TY - JOUR
AB - Friday, 04 May 2012, 08:30–12:30 Location: Poster Area P263 Reaching low-density lipoprotein cholesterol target levels among high risk dyslipidemic individuals in the Levant region (Jordan and Lebanon) The CEpulmonary hypertensionEUS Levant Study Group, A Ayman Hammoudeh1, G Ghanem2, E Chammas2, H Abu-Hantash3, O Hamoui2 1Istishari Hospital, Amman, Jordan, 2Clemenceau Medical Center, Beirut, Lebanon, 3Jordan University Hospital, Amman, Jordan Lipid Disorders (Prevention & Epidemiology) Purpose: Cardiovascular disease (CVD) is the leading cause of death in the Middle East, and dyslipidemia is one of its highly prevalent risk factors. It is largely unknown whether dyslipidemic individuals, specifically the high risk group, are adequately treated to recommended cholesterol target levels or not. The CEpulmonary hypertensionEUS 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 European and American 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 urban out-patient clinic settings in Jordan and Lebanon (August 2010-January 2011) who were on LLA for >3 months with stable doses for >6 weeks. Physicians and patients filled out dyslipidemia diagnosis and treatment questionnaires before the clinical data and fasting blood samples were collected during one visit. LDL-C target levels were defined according to the Third Joint European Task Force (JETF) and US National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) guidelines. Results: Full analysis set of 992 patients (mean age 58 ± 11 years, 41% women) showed hypertension, diabetes mellitus (DM), and smoking in 66%, 50%, and 29% respectively. History of coronary, peripheral, or cerebrovascular disease was present in 52%, 5%, and 3% respectively. LLA were prescribed for primary, secondary prevention, and familial hypercholesterolemia in 46%, 53%, and 1% respectively. Based on to the Third JETF guidelines risk stratification, 519 patients (52%) fell into the high risk category. Mean age was 60 ± 11 years, of which 45% were women. Hypertension, diabetes mellitus, and smoking were present in 77%, 95%, and 24%; respectively. Sixty percent of patients in the high risk group reached their target LDL-C goal of < 100 mg/dL. Smoking, diabetes mellitus, metabolic syndrome, cardiovascular disease history, increased waist circumference, and elevated pre-treatment LDL-C levels were all associated with not reaching LDL-C goals. Conclusion: Based on the Third JETF guidelines, the treatment of high risk dyslipidemic patients using LLA in the Levant region needs reinforcement. Only 60% of the cohort reached their LDL-C targets. These findings are in line with the results from a similar study, CEPEHEUS-Europe. National strategies to effectively control LDL-C levels to recommended targets, specifically in the highest risk groups, and aggressive awareness campaigns to the general population and health care providers are urgently needed in the Levant region. P264 Treatment pattern changes in high-risk patients on statin monotherapy in a managed care setting R Ross Simpson1, K Tunceli2, DR Ramey2, DR Neff2, DM Kern3, H-M Hseih3, DA Wertz3, JJ Stephenson3, E Marrett3, TA Jacobson4 1University of North Carolina, Chapel Hill, United States of America, 2Merck Sharp & Dohme Corp., Whitehouse Station, United States of America, 3HealthCore, Inc., Wilmington, United States of America, 4Emory University, Atlanta, United States of America Lipid Disorders (Prevention & Epidemiology) Purpose: To determine treatment pattern changes among high-risk patients not at LDL-C goal after being newly treated with statin monotherapy. Methods: Patients newly initiated on statin monotherapy between 1/1/06-8/31/09 were identified from the HealthCore Integrated Research Database. We examined rates and mean time to first and second treatment change in patients who had medical claims for coronary heart disease (CHD), atherosclerotic vascular disease (AVD) and/or diabetes mellitus (DM) at baseline and were not at optional goal <70 mg/dL at 1st eligible LDL-C result (≥ 4 weeks post index). Treatment change was assessed for 12 months after LDL-C result (follow-up). Analysis was limited to patients with 30-day prescriptions. Patients were considered to have discontinued index therapy if there was no refill within 45 days of previous statin fill. Results: Of 11,473 subjects, 51.3% were male, and mean (SD) age was 55.3 (11.1) years. 61.3% of eligible subjects had diabetes mellitus only, 26.6% had coronary heart disease and/or AVD, and 12.1% had CHD/AVD and diabetes mellitus. At index, 44.7% were prescribed simvastatin, 31.5% atorvastatin [mean (SD) dose 27.4 (14.9) and 19.6 (14.9) mg, respectively] and 23.8% other statin monotherapy. Mean (SD) LDL-C prior to statin initiation was 138 (34) mg/dL, and at 1st eligible LDL-C result post-index, 101 (25) mg/dL. During follow-up, 7,444 subjects (64.9%) experienced a first treatment change, with mean (SD) time to change 93.8 (92) days. Discontinuation of index therapy occurred in 46.9% of subjects and medication switches/titration in 18.0% [titration of index statin 62.7% (58.0% up-titration), switch to other statin monotherapy 21.8%, change to any regimen including ezetimibe 10.5%, change to any regimen including other lipid lowering therapies 4.6%]. Of subjects with a first treatment change who did not discontinue, 48.9% experienced a second therapy change. Results were similar between disease groups. Conclusions: In this cohort of high-risk patients, statin treatment was usually started at low-moderate doses and nearly half of the patients discontinued lipid-lowering therapy within 12 months. These treatment patterns demonstrate the need for more patient and provider education as well as other system-wide improvements to increase medication adherence. P265 Residual lipoprotein abnormalities in statin treated patients:results from the Israeli DYSIS D Dov Gavish1, R Bachrach2, Y Hebkin3 1Wolfson medical centre, Tel aviv University., Holon, Israel, 2Clalit Health Services, Hadera, Israel, 3Soroka University Medical Center, Faculty of Health Sciences-Ben Gurion University of the Negev, Beer-Sheva, Israel Lipid Disorders (Prevention & Epidemiology) Background: According to current guideline recommendations, medical treatment is often recommended for patients at risk for cardiovascular disease in order to achieve optimal lipoprotein goals. However, despite statin treatment many patients fail to attain the recommended goals. In the DYSIS Israel study, residual lipid profile abnormalities in patients on stable statin therapy in Israel were assessed as part of an international, multi-centre study. Setting: A prospective cross sectional study with data provided by office based physicians from 3 major HMOs in Israel (Clalit, Maccabi & Leumit). Methods: Each participating physician was instructed to recruit 10-15 consecutive patients aged 45 or more years, provided they had been on statin therapy for at least three months. Data on demographics, cardiovascular history and cardiovascular risk profile were recorded and compared with the European Society of Cardiology (ESC) risk classification. Results: In total, 755 patients were recruited from 80 clinics. Low-density lipoprotein cholesterol goals were achieved in 69% of the patients. Low high-density lipoprotein cholesterol levels were found in 31% and high triglycerides in 35%. At least one lipoprotein abnormality was present in 64% patients. There was no significant difference in the average statin potency and/or use of additional lipid-modifying medications between patients who had achieved and those who had not achieved target lipoprotein goals. Conclusion: Despite treatment with a statin, a substantial proportion of patients at risk for coronary heart disease retain residual lipoprotein abnormalities that intensify that risk. These findings highlight the importance of utilizing more potent statin doses as well as combination therapy with additional drugs in high-risk patients that have not achieved optimal lipoprotein control. P266 Low high-density lipoprotein and inadequate primary prevention in Offspring of Patients with Premature Coronary Heart Disease in Banja Luka Region/ Republic of Srpska/Bosnia and Herzegovina D Dusko Vulic1, S Loncar1, M Ostojic2, J Mrinkovic3, B Vulic1, I Tasic4, ND Wong5 1Center for medical research, Banja Luka, Bosnia and Herzegovina, 2Clinical Center of Serbia, Institute for Cardiovascular Diseases, Belgrade, Serbia, 3Institute for Statistics, Belgrade, Serbia, 4Intitute for rehabilitation, Niska Banja, Serbia, 5University of California, Irvine, United States of America Lipid Disorders (Prevention & Epidemiology) Background: Risk factor differences among offspring of patients with premature coronary heart disease (CHD) have not been widely studied. We examined differences in lipid and non-lipid risk factors among offspring of patients with premature coronary heart disease. Method: We examined 161 persons from the region of Banja Luka, including 81 children (mean age 25.9 years, 45.7% female) with a family history of coronary heart disease and a control group of 80 persons (mean age 24.1, 50% female). Medical history interviews and risk factor measurements were performed with lipid levels assessed by the Cholestech LDX analyser using reflectance photometry. Results: Comparing children from parents with coronary heart disease to controls, there were differences in body mass index (26.1 kg/m2 versus 23.1 kg/m2, p < 0.01), waist circumference (87.7 cm versus 83.9 cm, p < 0.01), hip circumference (99.3 cm vs 95.84 cm, p < 0.01), systolic blood pressure (128.1 mmHg versus 122.8 mmHg, p < 0.01), and target value of systolic blood pressure (59% vs 70%, p < 0.01). Moreover, HDL-C was significantly lower (1.1 mmol/l versus 1.4 mmol/l, p < 0.01), target value of HDL-C was significantly lower (>1.0 mmol/l in men and 1.2mmol/l in women) (44% versus 61%, p < 0.01), triglycerides significantly higher (2.2 mmol/l versus 1.6 mmol/l, p < 0.01), and target value of triglycerides <1.7 mmol/l (31% versus 45%, p < 0.01). Adjusted for age, gender, total cholesterol, LDL-C, HDL-C, smoking, systolic and diastolic blood pressure, and body mass index, factors associated with coronary heart disease showed a significance in reduction of calories (OR = 0.64) and having higher HDL-C levels (OR = 0.45). Conclusion: Children of parents with premature coronary heart disease have a significantly greater likelihood of coronary heart disease risk factors which shows the lack of conduction of primary prevention. Low HDL-C, in particular, is independently associated with the odds of being a child of a parent with premature coronary heart disease. This emphasizes the greater need for attention paid to primary prevention efforts in controlling risk factors of the children of coronary heart disease patients. P267 Relation of changes in total and ectopic fat to other cardiovascular risk factors in response to the MyAction vascular prevention programme SB Connolly1, S Jenni2, T Tillin1, L Thomas1, K Marsh1, C Park1, J Bell1, DA Wood1, A Hughes1, N Chaturvedi1 1Imperial College London, London, United Kingdom, 2Bern University Hospital, Bern, Switzerland Lipid Disorders (Prevention & Epidemiology) Background and aim: Adiposity is a well recognised risk factor for cardiovascular disease and can impact on other risk factors such as blood pressure (BP) and lipids. We explored the relationship between alterations in body fat and such risk factors in response to a 16 week nurse-led multidisciplinary vascular prevention programme (MyAction Westminster). Methods: The MyAction programme is delivered by a multidisciplinary team in a community setting and includes intensive lifestyle modification as well as medical risk factor management. Weight, waist circumference, blood pressure and lipids, together with fat depots were assessed before and on completion of the programme. 18 patients with high cardiovascular risk were included. Fat depots were determined using whole body magnetic resonance imaging and magnetic resonance spectroscopy. Table 1 shows the changes in both risk factors and fat on programme completion. Results: Marked reductions in total and ectopic fat were observed in response to the MyAction programme. Robust regression analysis, showed change in triglycerides was most closely associated with change in hepatic fat (r2 = 0.57, p = 0.002). In contrast, change in fasting glucose was predicted by change in both subcutaneous and visceral fat (r2 0.59, p = 0.006). Blood pressure and HDL-cholesterol were not associated with change in fat depots. Conclusion: The MyAction programme was associated with profound reductions in ectopic fat with a differential effect on other risk factors. Changes in risk factors and fat depots Measure Baseline percent change p value Total fat volume, L (n = 12) 29.3 (6.4) −10.8 (−15.7, −5.8) 0.0006 Subcutaneous fat, L (n = 12) 20.5 (4.6) −10.2 (−14.3, −6.0) 0.0002 Visceral fat, L (n = 12) 4.8 (1.8) −13.3 (−22.0,−4.5) 0.0066 Hepatic fat, AU (n = 15) 2.3 (1.5, 7.4) −41.3 (−59.0, −23.6) 0.0002 Waist, cm (n = 18) 99.3 (7.6) −3.7 (−5.3, −2.3) 0.0001 Fasting glucose, mmol/l (n = 15) 6.0 (1.5) −0.3 (−5.7, 5.0) 0.89 Systolic blood pressure, mmHg, (n = 17) 134 (15) −2.6 (−8.3, 3.0) 0.33 HDL-cholesterol, mmol/l (n = 15) 1.4 (0.3) 1.3 (−6.1, 8.6) 0.71 Triglycerides, mmol/l (n = 15) 1.08 (0.74,1.58) 6.5 (−8.4, 21.4) 0.36 Measure Baseline percent change p value Total fat volume, L (n = 12) 29.3 (6.4) −10.8 (−15.7, −5.8) 0.0006 Subcutaneous fat, L (n = 12) 20.5 (4.6) −10.2 (−14.3, −6.0) 0.0002 Visceral fat, L (n = 12) 4.8 (1.8) −13.3 (−22.0,−4.5) 0.0066 Hepatic fat, AU (n = 15) 2.3 (1.5, 7.4) −41.3 (−59.0, −23.6) 0.0002 Waist, cm (n = 18) 99.3 (7.6) −3.7 (−5.3, −2.3) 0.0001 Fasting glucose, mmol/l (n = 15) 6.0 (1.5) −0.3 (−5.7, 5.0) 0.89 Systolic blood pressure, mmHg, (n = 17) 134 (15) −2.6 (−8.3, 3.0) 0.33 HDL-cholesterol, mmol/l (n = 15) 1.4 (0.3) 1.3 (−6.1, 8.6) 0.71 Triglycerides, mmol/l (n = 15) 1.08 (0.74,1.58) 6.5 (−8.4, 21.4) 0.36 Open in new tab Changes in risk factors and fat depots Measure Baseline percent change p value Total fat volume, L (n = 12) 29.3 (6.4) −10.8 (−15.7, −5.8) 0.0006 Subcutaneous fat, L (n = 12) 20.5 (4.6) −10.2 (−14.3, −6.0) 0.0002 Visceral fat, L (n = 12) 4.8 (1.8) −13.3 (−22.0,−4.5) 0.0066 Hepatic fat, AU (n = 15) 2.3 (1.5, 7.4) −41.3 (−59.0, −23.6) 0.0002 Waist, cm (n = 18) 99.3 (7.6) −3.7 (−5.3, −2.3) 0.0001 Fasting glucose, mmol/l (n = 15) 6.0 (1.5) −0.3 (−5.7, 5.0) 0.89 Systolic blood pressure, mmHg, (n = 17) 134 (15) −2.6 (−8.3, 3.0) 0.33 HDL-cholesterol, mmol/l (n = 15) 1.4 (0.3) 1.3 (−6.1, 8.6) 0.71 Triglycerides, mmol/l (n = 15) 1.08 (0.74,1.58) 6.5 (−8.4, 21.4) 0.36 Measure Baseline percent change p value Total fat volume, L (n = 12) 29.3 (6.4) −10.8 (−15.7, −5.8) 0.0006 Subcutaneous fat, L (n = 12) 20.5 (4.6) −10.2 (−14.3, −6.0) 0.0002 Visceral fat, L (n = 12) 4.8 (1.8) −13.3 (−22.0,−4.5) 0.0066 Hepatic fat, AU (n = 15) 2.3 (1.5, 7.4) −41.3 (−59.0, −23.6) 0.0002 Waist, cm (n = 18) 99.3 (7.6) −3.7 (−5.3, −2.3) 0.0001 Fasting glucose, mmol/l (n = 15) 6.0 (1.5) −0.3 (−5.7, 5.0) 0.89 Systolic blood pressure, mmHg, (n = 17) 134 (15) −2.6 (−8.3, 3.0) 0.33 HDL-cholesterol, mmol/l (n = 15) 1.4 (0.3) 1.3 (−6.1, 8.6) 0.71 Triglycerides, mmol/l (n = 15) 1.08 (0.74,1.58) 6.5 (−8.4, 21.4) 0.36 Open in new tab P268 Achieving optimal low-density lipoprotein control in a large community based group practice:lipid optimization tool (LOT) audit 2011 at the Ottawa Cardiovascular Centre (OCC) J M Niznick1, A Chawla2, W Faiella2 1The Ottawa Hospital, Ottawa, Canada, 2University of Ottawa, Ottawa, Canada Lipid Disorders (Prevention & Epidemiology) Background: Despite compellng evidence of benefit, optimal low-density lipoprotein control rates are underachieved in high and very high risk cardiovascular patients. Contemporary published series and interventions show low-density lipoprotein control rates range from 22 to 55% to an low-density lipoprotein target of 2.0 mmol/L and 19 to 21% to an low-density lipoprotein target of 1.8 mmol/L. At the OCC we have recognized the need to improve low-density lipoprotein control rates and have developed a structured, nurse managed lipid control program using cost and evidence based dosing of statin and combination therapy to achieve optimal low-density lipoprotein control rates. The program is reinforced by direct nursing to patient telephone feedback and standardization across a large patient and physician population. Control rates have previously been reported at this meeting (2007). The current report updates control rates in an expanding patient volume with additional physicians and adds data on treatments rates, drug utilization and dosing and rates of utilization of combination therapy. Methods: All patients followed at OCC receive active lipid management initially. Optimized patients may be discharged from lipid follow-up. Lipid targets are set based on 10 year cardiovascular event risk. Patients are categorized as HR or VHR based on categorical risk factor counting. Low-density lipoprotein targets are set at 2.0 and 1.8 mmol/L respectively. Statin dose is selected based on efficacy (% reduction) required to achieve low-density lipoprotein target. Lipid profiles are followed at 2 and then 6 to 12 month intervals. Medications are reconciled and reinforced by nursng staff. Adjustments are signed off by the attending physician. Results are tracked using the Lipid Optimization Tool and tabulated in the Lipid Optimization Database. Results: As of September 20, 2011, data is available on 9941 patients. 7801 are VHR and 833 are HR. 4254 have had active lipid management in the preceding 2 years. In all patients the low-density lipoprotein control rates are 59% in the VHR population and 72% in the HR population. In statin treated patients low-density lipoprotein control rates are 60% in the VHR population and 74% in the HR population. Statin utilization rate is 85.6% in the entire population and 96.2% in the VHR and HR combined. Statin use is 47% atorvastatin, 41.2% rosuvastatin, 10.1% simvastatin and 1.6% other statin. Statin/ezetimibe combination therapy is used in 15.2% of all patients and 16.6% of VHR and HR patients. Conclusions: low-density lipoprotein control rates at OCC remain amongst the best if not the best reported in the world literature. Results could improve further with increased use of combination therapy. If these results could be reproduced broadly, significant event reduction should ensue. P269 Lp(a) is an independent risk factor for coronary heart disease in men and women: a matched pair analysis in 32.000 patients C Schatton1, T Kottmann1, F Van Buuren1, D Horstkotte1, K-P Klaus-Peter Mellwig1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Lipid Disorders (Prevention & Epidemiology) Background: There is little information on the influence of elevated Lp(a) on coronary artery disease (CAD), artery occlusive disease (AOD) and carotid artery stenosis. The impact of an isolated Lp(a)-enhancement on cardiac and noncardiac manifestations of atherosclerosis is discussed controversially. Methods: Between 01/04 and 12/09, the Lp(a) of 31.734 patients (pts) was measured. Inclusion criteria for the statistical analysis were: HBA1c ≤ 6.1 mg/dl, LDL < 130 mg/dl, and performed coronary angiography. A total of 265 pts with Lp(a) ≥ 110 mg/dl was found. After matching regarding age and sex, a group out of 319 pts with Lp(a) < 30 mg/dl was determined. Results: Between the groups (Lp(a) ≥ 110 versus < 30 mg/dl), no differences were found concerning age (66 ± 11 versus 64 ± 15 years; p = 0.512), sex (male: 67.5% versus 67.1%; p = 0.93) and body mass index (BMI) (27.1 ± 4.0 versus 26.7 ± 4.3; p = 0.111). High Lp(a) was significantly associated with advanced CAD (percentage of three vessel disease: 50.2% versus 25.1% and percentage of normal coronary state: 17.6% versus 47.0%; p < 0.001). Furthermore, pts with Lp(a) ≥ 110 mg/dl suffered significantly more often from myocardial infarctions (34.6% versus 16.6%; p < 0.001), coronary bypass graft surgeries (40.8% versus 20.8%; p < 0.001) and coronary interventions (55,3% versus 33,6%; p < 0.001) than pts with normal Lp(a). Pts with enhanced Lp(a) had in mean a significantly earlier onset of CAD than those with normal Lp(a) (61 ± 10 versus 65 ± 12; p < 0.001). When analysing Lp(a), age, sex, body mass index, genetic disposition, diabetes and hyperlipoproteinaemia in a multivariate analysis, Lp(a) was identified as an independent predictor for CAD. This independent association between Lp(a) and CAD was found in men and women. Patients with excessive enhanced Lp(a) suffered significant more frequently from AOD (12.6% versus 7.3%; p = 0.034) and carotid artery stenosis (10.9% versus 6.1%; p = 0.046). Conclusions: In pts with normal HBA1c and normal or slightly increased low-density lipoprotein, an excessive elevation of Lp(a) is an independent risk factor for manifestation of CAD. The frequency of advanced three vessel disease in patients with increased Lp(a) is significantly higher than in patients with normal Lp(a). An enhancement of Lp(a) is associated with higher prevalence of myocardial infarction, coronary interventions and an earlier onset of CAD. Elevated Lp(a) is correlated with higher prevalence of AOD and carotid artery stenosis. Because of the substantial prognostic impact of Lp(a), Lp(a) screening should be performed in all cardiac patients - especially in patients with severe risk factors for CAD. P270 Decreasing low-density lipoprotein cholesterol in relation to risk of cardiovascular and cerebrovascular events among people with type 2 diabetes L Li1, BM Ambegaonkar2, JPD Reckless3, SS Jick1 1Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, MA, United States of America, 2Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, United States of America, 3Royal United Hospital Bath NHS Trust, Bath, United Kingdom Lipid Disorders (Prevention & Epidemiology) Purpose: To evaluate effects of decreasing low-density lipoprotein cholesterol (LDL-C) on risk for cardiovascular (CV) or cerebrovascular (CB) events in type 2 diabetes (T2D) patients with no history of CV or CB disease. Methods: Using the UK General Practice Research Database we conducted a retrospective cohort study of T2D patients aged 35-69 with a first prescription for lipid modifying therapy (LMT) in 2000-2009. All subjects were required to have ≥ 2 prescriptions for LMT, ≥ 2 years registration before the index date (date of first LMT), and ≥ 1 complete lipid profiles ≤ 1 year before or on the index date and ≥ 28 days after. We excluded those with a CV or CB event any time before, on or within 28 days after the index date, or who had a CV or CB event prior to the first follow-up lipid test. We categorized changes in LDL-C between baseline and last available values in the follow-up as −6.5 to −3, −2.9 to −2.0, −1.9 to −1.0, −0.9 to −0.3, −0.2 to 0.2 (no-change), >0.2 mmol/L. The study outcomes were the first time composite CV or CB event. We separately estimated the adjusted hazard ratios (HRs) of CV or CB events and 95% confidence intervals (CIs) for each category of change compared to no change. Secondary analyses using different methods to define changes in LDL-C were conducted to examine whether the primary findings were robust. Results: The study comprised 21,998 T2D patients with an average of around 4 years of follow-up; mean age 57 and 54.4% were men. Of those, 89.2% had a reduction >0.2 mmol/L in LDL-C during follow-up, 5.5% had no-change, and 5.3% had an increase in LDL-C. We identified 621 CV and 274 CB events. Compared to those with no change in LDL-C, those with a reduction had a decreased risk of CV events, particularly those with the largest reduction (adjusted HR =  0.4, 95% CI: 0.2-0.7) and those with a change between −2.9 to −2.0 mmol/L (adjusted HR =  0.5, 95% CI: 0.3-0.8). There was a dose-response relation between the decrease in LDL-C and risk of CV events. Similarly, those with a reduction in LDL-C had a lower risk of CB events compared to those with no change, even with the smallest reduction (adjusted HR =  0.6, 95% CI: 0.4-1.0). The CV results of the secondary analysis provided additional evidence to support a protective effect of reduction in LDL-C, however the CB secondary analyses were less conclusive. Conclusions: Decreasing LDL-C is associated with a reduced risk of CV and CB events among T2D patients with no history of CV or CB events. However, the magnitude of the protective effect of CB events is less certain and further studies are warranted. P271 The effectiveness of primary prevention lags behind secondary prevention management of hyperlipidemia 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, CJ Watson2, E Tallon2, L Mcdonald3, M Ledwidge2, K Mcdonald2 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 Lipid Disorders (Prevention & Epidemiology) Purpose: Management of hyperlipidemia 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 risk management should result in increased application of lipid lowering therapies and improved control of global cardiovascular risk. We sought to examine the blood pressure health of an Irish primary care population at heightened cardiovascular risk. Methods: Analysis of the baseline data of the STOP HF study; a community based cohort of 1140 adults >40 years of age with ≥ 1 cardiovascular risk factor; we observed hypelipidemia in terms of diagnostic prevalence and fasting lipid levels 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 cardiovascular 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) was 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 hyperlipidemia. However, more individuals in the primary prevention group (61% versus 44%; p.