Conclusion: This study shows a significant hypertension overdiagnosis in treated hypertensive subjects. New diagnostic procedures may be performed after drug withdrawal and the help of out-of-office blood pressure monitoring. BP means and diagnostic cathegories VISIT 1 VISIT 2 Ambulatory blood pressure monitoring mean awake Hypertension 158  ±  18/101  ±  10 154  ±  16/99  ±  10 144  ±  10/91  ±  8 White coat hypertension 150  ±  13/92  ±  8 146  ±  11/89  ±  9 125  ±  6/77  ±  6 Normotension 141  ±  20/87  ±  10 130  ±  8/81  ±  7 124  ±  6/74  ±  5 VISIT 1 VISIT 2 Ambulatory blood pressure monitoring mean awake Hypertension 158  ±  18/101  ±  10 154  ±  16/99  ±  10 144  ±  10/91  ±  8 White coat hypertension 150  ±  13/92  ±  8 146  ±  11/89  ±  9 125  ±  6/77  ±  6 Normotension 141  ±  20/87  ±  10 130  ±  8/81  ±  7 124  ±  6/74  ±  5 Open in new tab BP means and diagnostic cathegories VISIT 1 VISIT 2 Ambulatory blood pressure monitoring mean awake Hypertension 158  ±  18/101  ±  10 154  ±  16/99  ±  10 144  ±  10/91  ±  8 White coat hypertension 150  ±  13/92  ±  8 146  ±  11/89  ±  9 125  ±  6/77  ±  6 Normotension 141  ±  20/87  ±  10 130  ±  8/81  ±  7 124  ±  6/74  ±  5 VISIT 1 VISIT 2 Ambulatory blood pressure monitoring mean awake Hypertension 158  ±  18/101  ±  10 154  ±  16/99  ±  10 144  ±  10/91  ±  8 White coat hypertension 150  ±  13/92  ±  8 146  ±  11/89  ±  9 125  ±  6/77  ±  6 Normotension 141  ±  20/87  ±  10 130  ±  8/81  ±  7 124  ±  6/74  ±  5 Open in new tab P143 To assess the effectiveness of the systematic identification and follow-up of hypertensive patients using ambulatory blood pressure measurement in cardiac rehabilitation. N Fallon1, G Mckee2, C Finn1, N Flynn1, R O Mahony1, P Mcgeary1 1Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland, 2Trinity College Dublin, School of Nursing and Midwifery, Dublin, Ireland Hypertension (Rehabilitation & Implementation) Purpose: Achieving hypertension guideline targets has always been difficult. The aim of this study was to assess the effectiveness of the systematic identification and follow-up of hypertensive patients using ambulatory blood pressure measurement (APBM) in cardiac rehabilitation. Methods: Automated standard blood pressure (BP) measurement was conducted on all attendees on commencement of an 8 week cardiac rehabilitation (CR) program. As part of the educational program all patients are educated about lifestyle management of blood pressure. Patients with sustained elevated blood pressure had a subsequent 24 hour APBM with medication change as required by parameters of ABPM. Patients blood pressure were again assessed by the end of the CR program. Hypertension was defined as values above 130/85mmHg. Results: A total of 344 patients attended CR. On initial assessment 34% (116) exhibited hypertension and an initial ABPM follow-up was performed on all 116. Of these: 46% (53) blood pressure was controlled; 36% (42) blood pressure was uncontrolled with 5% (6) of patients without previously diagnosed hypertension were identified by this stage; 12% (14) no longer exhibited hypertension, had no previous history of hypertension and therefore the hypertension exhibited on entry to CR was white coat hypertension; 5% (7) of patients were lost to follow-up or data was incomplete. Medications were changed in all uncontrolled blood pressure group (42) and all of these patients were assessed by ABPM. Within this group, 45% (19) had a further ABPM and medication change. By the end of CR a total of 18 (43%) of the patients that had uncontrolled hypertension had achieved control. The remainder of uncontrolled patients were referred to general cardiology clinics for follow-up. Conclusion: This systematic identification and follow-up of hypertensive patients using APBM in cardiac rehabilitation identified 5% previously unidentified hypertension, 12% white coat hypertension and 36% uncontrolled hypertension. The follow-up and assessment protocol used in this CR program was effective in achieving control of blood pressure in 43% of the initially uncontrolled hypertension, resulting in a total of 61% of hypertension controlled to standard values in the CR patients. P144 Reducing global risk of ambulatory assisted hypertensive patients - impact of new dyslipidaemia guidelines on clinical practice. Z Zoltan Preg1, MI Laszlo2, M German-Sallo1, P I Kikeli1 1University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania, 2Procardia Medical Society, Tirgu Mures, Romania Hypertension (Rehabilitation & Implementation) A good lipid controll for reducing the total cardiovascular risk of hypertensive patients is one of the basic targets in hypertension management. Purpose: To determine the impact of the ESC/EAS 2011 guidelines for the management of dyslipidaemias on the lipid management practice of a preventive profiled ambulatory cardiology system. Methods: The study included all the 7413 hypertensive patients examined between 2002-2011 in an integrated preventive ambulatory system. The sex distribution of the studied patients was 45.26% male average age 57,81 years, and 54.26% female average age 61,67 years. Patients received individualy tailored lifestyle advice and drug treatment targeting the reduction of global cardiovascular risk. Patienst were stratified in very high, high, moderate and low risk categories according to ESC 2011 guidelines. We considered that cholesterol lowering treatment is compelling in very high risk group when LDL >70 mg%, respective in high risk group when LDL > 100 mg%. We compared the frequency of prescribed cholesterol lowering medication with that indicated in the guidelines. We used an integrated patient data management system as an electronic health record. Results: Risk stratification could not be performed because of missing data elements in 31.26% (2318) of the population. Patients were stratified to very high risk 74.82% (3812), high risk 1.96% (100), moderate risk 8.66% (441), and low risk 14.56% (742). Cholesterol lowering treatment was prescribed for 39.58% (2934) of the patients. Very high-risk patients were treated more frequently (48.8%), than high (37.0%), moderate (26.5%), or low (16.4%) risk patients. According to the new ESC guidelines in the future will be indicated cholesterol lowering treatment for 52.07% (3860) of patients. The analysis of the yearly trends in prescribing cholesterol lowering drugs were as seen on the table below: Conclusions: The activity of the studied cardiology ambulatory provided data for risk stratification in the majority of hypertensive patients. A yearly improving trend can be observed in the frequency of indicating cholesterol lowering drugs. According to the new guideline cholesterol lowering medications has to be indicated for another 926 patients in our sample (18%). Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total % medication prescribed for patients with indication 0.0% 20.0% 37.2% 43.0% 46.9% 51.0% 54.5% 52.0% 57.2% 52.7% 48.7% Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total % medication prescribed for patients with indication 0.0% 20.0% 37.2% 43.0% 46.9% 51.0% 54.5% 52.0% 57.2% 52.7% 48.7% Open in new tab Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total % medication prescribed for patients with indication 0.0% 20.0% 37.2% 43.0% 46.9% 51.0% 54.5% 52.0% 57.2% 52.7% 48.7% Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total % medication prescribed for patients with indication 0.0% 20.0% 37.2% 43.0% 46.9% 51.0% 54.5% 52.0% 57.2% 52.7% 48.7% Open in new tab P145 Telemetric control of blood pressure in hypertensive patients PI Kikeli1, Z Preg1, L Mihaly-Imre2 1University of Medicine and Pharmacy, Targu Mures, Romania, 2SCM Procardia, Targu Mures, Romania Hypertension (Rehabilitation & Implementation) Introduction: Blood pressure control at target values recommended by the European guidelines is difficult to realize in daily practice. Telemetric monitoring of blood pressure is an effective method to increase blood pressure control. The former studies recommended four week period for telemetric monitoring. Purpose: To evaluate the effects of two weeks telemetric monitoring in achievement of target values and patient compliance. Study design: The study included 293 unselected hypertensive patients, belonging to an preventive ambulatory cardiology system. Average age: 59 years, male 68% -76 years, and female 32% -62 years. Patients were evaluated and treated according to the European guidelines and telemetric monitoring for 14 days was stared. Patient data was recorded with an integrated electronic health record system. Statistical evaluation included the target values achievement of systolic and diastolic values and the trend analysis for morning and evening systolic and diastolic blood pressure. Results: Target values achievement increased in two weeks from 36.3% to 54.5%. The compliance was evaluated calculating the frequency of measurement (meas). We observed a decrease in the frequency of measurements from 97% to 59%. The result of trend analysis and achievement of target values are included in the table below. Conclusions: The two weeks telemetric blood pressure control is efficient in increasing the target values achievement. The compliance decreased during the period. The two weeks telemetry increased the accessibility and had a positive financial burden. Results measurement day day1 day 14 p value correlation coefficient Morning SBP 145.0 139.6 0.0001 −0.85 morning DBP 90.0 86.5 0.0004 −0.81 evening SBP 143.7 139.0 0.0002 −0.84 evening DBP 87.4 84.6 0.0002 −0.83 no of morning meas 286 174 <0.0001 −0.9 no of evening meas 235 158 <0.0001 −0.9 On target SBP morning 44.4% 56.3% 0.0003 0.81 On target DBP morning 55.2% 60.5% 0.009 0.66 On target SBP evening 46.8% 53.0% 0.004 0.70 On target DBP evening 58.2% 47.4% 0.019 0.61 measurement day day1 day 14 p value correlation coefficient Morning SBP 145.0 139.6 0.0001 −0.85 morning DBP 90.0 86.5 0.0004 −0.81 evening SBP 143.7 139.0 0.0002 −0.84 evening DBP 87.4 84.6 0.0002 −0.83 no of morning meas 286 174 <0.0001 −0.9 no of evening meas 235 158 <0.0001 −0.9 On target SBP morning 44.4% 56.3% 0.0003 0.81 On target DBP morning 55.2% 60.5% 0.009 0.66 On target SBP evening 46.8% 53.0% 0.004 0.70 On target DBP evening 58.2% 47.4% 0.019 0.61 Open in new tab Results measurement day day1 day 14 p value correlation coefficient Morning SBP 145.0 139.6 0.0001 −0.85 morning DBP 90.0 86.5 0.0004 −0.81 evening SBP 143.7 139.0 0.0002 −0.84 evening DBP 87.4 84.6 0.0002 −0.83 no of morning meas 286 174 <0.0001 −0.9 no of evening meas 235 158 <0.0001 −0.9 On target SBP morning 44.4% 56.3% 0.0003 0.81 On target DBP morning 55.2% 60.5% 0.009 0.66 On target SBP evening 46.8% 53.0% 0.004 0.70 On target DBP evening 58.2% 47.4% 0.019 0.61 measurement day day1 day 14 p value correlation coefficient Morning SBP 145.0 139.6 0.0001 −0.85 morning DBP 90.0 86.5 0.0004 −0.81 evening SBP 143.7 139.0 0.0002 −0.84 evening DBP 87.4 84.6 0.0002 −0.83 no of morning meas 286 174 <0.0001 −0.9 no of evening meas 235 158 <0.0001 −0.9 On target SBP morning 44.4% 56.3% 0.0003 0.81 On target DBP morning 55.2% 60.5% 0.009 0.66 On target SBP evening 46.8% 53.0% 0.004 0.70 On target DBP evening 58.2% 47.4% 0.019 0.61 Open in new tab P146 The management of coronary patients with diabetes enrolled in rehabilitation programmes is more effective than usual care CA Avram1, S Iurciuc2, C Avram3, LM Craciun2, D Stancila4, M Iurciuc2, S Mancas2, D Gaita2 1City Hospital Timisoara, Timisoara, Romania, 2University of Medicine & Pharmacy Victor Babes, Timisoara, Romania, 3West University of Timisoara, Timisoara, Romania, 4St. James's Hospital, Dublin, Ireland Diabetes Type 1/2 (Rehabilitation & Implementation) Purpose: To assess the outcomes of ambulatory and hospital based cardiovascular rehabilitation (CVR) program in the management of coronary patients with diabetes. Methods: We performed a retrospective study which enrolled 103 coronary patients following myocardial revascularization who associated also diabetes to their clinical condition addressed to CVR. According to their participation in CVR we split the patients into 3 groups: Group A (n = 37) participated in a 12 weeks ambulatory program, Group H (n = 32) participated in a 4 weeks hospital program and Group C (n = 34) who did not attend CVR. At 3-6-12 months after revascularization we assessed the control of modifiable risk factors, reinforced healthy lifestyle measures and optimized drug therapy in order to reach the targets recommended in the 2007 ESC Prevention Guidelines. Results: After 12 months we found that systolic blood pressure (BP) had a favorable trend in Group A and Group H comparing to Group C (Group A: from 133.26 ± 26 to 125 ± 17.8, p < 0.01; Group H: from 135.3 ± 24.4 to 126.1 ± 13.9, p < 0.01; Group C: from 135.6 ± 22.2 to 138.7 ± 19.7, p = ns), whereas diastolic blood pressure decreased significant only in Group H (Group A: from 77.7 ± 12 to 76.22 ± 9.6, p = ns; Group H: from 78.9 ± 13.3 to 77.1 ± 11.5, p < 0.01; Group C: from 80.4 ± 10.9 to 81.6 ± 10.2, p = ns). Lipids control was improved after 12 months in Group A and Group H comparing to Group C for LDL-cholesterol (Group A: from 120.5 ± 23.7 to 103.8 ± 18.7, p < 0.01; Group H: from 123.8 ± 33.4 to 101.9 ± 30.3, p = 0.006; Group C: from 133.4 ± 51.2 to 142.8 ± 48.4, p = ns) and non-HDL cholesterol (Group A: from 174.1 ± 47.4 to 150.2 ± 32.1, p < 0.01; Group H: from 176.7 ± 71.5 to 151.8 ± 39.8, p = 0.007; Group C: from 163.6 ± 45.7 to 180.4 ± 44.8, p = 0.028). Glycaemic control was improved in Group A and Group H comparing to Group C statistical significant for plasma glucose (Group A: from 125.5 ± 37.4 mg/dl to 115.1 ± 27 mg/dl, p = 0.004; Group H: from 116.7 ± 36.7 mg/dl to 106.3 ± 21 mg/dl, p = 0.004; Group C: from 115.5 ± 33.1 mg/dl to 122.2 ± 27.3 mg/dl, p = ns). Conclusions: Diabetic's coronary patients, who participated in CVR, obtained an improvement of their cardio-metabolic risk due to significant improvement of blood pressure, lipids and glycaemic profile. Both ambulatory and hospital based CVR programmes provide a comprehensive approach and are VR is more effective than usual care in the management of coronary patients with diabetes. P147 Insulin resistance in secondary prevention: epidemiology and impact of a cardiac rehabilitation program in patients with ischaemic cardiomyophaty IRSPEAICRPISCH, S Sergio Garcia Blas1, F De Torres Alba1, D Iglesias Del Valle1, MC Monedero Martin1, D Gemma1, A Castro Conde1, R Dalmau1, JL Lopez-Sendon1 1University Hospital La Paz, Madrid, Spain Lipid Disorders (Rehabilitation & Implementation) Introduction: High ratio of Triglyceride/HDL cholesterol (TG/HDL) has been associated with insulin resistance, metabolic syndrome, progression of atherosclerotic plaque and also with the occurrence of cardiovascular events in high-risk patients. Aim: To evaluate the average levels of this ratio in ischaemic patients referred to a cardiac rehabilitation program and its relationship with classical risk factors, extent of cardiovascular disease and the changes of this ratio after the program. Methods: We included 388 consecutive patients submitted to cardiac rehabilitation after an acute coronary syndrome. Demographic data, cardiovascular risk factors and laboratory data were collected at admission to the rehabilitation program. Fasting lipid profile was determined 2-3 days after hospital admission for acute coronary syndrome and at the end of the program. Results: The subjects consisted of 331(85%) males and 57(15%) females, age 57 SD 10 years. Mean TG/HDL ratio in the study group was 4.2 SD 2.7. 