<0001) had total cholesterol and or low-density lipoprotein levels outside the range defined by ESC guidelines. Statin therapy was applied in 62% of the cohort, with more individuals in the secondary prevention group taking this medication (55% versus 70%; p < .0001). Comparing those with SCORE ≥ 5% in both groups; median total cholesterol and low-density lipoprotein levels were significantly higher in the primary prevention group (5.0mmol/L versus 4.5mmol/L and 3.0 mmol/L versus 2.5mmol/L respectively; both p < .0001) suggesting that ≥ 50% of both high risk groups had lipid values above guideline recommendations. Conclusion: This data suggests that management of hyperlipidemia in secondary prevention cohorts is superior to that in primary prevention, despite older age and heightened cardiovascular co-morbidity. This is likely due to teh effectiveness of increased vigilance in this setting via programmes such as Heartwatch and specialist out-patient clinics. Increased attention is warranted in the primary prevention of cardiovascular disease, particularly in the setting of heightened SCORE risk. P272 Serum triglyceride levels in patients attending a community based cardiovascular disease prevention programme in the West of Ireland M Smyth1, M Mc Namara1, C Kerins2, I Gibson2, J Jones3, S Connolly4, J Crowley5, G Flaherty1 1National University of Ireland, Galway, Ireland, 2Croí, West of Ireland Cardiac Foundation, Galway, Ireland, 3Imperial College London, London, United Kingdom, 4Imperial College Healthcare NHS Trust, London, United Kingdom, 5University College Hospital Galway, Galway, Ireland Lipid Disorders (Prevention & Epidemiology) Purpose: Raised triglyceride levels are associated with cardiovascular-disease. We examined triglyceride levels in patients attending a primary cardiovascular disease (CVD) prevention programme and studied the relationship between triglycerides and other cardiovascular disease risk factors. Methods: A retrospective analysis of data from participants completing the 16-week lifestyle-based programme was performed. Participants were at high risk of developing cardiovascular disease. The following variables were examined: triglycerides, and the relationship between triglycerides and blood pressure, lipids, glycaemia, anthropometrics, alcohol, smoking and exercise. Results: A significant reduction was observed in triglyceride levels from initial assessment (IA) to end of programme (EOP, n = 273) and at 1 year (1 YR n = 109). Thirty six percent of patients were above the target of 1.7mmol/L at IA, decreasing to 21.2% at EOP and 19.4% at 1 year. Median triglyceride levels reduced from 1.66 mmol/L at IA to 1.36 mmol/L at EOP and 1.27 mmol/L at 1 year; p < 0.001. There was a positive correlation between baseline triglycerides alcohol consumption in alcohol users (p = 0.01) and number of cigarettes smoked and EOP and 1YR triglyceride levels (p < 0.005). At each stage there was a negative correlation between triglycerides and high-density lipoprotein (p < 0.001) and a positive correlation with waist circumference, fasting blood glucose (p < 0.001), body mass index and HbA1c levels (p < 0.05). Triglyceride levels were lower in those achieving physical activity goals at IA and EOP (p < 0.05). Conclusions: Our study demonstrates the positive association between triglyceride levels and multiple other cardiovascular disease risk factors and the effectiveness of an intensive lifestyle-based cardiovascular disease prevention programme in achieving targets for triglyceride level reduction. P273 Is a lifestyle-based cardiovascular disease prevention programme effective in increasing high-density lipoprotein-cholesterol levels in patients at increased cardiovascular disease risk? M Smyth1, M Mc Namara1, I Gibson2, AM Walsh2, C Kerins2, J Jones3, S Connolly4, J Crowley5, G Flaherty1 1National University of Ireland, Galway, Ireland, 2Croí, West of Ireland Cardiac Foundation, Galway, Ireland, 3Imperial College London, London, United Kingdom, 4Imperial College Healthcare NHS Trust, London, United Kingdom, 5University College Hospital Galway, Galway, Ireland Lipid Disorders (Prevention & Epidemiology) Purpose: Studies show inverse associations between high-density lipoprotein (HDL) levels and cardiovascular disease (CVD). Increasing high-density lipoprotein levels in a cardiovascular disease prevention setting is therefore a therapeutic priority. High-density lipoprotein levels were examined in individuals attending a 16-week lifestyle-centred cardiovascular disease prevention programme and its association with other risk factors was examined. Methods: A retrospective analysis of data from participants completing the programme (n = 273) and attending 1 year (n = 109) follow-up was performed. Participants were at increased/ high risk of developing cardiovascular disease. The following variables were examined: high-density lipoprotein levels, and correlations between high-density lipoprotein and anthropometrics, triglycerides, smoking, glycaemia, exercise and alcohol. Results: 22.3% of male and 18.2% of female participants had high-density lipoprotein levels below target at Initial Assessment (IA). At IA there was a negative correlation between high-density lipoprotein and smoking and glycosylated haemoglobin levels in males (p < 0.05). At each stage of the programme there was a negative correlation between high-density lipoprotein and triglycerides, fasting venous glucose levels, waist circumference and body mass index (p=0.001). High-density lipoprotein was higher in those achieving physical activity goals at baseline (p = 0.035). There was a positive correlation between high-density lipoprotein and alcohol consumption in females at IA and males at End of Programme (EOP) and 1 year (p < 0.05). There was a significant increase in high-density lipoprotein levels from initial assessment (IA) to end of programme (EOP) and at 1 year (p=0.001). Conclusions: Given the cardioprotective role of high high-density lipoprotein levels and its inverse association with other cardiovascular disease risk factors, this study reinforces the need to target increased levels of high-density lipoprotein in cardiovascular disease prevention programmes and demonstrates the effectiveness of such interventions. P274 Lipids targets achievement in EUROASPIRE III ROMANIA FOLLOW-UP: from guidelines to clinical practice L Laura Craciun1, C Avram2, A Avram3, S Iurciuc1, M Iurciuc1, D Stancila4, D Gaita1, S Mancas1 1Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 2West University, Timisoara, Romania, 3Medicover, Timisoara, Romania, 4St. James's Hospital, Dublin, Ireland Lipid Disorders (Prevention & Epidemiology) Purpose: We proposed to evaluate the “reinforced” prevention measures that influenced lipids targets achievement according to ESC 2007 Prevention Guidelines in asymptomatic high-risk patients included in the first EuroAspire III Follow-Up. Methods: We followed-up 325 patients (age 56 ± 9 years, 62% women) out of 503 asymptomatic high-risk patients included in EuroAspire III Romania Primary Care. These patients were evaluated every 6 months for a period of 18 months of follow-up by general practitioners (GP) that participated in a professional training performed by diabetologists and cardiologists and have been advised to reinforce lifestyle changes and to optimize hipolipemiant drug therapy in order to reach the targets mentioned in the current guidelines. Results: The percentage of dyslipidemic patients reaching the lipid targets significantly increased for LDL-cholesterol (1.8% versus 30.6% versus 45.7%, p < 0.001) and non-HDL-cholesterol (4.1% versus 23.52% versus 44.1%, p = 0.002). In a logistic regression model, reducing calories intake (p = 0.03), increasing fish oil consumption of (p = 0.04), and increasing physical activity by following the recommendations of a sports instructor (p = 0.008) were independently correlated with low-density lipoprotein cholesterol target achievement. Similarly the attempt of weight loss (p = 0.04), low-density lipoprotein cholesterol level (p = 0.04) contributed significantly to non-HDL cholesterol target achieving in the univariate model. Conclusions: Preventive intervention, conducted by general practitioners, improved the lipid profile in dyslipidemic patients, even though the guidelines targets are far from being achieved. The data are similar with real life lipid management and highlighted that “reinforced” primary care represents a step forward from usual care and a model of changes applicable in other centres. P275 Triglycerides as marker of unfavourable lifestyle A Andrejs Kalvelis1, I Stukena1, I Skuja1, G Bahs1, A Lejnieks1 1Riga Stradins University, Riga, Latvia Lipid Disorders (Prevention & Epidemiology) Introduction: The lifestyle cardiovascular risk factors (RF) affect atherogenesis directly and through traditional RF such as lipid level, blood pressure and glucose level. Although the role of triglycerides (TG) is debatable; it is considered that TG level is both direct RF of atherogenesis and valuable cardiovascular risk marker with particular connection with unhealthy lifestyle. Aims: To evaluate TG level for patients with unfavourable lifestyle RF: sedentary lifestyle (SL), irrational nutrition, smoking and enlarged waist circumference. Methods: Fasting TG level were compared in 11.830 patients (mean age 57.9 ± 16.4, 28% males) with different level of physical activity (active (A) to sedentary (B) lifestyle), diet (healhy (A) to unhealthy (B) diet), smoking (non-smokers (A) to smokers (B)) and different body mass index (BMI) (<25kg/m2 (A) un ≥ 25kg/m2 (B)). As TG level don't correspond to normal distribution, mean indices were expressed as median and quartile I and III. Results: TG level depending on different level of physical activity, diet, smoking and body mass index are given in the table. The patients with SL and increased body mass index had higher TG level than patients with active lifestyle and normal body mass index. Healthy diet is relatively less connected with changes of TG level; there is only trend to higher TG level in case of unhealthy diet (B). It can be explained by the fact that the healthy diet contains less saturated fat and higher percentage of fruit and vegetable which less influence TG level. TG level mainly depends upon diet rich in carbonhydrates. Unfortunately this fact is undervalued by a patient and sometimes by a physician as well. Smoking as RF doesn't influence TG level. High TG level reflects unhealthy lifestyle and TG level should be corrected by lifestyle. Conclusions: Higher TG level is an integral marker to several unfavourable lifestyle RF such as SL and overweight. Unhealthy diet is less connected with increased TG level, but smoking doesn't correlate with changes in TG level. To decrease TG level it is recommended primary to increase physical activity and normalise body weight. TG lelev depending on lifestyle RF Physical activity Nutrition Smoking BMI A 1.28[0.94;1.85] A 1.49[1.01;2.08] A 1.52[1.04;2.19] A 1.16[0.86;1.68] B 1.66[1.10;2.31] B 1.53[1.04;2.20] B 1.57[1.08;2.19] B 1.61[1.13;2.31] p <0.001 p 0.052 p 0.171 p 0.001 Physical activity Nutrition Smoking BMI A 1.28[0.94;1.85] A 1.49[1.01;2.08] A 1.52[1.04;2.19] A 1.16[0.86;1.68] B 1.66[1.10;2.31] B 1.53[1.04;2.20] B 1.57[1.08;2.19] B 1.61[1.13;2.31] p <0.001 p 0.052 p 0.171 p 0.001 Open in new tab TG lelev depending on lifestyle RF Physical activity Nutrition Smoking BMI A 1.28[0.94;1.85] A 1.49[1.01;2.08] A 1.52[1.04;2.19] A 1.16[0.86;1.68] B 1.66[1.10;2.31] B 1.53[1.04;2.20] B 1.57[1.08;2.19] B 1.61[1.13;2.31] p <0.001 p 0.052 p 0.171 p 0.001 Physical activity Nutrition Smoking BMI A 1.28[0.94;1.85] A 1.49[1.01;2.08] A 1.52[1.04;2.19] A 1.16[0.86;1.68] B 1.66[1.10;2.31] B 1.53[1.04;2.20] B 1.57[1.08;2.19] B 1.61[1.13;2.31] p <0.001 p 0.052 p 0.171 p 0.001 Open in new tab P276 Association of severe hypertriglyceridemia and genetic lipoproteinlipase (lpl) mutation and cardio- or cerebrovascular disease Lipid Disorder Research Group Charite, IM M Missala1, U Kassner1, C Gelsinger1, N Gauer1, L Steimann1, E Steinhagen-Thiessen1 1Lipid Clinic, Charite Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany Lipid Disorders (Prevention & Epidemiology) SHTG may develop due to mutation of the LPL-gene. The LPL-enzyme hydrolyses triglycerides (TGs) in very low density lipoproteins(VLDL) and chylomicrons, initiating lipolysis with transformation of VLDL into low-density lipoprotein and chylomicrons into chylomicron-remnants. Homo-/ heterozygote SHTG leads to severe diseases due to decreased high density lipoprotein(HDL) levels, impaired glucose-tolerance and rheology, high pro-thrombogenic status and a high risk of pancreatitis. It's role as independent risk factor for cardio- and cerebrovascular disease is controversially discussed. Our aim was to identify SHTG-patients with (1) mutations in the LPL-gene, (2) comorbidities and (3) positive family history. Methods: 32 SHTG patients (TG >1700mg/dl) in the lipid clinic, Charité-Universitaetsmedizin, Berlin were included. Two saliva samples under fasting conditions were taken for DNA analyses of LPL-gene mutationand blood samples. Assessment of individual and family comorbidities was conducted. Results: Table1 show a positive association of SHGT and high body mass index, low high-density lipoprotein, hypertension, alcohol intake, smoking, pancreatitis and diabetes type II. The DNA-analysis still undergoes further examination. Conclusions: Our results show a strong association of SHGT and different comorbidities. It differs for various types of LPL-gene mutations. SHTG and Comorbidities Age SHTG diagnosis, years (mean) 48,28 sex - male female 266 TG value SHTG diagnosis (mean) 2568,59 TG value (highest recorded) (mean) 3145 BMI (kg/m2), mean 28,53 Diabetes Type II (%) 40,6 Hypertension (%) 62,5 Pancreatitis (%) 18,8 Abdominal Pain (%) 25 Coronary heart disease (%) 18,8 Cerebrovascular Disease (%) 6,3 regular alcohol intake (%) 75 current smoker (%) 43,8 ex-smoker (%) 21,9 Age SHTG diagnosis, years (mean) 48,28 sex - male female 266 TG value SHTG diagnosis (mean) 2568,59 TG value (highest recorded) (mean) 3145 BMI (kg/m2), mean 28,53 Diabetes Type II (%) 40,6 Hypertension (%) 62,5 Pancreatitis (%) 18,8 Abdominal Pain (%) 25 Coronary heart disease (%) 18,8 Cerebrovascular Disease (%) 6,3 regular alcohol intake (%) 75 current smoker (%) 43,8 ex-smoker (%) 21,9 Open in new tab SHTG and Comorbidities Age SHTG diagnosis, years (mean) 48,28 sex - male female 266 TG value SHTG diagnosis (mean) 2568,59 TG value (highest recorded) (mean) 3145 BMI (kg/m2), mean 28,53 Diabetes Type II (%) 40,6 Hypertension (%) 62,5 Pancreatitis (%) 18,8 Abdominal Pain (%) 25 Coronary heart disease (%) 18,8 Cerebrovascular Disease (%) 6,3 regular alcohol intake (%) 75 current smoker (%) 43,8 ex-smoker (%) 21,9 Age SHTG diagnosis, years (mean) 48,28 sex - male female 266 TG value SHTG diagnosis (mean) 2568,59 TG value (highest recorded) (mean) 3145 BMI (kg/m2), mean 28,53 Diabetes Type II (%) 40,6 Hypertension (%) 62,5 Pancreatitis (%) 18,8 Abdominal Pain (%) 25 Coronary heart disease (%) 18,8 Cerebrovascular Disease (%) 6,3 regular alcohol intake (%) 75 current smoker (%) 43,8 ex-smoker (%) 21,9 Open in new tab P277 The effect of statins on myocardial infarct extension V H Pereira1, M Fernandes1, J Guardado1, F Ferreira1, S Canario-Almeida1, I Machado1, F Sousa1, A Pereira1, A Lourenco1 1Hospital Guimaraes, Guimaraes, Portugal Lipid Disorders (Prevention & Epidemiology) Purpose: The benefits of statin treatment for primary prevention are well known in medical practice nowadays. Beside its efficacy on lipid profile, statins are also known for their pleotropic effects promoting stabilization of atherosclerotic plaque. The purpose of this study was to evaluate if statin treatment contributes to myocardial infarction extension in patients admitted with the diagnosis acute coronary syndrome. Methods: A prospective study was designed including all patients admitted with the diagnosis of acute coronary syndrome in our intensive care unit during a period of 10 consecutive months. Patients diagnosed with unstable angina and patients with a previous episode of acute coronary syndrome were excluded from the analyses. Myocardial infarction extension was estimated by the peak troponin I value. Patients were clinically evaluated using Killip classification and left ventricle function was evaluated at discharge by echocardiogram. Results: A total of 74 patients with a mean age of 64 were included (65% males) in the study. Of these 26% were previously medicated with a statin as part of primary prevention strategies. The mean of peak troponin was significantly lower in statin medicated patients when compared with individuals not previously medicated with these drugs (32 ng/mL vs 89 ng/mL). Interestingly there were no significant differences regarding Killip class or left ventricle function evaluated at discharge. Conclusion: Statin use as part of primary prevention strategy may influence the evolution of myocardial infarction and is associated with smaller infarct extension when evaluated by the peak troponin I value during acute coronary syndromes P278 How do European countries measure up? Quantifying tobacco control policy implementation over time 1970 - 2010 LM Currie1, L Clancy2, R Layte3, H Mcgee1 1Royal College of Surgeons in Ireland, Dublin, Ireland, 2TobaccoFree Research Institute Ireland, Dublin, Ireland, 3Economic and Social Research Institute, Dublin, Ireland Smoking (Prevention & Epidemiology) Purpose: To assess the extent to which countries with an earlier or higher degree of tobacco control policy implementation also have more favorable trends in smoking prevalence and cardiovascular health outcomes, we required a method to quantify the implementation of policy over time, consistently across countries. By modifying the cross-sectional Tobacco Control Scale (TCS) (Joossens & Raw, 2006), we created the Tobacco Control Policy Index (TCPI) to quantify the implementation of policies at country level between 1970 and 2010. Methods: The TCPI includes: smoke-free air laws, bans on tobacco advertising and marketing, health warnings and smoking cessation treatment. A policy-specific scoring system from the TCS was used to allocate points for component parts of each policy. Points were summed to yield an overall annual score, with changes in the obtained index reflecting changes in policy. Using published scores from 2005 and 2006 as a reference, peer-reviewed literature, (inter)national reports, WHO Databases, and several national experts were consulted to allocate points for each policy for each year in the series. Results: Figure 1 illustrates the TCPI scores for 11 study countries. Conclusions: The UK, Ireland and Spain rank highest for policy implementation among study countries in 2010, while Portugal, Austria, and Germany rank lowest. Some limitations to consider in using the TCS scoring system to create a time series index for analyses: 1) it relies on expert opinion of the relative effectiveness of policies and 2) since it reflects best practice in 2005 when it was developed, it does not adequately capture early tobacco control interventions not part of current best practice. Nonetheless, it is a useful measure of the duration and degree of policy implementation across countries. Open in new tabDownload slide P279 Socio-demographic predictors of effective smoking cessation in a group intervention K Kirsten Doherty1, S I Zali1, I Gilroy1, B Whiteside1, P Fitzpatrick2, D Comerford1, A T Clarke2, L Daly2, C C Kelleher1 1St Vincent's University Hospital, Dublin, Ireland, 2University College Dublin, School of Public Health, Physiotherapy & Population Science, Dublin, Ireland Smoking (Prevention & Epidemiology) This tertiary referral hospital has run an intensive six-week stop smoking programme for 10 years. The programme was evaluated to determine its effectiveness and the existence of variations according to socio-demographic characteristics. Over a decade 54 courses were run, with 620 participants. Pre- and post six-week-course carbon monoxide (CO) levels and participant questionnaires were completed. Logistic regression was used to determine independent predictors of quitting smoking including socio-demographic factors and smoking history. The validated quit rate was 40.5% at course end. Of the participants, 60% were female, 52% were aged 45-64 years and 41% were in socio-economic groups (SEG) 1 and 2. There were higher quit rates in those who had retired or were on home duties, and those in social classes 1 & 2 (p = 0.004). Furthermore, the more sessions a participant attended, the higher the chance of quitting (p = 0.002). Lighter smokers (less than 20 cigarettes/day) were more likely to quit (OR 4.5 [95% CI: 2.0-10.0]); however duration of smoking, and history of previous quit attempts did not influence quitting. Those who used pharmacotherapy (52.5%) were twice as likely to quit as those who did not (OR 2.3 [95% CI: 1.3-4.0]). This group intervention is effective, with several important factors relating to socio-economic group, practice and level of addiction influencing successful quitting. P280 An analysis of knowledge, attitudes and behaviours related to a progressive campus smoking ban in a large general hospital in the Republic of Ireland I Gilroy1, K Doherty1, D Comerford1, AT Clarke2, L Daly2, P Fitzpatrick2, CC Kelleher2 1St Vincent's University Hospital, Dublin, Ireland, 2University College Dublin, School of Public Health, Physiotherapy & Population Science, Dublin, Ireland Smoking (Prevention & Epidemiology) Ireland became the first country in the world to ban smoking outright in public places in March 2004. As a result of this ban smoking became more visible outside buildings, which impinged upon the ethos of our healthcare facility. Thus on the 1st January 2009, our large teaching hospital became the first hospital in Ireland to implement a campus wide smoking ban. There is limited evidence about the effectiveness of such passive smoking bans on active smoking. In this paper we describe how such a ban has influenced the smoking attitudes and behaviours of patients and staff in this hospital. Regular surveillance of patient and staff smoking rates and attitudes has taken place in this hospital since 1998. Surveys of patients (1998, 2002, 2004, 2006, 2010), staff (2001, 2006, 2010), visitors and outpatients (2011) were combined. Of 3,622 participants (combined total), 61% were female, 52% were <50 years old and there was an average smoking rate of 21%. Logistic regression was used to determine the independent predictors of change in active smoking behaviour related to the smoking bans, and predictors of attitudes towards quitting. In 2002, before the indoors ban, 10% of the patient population smoked, rising to 14% in 2004 when allowed to smoke outdoors and reducing again to 9% after the outright ban in 2010 (p = 0.076). Of patient current smokers, 61% (n = 38) in 2004 and 60% (n = 19) in 2010 said the bans had helped them to stop or reduce during their hospital admission. Men were significantly more likely to report such a positive impact than women (OR 3.5 [95% CI: 1.5 - 8.5]). Patients' intention to quit has increased steadily from 41% in 1998 to 55% in 2010 while staff intention has decreased from 44% to 38% in the same period. Those of a higher socioeconomic class were significantly more likely to want to quit smoking (OR 1.6 [95% CI: 1.0 - 2.6]). Awareness that passive smoking damages health has grown among participants, from 82% in 2004 to 95% in 2011 (p < 0.000). In 2011, 30% of respondents reported that they were exposed to passive smoke in their homes and 11% were exposed in their car/truck. This analysis provides evidence of the increased effect of complete smoking bans on several smoking-related attitudes and behaviours. P281 Predictors of smoking cessation after percutaneous coronary intervention M Marina Licina1, T Potpara1, M Polovina1, MM Ostojic1 1Institute for Cardiovascular Diseases, Belgrade, Serbia Smoking (Prevention & Epidemiology) Background: Smoking cessation after percutaneous coronary intervention (PCI) is an important goal for secondary prevention of new cardiovascular complication and mortality. Although effective strategies have been developed to enhance smoking cessation, many smokers still fail to benefit from these services. Aim: The aim of are study was to find independent predictors of smoking cessation in patients after percutaneous coronary intervention (PCI). Method: The study included 352 consecutive patients (mean age 59 ± 9 years; 252male) scheduled for regular 6 months check after percutaneous coronary intervention. All patients answered a questionnaire about their physical activity, socio-economic status, education and nutrition habits. All patients underwent laboratory examination (lipid status, fasting blood glucose) and evaluation of blood pressure, waist circumference, body-mass index (BMI) and smoking status. We look for predictors of smoking cessation in group of patient after percutaneous coronary intervention. Result: Among 352 patients after percutaneous coronary intervention, there were 49 (13,9%) smokers and 222 (63,1%) ex smokers on 6 months check after percutaneous coronary intervention (13, 9%). In the univariate analysis male sex (RR 2,31, CI 95% 1,2-4,3; p = 0,09), regular medical controls with counseling (RR 0,45; CI 95% 0,22-0,92; p = 0,03) and acute myocardial infarction (RR 1,65; CI 95% 1,02-2,70; p = 0,04) were predictors of smoking cessation in this high risk group of patients. The multivariate regression analysis shows male sex (p = 0,04) and regular medical controls with counseling (p = 0,09) as independent predictors of smoking cessation. Conclusion: Presence of regular medical controls and male sex were the independent predictors of smoking cessation in high-risk patients after percutaneous coronary intervention. P282 Intervention strategies for smoking cessation in primary health care in Russia: opportunities and challenges M H Marine Gambaryan1, AM Kalinina1, T A Grigoryan1, V A Vigodin1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Smoking (Prevention & Epidemiology) Smoking is big public health problem in Russia with highest prevalence of smokers and smoking related mortality in European Region. Since 3 years Russia is implementing FCTC and National Policy against tobacco use for years 2010-1015, launched 2010. One of the biggest challenges is that Health Care System is not prepared enough for effective tobacco control (TC). The aim of this study is to assess opportunities, challenges for and effectiveness of different smoking intervention strategies in various settings in pulmonary hypertension C to define algorithms for effective TC. Pilot studies in 2 different settings undertaken: 1) randomized control trial for smoking cessation (SC) interventions in cardiologist's practice of municipal outpatient clinic was conducted in 60 patients. Smoking cessation intensive advice combined with nicotine replacement therapy and without nicotine replacement therapy was offered to intervention and control groups, 2) prospective study to assess the impact of workplace health promotion programs (WHPP) on SC rates was conducted in 348 health professionals at 4 municipal outpatient clinics in 12-months period. Average age of patients of outpatient clinic was 49+/−12; 75,9% had reported arterial hypertension (AH), 27,6%-myocardial infarction, 45% high blood cholesterol (CH) levels, 45%-chronic obstructive pulmonary disease. At the first visit 77.6% of the patients were diagnosed with high blood cholesterol, and 94.8%-with chronic obstructive pulmonary disease GOLD stage II and III-meaning 51% and 58.2% respectively were never diagnosed with the disease before (p < 0,05). By the end of the treatment smoking cessation rate in the intervention group was 46.7% compared to 3.3% of controls (p<0,001). Significant increase of lung function parameter was observed in intervention group compared with the controls (p<0,01). A decrease in stress levels was observed in 32% in intervention group and 20% in controls (p = 0.07); among quitters the stress levels did not change in 50% and decreased in 35.7% cases. Among participants of WHPP 44% had AH, 61% were overweight, 69.3% had high CH level, and 30.7% were regular smokers. After 12-months in settings where intensive intervention was applied (group HE interventions+HP handouts) a significant decrease of 17% of smoking rates was reached, in the reference settings (only handouts given) no significant changes observed. Prevention and early detection of smoking related diseases require systematic identification of smokers and provision of smoking cessation assistance, implemented at all levels of pulmonary hypertensionC. Workplaces are ideal settings for HP interventions, where SC may be implemented as part of the program. Intensive and assisted SC interventions significantly increase the success rates. P283 Dark chocolate inhibits platelet isoprostanes via nox2 down-regulation in smokers P Pasquale Pignatelli1, R Carnevale1, L Loffredo1, S Di Santo1, F Violi1 1Sapienza University of Rome, Rome, Italy Smoking (Prevention & Epidemiology) Background: Dark chocolate is reported to decrease platelet activation but the underlying mechanism is still undefined. Dark chocolate is rich of polyphenols that could exert an antiplatelet action via inhibition of oxidative stress. Aim of the study was to assess if dark chocolate inhibits platelet reactive oxidant species (ROS) formation and platelet activation. Methods: Twenty healthy subjects (HS) and 20 smokers were randomly allocated to receive 40 g of dark (cocoa >85%) or milk chocolate (cocoa <35%) in a crossover, single blind study. There was an interval of 7 days between the two phases of the study. At baseline and 2 hours after chocolate ingestion platelet recruitment (PR), platelet ROS, platelet isoprostane 8-ISO-prostaglandin F2α (8-iso-PGF2α), Thromboxane (TxA2) and platelet activation of NOX2, the catalytic sub-unit of NADPH oxidase, and serum epicatechin were measured. Results: Compared to HS, smokers showed enhanced PR, platelet formation of ROS and eicosanoids and NOX2 activation. After dark chocolate platelet ROS (−48%, p < 0.001), 8-iso-PGF2α (−10%, p < 0.001) and NOX2 activation (−22%, p < 0.001) significantly decreased; dark chocolate did not affect platelet variables in HS. No effect of milk chocolate was detected in both groups. Serum epicatechin increased after dark chocolate in HS (from 0.454+/−0.3nM to 118.3+/−53.7nM) and smokers (from 0.5+/−0.28 nM to 120.9+/−54.2 nM). Platelet incubation with 0.1-10µM catechin significantly reduced PR, platelet 8-iso-PGF2α and ROS formation and NOX2 activation only in platelets from smokers. Conclusions: Dark chocolate inhibits platelet function by lowering oxidative stress only in smokers; this effect seems to be dependent on its polyphenolic content. P284 Longitudinal trends in cigarette smoking in the Czech population. The Czech MONICA and post-MONICA studies R Cifkova1, Z Skodova2, J Bruthans2, M Jozifova1, M Galovcova2, Z Petrzilkova2, P Wohlfahrt1, A Krajcoviechova1, V Adamkova2, V Lanska2 1Thomayer University Hospital, Center for CV Prevention, Prague, Czech Republic, 2Institute for Clinical and Experimental Medicine, Prague, Czech Republic Smoking (Prevention & Epidemiology) The Czech Republic, unlike most of the other East European countries, has seen a decrease in total, and cardiovascular (CV) mortality in particular; still CV disease accounts for 45.3% and 51.4% of total mortality in males and females, respectively. The aim of our study was to assess longitudinal trends in cigarette smoking, the major CV risk factor, 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 = 2570), 1988 (n = 2768), and 1992 (n = 2343). In 1997/98, 2000/01, and 2007/08, another three screenings for CV risk factors (a 1% random sample, aged 25-64, mean age 45 years) were conducted in the six original districts (n = 1990, 2055, and 2246, respectively). The response rate never fell below 60% (range 61-84%). Smoking was assessed using the WHO definition. A person was considered to be a current smoker if smoking at least one cigarette per day. Results: Over a period of 22/23 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 31.4%; p < 0.001) and no change in smoking habits in females (from 23.9% to 24.0%; n.s.). Prevalence of smoking decreased in younger individuals of both genders (25-44 years), did not change in males aged 45-64, and increased in females aged 45-64. A significant downward trend over the 22/23-year period was also seen in subgroups of males with basic and secondary education, and no change in individuals with a university degree. Prevalence of smoking increased in females with basic education, did not change in those with secondary education, and declined in females with a university degree. Conclusions: The decline in cigarette smoking in males has contributed to the decrease in CV and total mortality in the Czech Republic, contrary to the trends in the other post-communist countries. Our results support a differentiated approach to smokers according to their age, gender, and education. P285 The peculiarities of smokers behaviour among the medicine students I Irina Osipova1, EA Pravdina1, SB Silkina1, LF Makarova2 1Altay State Medical University, Barnaul, Russian Federation, 2Altai Regional Clinical Hospital, Barnaul, Russian Federation Smoking (Prevention & Epidemiology) The goal of the work is to analyse the frequency of behavioural risk factors (smoking) among the medicine students. Interviewees and methods: According to the large-scale prophylactic analysis there were examined 300 students. The analysis was based on data collected in the Regional Health Center, including Fangenstrem test, questionnaire Horn and give-up smoking motivation questionnaire. We used Smokilayzer to determine the amount of Carboxyhaemoglobin and Carbon dioxide. The results: The average age was 21,7 ± 1,7years old. Among the respondents there were 73% of women (w) and 27% of men (m). According to the results of the research 64% of them had never smoked (9%-m. and 55%-w.), 12% smoked only in past, but didn't do it then (4%-m. and 8%- w.). Amongst the being questioned students only 13% (7,6%-w. and 5,4-m.) were every day smokers of cigarettes and other forms of tobacco, 9,8% (6,6%-w. and 3,2-m.) were irregular ones. 88% (22%-m. and 66%-w.) of the students considered themselves as passive smokers, 47% of those students had parents who smoke cigarettes. In accordance with the results based on the usage of Smokilayzer 56% (47%-w. and 9-m.) had the standard amount of Carboxyhaemoglobin and Carbon dioxide, 12% (6,4 of w. and 5,6% of m.) were “light” smokers, 19% (11%-w. and 8-m.) were “heavy” ones. By the questionnaire about the differentiation of the type of the smokers behaviour (Horn 1976), several types of the smoking-students (n = 22) were determined, such as: 75% (p = 0,05) were of “support” and “weakness” type; 32% (p = 0,24) of “play with a cigarette” and “craving” type; 6% (p = 0,1) of “stimulus” and “reflex” type. Taking into consideration the Fagenstrem test (test on the definition of an addiction to nicotine) 83% of smokers had “low” addiction, 13% “middle” and only 4% “high”. But the majority of them (53%) had “high” motivation to give up smoking, 35% of the students “low” and 12% lack motivation (p = 0,86). 16% of the smokers gave up smoking (they hadn't been smoking for more than a year) and only 68% made some attempts. The reasons of the unlucky attempts, in the students' opinion, are crowds of smokers 60% (p = 0,35), stress 25% (p = 0,36) and other reasons 15% (p = 0,77) (there is no exact difference between m. and w.). 80% of the respondents think the best way to stop smoking is a strong will power. The conclusion: Thus, among the medicine students the large amount of smokers are passive (88%), 23% of them are every day and irregular and 19% are “heavy” ones, there are no gender differences. 53% of the smoking-students have high motivation to stop smoking, 68% are unlucky in trying to give it up. P286 Effects of nicotine and the smoking cessation aid varenicline on the expression of the acetylcholine receptor alpha4beta2 in-vivo C Charlotte Both1, T Peter1, C Lange-Asschenfeldt2, G Kojda1 1Heinrich-Heine University Duesseldorf, Institute for Pharmacology and Clinical Pharmacology, Duesseldorf, Germany, 2Heinrich-Heine University Duesseldorf, Department of Psychiatry and Psychotherapy, Duesseldorf, Germany Smoking (Prevention & Epidemiology) Purpose: A characteristic of chronic nicotine treatment and a potential cause for addiction development is the upregulation of nAchR. Based on this finding, we sought to investigate whether the alpha4beta2 receptor is regulated by nicotine respectively varenicline. We designed several treatment groups, representing the situations of a patient during smoking cessation with varenicline in the initial phase and after quitting smoking. We additionally asked if the nicotine-induced upregulation of alpha4beta2 is reducable to normal expression levels after smoking cessation. Methods: Male C57/Bl6 mice, 3-4 months old, were subjected to a protocol with increasing nicotine (mean dose: 16 mg/kg/day, oral) and varenicline (3 mg/kg/day, i.p.), both drugs given as monotherapy, together or consecutively. Following euthanasia of C57/Bl6 mice we determined receptor expression via western blotting in the main central regions for cognitive performance, the hippocampus and the cortex. Results: Nicotine treatment showed a robust and reproducible upregulation of alpha4 and beta2 subunits in cortex and hippocampus (Cortex alpha4:154,00 ± 24,41%, beta2: 242,80 ± 60,43%; Hippocampus alpha4: 158,01 ± 17,28%, beta2: 173,80 ± 23,08%), which returns to baseline expression levels two weeks after nicotine cessation (Cortex alpha4: 104,11 ± 11,14%, beta2: 119,49 ± 10,95%; Hippocampus: alpha4: 122,88 ± 9,00%, beta2: 111,57 ± 14,79%). Intraperitoneal varenicline treatment showed the same tendency for upregulation (Cortex: alpha4: 151,21 ± 12,7%, beta2: 122,37 ± 6,67%; Hippocampus alpha4: 112,47 ± 4,59% (ns), beta2: 136,25 ± 7,78%). The results of varenicline and nicotine given together showed some contradictions. Expecting a significant upregulation of alpha4 and beta2 subunits, however, the combined treatment did not induce an upregulation of alpha4beta2 protein expression with a n of 4 (Cortex alpha4: 72,40 ± 5,33%, beta2: 106,24 ± 4,56%; Hippocampus alpha4: 67,93 ± 7,13%, beta2: 76,71 ± 16,78%). The western blot results obtained from a varenicline following nicotine treatment group still reveals a tendency for upregulation in some cases, but without significance except the data for the beta2 subunit in the cortex (Cortex alpha4: 94,39 ± 1,29%, beta2: 124,78 ± 4,59%, Hippocampus alpha4: 104,05 ± 4,89%, beta2: 102,93 ± 7,71%). Conclusions: Varenicline as well as nicotine given alone showed an upregulation of specific alpha4beta2 receptors in cortex and hippocampus. The effect of nicotine-induced upregulation was reducable to baseline expression levels after smoking cessation. Both drugs given together or consecutively didn't induce a specific upregulation of nAchR. P287 Use of Swedish moist snuff and myocardial infarction: a case-control study of 726 patients and 726 control subjects matched for sex and age G Goran Nilsson1, A Rosenblad1, J Leppert1 1University of Uppsala, Centre of Clinical Research, Vasteras, Sweden Smoking (Prevention & Epidemiology) Purpose: To compare prevalence of snuff users among patients with acute myocardial infarction (AMI) and sex - and age matched control subjects. Snuffing has been reported to confer an excess risk of AMI. Methods: In the VAMIS study 759 AMI patients (534 men, 225 women) ≤ 80 years and 759 sex - and age matched control subjects were consecutively selected from a defined geographical area served by only one hospital. In total 988 patients were eligible for the study. Non-participation was due to: Dementia, confusion 19 cases, poor general condition 26 cases, logistical problems 73 cases, unwillingness 24 cases, language difficulties 38 cases, and other reasons 49 cases. Missing information on snuff use was found for 20 patients and 6 control subjects leaving 726 (514 men, 212 women) matched case-control pairs left for the present analyses. Results: The mean age (standard deviation) was 65.8(9.7): men 64.6 (9.6), women 68.5 (9.1). AMI patients and were categorized into never snuffers, ex-snuffers and snuffers. The proportion of snuffing categories (%) among AMI patients (men/women) was as follows: never snuffers 76/97, ex-snuffers 12/1 and snuffers 12/1. The table shows the number of current snuffers and non-snuffers among AMI patients and control subjects. No association between AMI and snuff use was found (p = 0.624; McNemar's test). The odds ratio of snuff use among AMI patients was 0.89 (95% confidence interval 0.59-1.33) Conclusion: There is no excess of snuff users among AMI patients when compared to age - and sex matched control subjects. Table Non-snuffers control subjects Snuffers control subjects Total Non-snuffers AMI patients 607 55 662 Snuffers AMI patients 49 15 64 Total 656 70 726 Non-snuffers control subjects Snuffers control subjects Total Non-snuffers AMI patients 607 55 662 Snuffers AMI patients 49 15 64 Total 656 70 726 Crosstabulation of matched pairs: AMI patients -control subjects/snuffers - non snuffers. Figures are number of pairs Open in new tab Table Non-snuffers control subjects Snuffers control subjects Total Non-snuffers AMI patients 607 55 662 Snuffers AMI patients 49 15 64 Total 656 70 726 Non-snuffers control subjects Snuffers control subjects Total Non-snuffers AMI patients 607 55 662 Snuffers AMI patients 49 15 64 Total 656 70 726 Crosstabulation of matched pairs: AMI patients -control subjects/snuffers - non snuffers. Figures are number of pairs Open in new tab P288 Real world evaluation of varenicline therapy within a secondary care smoking cessation programme AJ Andrew Howe1, J Shand1, I Menown1 1Craigavon Cardiac Centre, Craigavon, United Kingdom Smoking (Prevention & Epidemiology) Purpose: Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist and has demonstrated superiority in achieving smoking cessation when compared to placebo and Bupropion. However to date only one large randomized study has compared Varenicline and nicotine replacement therapy in achieving long term abstinence. Furthermore recent concerns have been raised regarding possible adverse cardiovascular and psychiatric effects associated with the drug. We sought to prospectively evaluate, in a real world population, the relative efficacy of Varenicline and nicotine replacement therapy therapy in achieving 4 week and 12 month abstinence within a secondary care smoking cessation program Methods: 566 patients referred to our nurse-led secondary care smoking cessation service between April 2009 and March 2011 were recruited. All patients underwent motivational interviewing at their first consultation with subsequent face to face interviews or telephone follow-up. The choice of nicotine replacement therapy or Varenicline was non-randomized and at the discretion of the treating healthcare professional. Abstinence was self-reported at 4 weeks and 12 months. Exhaled carbon monoxide testing was offered to all patients at 4 week and 12 month follow-up but was not mandatory. Results: 100% of patients were followed up at 4 weeks and 42% have been assessed at 1 year to date. Nicotine replacement therapy was pescribed for 342 patients and Varenicline prescribed for 224 with no crossover. The mean age of the cohort was 49 years with 51% of patients being male and 62% consuming more than 20 cigarettes per day. 56% of patients in the Varenicline group had suffered a previous treatment failure with nicotine replacement therapy compared with 25% in the nicotine replacement therapy group (p <0.01). In the total cohort of patients self-reported abstinence was 73% at 4 weeks and 62% at 1 year. Varenicline therapy was significantly more likely to result in abstinence at 4 weeks; 94% vs 60%, OR 11.9 (95% CI: 6.4-22.2) p <0.001. This benefit persisted at 52 weeks; 73% vs 52%, OR 2.16(95% CI: 1.16-4.01) p = 0.015. Logistic regression modelling using multivariable analyis demonstrated that sex, pregnancy status, smoking history, occupation and prior treatment failure with nicotine replacement therapy or Varenicline were not predictive of abstinence at 4 weeks or 1 year. Conclusion: Our study confirms the superiority of Varenicline therapy over nicotine replacement therapy in achieving 4 week and 12 month abstinence. Our abstinence rates compare favourably with the published literature and demonstrate the utility of pharmacotherapy therapy integrated within a secondary care smoking cessation service. P289 Is it possible a unique prevention for cardiovascular diseases and cancer? Preliminary data from an Italian study L Luigi Palmieri1, C Donfrancesco1, S Rossi1, F Pannozzo2, S Busco2, P Caiola De Sanctis1, R Capocaccia1, S Giampaoli1 1Istituto Superiore di Sanità, Rome, Italy, 2Azienda Sanitaria di Latina, Latina, Italy Smoking (Prevention & Epidemiology) Background: Cardiovascular diseases (CVD) and cancer together cause more than 70% of all deaths. Both the pathologies are caused by the interaction of environmental, behavioral and genetic risk factors. For some recognized cardiovascular disease risk factors (e.g. smoking and obesity) recent studies found a relation also with several cancers. It's rare to find studies including both cardiovascular disease and cancer, fatal and non fatal events. Aim: To pool data from cardiovascular disease longitudinal study and cancer register to investigate possible common risk factors and verify if cardiovascular favourable risk profile is protective also for cancer in order to implement common preventive strategies at population and individual level. Methods: Men and women (ages 20-75 years) data from the Italian Progetto CUORE cohorts and from the Cancer Register implemented in the area of Latina, were pooled. Risk factors were measured and collected using the same standardized procedures and methodologies: body mass index (BMI), diabetes, metabolic syndrome (MS) (ATP-III definition), total and high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, smoking habit, alcohol consumption, educational level. In women, menopausal status and parity were included. Follow-up was conducted until December 2004 for both cardiovascular disease and cancer, fatal and non fatal events. All Cox regression Hazard Ratios (HR) were adjusted by age, gender, educational level, and study. Results: In 9752 persons (5153 women and 4599 men without cardiovascular events and cancer at baseline) 628 cancer events in men and 531 in women, 504 cardiovascular events in men and 274 in women were identified during a median f-u of 18 years. Smoking resulted significantly associated with cancer risk, also when adjusted by body mass index, alcohol, and