209 patients (54%) had a TG/HDL ratio ≥ 3.5, which is the accepted threshold for insulin resistance. Males showed a trend toward a higher ratio in the limit of significance. It was significantly higher in patients who had one of the classical cardiovascular risk factors: hypertension, sedentary lifestyle (p <0.05), diabetes, dyslipidemia and active smoking (p <0.001). There was no association between a history of cardiovascular disease (ischemic heart disease, peripheral vascular disease and cerebrovascular disease) and the TG/HDL ratio, possibly because patients were previously treated with hypolipemiant drugs, mostly statins. We found a significant correlation (p < 0.01) between TG/HDL ratio and low-density lipoprotein levels, glycated hemoglobin, and body mass index (BMI), but not with the number of diseased vessels. 375 (98%) Patients completed a cardiac rehabilitation program that consisted of exercise training, lifestyle education and pharmacological treatment, for an average of 63 days (SD 31). After this period, the TG/HDL ratio decreased significantly (4.2 DS 2.7 at baseline, versus 2.8 DS 1.7, p <0.01), and there was less patients with insulin resistance (TG/HDL ≥ 3.5:54% at baseline versus 35%, p < 0.01). Conclusions: TG/HDL ratio, a marker of insulin resistance, is frequently altered in patients referred to cardiac rehabilitation after an acute coronary syndrome, with higher levels in patients with cardiovascular risk factors. A cardiac rehabilitation program improves the burden of insulin resistance in this group of patients. P148 Loss of inpatient tobacco cessation counselling services is associated with reduction and gender differences in referral to outpatient follow-up. MH Mackay1, JY Kwon2, C Mak2, S Yoon2 1Heart Centre, St. Paul's Hospital, Vancouver, Canada, 2University of British Columbia School of Nursing, Vancouver, Canada Smoking (Rehabilitation & Implementation) Background: Tobacco addiction is a significant, yet modifiable risk factor for heart disease, with 30% of all coronary artery disease deaths attributable to smoking. Smoking cessation (SC) reduces mortality from heart disease by up to 50% in asymptomatic patients, and 36% in patients with established disease. Our cardiac centre adopted the “Ottawa Model” for Smoking Cessation for inpatient units, in which best smoking cessation practices are systematized. A critical component for the first 3.5 years was a dedicated tobacco cessation counsellor (TCC), who visited all smokers, delivered a face-to-face intervention, and offered 3 months' post-discharge follow-up. Due to budget constraints this position was deleted, and responsibility for counselling and referral to outpatient follow-up has shifted to bedside nurses. Nurses' workload and limited confidence in SC counselling are possible concerns, so we evaluated the impact of eliminating this position on rates of delivering a brief intervention and referring to post-discharge SC support. Methods: Random audits of screening and referral rates during the tenure of the TCC, and a review of all discharges from cardiac inpatient units for 4 months after deletion, were conducted. Differences in pre- and post-deletion rates were tested, and predictors of referral were modelled using logistic regression. Results: Prevalence of smoking remained constant during both time periods, but the rate of screening for tobacco use increased significantly after deletion of the TCC (82.5% vs 95.2%, p = .02). Delivery of a brief intervention was unchanged, but the rate of referral to follow-up decreased after deletion of the TCC (71.2 vs 40.5, p < .01). Men's smoking prevalence was double that of women's (20.3% vs 10.2%, p = <.01), but after adjustment for covariates, women were more likely than men to be referred (OR: 6.45; 95% confidence interval 1.41-29.67). Discussion and Conclusions: In this acute cardiac setting, assessment of smoking status is entrenched in practice. However, although there is abundant evidence suggesting that SC rates are improved when patients receive ongoing support after discharge, this critical step has not been sustained since deletion of the TCC. Potential barriers (e.g., lack of time, knowledge or confidence in counselling) warrant further study. The significantly higher rate of referral for women compared with men represents a lost opportunity, and requires further study to elucidate reasons for this. Gender differences in severity of addiction and readiness to change, and implicit gender bias among professionals are possible explanations. P149 Special features of pharmacological approach of smoking cessation in patients with ischemic heart disease F Fernando De Torres Alba1, N Montoro Lopez1, A Iniesta Manjavacas1, S Garcia Blas1, O Salvador Montanes1, S Valbuena Lopez1, L Blazquez2, R Dalmau Gonzalez-Gallarza1, A Castro Conde1, JL Lopez Sendon1 1University Hospital La Paz, Department of Cardiology, Madrid, Spain, 2University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain Smoking (Rehabilitation & Implementation) Introduction and aims: pharmacotherapy with varenicline, bupropion or nicotine replacement therapy (NRT) increases abstinence rates in smokers. We analyse the features of the pharmacological intervention for smoking cessation in patients with a recent acute coronary syndrome. Methods: We studied 420 patients (84.8% male, mean age 57.4) referred to a cardiac rehabilitation program, following a recent admission for acute coronary syndrome. 54% were current smokers, 27% former smokers. An average of 6 successive visits per patient were made, including an in-person visit at 3 and 6 months of cessation. Motivational interviewing, and strategies to prevent smoking relapse and weight gain were displayed. Abstinence symptoms were explored and pharmacotherapy was offered as a possible intervention to all smokers. Abstinence was assessed at 3 and 6 months and confirmed with CO-oximetry. Results: Apart from behavioural support, 20% of smokers requested pharmacotherapy (65% varenicline, 13% nicotine replacement therapy, 3% bupropion, 19% combinations). Patients that required drugs had a more intense smoking habit, and a higher relapse rate. A higher prevalence of symptomatic chronic obstructive pulmonary disease and chronic ischemic heart disease was also seen in this group. No cardiovascular complications related to treatment were observed. Only 42% of patients completed at least 9 weeks of drug treatment, and relapse occurred after discontinuation of treatment in 78% of cases. Conclusions: After a recent acute coronary syndrome, a high degree of motivation explains that only a small proportion of patients requests drugs to quit smoking. Paradoxically, the relapse rate in this group of patients is higher, as it is a group with higher dependency and addiction. The trend toward early discontinuation of treatment may partially contribute to relapse. Intervention without drugs Intervention with drugs p Abstinence 3 m 88,9% 54,9% 0,002 Abstinence 6 m 81,1% 47,1% 0,002 Mean age 54,4 52,9 NS % women 11,7 21,6 NS N° cig/day 22,9 28,8 0,008 Packs-year 39,4 49,4 0,037 Chronic CAD 8,9% 27,5% 0,005 Intervention without drugs Intervention with drugs p Abstinence 3 m 88,9% 54,9% 0,002 Abstinence 6 m 81,1% 47,1% 0,002 Mean age 54,4 52,9 NS % women 11,7 21,6 NS N° cig/day 22,9 28,8 0,008 Packs-year 39,4 49,4 0,037 Chronic CAD 8,9% 27,5% 0,005 Open in new tab Intervention without drugs Intervention with drugs p Abstinence 3 m 88,9% 54,9% 0,002 Abstinence 6 m 81,1% 47,1% 0,002 Mean age 54,4 52,9 NS % women 11,7 21,6 NS N° cig/day 22,9 28,8 0,008 Packs-year 39,4 49,4 0,037 Chronic CAD 8,9% 27,5% 0,005 Intervention without drugs Intervention with drugs p Abstinence 3 m 88,9% 54,9% 0,002 Abstinence 6 m 81,1% 47,1% 0,002 Mean age 54,4 52,9 NS % women 11,7 21,6 NS N° cig/day 22,9 28,8 0,008 Packs-year 39,4 49,4 0,037 Chronic CAD 8,9% 27,5% 0,005 Open in new tab P150 Smoking cessation intervention after acute myocardial infarction, predictors of relapse analysed. R Dalmau1, A Castro1, M Marin2, F Torres1, S Valbuena1, A Araujo1, H Arranz1, S Espinosa2, N Montoro3, JL Lopez Sendon3 1University Hospital La Paz, Department of Cardiology, Cardiac Rehabilitation Unit, Madrid, Spain, 2University Hospital La Paz, Department of Rehabilitation, Cardiac Rehabilitation Unit, Madrid, Spain, 3University Hospital La Paz, Department of Cardiology, Madrid, Spain Smoking (Rehabilitation & Implementation) Background and aim: there is a wide evidence of the benefit of smoking cessation after myocardial infarction. Nevertheless, most patients fail to remain abstinent after 6 months. We analysed the results of a smoking cessation intervention after an acute coronary syndrome (ACS) in a cardiac rehabilitation program (CRP) and the factors related to relapse. Methods: smoking status was assessed at admission, 3 and 6 months after the acute coronary syndrome. Abstinence was confirmed with cooximetry (<10 ppm). Results: 420 patients, 86,1% male, were admitted to the CRP after an acute coronary syndrome. 54% were current smokers, 23% former smokers, 23% never smokers. Mean age was 7-8 years lower in the group of smokers. Most patients were heavy smokers (24,2 +/− 13,6 cigarettes/day, 36,6 +/− 11,1 pack-year). All smokers received cessation counselling (individual and group sessions), abstinence symptoms were explored at every visit and pharmacotherapy was offered to all patients as a possible tool of intervention, and was used in 22% (16% varenicline, 3% nicotine replacement products, 1%bupropion, 2% combined pharmacotherapy). Abstinence rates were 81,4% at 3-month follow-up, and 73,6% at 6-month. Relapse was more common in women (33% relapsed, whereas 20% male did), in patients with a previous diagnose of cardiovascular disease (44% relapsed, p = 0,001), or a symptomatic chronic obstructive pulmonary disease (46% relapsed). After a multivariate analyse relapse was significantly correlated to the pack-year history of smoking (p = 0,01), to the number of cigarettes smoked per day (p = 0,036) and to the need of pharmacotherapy (p = 0,0005). 48% of the patients who needed pharmacotherapy relapsed. No significant correlation was found with age, body mass index, functional capacity in METs, or ejection fraction. Mean weight gain at 6-month follow-up was 3,4+/−2,5 kg, but we didn't find any association between relapse and weight gain either. Conclusion: a smoking cessation intervention in a CRP improves the abstinence rates after myocardial infarction. After an acute coronary syndrome, a significant proportion of patients are motivated enough to quit without pharmacotherapy. Patients who need pharmacotherapy are more likely to relapse, according to a higher level of dependence and addiction. P151 Coping with myocardial infarction MH Mari Helena Salminen-Tuomaala1, E Paavilainen2 1Seinajoki University of Applied Sciences, The School of Health Care and Social Work, Seinajoki, Finland, 2University of Tampere, Tampere, Finland Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: The purpose of the study was to create a substantive theory on factors that affect patients' coping four and twelve months after a myocardial infarction. Methods: A grounded theory methodology was selected because of it's focus on the informants' personal experiences and on the identification of interaction influences. Theoretical sampling was selected in order to identify the patients' coping experiences. The participants had been selected on the basis on their experience of coping with the myocardial infarction. The data were collected by using individual interviews. The informants were 28 patients, who had suffered a myocardial infarction. The age of the patients varied from 32 to 82 years. The inclusion-criteria were a first-time myocardial infarction, and no cognitive or memory problems. The interviews were conducted by the same researcher in the patients' homes 4 and 12 months after the myocardial infarction. Data were analysed separately using the grounded theory techniques. Results: The substantive theory “Coping experiences -towards different coping orientations”, describes the patients' experiences of coping with myocardial infarction as a continuum. The main category “Positive and negative coping experiences” describes the patients' experiences 4 months after the myocardial infarction and the main category “Different coping orientations”, their experiences 12 months after the myocardial infarction. Conclusions: Coping with the myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centreed approach involving a post-hospital counseling intervention is recommended. The substantive theory can be used in planning counseling for the patient and also as a framework in nursing education. P152 Physical health summary measure of Short Form 36 (SF-36) quality of life questionnaire predicts mortality after myocardial infarction A Attila Simon1, I Tiringer2, I Berenyi1, E Gelesz1, G Veress1 1Balatonfured State Cardiology Hospital, Balatonfured, Hungary, 2Institute of Behavioral Medicine, PTE AOK, Hungary, Pécs, Hungary Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: Decreased exercise capacity, determined with different methods is treated as an independent predictor of mortality after acute myocardial infarction (AMI). Physical functions are also evaluated by Physical Health Summary Measure of SF-36, so our hypothesis was that this scale could predict mortality after AMI. Patients and methods: 302 patients (Pts) were entered in residential cardiac rehabilitation program after AMI. After exclusion of Pts who did not fill the SF-36 (53 Pts) or were lost from follow-up (2 Pts) 249 Pts remained (age: 60.8 +−12.1 years, 159 men, time from AMI 19.4 +− 9.6 days). AMI was treated with percutaneous coronary intervention in 43.8% of Pts, with thrombolysis in 10.8%, there were no revascularization in the others. Hypertension was present in 66.7%, peripheral vascular disease (PVD) in 11,6%, heart failure in 17.7%, diabetes mellitus in 25.3% of Pts. We evaluated previously mentioned diseases, age, gender, smoking habits, left ventricular ejection fraction, New York Heart Association and CCS classes, 6 minute walking distance as potential prognostic factors of mortality. We grouped the patients into three terciles according to Physical Health Summary Measure of SF-36. The mean duration of follow-up was 458 +−127 days. Kaplan-Meier survival analysis and Cox proportional hazard model were used to determine those factors