metabolic syndrome in men (current smokers HR =  1.74). In women, metabolic syndrome was positively associated with cancer risk, but not significantly. Persons with favorable risk profile (no smoking, BMI < 25 kg/m2, Total Cholesterol < 200 mg/dl, Blood Pressure < 120/80 mmHg, no diabetes) resulted at low risk for all cause, cardiovascular disease and cancer mortality. Conclusions: There are important common risk factors for cardiovascular diseases and cancers. People with favourable risk profile live longer and cost less to the Health System. This could be a first step to identify and implement common preventive actions at population and individual level in order to reduce both cardiovascular and cancer diseases. P290 Smokers can lose weight when they quit smoking The Inter99 study, C Pisinger1, U Toft1, T Jorgensen1 1Glostrup Hospital, Research Center for Prevention and Health, Glostrup, Denmark Smoking (Prevention & Epidemiology) Purpose: to find predictors of weight-loss after smoking cessation. This has previously not been investigated. Smoking is one of the major predictors of cardiovascular disease, and health advantages of smoking cessation are immense. However, many smokers increase weight when they quit smoking, which may blunt beneficial cardiovascular effects of smoking cessation on e.g. glucose metabolism. Methods: in a large population-based study, Inter99, 2,408 daily smokers were included at baseline. Out of these 262 attended the five year follow-up and reported that they had not smoked for at least 12 months. Participants completed self-report questionnaires at baseline and follow-up. In multivariable logistic regression analyses we investigated predictors of weight-loss. Results: A total of 17.6% of the quitters had lost weight from baseline to five year follow-up. Neither sex, age, number of daily meals, energy intake, dietary quality, physical activity, alcohol consumption at baseline, nor change in physical activity or alcohol consumption from baseline to five year follow-up was associated with weight-loss. Higher education (OR = 3.88(1.04-14.50)) and higher body mass index at baseline (OR = 1.20(1.06-1.36)) and change to healthier diet from baseline to five year follow-up (OR = 3.23(1.07-9.82)) predicted weight-loss. However, higher tobacco consumption at baseline decreased the probability of weight loss (OR = 0.93(0.87-0.99)). The mean weight-gain in quitters with normal baseline body mass index was 5.66kg (± 4.8), quitters who were overweight at baseline gained 5.32kg (± 7.0) and quitters who were obese gained 1.98kg (± 8.3), p = 0.038. Conclusion: Weight-loss after quitting smoking is feasible, and was achieved by about two out of ten quitters. High body mass index, high education, low tobacco consumption at baseline and change to a healthier diet predicted weight-loss in daily smokers who had quit for at least 12 months. Obese quitters gained significantly less weight than normal-weight quitters. P291 Acute smoking inhalation impairs left ventricular relaxation in healthy young individuals: a two-dimensional speckle-tracking echocardiography study. K Konstantinos Farsalinos1, D Tsiapras1, S Kyrzopoulos1, E Avramidou1, D Vasilopoulou1, V Voudris1 1Onassis Cardiac Surgery Center, 2nd Department of Cardiology, Athens, Greece Smoking (Prevention & Epidemiology) Purpose: Diastolic dysfunction is a preliminary manifestation of cardiac disease. Myocardial deformation imaging allows us to evaluate the early stages of diastolic dysfunction. The purpose of this study was to examine the effects of smoking on diastolic function in healthy young smokers by using two-dimensional speckle-tracking echocardiography. Methods: A total of 80 healthy young individuals (aged <45 years), smokers (38 subjects) and non-smoking controls (group C, 42 subjects) participated in the study. They did not take any medications and had no risk factors for cardiovascular disease. A complete echocardiographic exam was done at baseline in controls and in smokers (groups S1) after abstaining from smoking and coffee and alcohol consumption for 10 hours. A repeat echocardiogram was performed in smokers after smoking 2 cigarettes in 15 minutes and staying in a quiet room for 10 minutes (groups S2). Left ventricular (LV) longitudinal myocardial strain and strain rate were measured in 3 apical views. Global strain rate at isovolumic relaxation period (GSRivr), an index of left ventricle relaxation that has been validated by invasive studies in animals and humans, was derived from the average of the highest GSR values at the period between aortic valve closure and mitral valve opening in all apical views. The ratio of GSRivr to early diastolic GSR (GSRivr/GSRe) was also measured and averaged from all apical views. Results: Smokers and controls did not differ in age, body surface area, body-mass index, ejection fraction, left ventricle mass index and left atrial diameter and volume. Heart rate and blood pressure were significantly increased after smoking. Conventional echocardiographic measurements were normal in all participants. Peak longitudinal global strain did not differ between groups (C: −21.15 ± 1.87%, S1: −21.2 ± 2.6%, S2: −21.13 ± 2.76%). No difference was found for GSRe between groups (C: 1.54 ± 0.27/sec, S1: 1.49 ± 0.27/sec, S2: 1.52 ± 0.3/sec, p = ns). GSRivr did not differ at baseline (C: 0.75 ± 0.26/sec, S1: 0.68 ± 0.36/sec, p = 0.285), but was decreased by 16.2% after smoking inhalation (S2: 0.57 ± 0.28/sec, p < 0.01 compared to C and S1). GSRivr/GSRe was equal at baseline (C: 0.5 ± 0.16/sec, S1: 0.45 ± 0.21/sec, p = 0.248), but was decreased by 14.9% after smoking (S2: 0.39 ± 0.19/sec, p = 0.01 compared to C, p = 0.016 compared to S1). Conclusions: Smoking inhalation acutely impairs global left ventricular relaxation in healthy young smokers. Myocardial deformation imaging assessed by two-dimensional speckle-tracking technique is a method that can detect subtle cardiac dysfunction in these subjects. P292 smoking is risk factor of perioperative cardiovascular events in women undergoing abdominal surgery SY Songyun Chu1, PW Li1, WH Ding1 1Peking University First Hospital, Department of Cardiology, Beijing, China, People's Republic of Smoking (Prevention & Epidemiology) Purpose: To determine the role of smoking on perioperative cardiovascular events in patients undergoing abdominal surgery. Subjects and Methods: Retrospective analysis of perioperative cardiovascular events in 1079 consecutive cases of patients (Male/Female: 619/460, average age 57.5 ± 17yrs) undergoing abdominal surgery from July 2007 to June 2008 in our centre. Analysis potential relations between smoking history and perioperative cardiovascular events. Record of myocardial infarction, ischemic attack, cardiac dysfunction, new-onset arrhythmia, ischemic stroke, sudden cardiac death or death of cardiac origin was defined as perioperative cardiovascular events. Ischemic cardiac events were defined as myocardial infarction and/or ischemic attack demonstrated by electrocardiogram transient ST-segment change. Major cardiovascular events were defined as myocardial infarction, sudden cardiac death and/or death of cardiac origin. Results: There were 256 subjects with smoking history (past or current smokers)(23.7%) in the 1079 cases of patients. There was no significant difference of all type of perioperative cardiovascular events rate and all-cause mortality between smokers and non-smokers. However, stratification analysis by gender showed different trends in male and female subjects. As shown in the whole patient population, no significant difference of cardiovascular events rate or all-cause mortality was observed between male patients with and without smoking history. In female patients, occurrence of cardiac dysfunction, ischemic cardiac events and major cardiovascular events in smokers were significantly higher than non-smokers (16.7%versus2.0%, p = 0.031; 25.0% versus 4.6%, p = 0.019; and 25.0% versus 3.3%, p = 0.009, respectively). In Logistic regression analysis, smoking history was an independent risk factor of cardiac dysfunction (Odds Ratio (95%CI): 21.71(2.397-196.629), p = 0.006), ischemic cardiac events (Odds Ratio (95%CI): 14.962(1.428-156.748), p = 0.024) and major cardiovascular events (Odds Ratio (95%CI): 18.916(2.641-135.484), p = 0.003) in female patients. Conclusion: Smoking history in women was associated with elevated risk of perioperative major cardiovascular events. It suggested that more attention should be given to promote cigarette cessation especially in women to reduce their cardiovascular risks. P293 EUROACTION preventive cardiology programme plus intensive smoking cessation with varenicline: Changes in lipid metabolism EUROACTION Plus, C S Jennings1, D De Bacquer2, K Kotseva1, A Hoes3, J De Velasco4, S Brusaferro5, S Tonstad6, J Jones1, A Mead1, D Wood1 1Imperial College London, London, United Kingdom, 2Ghent University, Ghent, Belgium, 3University Medical Center Utrecht - Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, 4University General Hospital of Valencia, Department of Cardiology, Valencia, Spain, 5University Hospital “Santa Maria della Misericordia”, Udine, Italy, 6Oslo University Hospital, Oslo, Norway Smoking (Prevention & Epidemiology) Introduction: The EUROACTION preventive cardiology programme plus intensive smoking support (EA+) offered total risk management by addressing diet, physical activity, weight, blood pressure, lipids and glucose in smokers with vascular disease or at high cardiovascular disease risk. EA+ was evaluated in general practice in 4 countries in a RCT. Methods: These descriptive analyses focus on patients randomized to EA+. Self reported smoking cessation was validated by breath CO < 10 ppm at 16 weeks. The secondary outcomes included the % of patients achieving the European dietary, physical activity, risk factor and therapeutic targets for cardiovascular disease prevention. Results: 350 out of 696 patients were randomized to EA+. At 16 weeks, 85% EA+ patients returned. 51% stopped smoking with intensive counselling from nurses and the optional use of varenicline. Overall in EA+, management of total and low-density lipoprotein cholesterol was no better than UC (TC < 4.5 mmol/l EA+ 21% UC 24% p = 0.39; LDL-C < 2.5 mmol/l EA+ 27% UC 22% p = 0.24). There was a significant increase in HDL-C in EA+ between baseline and 16 weeks which may have been due to the effect of smoking cessation (+0.05 mmol/l, 95% CI + 0.02 to +0.09 mmol/l, p = 0.003). Triglycerides were unchanged. Patients gained an average of 1.63 Kg in weight and 1.76 cm in waist circumference (both P < 0.0001). When patients in EA+ were divided according to their weight gain (%) from baseline to 16 weeks (<0%; 0-5%; >5%), their changes in cholesterol levels were as shown in the table. Conclusions and Implications: Half of the high-risk patients stopped smoking. The change in total cholesterol, between baseline and 16 weeks, differed according to the degree of weight increase in all patients. Patients who gained no weight had the largest fall in total cholesterol compared to those who gained most weight. Therefore, it is important in a smoking cessation programme in high-risk patients to address all risk factors and thereby reduce total cardiovascular risk. Changes in TC according to weight gain EA+ Group 1 Group 2 Group 3 N 68 170 52 Weight gain between baseline and 16 weeks < 0% 0-5% > 5% Change in TC over same period −0.41 mmols/l −0.03 mmols/l +0.05 mmols/l Significance of TC change p = 0.004 p = 0.65 p = 0.71 Smoking cessation 42% 64% 65% EA+ Group 1 Group 2 Group 3 N 68 170 52 Weight gain between baseline and 16 weeks < 0% 0-5% > 5% Change in TC over same period −0.41 mmols/l −0.03 mmols/l +0.05 mmols/l Significance of TC change p = 0.004 p = 0.65 p = 0.71 Smoking cessation 42% 64% 65% Open in new tab Changes in TC according to weight gain EA+ Group 1 Group 2 Group 3 N 68 170 52 Weight gain between baseline and 16 weeks < 0% 0-5% > 5% Change in TC over same period −0.41 mmols/l −0.03 mmols/l +0.05 mmols/l Significance of TC change p = 0.004 p = 0.65 p = 0.71 Smoking cessation 42% 64% 65% EA+ Group 1 Group 2 Group 3 N 68 170 52 Weight gain between baseline and 16 weeks < 0% 0-5% > 5% Change in TC over same period −0.41 mmols/l −0.03 mmols/l +0.05 mmols/l Significance of TC change p = 0.004 p = 0.65 p = 0.71 Smoking cessation 42% 64% 65% Open in new tab P294 Family history and coronary disease risk. Interaction with smoking R Palma Dos Reis1, M Maria Isabel Mendonca2, A Pereira2, B Silva2, G Guerra3, S Freitas2, C Freitas2, I Ornelas2, A Brehm3, JJ Araujo2 1New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal, 2Hospital Funchal, Funchal, Portugal, 3Madeira University, Funchal, Portugal Smoking (Prevention & Epidemiology) Background: The existence of family history antecedents (FHA) and the causes of family coronary disease aggregation remain still to be explained. However some studies have been suggesting, in those families, the existence of certain genetic and environmental common factors. The identification of such factors can be of extreme interest in the study of the etiopathogenesis of this complex multifactorial disease Aims: To investigate the coronary disease risk conferred by the existence of a positive FHA, its association with some genetic factors and the interaction with the environmental risk factors. Methods: Case - Control study including 1768 individuals: 884 coronary patients and 884 healthy controls. Cases and controls were sex and age matched. In all the following variables were evaluated: traditional risk factors, biochemical markers and fifteen genetic polymorphisms (genetic markers) related to CAD. To compare averages between groups, the T Student test was used and for comparisons among genotypic frequencies the Chi square was used. To evaluate the coronary risk associated to the studied variables, the Odds Ratio and their respective 95% confidence intervals were calculated. To evaluate possible synergic/antagonist interactions between family history and the classical risk factors, a table 4x2 and the synergism measures in the addictive (SI) and multiplicative (SIM) model, was calculated. Finally the relative risk excess (RERI) and the proportion attributed to the interaction (AP) were calculated. Results: In this study 24.5% of the CAD patients had FHA and 13.7% of the controls (OR = 2.05; p < 0.0001). Of the total with FHA, 64.2% were coronary patients and 35.8 didn't have CAD. After correction for the other conventional and biochemical risk factors, FHA remained a significant and independent risk factor for CAD (OR = 2.4; CI 3.224-2.209; p < 0.0001). Only the RAS variant AGT 235 TT demonstrate statistical significance between groups with and without FHA (OR = 1.46; p = 0.010). There was a synergistic interaction between FHA and smoking (SI=1.93 and SIM = 1.12). The relative risk excess (RERI) was 2.76 and the proportion attributed to the interaction (AP) was 0.41 (41%). Conclusion: These data suggest the existence of complex interactions between genetic and environmental risk factors in CAD appearance. If our data are confirmed early measures of primary prevention are justified, namely smoking abstention, particularly in all individuals with family coronary history. P295 Understanding smoking prevalence trends in Ireland 2004 - 2011 LM Currie1, A Hickey2, E Shelley3 1Royal College of Surgeons in Ireland, Health Services Research Institute, Dublin, Ireland, 2Royal College of Surgeons in Ireland, Dublin, Ireland, 3Health Service Executive, Dublin, Ireland Smoking (Prevention & Epidemiology) Purpose: The most recent national population survey (SLÁN 2007), estimated that 29% of the Irish general population smoke. Since 2007, Ireland has implemented stronger policies and experienced economic change, which could be expected to impact smoking rates. In the absence of recent population-based data, the aim of this study is: 1) to critically appraise and compare recent Irish estimates of smoking prevalence, 2) to identify trends in sub-groups of the population, and 3) to identify groups with persistently high smoking rates. Methods: Recent prevalence estimates were compared across two data sets: 1) The Office of Tobacco Control (OTC) telephone survey, which uses quota sampling of 1000 adults monthly (2004 - 2010: n = 81,500, 47.4% male, age m = 43.5 SD 17.3, 35.7% lowest socioeconomic group (SEG)), 2) The FAST Survey, which uses quota samples of 1000 respondents at each of two time points (2009: n = 1000, 50.0% male, age m = 44.8 SD 16.8, 39.1 lowest SEG; 2011: n = 1010, 50.0% male, age m = 44.5 SD 15.3, 38.1% lowest SEG). Both data sets use similar sampling/survey methodology and the same SEG classification; however, current smoking is defined as smoking 1+ cigarettes per week in the OTC survey, and as having smoked >100 cigarettes and currently smoking every day or some days by the FAST surveys. Results: Figure 1 shows smoking prevalence by age and SEG from 2004 - 2011. Conclusions: Methodological differences limit strict comparability across data sets; however, those 18 - 34 in the lower/middle SEG and those 35-54 in the lower SEG appear to have persistently high rates of smoking. Consistent monitoring of tobacco use by age, gender and SEG using standardized methodology and agreed definitions is essential for effective planning and evaluation of tobacco control policies. Open in new tabDownload slide P296 The nicotine-induced alterations of blood pressure: the impact on the diurnal blood pressure profile E V Elena Pello1, SK Malyutina1, GI Simonova1, YP Nikitin1 1Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation Smoking (Prevention & Epidemiology) Purpose: The tobacco smoke exposure may accomplish a decisive role in the arising of arterial hypertension, and the perception of health detrimental effects of nicotine beyond doubt demands further acknowledgement. Therefore, a more in a depth analysis of the pathogenesis stem is necessary to account for by the influences of nicotine on diurnal blood pressure profile (DBPP). Methods: The sample of participants (EPOGH) was shared on smokers and nonsmokers. The subjects smoking cigarettes with and without filter were combined. The values of day (Ds, Dd), night (Ns, Nd), crest (Cs, Cd), trough (Ts, Td), circadian alteration magnitude (AMs, AMd), amplitude (As, Ad), acrophase (Ps, Pd), nocturnal fall (NFs, NFd), night-day ratio (Rs, Rd), high (Hs, Hd) and low (Ls, Ld) waves, difference between the high and low waves (HLs, HLd) of systolic (s) and diastolic (d) blood pressure (BP, mmHg) were estimated. Results: Alluding to the glittering achievements of the majority of studies and arguing about the intriguing reasons of the disease evolvement, researchers supposed that the hostility of smoking intensity facilitates the adrenergic heart rate and blood pressure products. In light of concept mentioned above, we defined the preponderance of AMs (25.1 ± 7.9 vs 21.9 ± 8.0, P = 0.004), AMd (22.3 ± 5.7 vs 19.9 ± 6.1, P = 0.004), As, Ad, NFs, HLs, and HLd of blood pressure in smokers than in nonsmokers. Against this background, our experience showed the declined Ts (105.2 ± 10.5 vs 108.5 ± 12.7, P = 0.047), Td (60.0 ± 7.9 vs 62.9 ± 9.4, P = 0.018), Ld, and Rs of blood pressure in group of patients with smoking habits as opposed to an adjacent group. Furthermore, the competitive suggestion generating the positive correlations of Ds, Ns, Cs (r = 0.422, P < 0.001), Cd (r = 0.228, P = 0.049), Ts (r = 0.309, P = 0.007), AMs, As, Hs, Hd, Ls, and HLs of blood pressure with daily quantity of cigarettes became actually complimentary to the rendered accumulative evidence suspecting the nicotine-integrated disorders of vasomotor susceptibility. Unfortunately, the gender-stratified discrepancies of obligations imposed by the nicotine loading on blood pressure remained a vague in current observation. Finally, the staggering significant findings confirm the predominance of augmented sympathetic activation in smokers in the response to the vicious aberrations engaged by nicotine. Conclusions: The present reassuring data are well in line with deductions quoted in preliminary established attainments and add the constructive comments to the serious catecholamines efforts. An abundance of DBPP parameters affords the reliance in the sufficiently harmful deterioration in systemic vascular resistance due to nicotine. P297 Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. M Haberka1, K Mizia-Stec1, M Mizia1, K Gieszczyk1, A Chmiel1, K Sitnik-Warchulska1, Z Gasior1 1Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland Psychosocial factors/Quality of life (Prevention & Epidemiology) The aim was to assess whether an early introduced n-3 Polyunsaturated Fatty Acids (n-3 PUFA) supplementation affects depression symptoms, anxiety and emotional state in patients with acute myocardial infarction (AMI) and no history of mental disorders. Methods: Fifty two patients with AMI were enrolled into the study and randomized to the study group (group P; n = 26; standard therapy + n-3 poly-unsaturated fatty acids 1g daily) or the control group (group C; n = 26; standard therapy). The following psychological tests were used at the baseline (3rd day of AMI) and after one-month (30 ± 1 days): Beck Depression Inventory (BDI), State-Trait Anxiety Inventory in a specific situation (STAI-S) and as a general trait (STAI-T), Emotional State Questionnaire (ESQ). Results: The baseline characteristics, pharmacotherapy and BDI, STAI-S/T and ESQ were similar between both groups. The mean test scores assessed for all patients (group P and C) during the one-month observation were significantly lower for BDI (p = 0.04), STAI-T (p = 0,03), STAI-S (p = 0.01) and harm/loss emotions (p = 0.005). The n-3 poly-unsaturated fatty acids intervention in the group P revealed additional significant influence on the following test scores: BDI (p = 0.046), STAI-S (p = 0.039) and ESQ4 (p = 0.03). There were no significant correlations between BDI, STAI-S, STAI-T or ESQ and demographic, clinical parameters, baseline TTE or intima-media thickness values. Conclusions: Our study provides novel and preliminary observations - n-3 poly-unsaturated fatty acids supplementation reveals mild decreasing effects on depressive and anxiety symptoms in early post-MI patients. P298 Predictive value of mixed anxiety-depressive symptoms in patients with arterial hypertension and coronary heart disease Y M Yulia Yufereva1, NV Pogosova1, RG Oganov1, IE Koltunov1, AD Deev1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: The aim of the first Russian multicentre prospective trial was to study the prognostic value of anxiety and depression in arterial hypertension (AH) and coronary heart disease (CHD) patients. Methods: The COORDINATA (Clinico-epidemiolOgical prOgram studying depRession in carDiological practIce: in patieNts with Arterial hyperTension and coronary heArt disease) was performed in primary care polyclinics in 37 cities of the Russian Federation. 