with statistically significant prognostic value. Results: 20 Pts (8,0%) died during follow-up. According to Kaplan-Meier analysis lower Physical Health Summary Measure values (P = 0.014), PVD (P = 0.0002) and heart failure (P = 0.0001) predicted mortality in univariate analysis. Cox proportional hazard model revealed hypertension (ExpB = 4.798, P = 0.036), PVD (ExpB = 0.124, P = 0.007) and lower left ventricular ejection fraction (ExpB = 0.920, P = 0.005) as independent prognostic factors of mortality. Conclusion: Physical Health Summary Measure of SF-36 Quality of Life Questionnaire not only evaluates the quality of life but lower values predict higher mortality after AMI. The prognostic value however disappears after controlling for other physical parameters. P153 Cardiovascular combined exercise training in patients with chronic ischemic heart disease: differences between men and women J Jarmila Siegelova1, J Pochmonova1, A Havelkova1, P Vank1, M Pohanka1, J Vitovec1, P Dobsak1, G Cornelissen2, F Halberg2 1Masaryk University, Faculty of Medicine, Brno, Czech Republic, 2University of Minnesota, Minnesota, United States of America Psychosocial factors/Quality of life (Rehabilitation & Implementation) Aim of the study: The study was aimed at evaluation of quality of life, physical performance and parameters of capacity of the transport system of oxygen that we monitored in the group of men and in the group of women with chronic ischemic heart disease (CHIHD) before and after the combined exercise training (aerobic combined training with resistance elements). Methodology: We examined 85 men (mean ± SD) at the age of 62 ± 10 years (without myocardial infarction) with ejection fraction (EF) 49 ± 10% diagnosed by echocardiography and body mass index (BMI) 27 ± 4 kg.m-2, and 29 women at the age of 64 ± 7 years (without myocardial infarction) with ejection fraction 46 ± 8% diagnosed by echocardiography and body mass index BMI 29 ± 4 kg.m-2 before and after aerobic training combined with resistance exercises (12 weeks, three times a week). We compared the parameters of capacity of the transport system of oxygen (VO2SL ml.min−1, VO2SL.kg−1 ml.min−1.kg−1), maximum achieved symptom-limited load (WmaxSL W, WmaxSL.kg−1 W.kg−1), and subjective perception of quality of life by means of the questionnaire of quality of life (Seattle Angina Questionnaire, SAQ 1-5). Results: In the group of men (CHIHD) we have found (before versus after) a significant change in WmaxSL (113 ± 33 v. 123 ± 35 W; p < 0.01), WmaxSL.kg−1 (1.3 ± 0.4 v. 1.4 ± 0.4 W.kg−1; p < 0.01), VO2SL (1692 ± 412 v. 1834 ± 45 ml. min−1.; p < 0.01), VO2SL.kg−1 (20 ± 5 v. 22 ± 6; p < 0.01), MET (5.7 ± 1.4 v. 6.2 ± 1.7; p < 0.01), points in the questionnaire of quality of life SAQ1 (81 ± 19 v. 85 ± 16; p < 0.01), SAQ2 (80 ± 22 v. 86 ± 16; p < 0.01), SAQ3 (83 ± 16 v. 88 ± 14; p < 0.01), SAQ4 (88 ± 16 v. 93 ± 10; p < 0.01), SAQ5 (67 ± 17 v. 74 ± 17; p < 0.01). In the group of women (CHIHD) we have recorded significant changes in VO2SL (1135 ± 155 v. 1215 ± 184; p < 0.05), VO2SL.kg−1 (15.1 ± 2.4 v. 16.3 ± 2.4; p < 0.05), MET (4.4 ± 0.7 v. 4.7 ± 0.6; p < 0.05), SAQ1 (69 ± 20 v. 75 ± 16; p < 0.01), SAQ2 (78 ± 18 v. 88 ± 16; p < 0.05), SAQ3 (77 ± 21 v. 84 ± 17; p < 0.01), SAQ4 (90 ± 12 v. 94 ± 9; p < 0.05), SAQ5 (63 ± 21 v. 72 ± 17; p < 0.01). Conclusion: The twelve-week aerobic training combined with resistance exercises in patients with CHIHD improves capacity of the transport system and subjective perception of quality of life in all evaluated spheres both in men and in women with CHIHD. Men, moreover, achieved a significant improvement of the maximum performance, also of the performance related to kilogram of the mass. P154 The CHARMS study: patients' views about discussing sexual issues following coronary heart disease CHARMS, A W Andrew Murphy1, S Doherty1, M Byrne1, HM Mcgee2 1National University of Ireland, Galway, Ireland, 2Royal College of Surgeons in Ireland, Dublin, Ireland Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: People who have experienced a coronary event in their lives and those with whom they are intimate often have inaccurate or incomplete information about the impact of their illness on sexual expression. They may know little about the options that are available to them in relation to resuming sexual activity, the impact of medication or simply discussing their fears. Sexual counselling for cardiac patients has received little attention in the literature. The aim of the current study is to document levels of sexual functioning, extent and causal attributions of sexual problems and the patient's experience of discussing sexual matters within the cardiac healthcare system. Method: Questionnaires have been administered over the telephone to 380 male and female patients who have met the selection criteria of completing cardiac rehabilitation within the previous two years but not within the previous two months. The questionnaire includes five sections: (a) demographic information, (b) general health, (c) sexual activity, (d) sexual problems and (e) sexual problems and heart condition. Results: Early indications would suggest that males predominately over the age of sixty years of age have lower levels of sexual activity following a cardiac event than younger patients with coronary disease, citing problems such as erectile dysfunction and fear of resuming sexual activity. According to patients, sex information following a coronary event is not readily available from healthcare providers. Many patients have expressed a need for an individual counselling programme to be provided as part of the cardiac rehabilitation programme. Conclusion: This research provides valuable information about the personal experiences of patients in Ireland with coronary heart disease, examining the impact on sexual and interpersonal relationships, their wellbeing and their general quality of life. It will also specifically contribute to the development of practice guidelines on sexual assessment and counselling for patients with coronary heart disease in Ireland. In addition, the international literature includes only limited recommendations with regard to service provision in this area. Therefore, this research has the potential to influence international recommendations. P155 Enhanced physical activity is associated with an improvement in quality of life one year after an inpatient lifestyle intervention in overweight and obese children M Rank1, M Siegrist1, DC Wilks1, H Langhof2, M Halle1 1Technical University of Munich, Department of Prevention and Sports Medicine, Munich, Germany, 2Clinic Schoensicht, Berchtesgaden, Germany Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: Childhood obesity is associated with an impaired quality of life (QoL), which in contrast appears to be positively influenced by regular physical activity (PA). The aims of this study were to investigate [1] the effect of an inpatient weight-loss program involving overweight and obese children and adolescents on QoL one year after the program and [2] the relationship between the changes in QoL and PA levels. Methods: Participants of this prospective study were 157 overweight and obese children (101 girls) aged 6-18 years undergoing an inpatient weight-loss intervention for 4-6 weeks. Body height and weight were measured in the clinic at the start of the intervention and one year later by the children's general practitioners at home. At both time points questionnaires on both QoL (KINDL) and the PA level (“How many days per week have you been physically active for at least 60 minutes a) last week and b) in a normal week?”) were completed by the children. Results: At baseline the mean age was 13.6 ± 2.1 years. From the start of the intervention to one year later body weight decreased from 83.6 ± 19.7kg to 80.3 ± 18.1kg and BMI-SDS (BMI-standard deviation score) declined by 0.4 ± 0.5 (both p < 0.001). Baseline QoL was lower in girls than in boys (64.4 ± 11.4 versus 68.5 ± 14.0; p = 0.04). In both sexes mean values of QoL were lower compared to reference values of normal weight children. At follow-up QoL increased to 67.8 ± 14.3 points in girls (p = 0.01), whereas in boys it was not different to baseline levels (67.9 ± 13.6; p > 0.05). There were no sex differences concerning PA levels, body weight or age both at baseline and follow-up. 44.6% of the children increased, 22.9% maintained and 32.5% reduced their PA levels from baseline to one year after the start of the program. Partial correlation analysis revealed a positive association between PA levels and QoL adjusted for age and changes in body weight in the total group (r = 0.30; p < 0.001) and in girls (r = 0.29, p = 0.003) but not in boys (r = 0.26, p > 0.05). Conclusions: This inpatient weight-loss intervention positively affected QoL in overweight and obese girls one year after the program. This seems to be related to changes in the PA level rather than body weight. P156 The impact of depressive disorders on platelet aggregation in patients with chronic ischaemic heart disease before the stenting of the coronary arteries AN Alexey Repin1, TN Sergienko1, EV Lebedeva2 1Research Institute of Cardiology SB of RAMS, Tomsk, Russian Federation, 2Research Institute of mental health, Tomsk, Russian Federation Psychosocial factors/Quality of life (Rehabilitation & Implementation) Urgency: Dual antiplatelet therapy is the standard of therapy in patients with stable angina pectoris after stenting for more than 10 years. This therapy includes aspirin and clopidogrel. Several studies have shown an increased risk of thrombotic events in patient with resistance to clopidogrel. The frequency of detection of resistance to antiplatelet drugs depends on the methods of its diagnostics. Many patients with ischaemic heart disease in combination with depressive disorders (DD) have increased platelet activity. Aim: To study the peculiarities of platelet aggregation in patients with chronic coronary heart desease (CHD) combined with DD. Material and methods: 66 patients were included in the study. All patients were men. These patients were screened by the hospital scale anxiety and depression HADS and by the depression scale of Beck (BDI). Patients were consulted by a psychiatrist if the level of depression was more than 8 points on a scale HADS and more than 19 points on a scale BDI. They were devided into 2 groups by the results of screening on depression. Group 1 included 44 patients who suffered from coronary heart disease without DD. Group 2 consisted of 22 patients with coronary heart disease and DD. The groups did not significantly differ by age and principal clinical and anamnestic parameters. Also we investigated the aggregation of platelets in all patients by using optical aggregation Analyser. Adenosine diphosphate 2,5 uMol/l and adenosine diphosphate 5,0 uMol/l, epinephrine and collagen were inductors used. Results: The platelet activity was significantly above at patients coronary heart disease with DD in comparison with patients without depression at treatment clopidogrel 300 mg. 1-st group 2-nd group p adenosine diphosphate 2,5 uMol/l 33,6 ± 14,6 41,7 ± 11,8 0,01 adenosine diphosphate 5 uMol/l 46,7 ± 15,8 54,7 ± 17,3 0,03 epinephrine 56,2 ± 19,1 56,3 ± 26,3 0,9 collagen 30,1 ± 18,3 48,8 ± 26,1 0,058 Conclusion: Patients with coronary heart disease and DD have lower efficiency of clopidogrel and increased activity of platelets. These features increase the risk of thrombosis of stents and acute coronary syndrome. platelet aggregation 1-st group 2-nd group p ADP 2,5 uMol/l 33,6 ± 14,6 41,7 ± 11,8 0,01 ADP 5 uMol/l 46,7 ± 15,8 54,7 ± 17,3 0,03 epinephrine 56,2 ± 19,1 56,3 ± 26,3 0,9 collagen 30,1 ± 18,3 48,8 ± 26,1 0,058 1-st group 2-nd group p ADP 2,5 uMol/l 33,6 ± 14,6 41,7 ± 11,8 0,01 ADP 5 uMol/l 46,7 ± 15,8 54,7 ± 17,3 0,03 epinephrine 56,2 ± 19,1 56,3 ± 26,3 0,9 collagen 30,1 ± 18,3 48,8 ± 26,1 0,058 Open in new tab platelet aggregation 1-st group 2-nd group p ADP 2,5 uMol/l 33,6 ± 14,6 41,7 ± 11,8 0,01 ADP 5 uMol/l 46,7 ± 15,8 54,7 ± 17,3 0,03 epinephrine 56,2 ± 19,1 56,3 ± 26,3 0,9 collagen 30,1 ± 18,3 48,8 ± 26,1 0,058 1-st group 2-nd group p ADP 2,5 uMol/l 33,6 ± 14,6 41,7 ± 11,8 0,01 ADP 5 uMol/l 46,7 ± 15,8 54,7 ± 17,3 0,03 epinephrine 56,2 ± 19,1 56,3 ± 26,3 0,9 collagen 30,1 ± 18,3 48,8 ± 26,1 0,058 Open in new tab P157 Cardiovascular diseases in medical history, and problems in physical functioning, and disability: the HAPIEE study Health, Alcohol and Psychosocial factors In Eastern Europe Study Group, A Agnieszka Dorynska1, A Pajak1, R Kubinova2, S Malyutina3, A Tamosiunas4, H Pikhart5, M Marmot5, M Bobak5 1CMUJ - Institute of Public Health, Institute of Clinical Epidemiology and Population Studies, Krakow, Poland, 2National Institute of Public Health, Prague, Czech Republic, 3Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation, 4Kaunas University of Medicine, Kaunas, Lithuania, 5University College London, London, United Kingdom Psychosocial factors/Quality of life (Rehabilitation & Implementation) Background: Cardiovascular disease (CVD) is the leading cause of death and sickness absence worldwide. While stroke is considered as a main cause of acquired disability in adults, less is known about the effects of other cardiovascular disease on impaired mobility, and ability loss in 4 populations of Central and Eastern Europe. Purpose: To assess the relationship between the history of cardiovascular disease and functional limitations, disability, and early retirement due to own ill health. Methods: Cross-sectional study of random population samples from Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns participating in the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) Study. 33,777 persons aged 45-69 years were included into the study. Information on medical history, FL, disability, and early retirement was collected using a standardized questionnaire. History of cardiovascular disease was defined as medical diagnosis of myocardial infarction (MI), angina or stroke. Self-reported functional limitations were measured using questions from the SF-36 scale. Disability status was defined using a question about receiving any health or disability benefits. Results: History of cardiovascular disease was reported by 16.3% of men, and 9.7% of women. The highest prevalence rates among men were reported in Russia (18.3%), and among women in Lithuania (17.0%), while the lowest in the Czech Republic (12.9% among men; 6.3% among women). After adjustment for age, country and socioeconomic factors (marital status, education, material deprivation), participants with any cardiovascular disease in the past had higher prevalence of functional limitations (OR = 3.80; 95% CI = 3.40-4.24 for men, OR = 3.20; 95%CI = 2.88-3.55 for women), more frequent had official disability status in pre-retirement age (OR = 3.46; 95% CI = 2.71-4.42 for men, OR = 2.23; 95% CI = 1.53-3.25 for women), and more frequent were early retired due to ill health (OR = 5.20; 95% CI = 4.56-6.06 for men, OR = 3.30; 95% CI = 2.80-3.89 for women) in comparison to those free of cardiovascular disease in the past. From specific types of cardiovascular disease, history of stroke was the strongest predictor of all outcomes. For all countries combined, history of any cardiovascular disease accounted for 31.6% (men) and 14.6% (women) of pre-retirement official disability, with the largest contribution of angina. Conclusions: cardiovascular disease in the past was related to higher odds of low physical functioning, disability, and early retirement, with the strongest effect seen for stroke. Broadly similar results were found in men and women. Cardiovascular disease is an important cause of disability in these populations. P158 Erectile dysfunction: also an issue of the cardiologist N Montoro Lopez1, F Fernando De Torres Alba1, R Cadenas Chamorro1, L Blazquez Arroyo2, S Garcia Blas1, A Iniesta Manjavacas1, S Valbuena Lopez1, A Castro Conde1, R Dalmau Gonzalez-Gallarza1, JL Lopez Sendon1 1University Hospital La Paz, Department of Cardiology, Madrid, Spain, 2University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain Psychosocial factors/Quality of life (Rehabilitation & Implementation) Introduction and Aims: Erectile dysfunction (ED) is a more prevalent condition among patients with ischaemic heart disease than in the general population. In addition to its known association with psychosocial factors, it is associated with systemic atherosclerosis and endothelial dysfunction. It has been reported that ED may start even 25 months before the debut of ischaemic heart disease (sentinel pathology), being accentuated after an acute coronary event. The aim of this study was to evaluate the real prevalence of ED in patients undergoing cardiac rehabilitation program (CRP) after suffering an acute coronary syndrome (ACS) and to analyse their baseline characteristics and risk profile. Patients and Methods: from October 2010 to April 2011 the SHIM (Sexual Health Inventory for Men) questionnaire was asked systematically to all men with acute coronary syndrome, with and without ST elevation, referred to our CRP. Demographic data, cardiovascular risk factors, severity of coronary artery disease, ejection fraction of left ventricle during hospitalization and drugs related to their coronary event were collected prospectively. Results: SHIM questionnaire was asked to 107 consecutive patients with a mean age of 55.7 years. 48.6% had ED of any severity (SHIM <21) and 26.92% had a severe degree of ED (SHIM ≤ 10). One fifth of patients under 50 years (21.2%) had ED and this percentage increased significantly with age (50% of 51-65 years, 93.8% over 65 years). In terms of cardiovascular risk factors, no significant differences were found between the groups with and without ED in smoking (p = 0.361), dyslipidemia (p = 0.76) or obesity, but ED was significantly more prevalent in diabetics (p <0,0001) and hypertensive patients (p = 0,008). Conclusions: In our population, the prevalence of patients with acute coronary syndrome and Doppler echocardiography reaches almost 50%, maintaining a high association in all age groups. Regardless of the psychosocial component, we believe, therefore, necessary to formalize the screening of ED in the patient after an acute coronary syndrome, and the therapeutic approach from the cardiological point of view. Further prospective studies are required to evaluate the long-term prognosis of this clinical entity in patients with ischemic heart disease. P159 Erectile dysfunction: a taboo subject in the 21st century? N Montoro Lopez1, R Cadenas Chamorro1, F Fernando De Torres Alba1, O Salvador Montanes1, S Garcia Blas1, C Monedero Martin1, A Iniesta Manjavacas1, A Castro Conde1, R Dalmau Gonzalez-Gallarza1, JL Lopez Sendon1 1University Hospital La Paz, Department of Cardiology, Madrid, Spain Psychosocial factors/Quality of life (Rehabilitation & Implementation) Introduction and aims: the high prevalence of erectile dysfunction (ED) in the general population and especially in those with structural heart disease is well known, especially in patients with severe ventricular dysfunction and/or diffuse coronary artery disease. Despite this, it is believed that a high percentage of patients do not consult their cardiologist or primary care physician, and protocols for screening of Doppler echocardiography in risk groups are lacking. The aims of this study were to evaluate the measures taken for the diagnosis of ED in a group of post infarction patients in a cardiac rehabilitation program (CRP) as well as the pharmacological treatment initiated and clinical follow-up in these patients. Patients and Methods: from October 2010 to April 2011 all men with a recent acute coronary syndrome referred to our CRP were asked to fill in the SHIM (Sexual Health Inventory for Men) questionnaire. We analysed the percentage of patients who requested medical help for ED and the treatment prescribed. Subsequently patients were contacted by telephone to assess the 6-month follow-up. Results: SHIM questionnaire was delivered to 107 consecutive patients (mean age 55.7 years). 57.7% had erectile dysfunction (SHIM<21). Only 61.4% of them requested specific medical advice. After individualized risk evaluation by a cardiologist, 94% of them received recommendations for the use of sildenafil (none of them under nitrates), but at 6-month follow-up only 50% of them had used it. Sildenafil improved erection in 70% of patients allowed to use it, and no cardiovascular complications were seen. Conclusions: ED is a prevalent condition in patients with coronary disease; nevertheless both patients and health care providers are quite reluctant to deal with it. As sildenafil can improve erectile function in selected patients with stable ischemic heart disease, an assessment of sexual function should be performed routinely in all men with a recent acute coronary syndrome. P160 Relationship between psychological risk factors and somatic factors in acute coronary syndromes B Bodone Rafael1, P Balog2, A Simon3, G Drotos4 1Deszk Hospital of Chest Disease, Deszk, Hungary, 2Semmelweis University Faculty of Medicine, Institute of Behavioral Sciences, Budapest, Hungary, 3State Hospital for Cardiology, Balatonfüred, Hungary, 4University of Szeged, Psychiatric Clinic, Szeged, Hungary Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: The aim of this study was to examine psychological risk factors (anxiety, depression, vital exhaustion, sleep disturbances) in patients after acute myocardial infarction who took part in residential cardiac rehabilitation. We proposed to study the relationship between somatic factors (left ventricular ejection fraction, left ventricular diastolic diameter, Body Mass Index, Metabolic Equivalent Value /METs/ achieved during exercise test and number of diseased vessels) and above mentioned psychological risk factors, and possible gender differences. Methods: In patients (N = 97, 30 women, 67 men, 30-81 years old) the level of depression and anxiety (Beck Depression Inventory /BDI/, Spielberger Trait Anxiety Inventory /STAI-T/), vital exhaustion (Maastricht Questionnaire /MQ/) and sleep disturbances (The Athens Insomnia Scale /AIS/) were assessed. Left ventricular ejection fraction /LVEF/, left ventricular diastolic diameter /LVDD/, Body Mass Index /BMI/, METs and the number of diseased vessels were retrieved from medical records. Statistical methods were: general linear model, linear correlation analysis and multivariable linear regression model. Results: 48% of patients showed depressive symptoms, 39% had high level of anxiety, 41% were vitally exhausted and 24% of them had sleep complaints. The level of anxiety in women was significantly higher than in men (45.91 versus 40.98, p = 0.05) however we could not find a significant difference in other psychological risk factors. Left-ventricular ejection fraction values in women were higher than in men (59.6 versus 56.04, p = 0.05) while MET values were lower (4.68 versus 5.74, p < 0.001). The connection between left-ventricular ejection fraction, LVDD and the number of diseased vessels, and psychological risk factors was not statistically significant. The MET value showed a significant linear correlation with BDI (r = −0.2, p = 0.03), MQ (r = −0.23, p = 0.02) and AIS (r = −0.22, p < 0.009) scores. After adjustment for psychological risk factors and other physical parameters sleep disturbances (AIS) were found to have a significant correlation with METs (R =  −0.26, p = 0.008). The body mass index score showed significant linear correlation with all psychological risk factors: BDI (r = 0.43, p < 0.001), STAI-T (r = 0.31, p = 0.004), MQ (r = 0.33, p = 0.001) and AIS (r = 0.43, p < 0.001). According to multivariable regression model only sleep disturbances showed correlation with body mass index scores (R = 0.4, p < 0.001). Conclusions: Our investigation revealed some new psychological risk factors among patients after myocardial infarction. Sleep disorders are particularly important and we demonstrated its correlation with body mass index and exercise capacity. P161 Relationship between Depression and selected Coronary Artery Disease Risk Factors J Wolszakiewicz1, E Piotrowicz1, M Stepnowska1, R Piotrowicz1 1National Institute of Cardiology, Warsaw, Poland Psychosocial factors/Quality of life (Rehabilitation & Implementation) Higher levels of depressive symptoms are common very soon after coronary artery bypass grafting (CABG). Depression is associated with an increased risk for coronary artery disease (CAD). The aim of the study was to investigate the relationship between depression and selected CAD risk factors (exercise capacity, autonomic balance, systemic immune activity, glycemia, hypercholesterolemia, and anxiety symptoms) in patients in early phase post coronary artery bypass grafting. Methods: In 116 patients; average age 59+/−8 years, 14+/−3 days post coronary artery bypass grafting, depressive status was assessed (BDI - Beck Depression Inventory). Based on BDI findings patients were divided into two groups: GR1, 40pts (BDI < 10ms); GR2, 76pts (BDI>10ms). All pts underwent 6-minute walking test (6-MWT), 24-Holter monitoring, where time domain (SDNN) and frequency domain (LF,HF) of heart rate variability were examined. We also analysed: body mass index, hsC-reactive protein (hsCRP), glycemia, lipid levels, anxiety levels (STAI-State-Trait Anxiety Inventory) and quality of life (SF-36). Results: There were no differences in such parameters as age, smoking, history of diabetes, obesity, hypercholesterolemia, hypertension, left ventricular ejection fraction, and medical treatment between both groups. The hsCRP, glycemia and lipid levels were similar in both groups. There were no differences in exercise capacity between the groups. Although there were no differences in SDNN, LF and HF between the groups, LF/HF was significantly higher in GR2 (LF/HF: GR1vsGR2, 2.19 vs 4.2, p < 0.05). Patients with higher BDI (BDI>10) were significantly more likely to have higher levels of anxiety (STAI: x1- GR1 vs GR2; 33 vs 45 p < 0.001; x2-GR1 vs GR2; 39 vs 42, p < 0.02) and lower levels of quality of life (SF- 36;GR1 vs GR2; 66 vs 72, p < 0.02). Conclusion: In the early phase post coronary artery bypass grafting higher levels of depressive symptoms are associated with decreased sympatho-vagal balance, higher levels of anxiety and lower levels of quality of life. P162 Outcome evaluation of a brief hospital-based intervention to improve psychosocial adjustment during cardiac rehabilitation Rehabilitation Cardiac Psychological Studies - RCPS, A C Fernandes1, TM Mcintyre2, MJ Maciel3 1Braga, Portugal - Portuguese Catholic University, Braga, Portugal, 2University of Houston, Houston, United States of America, 3Hospital Centre do Porto, Porto, Portugal Psychosocial factors/Quality of life (Rehabilitation & Implementation) Aims: To test the efficacy of a brief psychosocial intervention program implemented during hospitalization for acute coronary syndrome-acute coronary syndrome. The study compared the combined psychosocial intervention and medical treatment group with a control condition (medical treatment only). Hypothesis 1 predicted a significant effect of the intervention with better outcomes for the experimental group (EG) than for the control group (CG) in terms of anxiety, depression, illness representations, knowledge about the disease and health habits. Hypothesis 2 predicted the maintenance of these gains over the 1 and 2-month follow-ups. Method: Participants were 121 acute coronary syndrome inpatients at a Portuguese hospital. Design is a randomized controlled trial with two conditions: EG (n = 65); CG (n = 56). Measures: Portuguese versions of HADS, IPQ-B, Health Habits Questionnaire, Knowledge about Disease Questionnaire and a clinical and demographic survey. Intervention: Two 1hr. inpatient sessions and one outpatient 20-min. follow-up. Education about acute coronary syndrome risk factors and cardiac rehabilitation, illness representations and coping, were key components. Results: Results of the repeated measures MANOVAs, controlling for age and baseline levels of the outcomes, revealed a significant effect of the intervention, supporting H1 and H2 for most of the psychosocial outcomes. There was a significant reduction in anxiety, depression, and an improvement in health habit in the EG.. There was also a significant change among patients in the EG to more adaptive illness cognitions in terms of the perception of consequences of the illness, duration, illness symptoms (identity), preoccupation, personal control and comprehension of the illness. These changes did not occur or were not significant in the CG. The intervention also had a significant impact in increasing knowledge about the illness, which was not observed for the CG. For the EG, these changes were maintained or enhanced at the 1 and 2 month follow-ups, whereas for the CG, there was a deterioration in terms of psychosocial adjustment. Conclusions: The results indicate that a brief hospital-based psychosocial intervention, combined with traditional care, can have positive effects in terms of various psychosocial outcomes that have proven impact in cardiac rehabilitation and prognosis (e.g. emotional state). The hospital stay seems to offer a window of opportunity for the delivery of psychosocial interventions to promote cardiac rehabilitation. P163 Differences in major cardiovascular risk factors between unemployed and employed individuals in Poland - cross-sectional study P Pawel Zagozdzon1, J Parszuto1, J Ejsmont1 1Medical University of Gdansk, Gdansk, Poland Psychosocial factors/Quality of life (Rehabilitation & Implementation) Introduction: Increasing health discrepancies observedin last two decades in Poland after economic transition could be attributed inpart to social consequences of unemployment. Differences in majorcardiovascular risk factors between unemployed and unemployed people have notbeen investigated in Poland yet. The aim of this cross-sectional study was toassess the association between unemployment and major cardiovascular riskfactors in Poland. Methods: Data from 5111 participants were includedinto analysis. Data were collected during prophylactic health examination in the context of occupational medicine service tasks in period 2009-2010. 