235 physicians (GPs and cardiologists) randomly included 5038 consecutive pts aged 55 years and more: 1769 with AH and 3269 with coronary heart disease. The presence of mixed anxiety-depressive symptoms were assessed at baseline by means of the Hospital Anxiety and Depression Scale (HADS). Clinically significant mixed anxiety-depressive symptoms were defined as a total HADS score of 11 or above. Numerous characteristics including risk factors and clinical status were studied (by self-reports and medical records). Pts were followed for a median follow-up of 36 months. Logistic regression and Cox Proportional Hazards regression analysis were undertaken (adjusted to age, sex, AH and CHD). Results: 32% pts with AH and 34% pts with coronary heart disease had mixed anxiety-depressive symptoms. Mixed anxiety-depressive disorders at baseline were associated with increased risk of all-cause mortality ((risk ratio (RR) 1,41; 95% confidence interval (CI) 1,08-1,84; p < 0,0111) and combined fatal and nonfatal endpoints (RR 1,33; 95% CI 1,08-1,65; p < 0,0089) (table 1). Conclusions: Mixed anxiety-depressive symptoms are strong predictors of negative cardiovascular prognosis in AH and coronary heart disease pts. Table 1 Endpoints RR 95% CI P All-cause mortality 1,41 1,08-1,84 <0,0111 Combined fatal and nonfatal endpoints 1,33 1,08-1,65 <0,0089 Endpoints RR 95% CI P All-cause mortality 1,41 1,08-1,84 <0,0111 Combined fatal and nonfatal endpoints 1,33 1,08-1,65 <0,0089 Associations of mixed anxiety-depressive symptoms Open in new tab Table 1 Endpoints RR 95% CI P All-cause mortality 1,41 1,08-1,84 <0,0111 Combined fatal and nonfatal endpoints 1,33 1,08-1,65 <0,0089 Endpoints RR 95% CI P All-cause mortality 1,41 1,08-1,84 <0,0111 Combined fatal and nonfatal endpoints 1,33 1,08-1,65 <0,0089 Associations of mixed anxiety-depressive symptoms Open in new tab P299 Prognosis in post-MI patients with depression N Nana-Goar Pogosova1, NV Skazin1, IE Koltunov1, AK Ausheva1 1National Center for Preventive Medicine, Moscow, Russian Federation Psychosocial factors/Quality of life (Prevention & Epidemiology) Aim: to assess the influence of depressive symptoms on clinical outcomes in patients after acute myocaradial infarction (MI). Methods: 209 patients hospitalized for acute MI (98 (47%) men and 111 (53%) women, aged 37-90 years, mean 65.7 ± 10.1 years) were included. The diagnosis of MI was based on generally accepted criteria. The presence and severity of depression were assessed at discharge from the hospital by means of the Beck Depression Inventory (BDI) and confirmed by a clinical interview according to the ICD-10 diagnostic criteria. The BDI standard cut-off points were: 12-18 for minimal depressive symptoms, >19 - clinical depression. Clinical outcomes (cardiovascular events or death) were assessed at 1 year follow-up. Results: 32,5% pts had subclinical depression (12-18 BDI) and 28,7% - mild, moderate and severe depression (>19 BDI). During the 1 year after MI the depressive symptoms increased the risk of death 4.4 times and recurrent acute MI - almost 3.3 times (table 1). The depression is associated with the risk of the combined endpoint (death and/or recurrent MI). The depression in post-MI patients was related to higher hospital re-admission rates. Table 1. Relative risk of cardiovascular events and/or death in post-MI patients with clinical depression. Conclusion: Depression has a significant negative impact on cardiovascular prognosis in post-MI patients. Table 1. Events Clinical depression (>19 BDI) RR 95% CI p Recurrent MI 3,29 1,56-6,95 0,002 Combined endpoint (recurrent MI and/ or acute coronary syndrome) 2,19 1,15-4,16 0,017 Hospitalizations on cardiovascular reasons 2,86 1,51-5,39 0,001 Combined endpoint (recurrent MI and/or death) 3,88 2,04-7,38 0,001 Death 4,37 2,12-9,04 0,001 Events Clinical depression (>19 BDI) RR 95% CI p Recurrent MI 3,29 1,56-6,95 0,002 Combined endpoint (recurrent MI and/ or acute coronary syndrome) 2,19 1,15-4,16 0,017 Hospitalizations on cardiovascular reasons 2,86 1,51-5,39 0,001 Combined endpoint (recurrent MI and/or death) 3,88 2,04-7,38 0,001 Death 4,37 2,12-9,04 0,001 Relative risk of cardiovascular events and/or death in post-MI patients with clinical depression. Open in new tab Table 1. Events Clinical depression (>19 BDI) RR 95% CI p Recurrent MI 3,29 1,56-6,95 0,002 Combined endpoint (recurrent MI and/ or acute coronary syndrome) 2,19 1,15-4,16 0,017 Hospitalizations on cardiovascular reasons 2,86 1,51-5,39 0,001 Combined endpoint (recurrent MI and/or death) 3,88 2,04-7,38 0,001 Death 4,37 2,12-9,04 0,001 Events Clinical depression (>19 BDI) RR 95% CI p Recurrent MI 3,29 1,56-6,95 0,002 Combined endpoint (recurrent MI and/ or acute coronary syndrome) 2,19 1,15-4,16 0,017 Hospitalizations on cardiovascular reasons 2,86 1,51-5,39 0,001 Combined endpoint (recurrent MI and/or death) 3,88 2,04-7,38 0,001 Death 4,37 2,12-9,04 0,001 Relative risk of cardiovascular events and/or death in post-MI patients with clinical depression. Open in new tab P300 The association between depressive symptoms and diabetes in Polish adult population WOBASZ investgators, J Jerzy Piwonski1, E Sygnowska1, A Piwonska1, T Zdrojewski2 1National Institute of Cardiology, Warsaw, Poland, 2Medical University of Gdansk, Gdansk, Poland Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: Evidence-based medicine confirmed the role of psychosocial and somatic factors in pathogenesis of many diseases. We hypothesized that depressive symptoms (DS) were associated with prevalence of diabetes (DIAB) in Polish adult population. Methods: The data presented are based on random sample of Polish population (13545 persons), aged 20-74, examined in 2003-2005 in the frame of National Multicentre Health Survey (the WOBASZ study). The questionnaire, physical examination and laboratory data were collected. DS were evaluated using the Beck's Depression Inventory (≥ 10pts). Persons with DIAB were diagnosed based on glucose ≥ 7.0mmol/l or hypoglycemic treatment. Results: Out of screened persons, depressive symptoms were found significantly more often in women than in men (respectively: 34,3% vs 24,1%). The persons with depressive symptoms were significantly older and more often obese. The prevalence of DIAB was almost the same in men (7%) and women (6%), but it was significantly more often observed in persons with than in those without depressive symptoms. In men with depressive symptoms the prevalence of DIAB was 13,4% versus 5,6% in men without (p < 0.0001). The same situation in women (respectively 10,4% vs 4,2%, p < 0.0001). In the logistic regression analysis we found that depressive symptoms were significantly and independently of age and obesity associated with DIAB both in men as well as in women. The presence of depressive symptoms in men was associated with almost twice higher prevalence of DIAB than in non-depressive men (OR DIAB = 1,82, CI: 1,47-2,24) and in women respectively about 50% higher (OR DIAB = 1,51, CI: 1,22-1,87). Conclusions: In Polish adult population there was a high frequency of depressive symptoms, especially in women. The presence of depressive symptoms was significantly associated with diabetes independently of age and obesity. P301 In-hospital and long-term prognostic differences between elderly and non-elderly patients admitted for a non-st segment elevation acute coronary syndrome M A Miguel Angel Ramirez-Marrero1, B Perez-Villardon1, D Gaitan-Roman1, I Vegas-Vegas1, JL Delgado-Prieto1, G Ballesteros-Derbenti1, M De Mora-Martin1 1Regional Hospital Carlos Haya, Malaga, Spain Psychosocial factors/Quality of life (Prevention & Epidemiology) Introduction: Cardiovascular disease is the most common cause of death in industrialized countries, with rising incidence driven by an increased longevity of the population. The aim of this study was to establish a comparative analysis of hospital and long-term prognosis among elderly (defined as age ≥ 70 years) and non-elderly patients. Methods: Retrospective analysis of all patients admitted consecutively for NSTEACS, from January 2004 to December 2005, with a median follow-up of 24 months. Specific prognostic variables were studied during this period, establishing an adjusted analysis of the impact of age on them. Results: A total of 715 patients were analysed, 297 of whom were elderly (41.5%). In the baseline characteristics, elderly patients showed more hypertension (67.7% versus 59.8%, p = 0.02), anemia (40.7% versus 17%, p = 0, 0001), atrial fibrillation (20.9% versus 8.1%, p = 0.0001), comorbidity (Charlson index 3.01 ± 2.3 versus 1.9 ± 1.8, p = 0, 0001), female sex (44.4% versus 23%, p = 0.0001), left ventricular systolic dysfunction (31.9% versus 20.5%, p = 0.001), worse TIMI Risk score (3.3 ± 1.2 versus 2.5 ± 1.4, p = 0.0001) and worse coronary anatomy (66.9% versus 52.5%, p = 0.001 compared to multivessel coronary artery disease). Elderly patients received less prescription of drugs recommended by current guidelines (p = 0.04). Elderly patients had more frequency of in-hospital and long-term follow-up mortality (8.4% versus 3.6%, p = 0.005 and 14.1% versus 4.4%, p = 0.0001 respectively), more heart failure (HF) frequency (24.6% versus 7.9% and 16.3% versus 5.1%, p = 0.0001) and recurrent ischaemia (6.1% versus 3.1%, p = 0.04 and 23.6% versus 18.5%, p = 0.07). After adjustment, the age factor was not an independent predictor of poor prognosis (p > 0.1), except for presenting an increased risk of in-hospital heart failure (OR 1.7, 95% CI, 1-2, 9). Conclusions: In our series, elderly patients admitted with NSTEACS had more unfavourable clinical and epidemiological conditions. However, the age factor did not predict an increased risk of in-hospital or long term mortality, though more probability of acute heart failure. P302 Perceived control and cardiovascular disease risk factors in Poland M Magdalena Kozela1, K Szafraniec1, A Pajak1 1Jagiellonian University Medical College, Department of Epidemiology & Population Studies, Krakow, Poland Psychosocial factors/Quality of life (Prevention & Epidemiology) Background: Perceived control was found to be related with cardiovascular diseases (CVD) and cardiovascular disease risk factors control in populations of Western Europe. Studies in this area are scarce in Eastern Europe. Goal: to assess the relation between perceived control and prevalence of cardiovascular disease risk factors i.e. hypertension, hypercholesterolaemia, diabetes, smoking, overweight and low physical activity. Studied group: 10 543 men and women at age 45-64 years, random sample of permanent residents of Krakow, who participated in the Polish part of the HAPIEE (Health Alcohol and Psychosocial factors In Eastern Europe). Study design and methods: cross-sectional study; participants were interviewed at home using a structured questionnaire and invited for measurements to the clinic. Perceived control was measured using 11-item questionnaire. Prevalence of cardiovascular disease risk factors was assessed for quartiles of perceived control. Multivariate logistic regression was used to investigate the relation between prevalence of cardiovascular disease risk factors and perceived control. Results: Compared to the lowest quartile, after adjustment for age and education, men and women with higher perceived control had 24-48% lower prevalence of smoking and low physical activity (p < 0.05). Adjustment for other covariates did not attenuate the results. In men with perceived control over the median, prevalence of overweight was higher by 42-51% (p < 0.05). The relation between perceived control and overweight in women was not significant after adjustment for covariates. Women with the highest perceived control had lower prevalence of hypertension (OR = 0.75, 95%CI = 0.63-0.90). The negative relation between perceived control and diabetes was largely dependent on age and education and found only in women. Conclusions: There was a strong negative relation between perceived control and lifestyle characteristics i.e. smoking and physical activity. In men there was also a strong positive association between perceived control and overweight. Weaker positive relation of perceived control with hypertension and diabetes was found only in women. P303 Depression, anxiety and psychological distress assessment a year after coronary artery bypass grafting O Olga Raih1 1Siberian Branch RAMS Institution Scientific-Research Institute for Complex Problems of Cardiov. Dis., Kemerovo, Russian Federation Psychosocial factors/Quality of life (Prevention & Epidemiology) Objective: Assess depression and anxiety levels and type D personality contribution in patients with coronary artery disease a year after coronary artery bypass grafting. Material and methods: 563 patients, who had had assessment performed before coronary artery bypass grafting and a year after the surgery, were enrolled in the study. The mean age was 57.7 ± 7.3 years, there were 156 (27.2%) females and 407 (72.7%) males. Depression and anxiety levels were assessed with the Depression Scale and the Spielberger-Hanin State-Trait Anxiety Inventory. The DS14 questionnaire comprising NA (‘negative affectivity’) and SI (‘social inhibition’) subscales was used to assess type D personality and the SF36 questionnaire, including GH- General Health, PF - Physical Functioning, SF -Social Functioning and RP -Role-Physical scales, was used to asses the quality of life. Results: Type D personality was observed preoperatively in 96 (17.8%) patients; similar numbers were seen at 1 year follow-up: 86 (16.1%) patients with type D personality (p>0.05). A high level of trait anxiety (46 scores and more) was found preoperatively in 62 (11.6%) patients and in 9 (1.7%) patients a year after the surgery (p<0.0001). A moderately high level of trait anxiety (31- 45 scores) was seen preoperatively in 37.3% of cases and in 38.2% a year after the surgery (p>0.05). A moderate positive correlation was observed between trait anxiety, depression level, NA and SI scores (r = 0.26 and r = 0.27, respectively, p<0.0001). A year after the surgery there were better PF (from 57.5 ± 1.4 scores to 66.7 ± 1.4 scores) and RP (from 49.8 ± 1.6, to 62.6 ± 1.2 scores, respectively) scores (p<0.0001). No significant differences were demonstrated in the other SF36 scores a year after the surgery compared with the preoperative numbers. A high negative correlation was found postoperatively between the life quality indicators and NA and SI scores (r = 0.75). Conclusions: A year after the surgery there were less patients with high anxiety levels and the life quality got better according to the Physical Functioning and Role-Physical scales. Type D personality prevalence did not change, which suggests the stability of this chronic psychological risk factor. A negative impact of type D personality on depression and anxiety levels and the life quality a year after coronary artery bypass grafting was observed. P304 Impact of type D personality on life quality of patients with myocardial infarction and stroke or transient ischemic attack O Olga Raih1, AN Sumin1, EV Korok1, AV Karpovich1, AV Bezdenezhnykh1, NA Bezdenezhnykh1 1Siberian Branch RAMS Institution Scientific-Research Institute for Complex Problems of Cardiov. Dis., Kemerovo, Russian Federation Psychosocial factors/Quality of life (Prevention & Epidemiology) Objective: Assess the prevalence of type D personality and its impact on the life quality of patients after myocardial infarction, stroke or transient ischemic attack. Material and methods: 940 patients, who had received treatment in the Cardiovascular Surgery Clinic of the Research Institute for Complex Issues of Cardiovascular Diseases, were examined. The mean age was 57.7 ± 7.3 years, there were 334 (35.5%) females and 606 (64.5%) males. The patients were divided into 4 groups according to the presence of prior myocardial infarction (MI), stroke or transient ischemic attack (TIA): group 1 (n = 376, 40%) included patients with MI, group 2 (n = 141, 15%) enrolled patients with stroke or transient ischaemic attack, group 3 (n = 104, 11%), patients with prior MI, stroke and transient ischaemic attack and group 4 (n = 319, 34%), subjects with coronary artery disease and no prior myocardial infarction, stroke or transient ischaemic attack. The DS14 questionnaire comprising NA (‘negative affectivity’) and SI (‘social inhibition’) subscales was used to assess type D personality and the SF36 questionnaire, including GH- General Health, PF - Physical Functioning and SF -Social Functioning scales, was used to asses the quality of life. Results: NA scores were higher in group 1 and group 3 (11.9 ± 1.2 versus 10.4 ± 0.7, respectively), in group 2 and 4 the scores were 7.3 ± 0.2 versus 8.4 ± 0.5, respectively (p < 0.005). SI scores were also higher in patients with MI and multiple cardiovascular disease (11.3 ± 1.2 versus 10.6 ± 0.6, respectively). Type D personality was less often observed in group 2 and 4 (10.74%; 11.78%), and more often in group 1 and 3 (42.38% versus 35.1%, respectively) (p = 0.0001). GH, PF and SF scores were significantly lower in group 3 (36.2 ± 2.2; 40.0 ± 2.5; 40.3 ± 1.6, respectively) than in coronary artery disease patients (70.4 ± 1.3; 72.8 ± 1.2; 58.2 ± 1.3 respectively) (p < 0.0001 in all the cases). Conclusions: The prevalence of type D personality is higher in patients with multiple cardiovascular disease, which makes these patients a high-risk group for adverse outcomes of systemic atherosclerosis requiring a closer follow-up including programs of psychological correction and prevention. P305 Baseline MacNew Health Related Quality of Life drives outcome after percutaneous coronary intervention G Georg Gaul1, O Friedrich2, S Hoefer3, W Benzer4, G Titscher1, J Sipoetz1 1Hanusch Hospital, Vienna, Austria, 2KLI Research in Clinical Cardiology, Vienna, Austria, 3University of Innsbruck Department of Medical Psychology and Psychotherapy, Innsbruck, Austria, 4Academic Hospital, Department of Interventional Cardiology, Feldkirch, Austria Psychosocial factors/Quality of life (Prevention & Epidemiology) Background: Several studies have shown that MacNew HRQoL increases after percutaneous coronary intervention. Our trial sets out to examine the relationship between baseline MacNew-HRQoL and extent of increase taken place after percutaneous coronary intervention in a 12-month follow-up period. Methods: 308 Austrian non ST-elevation myocardial infarction percutaneous coronary intervention-patients (mean age 63.3, SD 9.3, 71,8% men) completed the MacNew-questionnaire before discharge. Follow-ups were collected at 1, 6 and 12 months. The patients were divided in tertiles with poor, moderate and good initial HRQoL according to the Baseline MacNew-Global-Score (MacNew-Global-Score: 2.2-4.6, 4.6-5.6, 5.7-7.0). Results: Although the groups did not differ significantly with respect to age, gender, cardiac risk factors (hypercholesterolemia, hypertension; diabetes, history of MI, family history of cardiac disease) and clinical status (percentage of acute coronary syndrome patients, CCS-classification) mean MacNew Global Score increased during the follow-up period about twice as much in patients with poor initial MacNew-HRQoL than in patients with moderate initial MacNew-HRQoL (0.9-1.0 versus 0.5). Patients with good initial HRQoL showed no mean increase, at all. After 1, 6 and 12 months clinically relevant increase of MacNew-Global-Score of more than 0.5 was found in 62-76% of the patients with poor initial MacNew HRQoL, in 52-62% of the patients with moderate initial HRQoL but only in 17-24% of the patients with good initial MacNew HRQoL. Conclusion: The extent of increase of MacNew-HRQoL after percutaneous coronary intervention strongly depends on MacNew-Scores at the baseline. Our finding strongly suggests that the evaluation of MacNew-Score-changes have to take into account the baseline-level of MacNew-Scores. Changes of MacNew HRQoL after percutaneous coronary intervention Poor initial HRQoL (N = 102) Moderate initial HRQoL (N = 103) Good initial HRQoL (N = 103) MacNew-Global Mean change 3.9 + 0.9-1.0* 5.1 + 0,5* 6.2 - 0-0.2 MacNew-Global Clinically significant increase (≥0. 5) 62-67% 52-62% 17-24% MacNew-Emotional Mean change 3.8 + 0.7-0.8* 5.1 + 0.4-0.5* 6.1 - 0-0.1 MacNew-Emotional Clinically significant increase (≥0.5) 55-61% 46-56% 19-24% MacNew-Physical Mean change 4.0 + 1.0-1.1* 5.0 + 0.5-0.7* 6.3 - 0-0.2 MacNew-Physical Clinically significant increase (≥0.5) 66-72% 56-63% 24-28% MacNew-Social Mean change 4.1 + 1.0-1.1* 5.4 + 0.3-0.5* 6.5 - 0-0.3 MacNew-Social Clinically significant increase (≥0.5) 56-71% 50-60% 9-17% Poor initial HRQoL (N = 102) Moderate initial HRQoL (N = 103) Good initial HRQoL (N = 103) MacNew-Global Mean change 3.9 + 0.9-1.0* 5.1 + 0,5* 6.2 - 0-0.2 MacNew-Global Clinically significant increase (≥0. 5) 62-67% 52-62% 17-24% MacNew-Emotional Mean change 3.8 + 0.7-0.8* 5.1 + 0.4-0.5* 6.1 - 0-0.1 MacNew-Emotional Clinically significant increase (≥0.5) 55-61% 46-56% 19-24% MacNew-Physical Mean change 4.0 + 1.0-1.1* 5.0 + 0.5-0.7* 6.3 - 0-0.2 MacNew-Physical Clinically significant increase (≥0.5) 66-72% 56-63% 24-28% MacNew-Social Mean change 4.1 + 1.0-1.1* 5.4 + 0.3-0.5* 6.5 - 0-0.3 MacNew-Social Clinically significant increase (≥0.5) 56-71% 50-60% 9-17% Mean change (*p>0.001) and percentage of patients with clinically significant increase of MacNew HRQoL after 1, 6 and 12 months. Open in new tab Changes of MacNew HRQoL after percutaneous coronary intervention Poor initial HRQoL (N = 102) Moderate initial HRQoL (N = 103) Good initial HRQoL (N = 103) MacNew-Global Mean change 3.9 + 0.9-1.0* 5.1 + 0,5* 6.2 - 0-0.2 MacNew-Global Clinically significant increase (≥0. 5) 62-67% 52-62% 17-24% MacNew-Emotional Mean change 3.8 + 0.7-0.8* 5.1 + 0.4-0.5* 6.1 - 0-0.1 MacNew-Emotional Clinically significant increase (≥0.5) 55-61% 46-56% 19-24% MacNew-Physical Mean change 4.0 + 1.0-1.1* 5.0 + 0.5-0.7* 6.3 - 0-0.2 MacNew-Physical Clinically significant increase (≥0.5) 66-72% 56-63% 24-28% MacNew-Social Mean change 4.1 + 1.0-1.1* 5.4 + 0.3-0.5* 6.5 - 0-0.3 MacNew-Social Clinically significant increase (≥0.5) 56-71% 50-60% 9-17% Poor initial HRQoL (N = 102) Moderate initial HRQoL (N = 103) Good initial HRQoL (N = 103) MacNew-Global Mean change 3.9 + 0.9-1.0* 5.1 + 0,5* 6.2 - 0-0.2 MacNew-Global Clinically significant increase (≥0. 