3052 unemployed participants (60%) were recruited from Employment Office in Gdansk. 2059 participants (40%) were employees of Gdansk Shipyard and clerks of public administration. Blood pressure measures, resting heart rate, smoking habit and body mass indexwere collected during these assessments. Multiple logistic regression was used in data analysis to perform age and sex adjustment. Results: There wereless hypertensive subjects among unemployed people compared to employed individuals:16% versus 32%. However after adjustment for age and sex odds ratio (OR) for hypertension in relation to unemployment was 0,99 95% confidence interval (95% CI) 0,83-1,15. There were more obese (BMI>=25) subjects in employed people compared to unemployed population: 34% versus 63%. In multiple regressionassociation between obesity and unemployment was statistically significant OR 0,72 95% CI 0,62-0,82. Smoking habit was equally frequent in unemployed andemployed group: 29% versus 30%. After adjustment for age and sex smoking wasindependently associated with unemployment: OR 1,46 95% CI 1,27-1,68. The effects ofunemployment were different among men and women. The stronger associationbetween obesity and unemployment was observed in men: OR 0,64 95% CI 0,54-0,75. The stronger association between higher heart rate (>75/min.) and unemployment was observed in women: OR 0,77 95% CI 0,59-0,99. Conclusion: There are differences in patterns of major cardiovascularrisk factors between unemployed and employed individuals in Poland. The observations we made indicate the role of employment status in Poland as an indicator for specific disease risk profiles and should implicate specific preventive measures in unemployed individuals. P164 Impact of different cardiac rehabilitation programs on exertion tolerance, quality of life and depression in women with ischemic heart disease. J Joanna Wojcieszczyk1, D Kalka2, R Bugaj1, J Szczepanska-Gieracha1, T Grzebieniak3, W Kucharski4, K Kropielnicka1, M Wozniewski1 1Wroclaw University School of Physical Education, The Faculty of Physiotherapy, Wroclaw, Poland, 2Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland, 3Wroclaw Medical University, Clinic of Cardiology, Wroclaw, Poland, 4Wroclaw Medical University, Department of Angiology, Hypertension and Diabetology, Wroclaw, Poland Psychosocial factors/Quality of life (Rehabilitation & Implementation) Introduction: There is no doubt that participation in CR programs is profitable for women. However low percentage of women enrolled in such programs and their frequent resignation from trainings are still alarming. Women with ischemic heart disease (IHD) demonstrate lower quality of life (QoL) and higher depression level (DL) than men. Current CR programs are not as well suited to women's as men's needs. Men expect practical while women social and emotional assistance. It is necessary to create separate model CR for women andit is agreed that it should be based on exercise and educational sessions together with psychological actions. Objectives: Use of Tai-Chi exercises in outpatient CR of women with ischaemic heart disease increases its effectiveness leading to essential improvementof psychophysical status. Aims: Valuation of effectiveness of different CRprograms in exertion tolerance, QoL and depression in women with ischaemic heart disease. Methods: Randomized, clinical trial included 68 women between 50 to 71 (average 62,07 ± 6,00) with ischaemic heart disease confirmed by angiographyand/or at least 1-2 months after myocardial infarction in stable disease, 24 MMSE points, EF > 45%, no pharmacologically treated mental disorders. Patients participated in 12 weeks' CR program, in three groups: C - classical CR, P -classical CR and cognitive behavior psychotherapy, T - Tai Chi training. Stages: I - 1-4 week - trainings 3 times/week,II - 5-12 week - therapy in previous form, 2 times/week and 1 time/week cycloergometer. Before CR and after its completion a complex physical efficiency has been verified: electrocardiographic diagnostic test on treadmill (CST) and 6 minutes' walk test (6MWT). Evaluation of QoL and DL before the intervention, after 4th and 12th week, were verified: SF36 (PCS, MCS: physical and mental component) and Beck Depression Inventory test. Results: After 12 weeks' CRprogram in all the groups statistically essential improvement of exertion tolerance showed by increase of CST duration and distance in 6MWT has been achieved. In that scope both before and after rehabilitation there were no differences between the groups. In all valuations no statistical differences between the groups in DL and QoL. Only in T group confirmed improvement in both tests. MCS improved after 1st and PCS after 2nd CR stage. Conclusions: Efficiency of CR program in improvement of exertion tolerance in women with ischaemic heart disease is not dependent on the program performed. Tai Chi exercises have in that scope comparable influence as classical and psychotherapy CR models. Nevertheless only Tai-Chi training positively affects quality of life and depression level in women with ischaemic heart disease. P165 Introducing an irish community based long term exersise maintenance programme for cardiac patients S Sophie Charles1, J Caulfield1, R Duffy1 1St Columcille's Hospital, Dublin, Ireland Other risk factors (Rehabilitation & Implementation) Introduction: Currently the majority of acute general hospitals in Ireland provide comprehensive P3 cardiac rehabilitation (CR) programmes. There is research to say that many patients fail to continue exercising at recommended guidelines following Phase 3 CR. A need was identified to provide support for patients who wish to continue to exercise in a gym environment. Aim: To describe the steps in introducing a Phase 4 programme in Irish community gym settings. Purpose: To provide a Phase 4 CR programme. To develop a training programme for Gym instructors to increase their knowledge of exercising patients with cardiovascular disease post Phase 3 CR. To ensure a safe environment for these clients to continue exercising in a community gym setting thus enabling them to continue to adhere to exercise guidelines. Method: Consultation was carried out with local area authorities, gym managers, CR team, cardiologist and hospital management team. Site visits were performed to assess levels of interest and suitability of gyms. A training programme and manual was developed for gym instructors. This consisted of a two day course provided by CR professionals in a Hospital based CR unit. The first day included information and teaching on cardiovascular disease, CR process, risk factors, cardiac investigations and interventions, medications, diet, motivation, cardiovascular exercise, phase 4, exercise prescription, special populations, and referral from P3 to P4. The second day included BLS/AED training and practical phase 4 class delivery, written questions, scenarios and emergencies. Gyms commenced delivery of Phase 4 classes, site visits and assessments of initial phase 4 class delivery were also performed. Results: Approximately 50 gym instructors were trained between February 2007 and November 2008. Phase 4 classes are now being delivered in seven local gyms. Classes run once a week for one hour and include warm up, circuit and cool down. Pay as you go system operates. Approximate numbers attending are between four to ten clients per session. The model is validated by SCH CR team and SCH Cardiologist. A resource training manual and a how to guide and practical information on setting up Phase 4 services is now available for other CR centres. Conclusion: This model has successfully provided a direct link with local gyms and hospital based P3 CR programmes. It has been possible to implement a phase 4 CR service in local community gym settings. Training has been provided by local CR team. Patients have been enabled to continue exercising and maintain a healthier lifestyle. P166 A review of a community phase 3 cardiac rehabilitation programme seven years on S Sophie Charles1, J Caulfield1, R Duffy1 1St Columcille's Hospital, Dublin, Ireland Other risk factors (Rehabilitation & Implementation) It is clear that many patients who would benefit from CR are not receiving it (Jolly, Gregory, Sandercock, Greenfield, Rafferty, 2003). This is due to both service and patient factors such as location of CR centres and accessibility. Uptake rates for CR have been reported to range from 15-59% (Pell, Morrison, Blatchford, and Dargie 1996). cardiovascular disease remains a major public health problem in Ireland. In 1998 a government survey found an under-provision of CR Services in Ireland (McGee, 1998). In 1999 one of the recommendations of the cardiovascular health strategy group concluded that every hospital that treats patients with heart disease should provide a cardiac rehabilitation service. (DOHC 1999). In February 2003 an outreach community Phase 3 CR programme was commenced, this programme is ongoing and provides services for cardiac patients living in parts of Wexford and Wicklow. The service was initiated in response to the need identified in provision of CR to patients unable to travel to hospital based programmes. Objectives: To review patients who had undergone P3 CR in a community based leisure centre over the past seven years. Method: Phase 3 community cardiac rehabilitation commenced in Arklow in 2003. The programme was reviewed from 2003 to 2009. These patients were reviewed in terms of age, gender, indication for CR. Description of programme: Venue: Local Public leisure centre - Costing: 560 euro per 8 week programme - Numbers: 8 to 10 per 8 week course Results: Numbers were 254, of which 59 were females and 195 males. Ages ranged from 42 years to 81 years, groups were mixe3d in respect of age and gender. Indications for CR included 98 patients with coronary artery bypass grafting or Valve surgery, 37 with myocardial infarction and medical management, and 109 with percutaneous transluminal coronary angioplasty and Stent and 10 with other cardiac indications. 3 patients also had AICD's. Outcomes and above factors were similar to hospital based P3 CR programmes provided by the same Multi disciplinary CR team. Conclusion: Benefits: Improved uptake of patients within distance to community leisure centre - Links with community gyms. Development of phase 4, Long term compliance e.g. Phase 4 exercise classes enhanced P3 CR programmes may be safely and effectively run in the community. Changes/Improvements: Pre assessments prior to commencing P3 CR, involves one to one assessment, cardiac status, current meds, current risk factors, BP/electrocardiogram recordings. Telemetry was introduced in 2010 and now allows high-risk patients to do Phase 3 CR eg AICDs/Heart Transplants in a community setting. P167 Personal trainer helps to maintain exercise performance after cardiac rehabilitation W Benzer1, C Grimm Blenk1, K Schneller2, M Burtscher2 1Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria, 2Institute of Sports Sciences, University, Innsbruck, Austria Other risk factors (Rehabilitation & Implementation) Background: Enhancing and maintaining physical function is an important target of cardiac rehabilitation (CR). But patients who have completed their CR program show low rates of maintenance of exercise. The purpose of this study was to quantify the effect of a personal trainer offering maintenance of exercise to patients who completed their regular CR program. Methods: 38 patients with ischemic heart disease were enrolled into the study. All patients surpassed an exercise-based outpatient CR program for 6 months. After completion of their regular program patients were randomly assigned for further exercise support by a personal trainer or usual care. Physical exercise was offered by a personal trainer for additional 6 months. Physical performance was measured by ergospirometry using a bicycle stress test. Patient perception of functional capacity was measured using the MacNew health-related quality of life questionnaire. Results: From the 38 patients initially enrolled 29 (15 interventional, 14 control) could be followed until the final tests. At the end of the regular CR program physical performance of the interventional group was significantly higher than in the usual care group (EC 184 ± 44 watts versus 145 ± 39 watts; p < 0.01 and oxygen uptake 27.8 ± 7.5 ml/kg/min versus 21.3 ± 2.9 ml/kg/min; p < 0.05). Exercise support by a personal trainer after completion of the regular CR program resulted in a significantly better maintenance of physical performance after 6 months (EC 185 ± 44 watts versus 132 ± 30 watts; p < 0.01 and oxygen uptake 27.3 ± 5.5 ml/kg/min versus 20.2 ± 6.0 ml/kg/min; p < 0.05). Regarding the patients perception of physical functioning at the end of the regular CR program MacNew physical scores were slightly better in the interventional group than in the usual care group (6,29 ± 0,50 versus 5,93 ± 0,78; p = n.s.). After 6 months of exercise support by a personal trainer MacNew physical scores became significantly higher in the interventional group compared with the usual care group (6,20 ± 0,56, versus 5,68 ± 1,12; p < 0.05). Conclusion: The results of this study demonstrate that after completion of a regular CR program further exercise support by a personal trainer leads to better maintenance of exercise performance and patient perception of physical functioning than usual care. Therefore after completion of a regular CR program long-term exercise support by qualified trainers should be offered to the patients. P168 A feasibility study of a randomized controlled trial of a pedometer based exercise intervention to promote physical activity in cardiac rehabilitation ME Cupples1, A Dean2, MA Tully1, M Taggart2, G Mccorkell2, S O'neill3, V Coates3 1UKCRC Centre of Excellence for Public Health Research (Northern Ireland), Belfast, United Kingdom, 2Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry, United Kingdom, 3University of Ulster, Londonderry, United Kingdom Other risk factors (Rehabilitation & Implementation) Purpose: Regular physical activity is a core component of many cardiac rehabilitation programs, but many participants do not achieve adequate levels of activity for cardiovascular health benefits. This study aims to evaluate the feasibility of a randomized controlled trial of a tailored pedometer-based exercise intervention to promote physical activity in cardiac rehabilitation participants. Method: Following participation in a hospital out-patient cardiac rehabilitation program individuals were invited to take part in a 6-week pedometer-based exercise intervention in the community. For baseline assessment all wore a pedometer for one week, blinded to their step-counts. Following this, program cohorts were allocated randomly to control or intervention groups, to minimise possible contamination effects from friendships within cohorts. The intervention involved setting a weekly step-count goal, weekly review, feedback and renewed goal-setting, tailored to individuals. The control group received weekly telephone contact with a nurse, or face-to-face, if wished, to allow discussion of any problems. All participants wore a blinded pedometer during week 6, following which semi-structured interviews explored their experiences of the study. These were analysed using a thematic framework. Results: Of the 68 invited, 45 participated (66%); reasons for not participating included time, work and disinterest. Baseline characteristics were comparable between groups: 91% were male (41/45); mean daily step-count was approximately 7,000. Mean steps/day increased significantly in the intervention group (2742, 95%CI 1169 to 4315) compared to controls (−42, 95%CI −1102 to 1017) (p = 0.004). The largest change was in the first week after setting a step-count goal. Most participants completed the study (90% (17/19), intervention; 96% (25/26), control). Individuals achieved their goals on a mean of 62% of days (range 29-91%). Reasons for failing to achieve goals included holidays, injury and inclement weather. Some participants had problems wearing pedometers and these were resolved by the researchers. Interview analysis revealed that most participants perceived that step-count monitoring encouraged them to be more active: they appreciated staff interest in delivering the intervention, felt they were promoting their own health and, by contributing to the research, that of others. Conclusion: Our findings indicate that, following hospital-based rehabilitation, a tailored pedometer-based exercise intervention increases physical activity significantly and a trial of this in a wider community is feasible. P169 An interpretation of the relationship between epicardial fat thickness and left ventricular morphology and function A Ali Khalil1, D Oxborough2, K M Birch1 1University of Leeds, Leeds, United Kingdom, 2University of Leeds, School of Healthcare, Leeds, United Kingdom Obesity (Sports Cardiology) Background: Epicardial fat is the visceral fat depot of the heart. It is an established marker for visceral adiposity and screening tool for cardiovascular risk assessment due to its close association with components of metabolic syndrome and heart disease. Purpose: This study explores the true relationship between epicardial fat thickness (EFT), measured by echocardiography, and indices of left ventricular (LV) size, morphology and function using allometric scaling. Methods: Two-dimensional (2D) and M-mode echocardiography were performed on 82 healthy subjects (53 females, 29 males, ages 20-65 years, body mass indices 18.5-43 kg/m2) to measure EFT and left ventricle indices. Measures of left ventricle size included end-diastolic and end-systolic left ventricle internal diameters (LVIDd and LVIDs respectively), and left ventricle volumes (LVEDV and LVESV respectively). Indices of left ventricle morphology included end-diastolic and end-systolic interventricular septal thickness (IVSTd and IVSTs respectively), left ventricle posterior wall thickness (LVPWd and LVPWs respectively) and left ventricle mass (LVM). Measures of left ventricle systolic function included stroke volume (SV), ejection fraction (EF) and fractional shortening (FS) and indices of left ventricle diastolic function, included early (E) and late (A) left ventricle inflow velocities, E/A ratio, deceleration time (DcT) and isovolumic relaxation time (IVRT). Relationships were assessed using the allometric log-log least squares regression model (y = a.xb) to determine the slope exponent b. Results: Initial linearity checks showed a close to linear relationship between EFT and indices of body size (eg. waist circumference and body mass). However, a non-linear relationship was seen between EFT and all indices of left ventricle size, morphology and function. Allometric b exponents ± 95% confidence intervals (95% CI) demonstrated a significant moderate correlation (r ≥ 0.3) between EFT and IVSTd (b = 0.53, 95% CI 0.18 to 0.88), E (b = 0.4, 95% CI 0.12 to 0.7) and E:A ratio (b = 0.62, 95% CI −0.96 to −0.28). EFT also showed a significant correlation (r = 0.27) with LVM (b = 0.43, CI 0.07 to 0.79). All other indices did not show a significant relationship with EFT. Conclusions: The allometric relationships derived from this study indicate that EFT is independent of left ventricle size, eliminating the need to scale for chamber size. However, there is a significant non-linear relationship between EFT and left ventricle morphology and diastolic function which requires further study. P170 Chronotropic response to exercise and blood pressure dynamics in middle-aged veteran elite athletes and sedentary healthy voluntaries N Nino Sharashidze1, Z Pagava1, G Saatashvili2, L Gujejiani1, N Mamamtavrishvili1, G Abuladze1, R Abashidze1 1Iv.Javakhishvili Tbilisi State University, Tbilisi, Georgia, Republic of, 2Tsinamdzgvrishvili Institute of Cardiology, Tbilisi, Georgia, Republic of Hypertension (Sports Cardiology) Present study was aimed to compare chronotropic and haemodynamic responses to exercise in middle- aged veteran elite athletes and sedentary healthy voluntaries. Methods: We studied 50 male elite ex-athletes at age 30-50 (soccer and water-polo players) and the same number of sex and age matched sedentary healthy volunteers. All athletes were asymptomatic. Inclusion criteria for athletes: at least 10 years of competitive sports activity and 5 years after sports cessation. They formed I group. Volunteers formed Control group (II group). All study subjects underwent graded bicycle maximal exercise test. To investigate chronotropic response to exercise (CRE) we measured peak heart rate (PHR), heart rate reserve (HRR), heart rate reserve used (HRRU), indices HR40-100 and WL100. During exercise test SBP (systolic blood pressure) and DBP (diastolic blood pressure) were recorded at any stage of exercise. Hypertensive response to exercise was defined as elevation of SBP > 50mm.hg and elevation of DBP>10mm.hg. Left ventricle mass was evaluated by echocardiography. Left ventricle hypertrophy was defined as wall thickness > 12mm, LV Edd >55mm, LV mass > 51 g/m2.7. Statistical tests: Whitney- Mann, Student's t-test, Spearman's and Pearson's correlations were used. Results: Positive criteria for left ventricle hypertrophy were found in 8(16%) athletes and none in controls. I group was divided in two groups: Ia gr - athletes with left ventricle hypertrophy and Ib gr- athletes without left ventricle Hypertrophy. All indices of CRE were higher in Ib group as well as in Ia group as compared with control group. Pulmonary hypertension was 147,1 ± 9,9; 146,5 ± 8,4 and 138,3 ± 19,4 in Ia, Ib and II groups. HRR was 67,9 ± 12,8; 69,3 ± 9,2 and 59,7 ± 23,3 in in IA, Ib and II groups. HRRU was 71,7 ± 7,4; 69,7 ± 8,2 and 60,7 ± 22,4 in Ia, Ib and II groups. HR40-100 was 52,1 ± 12,1; 49,6 ± 12,6 and 37,9 ± 16,9 in Ia, Ib and II groups. Differences between Ia and II groups, as well as Ia and Ib groups were significant (p < 0,001). Hypertensive response to exercise was detected in 59% of veteran athletes and 35% of controls. Conclusions: left ventricle hypertrophy and hypertensive response to exercise found in veteran athletes suggested to be unfavorable changes that may increase risk of hypertension and generally cardiovascular events. However, lower rest heart rate and better profile of chronotropic response to exercise in veteran athletes as compared with sedentary healthy voluntaries may be indicators of improved prognosis in respect to cardiovascular events in physically active subjects, as chronotropic indices have been shown to be strong prognostic markers of cardiovascular risk in healthy individuals as well as in patients. P171 Prehypertension and atrial and ventricular remodelling in middle-aged amateur athletes M Wilhelm1, L Roten1, H Tanner1, JP Schmid1, H Saner1 1Bern University Hospital and University of Bern, Bern, Switzerland Hypertension (Sports Cardiology) Purpose: Veteran athletes have an increased risk of developing atrial fibrillation (AF). We studied the impact of prehypertension on signal-averaged P wave duration (SAPWD), left atrial volume index (LAVI) and early mitral annular tissue Doppler velocity (Ea) as potential risk factors for atrial fibrillation. Methods: Amateur runners participating in the 2010 Grand Prix of Bern, a 10 Mile race, were invited. 873 runners applied, of whom 70 female and 70 male athletes were randomly selected and stratified according to their resting blood pressure (BP) in a normotensive group (NT, RR<120/80 mmHg) and a prehypertensive group (pulmonary hypertension, RR ≥ 120/80 mmHg). Runners with arterial hypertension (RR ≥ 140/90 mmHg) were excluded. Results: 122 healthy athletes entered the final analysis. Mean age was 42 ± 7 years. 42 athletes (34%) had prehypertension with a male predominance (81%; P < 0.001). The groups showed no differences in mean age, lifetime training hours, and race time. SAPWD was longer in the pulmonary hypertension group (133 ± 12 versus 125 ± 13 ms; P = 0.003), but the effect was lost after adjustment for gender. LAVI showed no difference between the groups. Athletes in the pulmonary hypertension group had a higher left ventricle mass index and a lower Ea (10.4 ± 1.5 versus 11.0 ± 1.5 cm/s; P = 0.004). In a multivariate regression model, gender, left ventricle mass index, and Ea, but not systolic blood pressure, were independent predictors of SAPWD. Systolic blood pressure and left ventricle mass index were inversely associated with Ea. Conclusions: Prehypertension is more prevalent in male athletes and associated with left ventricle remodelling and an altered diastolic function. Atrial remodelling was mainly driven by male gender and only indirectly associated with prehypertension. Taken together, the results might explain the higher incidence of atrial fibrillation in male athletes. P172 Alteration on Spontaneous Baroreflex Sensitivity in Anabolic Steroids Users MR Dos Santos1, RA Porello1, ALC Sayegh1, E Toschi-Dias1, M Yonamine2, CE Negrao1, M J N Maria Janieire De Nazare Nunes Alves1 1Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil, 2University of Sao Paulo, School of Pharmaceutical Sciences, Department of Toxicology, Sao Paulo, Brazil Hypertension (Sports Cardiology) Purpose: Previous studies showed exacerbated muscle sympathetic nerve activity and increase 24 hours blood pressure in anabolic androgenic steroid users (AASU). However these autonomic and haemodynamic alterations on spontaneous baroreflex sensitivity (SBR) are unknown. Methods: Eleven AASU and 10 anabolic androgenic steroid nonusers (AASNU) were studied (33 ± 2 and 30 ± 1 age, respectively; P = 0.26). Both groups were involved in strength training (90% 1MR) and AASU were self-administered anabolic steroids for at least 2 years. The dopping was proved by urine. Heart rate (HR) was recorded by electrocardiogram and non-invasive blood pressure beat by beat was evaluated by Finometer. The SBR was analysed by time domain through spontaneous fluctuations between systolic blood pressure (SBP) and HR. Results: HR tended to be higher in AASU compared to AASNU (67 ± 3 versus 59 ± 3 bpm, respectively; P = 0.08). SBP (123.1 ± 3.3 versus 118.4 ± 2.3 mmHg, P = 0.26) and mean blood pressure (90.5 ± 2.5 versus 85.11 ± 1.9 mmHg, P = 0.11) were not different between groups. Diastolic blood pressure tended to be higher in AASU (72.6 ± 2.1 versus 67.4 ± 1.7 mmHg, P = 0.08). However, the SBR for increases (13.9 ± 2 versus 22.8 ± 3.4 msec/mmHg, P = 0.03) and decreases (13.4 ± 1.3 versus 19.2 ± 2.3 msec/mmHg, P = 0.04) were lower in AASU compared to AASNU, respectively. Conclusion: The spontaneous baroreflex sensitivity is impaired in AASU which may lead to an increase cardiovascular risk in young AASU. P173 GIO mind-body exercise program increases heart rate variability and T-wave variability in patients with chronic heart failure P Grom Simpson1, B Borut Jug2, Z Fras2 1Coronary Disease Club, Ljubljana, Slovenia, 2Dept. of vascular diseases, University clinical centre, Ljubljana, Slovenia Psychosocial factors/Quality of life (Sports Cardiology) Background: Loss of heart rate variability (HRV) and T-wave variability (TVAR) independently predict sudden cardiac death in patients with heart failure. Some forms of mind-body exercise (yoga, qui gong and tai chi) have been shown to restore heart rate variability; in the present pilot study, we sough to assess the impact of a novel mind-body integrated exercise program (GIO) on parameters of heart rate variability and TVAR. Study patients and methods: Sixteen patients with chronic stable (>3 months) systolic heart failure (mean age 71 ± 9 years; LVEF 36 ± 8%) New York Heart Association II (n = 7) or III (n = 9) were included. 10 patients underwent a mind-body integrated exercise GIO program twice a week for 8 weeks (intervention group), and 6 patients underwent usual care (control group). Before and after the intervention period, patients had a 20-minute high-resolution (1000 Hz) electrocardiogram recording. TVAR and frequency-domain power spectral density heart rate variability parameters were extracted using Fourier transformation: TP (total power), VLF (very low frequency <0.04 Hz), LF (low frequency 0.04-0.15 Hz), HF (high frequency 0.15-0.4 Hz) and LF/HF ratio. Results: HF significantly increased in the intervention group (from 63.9 ± 15.9 to 133.6 ± 48.7; p = 0.001), but not in the control group (from 66.4 ± 21.1 to 58.6 ± 24.5; p = 0.683). Conversely, a trend to decrease was observed for LF (from 160.3 ± 34.6 to 188.0 ± 46.9, p = 0.048 in the intervention group versus from 160.4 ± 44.6 to 172.1 ± 26.6, p = 0.630 in the control group); the LF/HF ratio consequently decreased significantly in the intervention group (from 2.7 to 1.7, p = 0.0012), but not in the control group (from 2.5 to 3.4, p = 0.3125). As for TVAR, median values increased in the intervention group (from 17.9 to 23.7, p = 0.017), but not in the control group (from 20.4 to 20.9, p = 0.931). Conclusion: Eight weeks mind-body exercise GIO program increase heart rate variability (especially the LF/HF ratio) and median TVAR, suggesting a pro-parasympathetic shift in cardiac autonomic regulation. P174 Fitness trainers: are they really fit? EA Kalinina1, A Alexandra Kutuzova2 1Federal Almazov's Heart, Blood, Endocrinology centre, St. Petersburg, Russian Federation, 2Pavlov's state medical university, Federal Almazov's Heart, Blood, Endocrinology centre, St. Petersburg, Russian Federation Other risk factors (Sports Cardiology) Overtraining syndrome is a well-known negative phenomenon in the field of modern sport. Fitness trainers (FT) with theirs' every-day hours-long business-exercises, self-training sessions, emotional stress could be considered as the excessive trained and affected persons. Despite of that, the classic symptoms of overtraining (ex. mood changes, fatigue, decrease of fitness level) have not been the topic of systematic investigation in the FT' cohort. The aim of the study was to assess physical and psychic condition among FT. Methods: 25 FT(13 male and 12 female, age 31 ± 7) who undergo Tecumseh step-test and were interviewed. FT' depression and anxiety, coping and adaptation strategies, fatigue were assessed using the Hospital Anxiety and Depression Scale (HADS), E.Heim's coping and Maklakov adaptation inventories, Fatigue Assessment Scale (FAS). 