5) 62-67% 52-62% 17-24% MacNew-Emotional Mean change 3.8 + 0.7-0.8* 5.1 + 0.4-0.5* 6.1 - 0-0.1 MacNew-Emotional Clinically significant increase (≥0.5) 55-61% 46-56% 19-24% MacNew-Physical Mean change 4.0 + 1.0-1.1* 5.0 + 0.5-0.7* 6.3 - 0-0.2 MacNew-Physical Clinically significant increase (≥0.5) 66-72% 56-63% 24-28% MacNew-Social Mean change 4.1 + 1.0-1.1* 5.4 + 0.3-0.5* 6.5 - 0-0.3 MacNew-Social Clinically significant increase (≥0.5) 56-71% 50-60% 9-17% Mean change (*p>0.001) and percentage of patients with clinically significant increase of MacNew HRQoL after 1, 6 and 12 months. Open in new tab P306 Anxiety, depression and Health Related Quality of Life after percutaneous coronary intervention: gender specific differences in 2 european data samples G Georg Gaul1, O Friedrich2, G Titscher1, S Hoefer3, W Benzer4, E Garcia5, J Sipoetz1 1Hanusch Hospital, Vienna, Austria, 2KLI Research in Clinical Cardiology, Vienna, Austria, 3University of Innsbruck Department of Medical Psychology and Psychotherapy, Innsbruck, Austria, 4Academic Hospital, Department of Interventional Cardiology, Feldkirch, Austria, 5University General Hospital Gregorio Maranon, Department of Cardiology, Madrid, Spain Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: Our study aims to compare sex specific differences in anxiety and depression in Austrian and Spanish non ST-elevation myocardial infarction percutaneous coronary intervention patients considering the close relationship between anxiety, depression and HRQoL. Methods: 733 Non-STEMI percutaneous coronary intervention patients from 40 centres in Spain (N = 487; age: 62.9 ± 10.3, male sex: 69.8%) and 7 centres in Austria (N = 246; age: 63.1 ± 9.3, male sex: 71.5%) completed the Hospital Anxiety and Depression Scale and the MacNew HRQoL questionnaire before discharge. Linear regressions were calculated to evaluate the influence of anxiety and depression on HRQoL Results: Spanish male and female patients differed significantly with respect to HAD scores although they did not differ significantly with regard to risk factors (hypercholesterolemia, hypertension, diabetes, obesity, history of MI, family history of cardiac disease) and severity of cardiovascular disease (CCS-, AHA-classification; single/multivessel disease). Applying cutoff values for probable mood disorder we found significantly more cases of anxiety and depression disorder in Spanish female patients than in their male counterparts. No significant sex specific differences were found in the Austrian sample. In both samples HRQoL is closely associated with anxiety and depression (p < 0.001; Austria: r2=0.49, Spain: r2=0.59). The significant higher HAD scores of Spanish women were related to significant lower HRQoL scores. Conclusion: Our trial suggests that there is no uniform relationship between gender and anxiety/depression in non ST-elevation myocardial infarction percutaneous coronary intervention patients. Because of the close association of anxiety and depression to HRQoL this finding is consequential for the assessment of HRQoL in patients with cardiovascular disease. Austria Spain male female p m/f male female p m/f N 176 70 340 147 MacNew Global (mean ± SD) 5.09 ± 1.01 4.96 ± 1.17 0.543 5.16 ± 1.05 4.50 ± 1.19 <0.001 HADS anxiety (mean ± SD) 5.87 ± 3.65 5.26 ± 4.07 0.178 6.14 ± 4.20 8.22 ± 4.96 <0.001 HADS depression (mean ± SD) 4.39 ± 3.62 4.23 ± 4.35 0.306 4.21 ± 3.61 6.31 ± 4.61 <0.001 anxiety disorder (HADS anxiety >11) 13.1% 8.6% 0.324 15.9% 34.7% <0.001 depression disorder (HADS depression>8) 13.1% 12.9% 0.965 15.3% 29.9% <0.001 Austria Spain male female p m/f male female p m/f N 176 70 340 147 MacNew Global (mean ± SD) 5.09 ± 1.01 4.96 ± 1.17 0.543 5.16 ± 1.05 4.50 ± 1.19 <0.001 HADS anxiety (mean ± SD) 5.87 ± 3.65 5.26 ± 4.07 0.178 6.14 ± 4.20 8.22 ± 4.96 <0.001 HADS depression (mean ± SD) 4.39 ± 3.62 4.23 ± 4.35 0.306 4.21 ± 3.61 6.31 ± 4.61 <0.001 anxiety disorder (HADS anxiety >11) 13.1% 8.6% 0.324 15.9% 34.7% <0.001 depression disorder (HADS depression>8) 13.1% 12.9% 0.965 15.3% 29.9% <0.001 Sex specific differences in the Austrian and the Spanish data sample. Open in new tab Austria Spain male female p m/f male female p m/f N 176 70 340 147 MacNew Global (mean ± SD) 5.09 ± 1.01 4.96 ± 1.17 0.543 5.16 ± 1.05 4.50 ± 1.19 <0.001 HADS anxiety (mean ± SD) 5.87 ± 3.65 5.26 ± 4.07 0.178 6.14 ± 4.20 8.22 ± 4.96 <0.001 HADS depression (mean ± SD) 4.39 ± 3.62 4.23 ± 4.35 0.306 4.21 ± 3.61 6.31 ± 4.61 <0.001 anxiety disorder (HADS anxiety >11) 13.1% 8.6% 0.324 15.9% 34.7% <0.001 depression disorder (HADS depression>8) 13.1% 12.9% 0.965 15.3% 29.9% <0.001 Austria Spain male female p m/f male female p m/f N 176 70 340 147 MacNew Global (mean ± SD) 5.09 ± 1.01 4.96 ± 1.17 0.543 5.16 ± 1.05 4.50 ± 1.19 <0.001 HADS anxiety (mean ± SD) 5.87 ± 3.65 5.26 ± 4.07 0.178 6.14 ± 4.20 8.22 ± 4.96 <0.001 HADS depression (mean ± SD) 4.39 ± 3.62 4.23 ± 4.35 0.306 4.21 ± 3.61 6.31 ± 4.61 <0.001 anxiety disorder (HADS anxiety >11) 13.1% 8.6% 0.324 15.9% 34.7% <0.001 depression disorder (HADS depression>8) 13.1% 12.9% 0.965 15.3% 29.9% <0.001 Sex specific differences in the Austrian and the Spanish data sample. Open in new tab P307 Subjective well-being and its relation to physical activity in Swedish active seniors LA Olsson1, A Anita Hurtig-Wennlof1, TK Nilsson2 1Orebro University, School of Health and Medical Sciences, Department of Clinical Medicine, Orebro, Sweden, 2Orebro University Hospital, Dept of Laboratory Medicine, OREBRO, Sweden Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: Well-being (WB) is a complex variable in its relation between health and other personal and social characteristics. Physical activity is often claimed to be related to WB. Another aspect of WB is Subjective wellbeing (SWB) the person's own evaluation of his or her life. More recently, biomarkers have been introduced in studies on WB and in quality of life research as markers of somatic health in order to extend the understanding of the complex interplay between somatic processes and WB. The aim was to study possible associations of subjective wellbeing (SWB) with selected biomarkers of cardiovascular risk and physical activity, in a sample of Swedish active seniors. Methods: The sample consisted of 389 community dwelling senior citizens recruited from several retired persons' organizations. All were Caucasians, mean age 74 ± 5 years for both sexes, and the sex ratio M/F was 127/262 (32.6/67.4%). Height, weight and the resting systolic and diastolic blood pressure was measured. Serum samples were analysed for lipoproteins and makers of inflammation. The Psychological General Well-Being (PGWB) index was used to measure subjective well-being or distress. It consists of 22 items in six subdimensions (anxiety, depressed mood, positive well-being, self-control, general health and vitality, that reflect subjective well-being and distress during the past week. PA was assessed by a version of the International Physical Activity Questionnaire (IPAQ) modified for elderly, based on the short version of the IPAQ. The categorical outcome from IPAQ assigns the subjects into three PA categories (Low, Moderate and High) Results: Of the PGWB sub-dimensions, General Health had the strongest relation with PA (r2 = 5.4%), also sex and age (r2 = 7.2%) and body mass index (r2 =9.4%) contributed to WB in this subdimension. For the subdimensions depressed mood, positive Well-Being, vitality and PGWBsum score PA explained around 4% of the variance, while sex, age and biomarkers of somatic health had a minor contribution to the variance, while the subdimension anxity was not associated with PA. Conclusions: Physical activity is important for subjectively reported wellbeing and account to a higher degree than biomarkers of somatic functions to the variance in SWB in this cohort of active Swedish seniors. P308 Health-related behaviors and diet quality of Polish women in procreative age in the context of the cardiovascular risk A Anna Waskiewicz1, E Sygnowska1, A Piwonska1 1National Institute of Cardiology, Warsaw, Poland Psychosocial factors/Quality of life (Prevention & Epidemiology) Propose: Healthy lifestyle, including proper diet is very important in young women, because it prevents metabolic diseases and during potential pregnancy can change the expression of fetal development having lifelong consequences in children. Our aim was to evaluate the health-related behaviors and the quality of nutrition of Polish women in procreative age. Methods: Within the frame of the National Multicentre Health Survey (WOBASZ), a representative sample of 2003 women of whole Polish population aged 20-49 was screened in years 2003-2005. In all women a wide range of common risk factors was assessed on the basis of questionnaires, laboratory tests, anthropometric studies and blood pressure measurement. Dietary intake was estimated by means of a 24-hour recall method and compared with Polish dietary recommendations. Results: The prevalence of cardiovascular risk factors in Polish women in procreative age was rather common: overweight and obesity (34%), hypercholesterolemia (49%), hypertension (13%), hyperhomocysteinemia (8%), metabolic syndrome (11%), diabetes (2,4%). Simultaneously 30% of women were smokers and 57% were characterized by low leisure time physical activity. In last year before screening, 12% of women measured cholesterol level and 81% blood pressure in frame of preventive medical examinations concerning cardiovascular diseases. 85% of women self evaluated their health as good or very good. The average daily food ration was characterized by (mean vs estimated average requirement) high atherogenicity (fat 37% vs 30% energy), saturated fatty acids (13,3% vs 10,0% energy) and insufficient folate (200 vs 400 µg), iron (9,2 vs 18,0 mg), calcium (491 vs 1000 mg) and magnesium (230 vs 310 mg). Vitamins A (1021 vs 700 µg), E (9,4 vs 8,0 mg), C (74 vs 75 mg), B1 (1,0 vs 1,0 mg), B2 (1,2 vs 1.1 mg), B6 (1,5 vs 1,3 mg) and B12 (3,4 vs 2,4 µg) were consumed in the recommended doses. The use of vitamins/minerals supplement was reported by 11% women. Conclusions: The prevalence of cardiovascular disease risk factors of Polish women aged 20-49 was rather high. Simultaneously the average food ration was not balanced concerning some nutrients, first of all insufficient folate and minerals (calcium, iron and magnesium) and characterized by high fat intake. Those factors foster the prevalence of cardiovascular disease and may also influence potential pregnancy and health of a future child. P309 The long-term benefits of a community based vascular disease prevention programme on psychosocial outcomes - the West of Ireland experience. AM Walsh1, B Rice1, I Gibson1, S Connolly2, J Jones3, G Flaherty4, J Crowley5 1Croí, West of Ireland Cardiac Foundation, Galway, Ireland, 2Imperial College Healthcare NHS Trust, London, United Kingdom, 3Imperial College London, London, United Kingdom, 4National University of Ireland, Galway, Ireland, 5University College Hospital Galway, Galway, Ireland Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: The aim of this study was to investigate the effects of a community based vascular disease prevention programme on quality of life and anxiety and depression levels, among high risk individuals, at both end of programme and one year review. Method: High risk patients (Heart SCORE ≥ 5%, type 2 diabetes, peripheral arterial disease) and their family members were invited to attend a 16 week intensive multidisciplinary risk factor and lifestyle modification programme. Psychosocial measures such as Anxiety and Depression and Health Related Quality of Life were assessed using validated tools: Hospital Anxiety and Depression Scale (HAD scale), Dartmouth Co-op chart and EQ-VAS from the EQ-5D. Results: Data on patients (n = 296) who attended initial (IA), end of programme (EOP) and one year follow-up assessment (n = 157) were analysed (Table 1). There was a somewhat surprisingly high prevalence of psychosocial ill health (anxiety and depression) at baseline. Conclusion: It is increasingly recognised that a healthy diet, regular physical activity and participation in group-based activities can have a positive impact on psychosocial outcomes. The significant reduction in HAD scores and improvement in Quality of Life outcomes achieved by this programme and which were maintained at one year add further support to this premise. Table 1. Patients IA (n = 296) Patients EOP (n = 296) Patients IA (n = 157) Patients 1 yr (n = 157) % HAD Anxiety ≥ 8 33.0 19.4 p < 0.001 30.4 16.3 p < 0.001 % HAD Depression ≥ 8 17.4 7 p < 0.001 14.8 5.9 p = 0.004 Dartmouth Co-op Total Score Median 19 17 p < 0.001 19 17 p < 0.001 EQ-VAS Median 65 78 p < 0.001 70 80 P < 0.001 Patients IA (n = 296) Patients EOP (n = 296) Patients IA (n = 157) Patients 1 yr (n = 157) % HAD Anxiety ≥ 8 33.0 19.4 p < 0.001 30.4 16.3 p < 0.001 % HAD Depression ≥ 8 17.4 7 p < 0.001 14.8 5.9 p = 0.004 Dartmouth Co-op Total Score Median 19 17 p < 0.001 19 17 p < 0.001 EQ-VAS Median 65 78 p < 0.001 70 80 P < 0.001 Summary of psychosocial outcomes, between IA and EOP, and IA and 1-year Open in new tab Table 1. Patients IA (n = 296) Patients EOP (n = 296) Patients IA (n = 157) Patients 1 yr (n = 157) % HAD Anxiety ≥ 8 33.0 19.4 p < 0.001 30.4 16.3 p < 0.001 % HAD Depression ≥ 8 17.4 7 p < 0.001 14.8 5.9 p = 0.004 Dartmouth Co-op Total Score Median 19 17 p < 0.001 19 17 p < 0.001 EQ-VAS Median 65 78 p < 0.001 70 80 P < 0.001 Patients IA (n = 296) Patients EOP (n = 296) Patients IA (n = 157) Patients 1 yr (n = 157) % HAD Anxiety ≥ 8 33.0 19.4 p < 0.001 30.4 16.3 p < 0.001 % HAD Depression ≥ 8 17.4 7 p < 0.001 14.8 5.9 p = 0.004 Dartmouth Co-op Total Score Median 19 17 p < 0.001 19 17 p < 0.001 EQ-VAS Median 65 78 p < 0.001 70 80 P < 0.001 Summary of psychosocial outcomes, between IA and EOP, and IA and 1-year Open in new tab P310 A nurse coordinated prevention program improves quality of life in coronary patients: results from the RESPONSE trial RESPONSE trial, HT Jorstad1, M Madelon Minneboo1, ND Fagel1, WJ Scholte Op Reimer2, JG Tijssen1, RJG Peters1 1Academic Medical Center, Department of Cardiology at the University of Amsterdam, Amsterdam, Netherlands, 2Amsterdam University of Applied Sciences, School of Nursing, Amsterdam, Netherlands Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: To quantify the impact of a hospital based Nurse Coordinated Prevention Program (NCPP), including intensive lifestyle modifications, on patients' quality of life after an Acute Coronary Syndrome (ACS). Methods: A multi-centre, randomized clinical trial in The Netherlands. Patients (18-80 years) were eligible within 8 weeks after hospitalisation for an acute coronary syndrome. Patients were randomized to either NCPP in addition to usual care (intervention) or usual care alone (control). The intervention consisted of 4 NCPP visits within six months, and focused on risk factor management through lifestyle modification and medication management (based on current guidelines). Quality of life was assessed with the “Macnew quality of life in heart disease”-questionnaire at baseline and 12 months follow-up. Results: 617 participants were randomly assigned to the intervention (n = 308) or to control (n = 309). At baseline, Macnew was 5.18 (SD 1.08) in the intervention group and 5.20 (SD 1.04) in the control group (Table). At 12 months, Macnew improved more in the intervention group than in the control group [0.59 (SD 0.87) vs 0.43 (SD 0.88), p = 0.02]. This improvement reflected an increase on all subscales (emotional, physical and social) of the Macnew questionnaire (Table). Conclusion: A 6-month NCPP corresponds with greater improvement in quality of life than usual care alone, showing that NCPP lifestyle modification and medication management does not come at the cost of a decrease in quality of life. The improvement in quality of life is due to small improvements in emotional, physical and social functioning. Macnew at baseline and 12 months change Baseline Change at 12 months Intervention (n = 308) Control (n = 309) Intervention (n = 295) Control (n = 294) p-value MacNew Total (SD) 5,18 (1,08) 5,20 (1,04) 0,59 (0,87) 0,43 (0,88) 0,022 Emotional subscale (SD) 5,04 (1,21) 5,03 (1,15) 0,53 (0,99) 0,37 (1,00) 0,050 Physical subscale (SD) 5,01 (1,20) 5,04 (1,16) 0,67 (1,02) 0,48 (1,01) 0,022 Social subscale (SD) 5,53 (1,12) 5,53 (1,10) 0,66 (1,00) 0,51 (1,01) 0,056 Baseline Change at 12 months Intervention (n = 308) Control (n = 309) Intervention (n = 295) Control (n = 294) p-value MacNew Total (SD) 5,18 (1,08) 5,20 (1,04) 0,59 (0,87) 0,43 (0,88) 0,022 Emotional subscale (SD) 5,04 (1,21) 5,03 (1,15) 0,53 (0,99) 0,37 (1,00) 0,050 Physical subscale (SD) 5,01 (1,20) 5,04 (1,16) 0,67 (1,02) 0,48 (1,01) 0,022 Social subscale (SD) 5,53 (1,12) 5,53 (1,10) 0,66 (1,00) 0,51 (1,01) 0,056 Open in new tab Macnew at baseline and 12 months change Baseline Change at 12 months Intervention (n = 308) Control (n = 309) Intervention (n = 295) Control (n = 294) p-value MacNew Total (SD) 5,18 (1,08) 5,20 (1,04) 0,59 (0,87) 0,43 (0,88) 0,022 Emotional subscale (SD) 5,04 (1,21) 5,03 (1,15) 0,53 (0,99) 0,37 (1,00) 0,050 Physical subscale (SD) 5,01 (1,20) 5,04 (1,16) 0,67 (1,02) 0,48 (1,01) 0,022 Social subscale (SD) 5,53 (1,12) 5,53 (1,10) 0,66 (1,00) 0,51 (1,01) 0,056 Baseline Change at 12 months Intervention (n = 308) Control (n = 309) Intervention (n = 295) Control (n = 294) p-value MacNew Total (SD) 5,18 (1,08) 5,20 (1,04) 0,59 (0,87) 0,43 (0,88) 0,022 Emotional subscale (SD) 5,04 (1,21) 5,03 (1,15) 0,53 (0,99) 0,37 (1,00) 0,050 Physical subscale (SD) 5,01 (1,20) 5,04 (1,16) 0,67 (1,02) 0,48 (1,01) 0,022 Social subscale (SD) 5,53 (1,12) 5,53 (1,10) 0,66 (1,00) 0,51 (1,01) 0,056 Open in new tab P311 Anhedonia, but not other depressive or anxiety symptoms, predicts 8-year mortality in persons with acute coronary syndrome F Doyle1, H Mcgee1, R Conroy1 1Royal College of Surgeons in Ireland, Dublin, Ireland Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: Both depression and anxiety and been associated with poor prognosis in patients with patients with acute coronary syndrome (ACS). However, certain symptoms, and how they are measured, may be more important than others. We investigated 3 different scales to determine their predictive validity in a national sample. Methods: Patients with acute coronary syndrome (N = 598) completed either the Hospital Anxiety and Depression Scales or the Beck Depression Inventory-Fast Screen (BDI-FS). Their all-cause mortality status was assessed at 8 years. Results: Mortality rate was 121/598. Cox proportional hazards modelling showed that anhedonia (as measured by the HADS depression subscale) was predictive of mortality (Hazard Ratio [HR]=2.57, 95% CI 1.4-4.6, p = 0.002), even when adjusting for clinical and sociodemographic variables. Other depressive symptoms (BDI-FS depressed cases - HR =  0.8, 95% CI 0.4-1.3, p = 0.357) and anxiety symptoms (HADS anxiety subscale - HR =  1.07, 95% CI 0.56-2.0, p = 0.832)) were not predictive of mortality. Conclusions: Anhedonia, as measured by the HADS depression subscale, predicted all-cause mortality over 8 years in patients with acute coronary syndrome. Other depressive and anxiety symptoms did not. These results suggest that interventions to reduce cardiovascular risk should focus on symptoms of anhedonia. P312 Risk factors associated with acute coronary syndromes in south african asian indian patients the air study N Ranjith1, R J Pegoraro2 1R. K. Khan Hospital, Durban, South Africa, 2Nelson R Mandela School of Medicine University of KwaZulu Natal, Durban, South Africa Other risk factors (Prevention & Epidemiology) Aims: To examine the association between traditional risk factors and acute coronary syndrome [ACS] in the South Asian Indian population in KwaZulu Natal, South Africa. Methods and Results: The study population comprised 4418 patients [mean age 54.6 ± 10.9 years], of whom 67% were males. The majority presented with ST-elevation myocardial infarction [75%], non ST-elevation myocardial infarction [16%], and 9% unstable angina. Visceral obesity [82%, mean waist circumference 101.43 ± 10.34 cm] was the most commonly observed risk factor, while 78% had hypercholesterolaemia [mean 5.97 ± 1.11 mmol/L] and 74% a family history of vascular disease [FHVD]. More males compared to females were smokers [p < 0.0001], while females were more likely to have visceral obesity, diabetes, hypertension, increased body mass index, and low high-density lipoprotein cholesterol levels [p < 0.0001]. Young patients [≤ 45 years, n = 968] had a higher incidence of FHVD [83%, p = 0.019], smoking [79%, p = < 0.0001], and hypertriglyceridaemia [62%, p = 0.014] compared to middle [46 - 65 years, n = 2708] or old age [> 65 years, n = 742] groups, whilst older patients were more likely to have diabetes [59%, p = 0.001], and hypertension [68%, p = <0.0001]. Conclusion: Asian Indians in South African have multiple risk factors for acute coronary syndrome, possibly contributing to the increased incidence of coronary heart disease at a young age. A FHVD emerged as an important contributor to disease aetiology and should be incorporated in future risk factor analyses. Risk Factors in Patients with acute coronary syndrome RISK FACTORS All Patients [n = 4418] % Total Males [n = 2963] % Total Females [n = 1455] % Total OR [95% CI] [Males versus Females] p value Visceral Obesity 82 75 95 0.15 [0.10 - 0.22] <0.0001 FH of Vascular Disease 74 74 75 0.97 [0.84 - 1.12] 0.64 Current/Former Smoker 60 80 20 16.05 [13.72 -18.78] <0.0001 Diabetes 46 37 65 0.31 [0.27 - 0.35] <0.0001 Hypertension 45 33 68 0.24 [0.21 - 0.27] <0.0001 BMI ≥ 30kg/m2* 16 11 24 0.40 [0.34 - 0.47] <0.0001 ABNORMAL LIPID LEVELS % Total [mean ± SD] % Total [mean ± SD] % Total [mean ± SD] Total Cholesterol ≥ 4.5 mmol/L* 78 [5.97 ± 1.11] 78 [5.91 ± 1.09] 79 [6.09 ± 1.15] 0.92 [0.80 - 1.10] 0.44 Triglycerides ≥ 1.7 mmol/L 51 [3.07 ± 1.81] 50 [3.08 ± 1.74] 51 [3.04 ± 1.94] 0.97 [0.85 - 1.10] 0.65 HDL Cholesterol Males <1.03 mmol/ LFemales <1.29 mmol/L* 68 [0.86 ± 0.17] 63 [0.81 ± 0.14] 79 [0.94 ± 0.19] 0.47 [0.40 - 0.55] <0.0001 LDL Cholesterol >2.5 mmol/L* 82 [3.87 ± 0.96] 81 [3.86 ± 0.96] 82 [3.89 ± 0.96] 1.03 [0.86 - 1.23] 0.81 RISK FACTORS All Patients [n = 4418] % Total Males [n = 2963] % Total Females [n = 1455] % Total OR [95% CI] [Males versus Females] p value Visceral Obesity 82 75 95 0.15 [0.10 - 0.22] <0.0001 FH of Vascular Disease 74 74 75 0.97 [0.84 - 1.12] 0.64 Current/Former Smoker 60 80 20 16.05 [13.72 -18.78] <0.0001 Diabetes 46 37 65 0.31 [0.27 - 0.35] <0.0001 Hypertension 45 33 68 0.24 [0.21 - 0.27] <0.0001 BMI ≥ 30kg/m2* 16 11 24 0.40 [0.34 - 0.47] <0.0001 ABNORMAL LIPID LEVELS % Total [mean ± SD] % Total [mean ± SD] % Total [mean ± SD] Total Cholesterol ≥ 4.5 mmol/L* 78 [5.97 ± 1.11] 78 [5.91 ± 1.09] 79 [6.09 ± 1.15] 0.92 [0.80 - 1.10] 0.44 Triglycerides ≥ 1.7 mmol/L 51 [3.07 ± 1.81] 50 [3.08 ± 1.74] 51 [3.04 ± 1.94] 0.97 [0.85 - 1.10] 0.65 HDL Cholesterol Males <1.03 mmol/ LFemales <1.29 mmol/L* 68 [0.86 ± 0.17] 63 [0.81 ± 0.14] 79 [0.94 ± 0.19] 0.47 [0.40 - 0.55] <0.0001 LDL Cholesterol >2.5 mmol/L* 82 [3.87 ± 0.96] 81 [3.86 ± 0.96] 82 [3.89 ± 0.96] 1.03 [0.86 - 1.23] 0.81 FH = Family History; BMI = Body Mass Index; HDL = High-Density Lipoprotein; LDL = Low Density Lipoprotein; * = Data missing for some patients Open in new tab Risk Factors in Patients with acute coronary syndrome RISK FACTORS All Patients [n = 4418] % Total Males [n = 2963] % Total Females [n = 1455] % Total OR [95% CI] [Males versus Females] p value Visceral Obesity 82 75 95 0.15 [0.10 - 0.22] <0.0001 FH of Vascular Disease 74 74 75 0.97 [0.84 - 1.12] 0.64 Current/Former Smoker 60 80 20 16.05 [13.72 -18.78] <0.0001 Diabetes 46 37 65 0.31 [0.27 - 0.35] <0.0001 Hypertension 45 33 68 0.24 [0.21 - 0.27] <0.0001 BMI ≥ 30kg/m2* 16 11 24 0.40 [0.34 - 0.47] <0.0001 ABNORMAL LIPID LEVELS % Total [mean ± SD] % Total [mean ± SD] % Total [mean ± SD] Total Cholesterol ≥ 4.5 mmol/L* 78 [5.97 ± 1.11] 78 [5.91 ± 1.09] 79 [6.09 ± 1.15] 0.92 [0.80 - 1.10] 0.44 Triglycerides ≥ 1.7 mmol/L 51 [3.07 ± 1.81] 50 [3.08 ± 1.74] 51 [3.04 ± 1.94] 0.97 [0.85 - 1.10] 0.65 HDL Cholesterol Males <1.03 mmol/ LFemales <1.29 mmol/L* 68 [0.86 ± 0.17] 63 [0.81 ± 0.14] 79 [0.94 ± 0.19] 0.47 [0.40 - 0.55] <0.0001 LDL Cholesterol >2.5 mmol/L* 82 [3.87 ± 0.96] 81 [3.86 ± 0.96] 82 [3.89 ± 0.96] 1.03 [0.86 - 1.23] 0.81 RISK FACTORS All Patients [n = 4418] % Total Males [n = 2963] % Total Females [n = 1455] % Total OR [95% CI] [Males versus Females] p value Visceral Obesity 82 75 95 0.15 [0.10 - 0.22] <0.0001 FH of Vascular Disease 74 74 75 0.97 [0.84 - 1.12] 0.64 Current/Former Smoker 60 80 20 16.05 [13.72 -18.78] <0.0001 Diabetes 46 37 65 0.31 [0.27 - 0.35] <0.0001 Hypertension 45 33 68 0.24 [0.21 - 0.27] <0.0001 BMI ≥ 30kg/m2* 16 11 24 0.40 [0.34 - 0.47] <0.0001 ABNORMAL LIPID LEVELS % Total [mean ± SD] % Total [mean ± SD] % Total [mean ± SD] Total Cholesterol ≥ 4.5 mmol/L* 78 [5.97 ± 1.11] 78 [5.91 ± 1.09] 79 [6.09 ± 1.15] 0.92 [0.80 - 1.10] 0.44 Triglycerides ≥ 1.7 mmol/L 51 [3.07 ± 1.81] 50 [3.08 ± 1.74] 51 [3.04 ± 1.94] 0.97 [0.85 - 1.10] 0.65 HDL Cholesterol Males <1.03 mmol/ LFemales <1.29 mmol/L* 68 [0.86 ± 0.17] 63 [0.81 ± 0.14] 79 [0.94 ± 0.19] 0.47 [0.40 - 0.55] <0.0001 LDL Cholesterol >2.5 mmol/L* 82 [3.87 ± 0.96] 81 [3.86 ± 0.96] 82 [3.89 ± 0.96] 1.03 [0.86 - 1.23] 0.81 FH = Family History; BMI = Body Mass Index; HDL = High-Density Lipoprotein; LDL = Low Density Lipoprotein; * = Data missing for some patients Open in new tab P313 Decrease of bone mineral density as a marker of cardiovascular remodelling N Natalya Khozyainova1, V Tsareva1, Y Kurbasova1, V Mukonina1, N Romanchenko1, O Petrushenkova1 1Smolensk State Medical Academy, Smolensk, Russian Federation Other risk factors (Prevention & Epidemiology) Background: to assess the correlation between structure-geometrical cardiac remodelling, pulse wave velocity (PWV), results of 24-hours monitoring of blood pressure (BMP) and bone mineral density (BMD) in patients with essential arterial hypertension (EH). Methods: we performed 157 postmenopausal women with confirmed diagnosis of EH stages I-II. The control group included 54 age-matched healthy volunteers-women. All participants underwent echocardiography, BMP. Arterial stiffness was measured by brachial-ankle PWV using an automated device. BMD was estimated by dual-energy X-ray absorbtiometry using T-criterion. Statistical analysis was done with Statistica 6.0 (StatSoft, USA). Results: In postmenopausal hypertension women reduced BMD was associated with adverse concentric remodelling variant - increased myocardial mass index and relative left ventricular wall thickness (r = −0.49 p = 0.001 and r = −0.57 p = 0.0001 respectively). Women with low BMD had circadian rhythm of diastolic BMP non-dipper. Women with osteoporosis had more severe arteriosclerotic changes detected by significantly higher PWV measurement than those with normal BMD (p < 0.01). In regression analysis the decrease BMD was associated with PWV elevation (r = −0.33 p < 0.01). It reflects that arterial stiffness assessed by PWV measurement it closely connected with BMD. Positive correlation between PWV and age, systolic blood pressure, diastolic blood pressure (r = 0.42, 0.34, 0.28 p < 0.05 respectively) confirms that arterial stiffness is dependent on age and blood pressure. Conclusions: decrease of BMD is a marker of unfavorable variants of myocardial