10-score Visual Analogue Scale (VAS) was also used. Results. FT were highly qualified athletes: 40% weightlifters, 24% swimmers, football (n = 3) and volleyball players (n = 2), dancers (n = 2)), who performed everyday fitness classes (13 hours per week) and about 6 self-training sessions per week. Step test was excellent (55%), very good (25%) and fair (20%, as anticipated in weightlifters predominantly). Unexpectedly FT assessed their own health condition level as not very high (5.4 ± 2.1, VAS); the data were associated with the number of self-training sessions per week (r = 0.41, p < 0.05). No anxiety and depression were revealed in FT, but the depression (3 ± 0.3) and anxiety (5.1 ± 0.4) HADS scores were associated with fatigue (r = 0.55, p < 0.05) and physical deconditioning (r = 0.49, p < 0.05) self-assessment. According to FAS all FT were exhausted (39.8 ± 1). This symptom is not only similar to one found in the overtrained athletes, but provide evidence of chronic stress in FT' cohort. Chronic stress apparently happened to be a result of excessive physical activity, but as a known risk factor for cardiovascular disease it could possibly modify health outcomes in FT. Fatigue did not impact FT' behavioural models: the majority of them used adaptive cognitive and emotional coping strategies; 48% revealed relatively adaptive coping strategies (“diverting” models dominated). As among general population, female participants predominantly experienced maladaptive behaviour patterns in their every-day life. Conclusions. Most of the ordinary fitness facilities trainers reveal psychic fatigue and subjective physical deconditioning. Further research in this area should investigate health outcomes and cardiovascular disease prevalence in the target fit and physically “very active” population. P175 Increased atherothrombotic markers and endothelial dysfunction in steroid users R Stein1, CB Severo1, AD Anderson Donelli Silveira1, DU Moraes1, FRA Neto1, J Pinto Ribeiro1 1Federal University of Rio Grande do Sul (UFRGS), Department of Cardiology, Porto Alegre, Brazil Atherosclerosis/CAD (Sports Cardiology) Purpose: The use of androgenic anabolic steroids (AAS) may be associated with changes inatherothrombotic markers and endothelial function The purpose of this study wasto compare atherothrombotic markers and endothelial function of AAS users and non-users. Methods: Ten athletes who were users of AAS (confirmed by urine analysis) and 12 non-user athletes were evaluated. Body weight, blood pressure, exercise load (hours/week), complete blood count (CBC), platelets, fibrinogen, lipids, high-sensitivity C-reactive protein (hs-CRP), follicle stimulating hormone, testosterone, and estradiol were measured. Endothelium-dependent and independent functions were assessed by brachialartery ultrasound. Results: AAS users had higher body mass and blood pressure (P < 0.05). Platelet count was higher whereas HDL-cholesterol was lower in AAS users compared with non-users (P < 0.05). Levels of hs-CRP were higher in AAS users (P < 0.001). Follicle stimulating hormone was suppressed in all users and not suppressed in non-users (P < 0.001). Compared with non-users, flow-mediated dilation was significantly reduced in AAS users (P = 0.03), whereas endothelium-independent function was similar in both groups (Figure 1). Additionally, flow-mediated dilation was positively associated with levels of HDL-cholesterol (r = 0.49, P = 0.03). Conclusions: AAS users present important changes in blood lipids as well as in inflammatory markers, which are compatible with increased cardiovascular risk. Furthermore, this profile is accompanied by a reduction in the endothelial function. Open in new tabDownload slide P176 Cardioprotective effects of red palm oil intake demonstrated in hypertensive rats. B Bacova1, C Viczencz2, J Radosinska3, V Knezl4, I Bernatova5, R Sotnikova4, J Navarova4, J Vanroyen6, N Narcisa Tribulova7 1Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic, 2Comenius University, Faculty of Life Sciences, Bratislava, Slovak Republic, 3Comenius University, Faculty of Medicine, Bratislava, Slovak Republic, 4Slovak Academy of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava, Slovak Republic, 5Slovak Academy of Sciences, Institute of Normal and Pathological Physiology, Bratislava, Slovak Republic, 6Cape Peninsula Univ. Technology,, Bellwille, South Africa, 7Slovak Academy of Sciences, Bratislava, Slovak Republic Hypertension (Exercice & Translational Science) Background and purpose: Previously we have shown that spontaneously hypertensive rats (SHR) benefit from n-3 unsaturated fatty acids supplementation that is known to reduce cardiovascular diseases and sudden cardiac death in humans. Recently, cardioprotective effect of red palm oil (RPO) containing 50% saturated fatty acids and high level of carotenoids, tocoferol and tocotrienols has been reported. The purpose of this study was to examine effects of RPO supplementation in SHR. Methods: Male SHR and and nomrotensive WKY rats were fed with a standard rat chow plus RPO (200microL/day) for 5 weeks and compared with untreated controls. Systolic blood pressure (SBP) and plasma cholesterol (CH), triglycerides (TG) and blood glucose (BG) were registered at the end of experiment. Nitric oxide synthase (NOS) activity was determined in the left ventricle and aorta, which was also submitted for functional examination. Isolated perfused heart was used for the examination of postischemic reperfusion-induced arrhythmias and inducible ventricular fibrillation (VF). Results showed that RPO reduced significantly blood pressure (160+ 13 vs 184 + 20 mmHg) in SHR and BG in SHR as well as WKY (4.48 + 0.2 vs 5.61 + 1.1 and 5.5 + 0.4 vs 6.38 + 0.8 mmol/L), while there were no significant differences in plasma CH and TG among the groups. Body and heart weights were not affected by RPO as well. Compared to WKY rats the activity of nitric oxide synthase was higher in SHR heart and aorta (4.67 + 0.3 and 3.18 + 0.5 vs 3.02 + 0.3 and 1.54 + 0.1 pmol/mg/min). RPO reduced nitric oxide synthase in the heart of both SHR and WKY. However, RPO enhanced nitric oxide synthase activity in the aorta but supressed relaxation of the aorta. Duration of reperfusion-related bradykardia was markedly shorter in SHR versus WKY and prolonged due to RPO, which also supressed reperfusion-induced ventricular fibrillation/flutter in both strains and reduced incidence of electrically-induced ventricular fibrillation/flutter. Conclusions: Results suggest beneficial effects of RPO in SHR and challenge to elucidate underlying mechanisms more in details. P177 Intense supervised exercise training and blood pressure in hypertension: results from the ERGOCISER-RR study F Frank Van Buuren1, D Horstkotte1, C Prinz1, KP Mellwig1, J Gilis-Januszewski1, B Koerber1, M Vlachojannis1, M Moellenberg1, JB Dahm2, L Vanhees3 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany, 2Heart and Vascular Center Neu-Bethlehem, Goettingen, Germany, 3Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium Hypertension (Exercice & Translational Science) Purpose: Aerobic physical activity generates beneficial effects on blood pressure (BP) and other cardiovascular risk factors. In contrast to secondary prevention for patients with coronary heart disease, comparable programmes have not been established for hypertensives on the same scale. In this prospective study over 2 years we investigated the influence of a moderately intense, long-term supervised aerobic exercise training (IAET) on blood pressure, with special emphasis on the physician's role regarding motivation. Methods: 7 patients (42 ± 11 years) conducted a daily IAET (≥ 5 times weekly, 25-30 min/day, 70% of their maximum exercise capacity) for > 120 weeks (control group 9 patients, once weekly 90 minutes). Submaximal blood pressure, drug therapy and serum lipids were measured on follow-up (3, 6, 12, 18, 24 months). The influence of physician's feedback on motivation was evaluated through energy utilization during a timely limited period of less physician's assistance. Results: Under IAET (989 ± 83 J/week) exercise capacity improved (32.6%; p < 0.001), submaximal-blood pressure decreased (9.7%; p < 0.001), drug therapy declined significantly (27.9%; p < 0.001), high-density lipoprotein cholesterol increased (18.5%; p = 0.007), body mass index declined (4.1%; p = 0.002). Motivation and maintenance declined substantially during reduced physician's feedback. During the time-limited period of reduced physician feedback, energy utilization decreased significantly by 9.3% to 898 ± 88 J/week. Exercise capacity did not differ between the two groups at baseline. Patients of the IAET group performed 178 ± 98 minutes of aerobic exercise training per week with a work load of estimated 989 ± 83 J/week. The exercise capacity of the IAET group increased significantly by 32.5% after 3 months from 109 ± 9.5 (range 98-122) to 144 ± 12.1 (130-161) watts and remained constant around 140 W after 24 months, while it was unchanged in the control group with corresponding values of 114 ± 13.3 (range 96-132) at baseline and 115 ± 12.0 (100-132) at 3 months. Conclusions: In contrast to a weekly physical fitness programme, IAET with a work load of appr. 1000 J/week has favourable effects. Because of its easy availability, it should be recommended but physician's assistance is crucial to keep patient motivation high. P178 Ventilatory efficiency slope is associated with an increased risk for the development of arterial hypertension in adult patients with repaired isolated coarctation of the aorta R Buys1, W Budts2, J Mueller3, A Hager3, A Giardini4, L Vanhees1 1Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 2University Hospitals (UZ) Leuven, Department of Congenital & Structural Cardiology, Leuven, Belgium, 3German Heart Center, Department for Pediatric Cardiology and Congenital Heart Disease, Munich, Germany, 4Great Ormond Street Hospital for Children, London, United Kingdom Hypertension (Exercice & Translational Science) Background: Patients who underwent surgical repair for isolated aortic coarctation (COA) have an increased risk for the development of arterial hypertension. Yet limited information is available on how to evaluate risk in this population. Therefore the aim of this study was to assess whether exercise testing variables, along with known demographic and clinical determinants of hypertension, are predictive for the development of arterial hypertension in these patients. Methods: This study is part of a multicentre prospective investigation of the prognostic value of cardiopulmonary exercise testing (CPET) in COA. One hundred and twenty one adults with COA (age 27 ± 8.5 years; 81 male, 40 female) who underwent maximal CPET between 1999 and 2010 and who were normotensive at that time, were included in this study. Results: At baseline, mean systolic blood pressure was 125 ± 16 mmHg at rest. Peak oxygen uptake averaged 32.3 ± 8.77 ml.min−1.kg−1 (82 ± 15 percent of predicted) and mean peak respiratory exchange ratio was 1.15 ± 0.08. The ventilatory efficiëncy slope (VE/VCO2-slope) averaged 25.6 ± 4.6. During a follow-up period of 3.6 ± 1.2 years (range 1.01 to 11.7 years), 13 patients needed to start with antihypertensive drug therapy. Cox proportional-hazards multiple regression analysis was used to assess the relation between demographic, clinical and exercise variables and the need to start antihypertensive drug treatment. Following variables were included in the regression analysis: gender, age at CPET, age at surgical repair, body mass index, resting systolic blood pressure, resting heart rate, presence of a bicuspid aortic valve, restenosis at the coarctation site, peak oxygen uptake, Peak oxygen pulse, VE/VCO2-slope, heart rate reserve, hypertensive blood pressure response to exercise and chronotropic incompetence during exercise. At multivariate Cox analysis, male gender (hazard ratio: 0.002, p = 0.0035), older age (hazard ratio: 0.670, p = 0.0149), higher resting systolic blood pressure (hazard ratio: 1.271, p = 0.0135) and steeper VE/VCO2-slope (hazard ratio: 1.276, p = 0.0351) were significantly related to the need to start with antihypertensive treatment during medium follow-up. Conclusions: A steeper VE/VCO2-slope is associated with an increased risk for the development of arterial hypertension in adult patients with COA. When patients with COA are at higher risk to develop hypertension based on age, gender and prehypertensive systolic blood pressure values, assessment of the ventilatory efficiency slope might help the clinician to decide whether antihypertensive drug therapy is needed. P179 Omega-3 fatty acids intake affects red blood cells fatty acids profile in male and female rats suffering from essential hypertension. N Tribulova1, P Sec2, B Bacova3, T Benova3, J Radosinska4, M Certik2 1Slovak Academy of Sciences, Bratislava, Slovak Republic, 2Slovak University of Technology, Bratislava, Slovak Republic, 3Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic, 4Comenius University, Faculty of Medicine, Bratislava, Slovak Republic Hypertension (Exercice & Translational Science) Background and purpose: Omega-3 fatty acids (omega-3 FA) are important components of cell membranes affecting their function, as they are incorporated into the phospholipids. Dietary deprivation of essential eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) is deleterious to health. Because omega-3 FA content of red blood cells (RBC) membranes reflects cardiac membrane it was previously proposed to evaluate omega-3 index (1), i.e. the content of EPA and DHA in RBC, as a risk factor for coronary heart disease. Purpose of this study was to examine plasma (PL) and RBC fatty acids profile in spontaneously hypertensive rats (SHR) and whether omega-3 intake can affect it. Methods: 1-year-old male and female SHR and age-matched normotensive Wistar rats (WR) were fed with omega-3 FA (Vesteralens, Norway, EPA+DHA 200mg/day/2month) and compared with untreated ones. PL and RBC were collected at the end of experiment and stored frozen until use. Total lipids were extracted into chloroform solution followed by chloroform evaporation in vacuum. In next step the samples were used for preparing FA methyl esters, which were assayed on a gas chromatograph GC-6890N. Recordings were evaluated using ChemStation B0103 and quantified using C-4-C24 FA standards. The level of each omega-3 FA: ALA (alfa linolenic acid), EPA and DHA as well as omega-6 FA: LA (linoleic acid), AA (arachidonic acid) and GLA (gama linolenic acid) was expressed in percentage of total free FA. Key results: The levels of assayed free FA were lower in PL than RBC in all groups of rats. PL content of LA and EPA or DHA was increased due to omega-3 FA intake in male and female SHR and male WR. Comparing to normotensive rats RBC levels of estimated FA were lower in male SHR (with exception of AA), while higher (with exception of AA) in female SHR. Omega-3 intake increased of RBC levels of EPA, DHA and to lesser extent AA and GLA in males SHR and WR. Likewise to male SHR omega-3 intake in females resulted in an increase of RBC levels of EPA, DHA and also ALA and GLA while not AA. Conclusions: Results showed that there are sex-related differences in red blood cells levels of both omega-3 and omega-6 FA and that omega-3 intake affect red blood cells FA profile by increasing omega-3 to omega-6 ratio. 