remodelling associated with increase arterial stiffness as a prognostic marker of an adverse current in postmenopausal women with EH. Including BMD measurement into EH diagnostic algorithm provides additional benefits for assessment of individual total cardiovascular risk in postmenopausal women. Comprehensive studies of patients with normal blood pressure and osteopenic syndrome provide early diagnostics of cardiovascular remodelling and secondary prevention of osteoporosis. Investigation of BMD gives a chance to clear up cardiovascular risks and individualize diagnostic and curative approaches to patients with EH and osteoporosis. P314 Incidence of contrast induced nephropathy after angiogram compared to different radiological investigations A Asaad Khan1, RB Boner1, A Mcgowan1, M O'sullivan1, E Joyce1, S Browne1, B Mcneil1, D Reddan1, J Crowley1, P Nash1 1University Hospital Galway, Galway, Ireland Other risk factors (Prevention & Epidemiology) Purpose: The number of cardiac angiography and computed tomography (CT) scans has increased steadily in recent years. This has resulted in the increasing incidence of contrast-induced nephropathy (CIN), an acute impairment of renal function that occurs after the administration of the contrast media (CM). The primary aim of this study was to assess and compare the incidence of clinically significant CIN among patients undergoing non-emergent coronary angiography (CAG) and computed tomography. Methods: Data was obtained from the cardiac catheterization lab data, PACS radiology system and the hospital information system. Demographics, type and volume of contrast and type of computed tomography scan were recorded.eGFR was derived from the MDRD formula. Presence or absence of pre and post computed tomography scan renal function assessment was determined and documentation of risk profile on online radiology requests was ascertained. All patients undergoing angiogram had renal profile assessed in the angiogram lab pre procedure but post procedure assessment was done by general physicians for day case procedures. Information was gathered re patient mortality. CIN was defined by either a 25% increment in eGFR or a 44 µmol/l (>0.5 mg /dl) absolute rise in serum creatinine levels after exposure to contrast medium. Multivariable modelling of CIN predictors is ongoing. Results: Data of 1100 patients who underwent in-patient computed tomography (1000) and non emergent coronary angiograms (100) was gathered. Of the patients undergoing computed tomography 46% were females and 54% were males while 40% were females and 60% were male in the CAG population. Mean age of the population in computed tomography and CAG group was 61 ± 18yrs and 65 ± 11 yrs respectively. Pre and post computed tomography scan renal profiles were performed on 97% and 82% respectively. While 100% and 97% patients had renal function assessment in the pre and post CAG group, respectively. Observed incidence of CIN was 8.9% in the computed tomography group and 5% in the CAG group. In the computed tomography group, Of the 25% of patients with eGFR <60ml/min pre scan, 8.5% did not have follow-up creatinine assessment. Contrast type was recorded among 74% and contrast volume among 75% of patients in the computed tomography group while 98% patients had contrast type and voulme recorded in the CAG group. Conclusion: The incidence of CIN in our study population was similar or lower than reported in other populations and was associated with increased mortality. CIN prevention could potentially be improved by more accurate recording of contrast administration and renal function. P315 Clopidogrel and Proton Pump Inhibitors: preventing a potentially dangerous combination. V Vassilis Vassiliou1, A Silva1, R Schofield1, F Kavvoura2, DB Rowlands3 1Addenbrooke's Hospital, Cambridge, United Kingdom, 2University of Oxford, Oxford, United Kingdom, 3Peterborough City Hospital, Peterborough, United Kingdom Other risk factors (Prevention & Epidemiology) Purpose: Following Acute Coronary Syndromes (ACS) appropriate secondary prevention medication can improve prognosis. The enzymatic conversion of clopidogrel to its active metabolite can be inhibited by certain proton pump inhibitors (PPI) e.g. omeprazole/esomeprazole but not others e.g. lansoprazole/pantoprazole. We present our experience in preventing this potentially harmful combination and ensuring that secondary prevention in our patients complies with recent European guidance on this issue. Methods: Patients with acute coronary syndrome discharged on clopidogrel from 06/08/08-04/08/09 were identified and PPI use audited. A simple algorithm was devised to prompt confirmation of indication for PPI use and encourage either discontinuation, switching to ranitidine or an appropriate PPI (lansoprazole, pantoprazole and esomeprazole were then considered safe; the guidance on esomeprazole has since changed and is no longer considered safe). All cardiology doctors were briefed. Following our intervention we re-audited from 05/08/09-03/02/10. Results: Pre-intervention: 91/253 cases reviewed. PPI use was high: 43/91 patients (47.3%). Only 4 patients (4.4%) were on an H2 blocker (ranitidine 4/4). Only 30% discharged on PPI had an appropriate indication: 9/29 patients (31.0%) on omeprazole, 4/14 (28.6%) on non-omeprazole PPI. Post-intervention: 101/128 cases reviewed. PPI use decreased significantly: 27 patients (26.7%) took PPI confirming a relative 44% and absolute 21% decrease (p = 0.018 by X2 test). This was predominently driven by a decrease in the use of omeprazole from 29/91 patients (31.9%) to 17/101 patients (16.8%). Furthermore, 54 patients (53.5%) were now discharged on ranitidine. 13/17 patients on omeprazole (76.5%) had a good indication for PPI compared to 3/10 (30%) in the non-omeprazole group. Conclusions: Through a simple intervention we have shown that appropriate use of PPI in patients taking clopidogrel following acute coronary syndrome can be rationalized significantly leading to a dramatic decrease in the potentially hazardous co-administration of PPI with clopidogrel, at the expense of increased use of the safer tablet ranitidine. Audit and a simple algorithm implementation have assisted in providing safer secondary prevention therapy in line with current European recommendations. P316 Predictors of new-onset of chronic kidney disease in Japanese population: Kyoto surveillance S Shinji Yasuno1, K Ueshima1, K Oba2, Y Nakao1, S Tanaka1, M Kasahara1, A Fujimoto1, T Miyawaki3, I Masuda4, K Nakao5 1EBM Research Center, Kyoto University Graduate School of Medicin, Kyoto, Japan, 2Translational Research and Clinical Trial Center Hokkaido University Hospital, Hokkaido Universit, Sapporo, Japan, 3Health Administration Center, NTT West Kyoto Hospital, Kyoto, Japan, 4Takeda Hospital, Kyoto, Japan, 5Kyoto University, Graduate School of Medicine, Department of Medicine and Clinical Science, Kyoto, Japan Other risk factors (Prevention & Epidemiology) Objective: Accumulating evidence has showed that proteinuria and a decreased glomerular filtration rate (GFR) are independent risk factors not only for loss of renal function but also for increased cardiovascular morbidity and mortality. We examined the predictors of new-onset of chronic kidney disease (CKD) in Japanese population, as a retrospective cohort study. Methods: Of 22,233 persons who underwent a complete medical checkup in NTT West Kyoto Hospital from 1996 to 2009, subjects were 10,926 healthy individuals who had at least more than two visits without treatment of hypertension, diabetes mellitus, and dyslipidemia and whose first visit was before 2005. Primary endpoint was new-onset of CKD, which was defined as eGFR less than 60 mL/min/1.73m2 or proteinuria during the follow-up period. Hazard ratio of each parameter for new-onset of CKD was calculated with the multiple Cox regression analysis adjusted for possible confounders. Results: In the subjects, proportion of men was 87.1%, mean age was 46.8 and mean body mass index was 23.2 kg/m2. For 6.2 years of follow-up, 1,694 CKD events were observed. The multiple Cox regression analyses showed that higher level of systolic blood pressure, fasting blood sugar, uric acid, and triglyceride and lower level of high-density lipoprotein cholesterol were significantly associated with the risk of new-onset of CKD. Conclusion: Systolic blood pressure, fasting blood sugar, uric acid, high-density lipoprotein cholesterol and triglyceride are independent predictors of new-onset of CKD in Japanese healthy individuals. The present study could provide useful information to take appropriate preventive measures against the onset of CKD. P317 Metabolic syndrome increases cardiomyocytes stress in human heart after cardiopulmonary bypass G Giovanni Corsetti1, E Pasini2, M Ferrari-Vivaldi3, C Romano4, F Bonomini1, G Tasca5, R Rezzani1, D Assanelli4 1University of Brescia, Department of Biomedical Sciences and Biotechnology - Clinical Biochemistry, Brescia, Italy, 2Salvatore Maugeri Foundation, IRCCS - Cardiovascular Research Center, Lumezzane, Italy, 3Cardiovascular Surgery Department, San Rocco Hospital,, Ome (Italy), Italy, 4University of Brescia, Department of Internal Medicine, Brescia, Italy, 5Alessandro Manzoni Hospital, Department of Cardiology, Lecco, Italy Other risk factors (Prevention & Epidemiology) Purpose: Metabolic syndrome (MetS) is a cluster of various clinical cardiovascular risk factors and causes metabolic and structural cardiomyocytes damage. During cardiopulmonary bypass (CPB), the heart suffers from severe metabolic injury which in turn causes contractile dysfunction. The myocardial adaptive response to Ischemia/Reperfusion (I/R) injury is to produce specific proteins which reduce I/R damage. The mitochondria and endoplasmic reticular functions play a fundamental role in post ischemic metabolic impairment. Stress molecules such as the chaperones Grp75 and Grp78 are expressed as a response to injury and regulate cell metabolism and pro-apoptotic enzymes (Bax). We have investigated myocardial expression of these chaperones and Bax both before and after CPB in selected patients with MetS, with or without first generation statin (Stat) therapy before surgery. Methods. We recruited fifteen MetS patients with stable angina, undergoing coronary artery bypass graft surgery. Ten matched age subjects, non-smokers and without MetS undergoing cardiac surgery for other reasons than coronary bypass were used as controls. Myocardial biopsies were obtained both before and after CPB. The samples were fixed and processed for Grp75, Grp78 and Bax by immunohistochemistry. Results: Before-CPB, controls and MetS patients had similar Grp75, Gpr78 and Bax staining in cardiomyocytes cytoplasm. On the contrary, MetS+Stat patients had significantly less Grp75 vs controls (IOD: 0.15 ± 0.08 vs 0.29 ± 0.05. p < 0.003) and more Gpr78 vs controls and MetS patients (0.47 ± 0.1 vs 0.26 ± 0.07 and 0.28 ± 0.07. p < 0.000). Moreover there was increased Bax immuno-staining vs control and MetS patients. After-CPB, Grp75 staining increased significantly in all groups. Grp78 also significantly increased weakly but significantly in the controls (0.39 ± 0.12 vs 0.26 ± 0.07. p < 0.008), strongly in the MetS group (0.61 ± 0.15 vs 0.28 ± 0.12. p < 0.000) and much more in Mets+Stat (0.68 ± 0.14 vs 0.47 ± 0.1. p < 0.001). Bax expression decreased after-CPB in the controls (0.17 ± 0.08 vs 0.24 ± 0.02. p < 0.015), whereas increased in MetS patients (0.31 ± 0.08 vs 0.24 ± 0.04. p < 0.02) and more in the MetS+Stat vs MetS and control ones (0.34 ± 0.07 vs 0.31 ± 0.07 and 0.17 ± 0.08. p < 0.000). MetS+Stat patients did not show any significant increase of Bax staining after-CPB. Conclusions. MetS patients had significant metabolic stress after CPB with an activated pro-apoptotic phenomena, particularly when chronically treated with statin therapy. These findings are important for the health and cardio-surgical management of MetS patients. P318 Preventing cardiovascular complications after non-cardiac non-vascular surgery by using perioperative statin therapy. 1-year prospective study in Constanta County, Romania I R Irinel Parepa1, L Mazilu1, A I Suceveanu1, A Suceveanu1, A Rusali1, L Cojocaru1, L Matei1, M Toringhibel1, N Ciufu1, I Aschie1 1"OVIDIUS" University of Constanta, Faculty of General Medicine, CONSTANTA, Romania Other risk factors (Prevention & Epidemiology) Background: Although literature data indicates that statins are beneficial when given perioperatively in non-cardiac non-vascular surgery, recent reports are controversial. Aim: To evaluate if the perioperative statin use reduces the risk of cardiovascular events in general surgery. Method: 1380 patients undergoing elective non-cardiac non-vascular surgery and with no previous evidence of cardiac disease were randomized for perioperative statin therapy during 1 year, in the General Surgery Department of Constanta County Hospital. All patients included in our study were “naive” (no previous statin therapy). Patients received rosuvastatin 10mg/day (n = 691), respectively placebo (n = 689), 3 days before and 20 days after surgery; they were followed-up 3 months after surgery. The endpoint was defined as a composite cardiovascular event (stable angina, silent cardiac ischaemia, acute coronary syndrome or cardiac death). Results: At baseline, the average LDL-colesterol level was 112 ± 3.4mg/dl (interval 96-158mg/dl); after 23 days LDL-colesterol was 108 ± 4.7mg/dl (interval 94-149mg/dl). No significant decrease in LDL-colesterol was detected (113 ± 3.8mg/dl at baseline, 106 ± 4.9mg/dl after 23 days of treatment, P = 0.5664) among statin patients. 82 patients (5.95%) underwent a cardiovascular complication during follow-up period: 33 patients from statin arm and 49 patients from placebo arm, with a significantly lower incidence among statin patients (40.2% vs 59.8%, P = 0.0103). After adjusting for age, sex, LDL-colesterol and other risk factors (smoking, diabetes mellitus, blood pressure), the statin arm had a relative risk reduction of 39% (OR = 0.4536; 95%CI, 0.2429-0.8468; P = 0.0189) for cardiovascular events during follow-up period. Conclusion: In our study, perioperative statin therapy had a protective effect against cardiovascular complications of non-cardiac non-vascular surgery, no matter the LDL-col levels. P319 Prognostic values of elevated Interleukin-6 and C - reactive protein for all-cause mortality in the elderly. S A Shalnova1, AD Deev2, VA Metelskaya2, AV Kapustina2, MA Shkolnikova3, JA Balanova2, TN Timofeeva2, VV Konstantinov2, VA Zhukova2, SK Kukushkin2 1Russian Cardiology Research Center, Moscow, Russian Federation, 2National Research Center for Preventive Medicine, Moscow, Russian Federation, 3Moscow Institute for Paediatry and Pediatric Surgery, Moscow, Russian Federation Other risk factors (Prevention & Epidemiology) Background: Aging is associated with a high-grade inflammatory activity reflected both by an enhanced level of circulating acute phase C-reactive protein (CRP) and by interleukin-6 (IL-6) regulating CRP production. Purpose: To investigate whether interleukin-6 and C-reactive protein levels predict all-cause mortality in Muscovites aged 55 years and older. Methods: The representative sample of 1,876 subjects (47.9% males) took part in the baseline survey of the Stress, Aging and Health Study (SAHR), which is a prospective population-based cohort study being conducted in Moscow. High sensitive CRP (hs-CRP) level was measured by immunoturbidimetric assay; Interleukin-6 level - by ELISA. A cut off point for high hs-CRP was 10 mg/L (H10CRP) and for IL-6 - 4 pg/ml (H4IL6) were taken. Mean follow-up time was 2.1 years. Socio-demographic characteristics, smoking status, body mass index (quadratic), heart rate (HR), coronary heart disease symptoms and other diseases status were included in analysis as well. Proportional hazard (Cox) regression was applied for linking mortality with H10CRP and H4IL6 controlling on demographic and medical characteristics. Results: 79 deaths were identified during ongoing study. H4IL6 were associated with a 1.9 greater risk of death (RR) compared with the lower level (95% confidence interval, CI, 1.1 to 3.1) after sex and age adjustment. High hs-CRP was also associated with increased risk (RR = 2.4; CI, 1.3 to 4.6). Controlling additionally on body mass index, smoking, high HR (>80 beat/min), low level of gripstrength (=30 kg for men and ≤ 20 kg for women), Parkinson's disease, coronary heart disease and heart failure status reduced RR for H4IL6 to 1.5 (CI 0.9 to 2.4); for H10CPR - to 2,3 (CI 1.4 to 4.5). Conclusion: Increasing levels of acute inflammation, as measured by hs-CRP and IL-6, were found to be associated with an increasing risk of all-cause mortality. These measures may be useful for identification of high-risk subgroups for anti-inflammatory interventions. P320 High calcium score is a risk factor for clinical outcome despite normal myocardial perfusion and left ventricular ejection fraction as determined by 99mTc-sestamibi myocardial perfusion imaging B Bo Zerahn1, CJ Madsen1 1Department of Nuclear Medicine at Herlev Hospital, Herlev, Denmark Other risk factors (Prevention & Epidemiology) Purpose The aim of this study was to evaluate potential risk factors for cardiac events and death in patients with normal myocardial perfusion imaging, normal left ventricular ejection fraction, and calcium score higher that 0. Methods: The study comprised 226 consecutive patients who underwent a 99mTc-sestamibi myocardial perfusion imaging (MPI) protocol with either ergometer bicycle- or pharmacological stress. Patients were referred to MPI by a cardiologist if they were considered to have an intermediate risk of having ischaemic heart disease, had a history of ischaemic heart disease with renewed suspicion of ischaemia, or prior to renal transplantation because of chronic renal insufficiency. In the latter group of patients all needed haemodialysis. Patients were included if they had a normal myocardial perfusion, a normal left-ventricular ejection fraction, and a calcium score > 0. Assessment of coronary artery calcium score (CACS) was performed immediately prior to MPI. Patient risk factors, history and events were retrieved from hospital files. Evaluated risk factors were: CACS ≥ 400, male gender, family history of coronary artery disease, hypertension, chronic renal insufficiency, diabetes, smoking, age > 66 years, BMI > 25, known ischaemic heart disease, inability to perform ergometer bicycle stress, and hypercholesterolemia. End points were myocardial infarction, need for revascularisation of coronary arteries and/or death. Results: CACS was 1-399 in 157 patients (69%) and ≥ 400 in 69 patients. Cox regression analysis showed that CACS was the most powerful predictor of cardiovascular events or death (RR 16.8, p = 0.013, CI 1.8 to 153) with renal insufficiency (RR 11.7, p = 0.02, CI 1.5 to 93) and family history of CAD (RR 9.8, p = 0.025, CI 1.3 to 72) included in the model too. Log-rank test showed that CACS was the only significant risk factor for cardiovascular events without death (p < 0.001). Conclusions: CASC is the single most important risk factor for death and/or cardiac events in patients with normal MPI and left-ventricular ejection fraction as determined by 99mTc-sestamibi myocardial perfusion imaging. CASC should be included whenever possible, when performing MPI in order to identify high-risk patients in order to be able to prevent cardiac events and/or death. P321 Association of subcutaneous allergen immunotherapy with incidence of autoimmune disease, ischaemic heart disease, and mortality: a nation-wide pharmaco-epidemiologic study A Allan Linneberg1, RK Jacobsen1, L Jespersen2, SZ Abildstrom2 1Research Centre for Prevention and Health, Glostrup, Denmark, 2Dept of Cardiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark Other risk factors (Prevention & Epidemiology) Background: Subcutaneous allergen-specific immunotherapy (SCIT) is a well-documented treatment of IgE-mediated allergic disease. Little is known about potential effects of SCIT on the risk of other chronic immune-related diseases. Over the years, a few casuistic reports have caused concern that SCIT may act as a trigger of autoimmune disease. Objective: We aimed to investigate the association of SCIT with the incidence of autoimmune disease and ischemic heart disease (IHD) as well as all cause mortality. Methods: All Danish citizens without other known diseases were linked and followed through central registries on medications and hospital admissions. Persons receiving SCIT and persons receiving conventional allergy treatment (CAT) (nasal steroids or oral antihistamines) were compared with regard to mortality and development of autoimmune diseases, acute myocardial infarction (AMI), and ischaemic heart disease. Cox regression (survival analysis) with age as underlying time scale was used to estimate relative risks (hazard ratios with 95% CIs) associated with SCIT as compared to CAT, adjusted for age, sex, vocational status, and income. Results: During the 10-year study period (1997 to 2006), a total of 18,841 and 428,484 persons were followed in the SCIT and CAT group, respectively. Receiving SCIT was associated with lower mortality (0.71; 95% CI: 0.62-0.81) and lower incidence of AMI (0.70; 95% CI: 0.52-0.93), ischaemic heart disease (0.88; 95% CI 0.73-1.05), and autoimmune disease (HR 0.86; 95% CI 0.74-0.99). Conclusion: In this registry-based observational study, receiving SCIT as compared to CAT was associated with lower risk of autoimmune disease and AMI as well as lower all cause mortality. P322 Gender difference in factors associated to the Liver Steatosis Index in a large population sample: data from the Brisighella Heart Study Brisighella Heart Study, A Arrigo Cicero1, S D'addato1, F Santi1, B Gerocarni1, M Rosticci1, M Giovannini1, E Grandi1, C Borghi1 1Sant'Orsola-Malpighi Polyclinic, Department of Internal Medicine, Bologna, Italy Other risk factors (Prevention & Epidemiology) Purpose: Non-alcoholic fatty liver disease (NAFLD) is a largely prevalent emerging cardiovascular risk factor. The Liver Steatosis Index (LSI) is a validated index, useful for epidemiological evaluation of NAFLD. The aim of our study was to evaluate the factors associated to LSI in a large sample of general population. Methods: We selected the 1638 volunteers (M: 48.2%, W: 51.8%; mean age: 53.04 ± 18.06 years old) attending to the 2008 Brisighella Heart Study survey without a known history of liver disease and a known history of alcohol abuse. Then we calculated the LSI for all subjects (LSI = 8 x GOT/GPT ratio + BMI +2 if women/+2 if type 2 diabetes) and evaluated by linear regression the factors predicting the LSI level. The considered factors included working physical activity, leisure-time physical activity, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoprotein B100, apolipoprotein AI, uric acid, eGFR. Results: The selected population sample was representative of the Brisighella Heart Study historical cohort as it regards sex, age and body mass index distribution. Mean LSI was 35.78 ± 6.13, not significantly different in men and women. In an age adjusted model, the best predictor of LSI in men were LogTG (OR 9.53; 95% CI 7.66, 22.43) and leisure-time physical activity (OR −0.939; 95% CI −1.49, −0.39). In women, in an age adjusted model, the best predictor of LSI were LogTG (OR 6.33; 95% CI 4.58, 8.07) and uric acid (OR 1.27; 95% CI 0.91, 1.64). Conclusion: In a general population sample LogTG are the more strong predictor of high LSI in both genders, while leisure-time physical activity is inversely associated to LSI in men and uric acid directly in women, despite a similar LSI level. P323 Vitamin d status and incidence of cardiovascular disease and mortality T Tea Skaaby1, LL Husemoen1, C Pisinger1, T Jorgensen1, BH Thuesen1, A Linneberg1 1Research Centre for Prevention and Health, Glostrup, Denmark Other risk factors (Prevention & Epidemiology) Background: Low vitamin D status has been associated with cardiovascular disease and mortality in cross-sectional studies. Aims: We investigated the association of vitamin D status with the incidence of a registry-based diagnosis of cardiovascular disease, cardiovascular mortality, and all cause mortality. Methods: The Monica10 is a population-based study of 2,656 individuals aged 40-71 years examined in 1993-1994. Measurements of vitamin D (serum 25-OH-vitamin D) at baseline were carried out using the IDS ISYS immunoassay system. Information on cardiovascular disease and causes of death was obtained from the Danish National Patient Register and The Danish Registry of Causes of Death, respectively. Participants were followed until 31 December 2008. Results: Survival analysis with age as underlying time showed consistently lower hazard ratios for vitamin D levels above 50 nmol/l compared with levels below 50 nmol/l. In the crude models, the hazard ratios were 0.88 (p = 0.215), 0.66 (p = 0.030) and 0.68 (p < 0.0001) for cardiovascular disease, cardiovascular mortality, and total mortality, respectively. The associations remained statistically significant for cardiovascular and total mortality when adjusting for gender, social class, and season, but were only statistically significant for total mortality, when further adjusting for diet, physical activity, smoking habits, body mass index, and alcohol consumption. Conclusion: Vitamin D status may affect cardiovascular and total mortality but further studies are needed to establish causality and the underlying biological mechanisms. P324 Vitamin D status and changes in cardiovascular risk factors: a prospective study of a general population T Tea Skaaby1, LL Husemoen1, C Pisinger1, T Jorgensen1, BH Thuesen1, A Linneberg1 1Research Centre for Prevention and Health, Glostrup, Denmark Other risk factors (Prevention & Epidemiology) Background: A low vitamin D level has been associated with mortality, cardiovascular disease, type 2 diabetes, hypertension, and obesity. The vitamin D receptor is found in numerous different body tissues including vascular smooth muscle, and the cardiac muscle, raising the question of a possible direct effect on the cardiovascular system. Vitamin D could, however, affect the cardiovascular system through a number of different cardiovascular risk factors. Aims: We investigated the association of vitamin D status with 5-year changes in blood pressure, lipids, and incidence of the metabolic syndrome. Methods: A random sample of 6,784 individuals aged 30-60 years from a general population participated in the Inter99 study in 1999-2001. 