1. Harris WS and von Schacky C. 2004. P180 Important role of extra-endothelial activity of endothelial nitric oxide synthase for the regulation of blood pressure T Tatsiana Suvorava1, S Friedrich2, M Cortese-Krott3, VT Dao1, T Hohlfeld1, C Rump2, M Kelm3, J Stegbauer2, G Kojda1 1Institute of Pharmacology and Clinical Pharmacology, University Hospital, Duesseldorf, Germany, 2Departhment of Nephrology, University Hospital, Düsseldorf, Germany, 3Department of Cardiology, Pneumology, Angiology, University Hospital, Duesseldorf, Germany Hypertension (Exercice & Translational Science) Purpose: Disruption of endothelial nitric oxide synthase in mice (eNOS-Ko) causes a profound hypertension which is assumed to be caused by the lack of endothelium-derived NO-generation. We sought to investigate whether endothelial-specific targeting of endothelial nitric oxide synthase in eNOS-Ko normalizes vacular reactivity and blood pressure (BP). Methods and Results: Transgenic mice carrying bovine endothelial nitric oxide synthase (eNOS-Tg) were generated on C57Bl/6 background using the endothelium-specific Tie-2 promoter. By breeding eNOS-Tg with eNOS-Ko, mice that express endothelial nitric oxide synthase only in the endothelium (eNOS-Ko/eNOS-Tg) were obtained. Western blot confirmed eNOS-expression in aorta, myocardium, kidney and skeletal muscle of eNOS-Ko/eNOS-Tg. Activity of endothelial nitric oxide synthase in vivo was demonstrated by significantly increased aortic and skeletal muscle Ser239-phosphorylated/total VASP ratio as a marker for protein kinase G activity and by increased expression of ecSOD which is known to be upregulated by vascular endothelial nitric oxide synthase (all compared to eNOS-Ko, n = 4-5, P < 0.05). Organ bath studies revealed a complete normalization of aortic reactivity to acetylcholine (ACh), phenylephrine and NO-donors S-nitroso-N-acetyl-penicillamine and diethylamine/nitric oxide in eNOS-Ko/eNOS-Tg (P>0.05, n = 8-11 vs C57Bl/6). Measurement of vascular peripheral resistance in isolated perfused kidneys of eNOS-Ko/eNOS-Tg demonstrated 63.6 ± 5.4% reduction in perfusion pressure in response to ACh. The NOS-inhibitor L-NAME significantly decreased ACh-induced response in isolated kidney of eNOS-Ko/eNOS-Tg (P < 0.05, n = 5) but not in eNOS-Ko (P>0.05, n = 4). Four weeks of voluntary exercise training of eNOS-Ko/eNOS-Tg resulted in upregulation of aortic endothelial nitric oxide synthase protein level and increased endothelial nitric oxide synthase phosphorylation on Ser 1176/79 (n = 5, P < 0.05) which was comparable to that observed in C57Bl76 and suggests a normal activation pattern of reintroduced endothelial nitric oxide synthase in response to increased shear. In striking contrast there was no effect of bovine endothelial nitric oxide synthase on systolic blood pressure. While C57Bl/6 mice showed a normal systolic blood pressure (118.4 ± 3.1 mmHg, n = 6), sBP in eNOS-Ko/eNOS-Tg was strongly increased to 137.0 ± 2.3 mmHg (n = 8, P < 0.05) and this was similar to that of eNOS-Ko (135.9 ± 3.0, n = 8, P = 0.7). The same observation was made in 2 additional sets of sBP measurements. Conclusions: Endothelium-specific reintroduction of functionally active endothelial nitric oxide synthase in eNOS-Ko, i.e. vascular-specific eNOS-rescue, resulted in restoration of endothelial eNOS-activity in conductance and resistance arteries and normal physiological response to increased shear, but does not reduce blood pressure. These data demonstrate a limited role of endothelial endothelial nitric oxide synthase for the regulation of blood pressure. P181 Serial changes in LRG, a novel biomarker of ventricular dysfunction and heart failure, reflects progressive cardiac remodelling. CJ Watson1, M Ledwidge2, D Phelan1, P Collier1, S Horgan1, M Dunn1, K Mcdonald2, J Baugh1 1University College Dublin, Dublin, Ireland, 2Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland Hypertension (Exercice & Translational Science) Heart failure with preserved ejection fraction (HFpEF) is commonly preceded by a prolonged asymptomatic phase during which progressive left ventricular diastolic dysfunction (LVDD) develops. HFpEF preventative strategies urgently require better biomarkers for identifying disease manifestations before the onset of symptoms and irreversible myocardial damage. In addition, biomarkers that predict the likelihood and rate of disease progression over time would help streamline and focus clinical efforts. To help address this we adopted a proteomic screening approach (2D-DIGE and mass spectrometry) to dissect the coronary sinus serum proteome of asymptomatic hypertensive patients with low and high risk for future development of HFpEF. Risk was based on B-type natriuretic peptide (BNP) levels, a cardiac hormone that correlates with increased risk of cardiovascular events and is reflective of an active pathological process. We identified several differentially expressed disease-associated proteins, one of which was leucine-rich α2-glycoprotein (LRG). In various validation cohorts, LRG was found to be consistently over-expressed in the serum of patients who exhibit high BNP levels. Serum LRG levels correlated significantly with BNP in hypertensive, asymptomatic LVDD and HF patient groups (p < 0.05) and were found to increase across the spectrum of disease. LRG levels were able to identify heart failure independent of BNP. Although a precise biological function for LRG is yet to be determined, LRG correlated with serum levels of TNFα (p < 0.01) and IL-6 (p < 0.05). Furthermore, LRG expression was detected in myocardial tissue and correlated with fibrotic genes (p < 0.01). To investigate the dynamics of LRG levels with progressive LVDD, we identified a cohort of 30 subjects from a population of over 500 asymptomatic hypertensive patients, whom following serial clinical and echocardiographic assessment exhibited evidence of progressive left ventricular diastology. Progression was based on changes in left atrial volume index (LAVI) which is a robust continuous echocardiographic measure of LVDD that has relative load independence. Progressors were identified as those having a change in ΔLAVI ≥ 3.5mls/m2 from an initial LAVI between 20 and 34mls/m2. A matched non-progressor cohort was selected and were similarly identified as those having ΔLAVI<3.5mls/m2. Serum analysis revealed that, unlike BNP, LRG was able to predict changes in left ventricular diastology over time highlighting a potential role for identification of sub-clinical disease progression in pre-HFpEF syndromes. P182 Characteristics of subjects with exercise hypertension according to different definitions. Results from a population-based sample. M Marcus Dorr1, C Doehn2, R Lorbeer3, S Glaeser2, SB Felix2 1Ernst Moritz Arndt University of Greifswald, Greifswald, Germany, 2Ernst Moritz Arndt University of Greifswald, Department of Internal Medicine B, Greifswald, Germany, 3Ernst Moritz Arndt University of Greifswald, Institute of Community Medicine, Greifswald, Germany Hypertension (Exercice & Translational Science) Objective: Exercise hypertension is associated with an increased risk for new-onset hypertensionand incident major cardiovascular events in healthy, asymptomatic subjects with normal resting blood pressures. Different definitions of exercise hypertension have been used in various studies. Our aim was to investigate the impact of different previously published definitions of exercise hypertension on the demographic and cardiovascular characteristics of affected subjects. Methods: Among 1708 subjects that volunteered symptom-limited exercise testing during the first follow-up of the population-based Study of Health in Pomerania (SHIP) data of 662 and 473 subjects aged 25-88 yrs without hypertension, antihypertensive medication and cardiovascular diseases were available for the present analyses at submaximal and maximal workload, respectively. Ten different definitions of exercise hypertension were applied (Fig. 1). Age- and gender-adjusted multivariable regression models were used to compare patterns of demographic and cardiovascular variables with respect to different definitions. Results: Prevalence rates of exercise hypertension varied significantly when different definitions were used, ranging from 4.5% to 38.3% (Fig. 1). Accordingly, demographic and cardiovascular characteristics among affected subjects changed substantially. For example, the proportions of men and of subjects with diabetes varied from 13.3% to 78.8% and from 1.6% to 6.7%, respectively. Likewise, determinants that were associated with exercise hypertension in fully adjusted regression models changed markedly when different definitions were applied. Conclusion: Application of different definitions of exercise hypertension results in substantial changes of the demographic and cardiovascular characteristics of affected subjects, making selection of the best definition difficult. P183 Fermented Soya Product Effect in addition to exercise training on endothelial function in rats with type 2 diabetes. C Christelle Goanvec1, T Efstathiou2, N Plu2, T Le Tallec1, E Poirier1, A Feray1, F Guerrero1, J Mansourati3 1University of Bretagne Occidentale - EA 4324, Brest, France, 2SOJASUN TECHNOLOGIES filiale du groupe TRIBALLAT, Noyal sur Vilaine, France, 3University Hospital of Brest, Department of Cardiology, Brest, France Diabetes Type 1/2 (Exercice & Translational Science) Introduction: The purpose of our study was to determine whether Fermented Soya Product (FSP), an antioxidant and anti-inflammatory food compound with proven biological effects, result in an additional effect to chronic exercise on endothelial function in Type 2 Diabetic (DT2) rats. Methods: 9 weeks old male Zucker rats, 40 obese (ZF) and 40 lean (ZL) were randomly assigned into sedentary (Sed) or trained groups (Tr), with or without FSP supplements (+ or −FSP, 0.2 g/day, 5 days/week) administered by oral gavage. Tr rats were submitted to a treadmill training protocol (Tr, n = 10) (15 m.min−1, 10° incline, 60 min/day, 5 days/week, 8 weeks). At the end of the program, we analysed glycaemia, plasmatic FSP metabolites levels, total anti-oxidant capacity (Oxygen Radical Absorbance Capacity, ORAC test), pro-oxydant NADPH oxydase (gp91 phox), endothelial nitric oxide synthase expression (eNOS total) and dimer/monomer ratio (D/M) of endothelial nitric oxide synthase on myocardial tissue by densitometry. Results: ZF rats had a significantly higher glycaemia (1.49 ± 0.07 mg.mL-1 vs 1.10 ± 0.04 mg.mL-1) and endothelial nitric oxide synthase quantity (126.07 ± 23.24 vs 53.92 ± 13.30 A.U., p = 0.01) than ZL. No difference was found in ORAC, D/M and NADPH oxydase enzyme quantity. Exercise training led to a higher endothelial nitric oxide synthase expression in ZL rats in addition to a surprisingly decrease of D/M without modification of ORAC and NADPH oxydase. For ZF rats, only NADPH oxydase expression was increased (69.9 ± 4.6 vs 110.1 ± 12.8 U.A., p < 0.005) with exercise. FSP alone led to the decrease of endothelial nitric oxide synthase expression in ZF but not in ZL group without modifying D/M, NADPH oxydase expression nor ORAC. FSP in addition to exercise training prevented the training-induced increase of NADPH oxydase expression in ZF rat (p = 0.018) and the decrease of D/M in ZL group. Conclusion: The addition of FSP to exercise training seems to stabilize endothelial nitric oxide synthase expression in control group and to improve the heavy training-induced NADpulmonary hypertension oxydase expression in DT2. Therefore, FSP early associated with exercise training may be an interesting preventive strategy in DT2. P184 Cardiovascular prevention in childhood. First results from the get fit-stay healthy project J Elmenhorst1, B Boehm1, J Mueller1, B Barta1, G Starringer-Kirchmair1, A Chmitorz1, R Oberhoffer1 1Technische Universität, Institute of Preventive Pediatrics, München, Germany Other risk factors (Exercice & Translational Science) Objective: Atherosclerotic cardiovascular disease remains the leading cause of both, death and disability in the Western European countries. Coronary risk factors measured in childhood are associated with coronary artery calcification already in young adulthood. Therefore, cardiovascular prevention already in childhood is a tremendous task to detect those children who are on higher cardiovascular risk and to apply preventive strategies. Patients and methods: From April 2011 to July 2011 we studied 88 healthy schoolchildren aged 12.6 years (39 female, range 11.4 - 14.9 years) with a median BMI-SDS of −0.13 (interquartile range −1.02; 1.00). Children having a Body mass index standard deviation score (BMI-SDS) >1 were defined to be on cardiovascular risk. Those twenty-two (24.7%) were compared with the whole study group regarding exercise capacity, blood pressure and serum lipids. Results: Children at risk had a lower peak oxygen uptake after correcting for age, sex, height and weight (87% of predicted [75; 93] versus 102% of predicted [88; 115]; p < .001) and lower high density lipoprotein (52 mg/dl [46; 59]) versus 63 mg/dl [53; 72]; p = .001). Systolic blood pressure was elevated but failed statistically significance (114 mmHg [109; 117] versus 110 mmHg [106; 115] p = .084). There was no difference in low density lipoprotein (p = .808), total cholesterol (p = .184) nor in triglycerides (p = 0.191) Peak oxygen uptake was associated to BMI-SDS (r = −.515; p < .001), high density lipoprotein (r = .256; p = .017) and systolic blood pressure (r = −.222, p = .048) Conclusions: Enhancing physical fitness and particularly promoting an active lifestyle should be the key element of prevention programs already in early childhood. © The European Society of Cardiology 2012 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2012
TI - Poster session 1
JO - European Journal of Preventive Cardiology
DO - 10.1177/2047487312448006
DA - 2012-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-1-0NnH4Vm49K
SP - S1
EP - S33
VL - 19
IS - 1_suppl
DP - DeepDyve
ER -