4513 individuals also participated in the 5-year follow-up. Vitamin D (serum-25-hydroxyvitamin D) was measured at baseline by High-performance liquid chromatography. A total of 4330 persons with successful measurements of vitamin D were included in the analyses. Results: In linear regression analyses, triglycerides and VLDL-cholesterol significantly decreased by 0.51% (p = 0.028) and 0.65% (p = 0.005) respectively per 10 nmol/l increase in vitamin D, when adjusted for gender, age, season, lifestyle factors, body mass index, and waist circumference. In logistic regression analyses, the odds ratio per 10 nmol/l increase in vitamin D was 0.96 (p = 0.036) for the metabolic syndrome and 0.95 (p = 0.02) for hypercholesterolemia. There were no significant association between vitamin D and blood pressure. Conclusion: A low level of vitamin D may influence cardiovascular health by increasing triglyceride level and the incidence of the metabolic syndrome. P325 Impact of a national media campaign on population knowledge and intentions in relation to stroke. A Anne Hickey1, R Conroy1, D Holly1, T Cosco1, H Mcgee1, E Shelley1 1Royal College of Surgeons in Ireland, Dublin, Ireland Other risk factors (Prevention & Epidemiology) Purpose:Acute medical management of stroke is time sensitive. Appropriate response requires significant awareness of stroke warning signs and appropriate response. This study examined changes in knowledge of stroke risk factors and warning signs in response to a national mass media campaign (F.A.S.T.). Methods: In June 2009 and February 2011, 1000 members of the general adult population in the Republic of Ireland were interviewed by telephone using quota sampling based on the most recent Irish Census (2006). A mass media campaign was run from May 2010 to January 2011. Results: Wave 1 findings indicated significant gaps in knowledge of stroke warning signs. 71% and 72% of respondents could identify 2 or more stroke risk factors in waves 1 and 2 of the surveys, respectively. Knowledge of stroke warning signs increased from 30.7% to 68.7% (OR 4.9, p < .0001) between survey waves. Numbers who would call an ambulance in response to stroke increased from 47.1% to 57.6% (OR 1.5, p < .001). Conclusions: Results of this survey indicate that the first waves of the FAST campaign had a very significant positive impact on population awareness of stroke warning signs in Ireland. Where gaps in knowledge are in evidence, there is the opportunity for ongoing public education efforts. P326 Cardiovascular multimorbidity in primary care: the Clarity study. J Mulqueen1, AW Murphy1, LG Glynn1 1National University of Ireland, Galway, Ireland Other risk factors (Prevention & Epidemiology) Purpose: Cardiovascular multimorbidity (simultaneous coexistence of two or more of the conditions of cardiovascular disease, diabetes mellitus and chronic kidney disease) is an independent predictor of morbidity and mortality but little data exists on its prevalence, cardiovascular risk management, psychosocial impact and healthcare utilisation in the community. The study's objective was to examine cardiovascular multimorbidity prevalence and associated cardiovascular risk management, psychosocial measures and healthcare utilisation rates in patients ≥ 50 years of age in a representative Irish primary care population. Methods: A cross-sectional observational study was carried out in the West of Ireland within a University-affiliated primary care research network. Individuals with cardiovascular disease, diabetes mellitus and chronic kidney disease were identified. Factors associated with the management of cardiovascular risk, psychosocial measures and healthcare utilisation were recorded. Results: Of the seventeen practices invited to participate in the study eleven agreed to take part. In the sample of 9698 patients ≥ 50 years of age, 794 (8%, 95% CI 7.65-8.75) had cardiovascular disease; 637 (7%, 95% CI 6.08-7.08) had diabetes and 812 (8%, 95% CI 7.83-8.94) had chronic kidney disease. This study found that 778 patients (8%, 95% CI 7.49-8.58) had cardiovascular multimorbidity while 118 patients (1.22%, 95% CI 1.01-1.46) had cardiovascular disease, diabetes and chronic kidney disease. Patients with cardiovascular multimorbidity had a significantly higher average number of other comorbidities than patients without cardiovascular multimorbidity (p-value<0.001). Patients with cardiovascular multimorbidity had poorer scores in all psychosocial measures examined (p-values <0.001 and linear regression models fitted), higher healthcare utilistation rates in all forms of healthcare utilisation studied (p-values <0.001 and linear regression models fitted) but overall better management of cardiovascular risk than patients with none or one of the three index conditions. Conclusions: Cardiovascular multimorbidity is very common in primary care and is associated with poorer psychosocial outcomes and increased healthcare utilisation, resulting in increased healthcare cost. However, there is evidence that cardiovascular risk factor control is more intensively managed in patients with cardiovascular multimorbidity. Recognition of cardiovascular multimorbidity may therefore be a key step in improving standards of care and risk factor management in patients with cardiovascular disease, diabetes and chronic kidney disease. P327 Impact of gender on the prognosis of elderly patients admitted for non-st-segment elevation acute coronary syndrome M A Miguel Angel Ramirez-Marrero1, B Perez-Villardon1, D Gaitan-Roman1, I Vegas-Vegas1, JL Delgado-Prieto1, G Ballesteros-Derbenti1, M De Mora-Martin1 1Regional Hospital Carlos Haya, Malaga, Spain Other risk factors (Prevention & Epidemiology) Introduction: The influence of gender on the prognosis of non-st-segment elevation acute coronary syndrome (NSTEACS) is a controversial issue today. Very few data are found in the medical literature refering to the subgroup of elderly patients. Our objective was to analyse the prognostic impact of gender in elderly patients (defined as age ≥ 70 years) admitted with NSTEACS. Methods: Retrospective analysis of all elderly patients admitted in our hospital consecutively for NSTEACS, from January 2004 to December 2005, with a median follow-up of 20 months. Specific prognostic variables were studied during this period, establishing an adjusted analysis of gender impact on them. Results: A total of 297 patients were included, 132 of whom were women (44.4%); women group had a higher prevalence of hypertension (74.2% versus 28.5%, p = 0.02) and diabetes (48.5% versus 38.2%, p = 0.04). Men group had more common a prior history of ischemic heart disease (62.4% versus 45.5%, p = 0.003) and previous coronary revascularization (22.4% versus 9.8%, p = 0.003). Women had a higher percentage of angiographically normal coronary arteries (21.1% versus 7.9%, p = 0.008) and received less antiplatelet prescription (75.8% versus 88.8%, p = 0.003), beta-blockers (50.8% versus 67.5%, p = 0.003) statins (44.5% versus 64.4%, p = 0.001) and ACE inhibitor-ARA-II (76.6% versus 56, 3%, p = 0.0001). There were no gender differences in in-hospital mortality rates (8.3% versus 8.5%, p = 0.5), but greater numbers of cardiovascular mortality after follow-up in women were found (14.5% versus 5.5%, p = 0.01). Moreover, heart failure (HF) was more frequent in women in acute phase and also after follow-up (33.3% versus 17.6% and 27.4% versus 7.5%, p = 0.0001, respectively). Although, after adjustment, gender did not influence in mortality; female sex predicted greater risk of HF either in-hospital (OR 2.1, 95% CI, 1.2 to 3.9) and after long-term follow-up (OR 4.9, 95%, 2.2 to 11.2). Conclusions: In our series, there were no prognostic differences in terms of mortality in elderly patients admitted with NSTEACS in relation to gender. In the serie analysed, women had an increased risk of heart failure both, in acute phase and after follow-up. P328 Prognostic repercussion of advanced renal failure in patients admitted for non-st segment elevation acute coronary syndrome M A Miguel Angel Ramirez-Marrero1, B Perez-Villardon1, D Gaitan-Roman1, I Vegas-Vegas1, JL Delgado-Prieto1, G Ballesteros-Derbenti1, M De Mora-Martin1 1Regional Hospital Carlos Haya, Malaga, Spain Other risk factors (Prevention & Epidemiology) Introduction and objectives: Renal insufficiency is an established independent cardiovascular risk factor, often underestimated by considering only the creatinine levels in patient's plasma. Our objective was to analyse the influence on long-term prognosis of advanced renal insufficiency (RI) (defined as renal clearance <60 ml/min/1,73m2 by MDRD abbreviated formula) in patients admitted for non-st-segment elevation acute coronary syndrome (NSTEACS). Materials and methods: Retrospective analysis of all patients admitted in our hospital consecutively for NSTEACS, from January 2004 to December 2005; in 96.4% of cases, we completed a median follow-up of 24 months. Results: A total of 715 patients were included, 70.6% of whom were male; the average age was 66.3 ± 11.3 years. 172 patients (24.1%) had RI according to the abbreviated MDRD formula, a percentage much higher than the one obtained just having in mind the plasma creatinine levels (36 patients, 5%). Patients with RI were older (73.1 ± 11.5 versus 57.8 ± 15.4, p = 0.0001) and had greater comorbidity (Charlson index 3.6 ± 1.6 versus 0.7 ± 1, p = 0.0001). Patients with RI had worse long-term prognosis, with higher cardiovascular mortality (37.5% versus 5.9%, p = 0.0001) and major cardiovascular events (67.3% versus 37.5%, p = 0.0001). After adjustment, the presence of RI was associated with an increased risk of developing major cardiovascular events during follow-up (OR 2.04, 95% CI, 1.34 to 3.09). Conclusions: Advanced renal failure is an extremely important prognostic factor in NSTEACS, as two thirds of these patients developed cardiovascular complications during long term follow-up. It is necessary to be diagnosed by more reliable methods than the single determination of plasma creatinine levels. P329 The influence of partial and radical nephrectomy on cardiovascular risk factors M Magdalena Rostek1, M Dluzniewski1, AA Antoniewicz2, A Borowka2, W Pikto-Pietkiewicz1 1Medical University of Warsaw, Brodnowski Hospital, Warsaw, Poland, 2The Medical Centre of Postgraduate Education, Department of Urology, Warsaw, Poland Other risk factors (Prevention & Epidemiology) Aim: Chronic kidney disease is cardiovascular (CV) risk factor. Impact of sudden loss of renal excretory and hormonal function after surgical removal of whole kidney (radical nephrectomy, RN) or partial resection of kidney (PN) on CV system is not known. We investigated changes in CV risk factors after the urologic surgery in 1-year prospective follow-up. Methods: Patients referred to nephrectomy were assessed on the basis of clinical and biochemical data. The examinations were performed before, 3 and 12 months after the surgery. Results: 59 pts (32 men, 17 women) with diagnosis of renal tumour were included. Radical one-sided nephrectomy was performed in 40 pts and partial nephrectomy was performed in 19 pts (34%). 1-year follow-up was performed fully in 52 pts. Mean age of the cohort was 62,9 years (42-78 yrs). Diabetes, dyslipidemia and smoking were more common in the RN group than in the PN group. In both groups there was a significantly high percentage of patients with hypertension amounting to 75%. Overweight and obese patients were prevalent in both study groups: 32 (82%) in the RN group and 17 (89%) in the PN group. During the study, a tendency towards body mass increase was observed in both groups, which was statistically significant in the RN group. No significant changes in blood pressure were observed in either subgroup. One sided nephrectomy was connected with fall of estimated GFR in one year follow-up and it was significant in RN group (from 71,48 ± 19,1 to 50,21 ± 14,44 ml/min; p < 0,001). A significant increase in the concentration of uric acid was observed in the RN group: 334.8 ± 74.1 µmo/l at baseline, 374.7 ± 73.18 µmol/l 3-4 months after nephrectomy and 383.7 ± 80.5 µmol/l 12 months after nephrectomy (p < 0.001). Similar changes in uric acid concentrations were not found in the PN group. The lipid panel showed a tendency to an elevated triglyceride level in the RN group and a decreased high-density lipoprotein level in the PN group. Conclusion: This study identified a relatively frequent occurrence of CV risk factors in the RN group, especially hypertension and obesity. It was proved that radical nephrectomy is associated with a significant increase in body mass, risk of CKD, hyperuricemia and hypertrigliceridemia, in contrast to a partial nephrectomy procedure. P330 Relative coronary risk in young individuals I Irina Osipova1, E Lukerenko1, A Osipov1, S Silkina1, E Pravdina1, L Makarova2 1Altay State Medical University, Barnaul, Russian Federation, 2Altai Regional Clinical Hospital, Barnaul, Russian Federation Other risk factors (Prevention & Epidemiology) Objectives: To study the frequency of factors forming relative summarized coronary risk (RR) in the patients younger 40 years for both men and women. Materials and methods: 745 individuals with no revealed cardiovascular disease and D at the age of 18-39 years (average age 24 ± 0,3 years) were examined. Smoking frequency, office blood pressure (BP), total cholesterol, relative risk SCORE were investigated. 76,5% were female, 23,5% were male. Results: The frequency of individuals with hypercholesterolemia (HCS) was 31,7%, with smok-ing frequency - 25,8%. The frequency of individuals with hypertension (H) was 3,2%. In women compared with men the frequency of HCS was 9,2% higher (((p > 0,05), 33,9% and 24,7%), whereas smoking frequency was higher in men ((p < 0,05), 40,8% и 21,2%). The frequency of hypertension was not significantly gender-related (among men 5,7% and among woman - 2,5%). While assessing the relative coronary risk it was revealed that 98,2% of women had moderate RR, 1,8% had high RR (including manifested singular risk factor - 1,1%); 54,6% of men had moderate RR, 37,9% had high RR (including manifested singular risk factor - 1,7%), the highest RR - 7,5%. Conclusions: Analysing the factors of forming relative summarized coronary risk (RR), the highest frequency of HCS and smoking are revealed in both genders. Almost half of the young men has high and the highest relative coronary risk (45,4%). Thus, the assessment of relative co-ronary risk in young men helps to define the individuals with unfavorable prognosis for cardiovascular disease and motivates them to make better life-style. P331 Resting heart rate: a cardiovascular risk predictor for healthy middle aged men M Hellstrom1, L Hellstrom1, J Joep Perk2 1Kalmar County Public Health Institute, Oskarshamn, Sweden, 2Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden Other risk factors (Prevention & Epidemiology) Background: During the past decade several studies have indicated an association between elevated resting heart rate (RHR) and mortality or coronary heart disease (CHD) morbidity. The aim of this study was to investigate if this applies to a non-selected cohort of healthy 40-year old men followed over a period of 20 years. Is an elevated RHR in middle-aged men still a risk marker for mortality and coronary heart disease morbidity once adjusted for the most common coronary heart disease risk factors and can a cut-off RHR level for an increased risk be identified? Methods: The cohort consisted of 1407 men, 40 years of age, invited to attend a general health check and lifestyle counselling at the Kalmar County Public Health Unit, Sweden. At this investigation a wide range of blood samples were collected, RHR and blood pressure was measured and a fitness test was performed. With data collected from hospital and primary care files and from the National Death Register we analysed the effect of RHR on the end points total mortality and coronary heart disease, using the Cox proportional hazards model. Result: There were 62 deaths and 101 patients had suffered from coronary heart disease as age proceeded from 40 to 60 years; 118 were lost from follow-up or had moved away from the region; 110 had pre-existing cardiovascular disease, antihypertensive therapy or diabetes and were excluded from the analysis. The hazard ratio coronary heart disease morbidity was 1.53 (1.06-2.20) for RHR 65-80 beats/min and 2.34 (1.48-3.70) for RHR >80 beats/min, adjusted for heredity, smoking, physical activity, physical fitness, body mass index, blood-pressure, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. A similar outcome was observed for total mortality: the adjusted hazard was 1.54 (1.08-2.29) RHR 65-80 beats/min and 2.38 (1.08-5.24) RHR >80 beats/min. Conclusions: An independent relationship between resting heart rate and incident of coronary heart disease and total mortality was demonstrated among healthy middle aged men, during a twenty years follow-up. We suggest that using RHR might be of interest as an add-on option for improved cardiovascular disease risk assessment in this specific male age group as the conventional SCORE algorithm for 40-year old men tends to show low mortality percentages. P332 The relationship between alcohol intake and selected cardiovascular risk factors in Polish men E Elzbieta Sygnowska1, A Piwonska1, A Waskiewicz1 1Institute of Cardiology, Department of cardiovascular disease Epidemiology & Prevention & Health Promotion, Warsaw, Poland Other risk factors (Prevention & Epidemiology) Cardioprotective effects of alcohol recently gained wide spread interest and have been examined in several studies. Purpose: Estimation of relationship between alcohol intake and selected cardiovascular risk factors in adult Polish men. Methods: In 2003-2005 in the frame of National Multicentre Health Survey (WOBASZ) a random sample of Polish men aged 20-74 were examined. Data on anthropometric parameters, blood pressure, lipid and glucose measurements were collected. The annual beer, wine and vodka intake was assessed using a standardized questionnaire and calculated for a daily pure ethanol intake. The studied subjects were divided into four groups according to average alcohol consumption (non-drinkers, light drinkers, ≤ 15.00g ethanol/day; moderate drinkers, 15.01-30.00g ethanol/day; heavy drinkers, >30.00g ethanol/day). Results: Among the 6912 men over 72% were light, 13% moderate, 7% heavy drinkers and 7% non-drinkers. The mean ethanol intake was 4.7g/day in light, 20g/day in moderate and 54g/day in heavy drinkers. Differences in age, education level, income, smoking status, physical activity between studied groups were find. Higher HDL-cholesterol, triglycerides, homocysteine and blood pressure were observed with increasing alcohol intake. In multivariate logistic analyses, adjusted for age, education level, income, smoking status, physical activity, the alcohol intake was significantly associated with hypertension (OR = 1.37, 95%CI 1.15-1.63 for moderate, OR = 1.52, 95% CI 1.21-1.90 for heavy drinkers as compared to light drinkers), with elevated cholesterol level (OR = 1.34, 95% CI 1.12-1.59 and OR = 1.53, 95% CI 1.21-1.94 respectively), with elevated triglycerides level (OR = 1.25, 95% CI 1.05-1.48 and OR = 1.46, 95% CI 1.17-1.83 respectively) and with elevated homocysteine level in heavy drinkers (OR = 1.95, 95% CI 1.42-2.66). Probability of elevated cardiovascular risk factor for non drinkers did not differ from light drinkers, excluding elevated cholesterol level (OR = 0.64, 95% CI 0.52-0.79). Conclusion: Moderate and heavy drinkers displayed worse cardiovascular risk profile then light drinkers. P333 Knowledge of risk factors for cardiovascular diseases in development of healthy lifestyle habits among third-year students at Wroclaw medical university D Kalka1, Z A Domagala2, L Rusiecki1, P Koleda1, M Mical1, L Kipinski1, T Szawrowicz-Pelka1, A Bielous-Wilk1, T Sebzda1, W Pilecki1 1Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland, 2Wroclaw Medical University, Departament of Normal Anatomy, Wroclaw, Poland Other risk factors (Prevention & Epidemiology) Introduction: Modifiable risk factors (MRF) for cardiovascular diseases (CVD) have proven significance in their pathogenesis. Knowledge of the significance of these factors in the development of cardiovascular disease should influence the formation of healthy lifestyle habits. Aim of study: Assessment of knowledge of chosen MRF for cardiovascular disease among medical students and analysis of the influence of this knowledge on following recommendations and developing a healthy lifestyle. Materials and methods: The study was conducted between 2008 and 2011 on a group of 1377 third-year students at Wroclaw Medical University (average age 21.68 ± 1.54). Knowledge of the influence of chosen MRF on cardiovascular disease was assessed. The risk factors included: smoking tobacco, not following dietary recommendations for cardiovascular disease prevention, excessive body mass and low intensity of leisure-time physical activity (LTPA) (<1000 kcal/week). Intensity of LTPA was assessed using the Framingham questionnaire. Intensity of other factors was determined using a survey designed for the study. Results: Smoking tobacco as a risk factor for cardiovascular disease was indicated by 70.08% of respondents, 76.48% of whom followed recommendations and did not smoke. In the subgroup not indicating this risk factor, i.e. in 29.92% of the test population, recommendations were followed statistically relevantly (p < 0.0001) by a higher percentage of respondents, constituting 87.62% of this subgroup. Inappropriate body weigh as a risk factor for cardiovascular disease was indicated by 54.03% of the test population, 88.17% of whom followed recommendations. The subgroup not indicating this factor constituted 45.97% of the test group, and 87.36% of these respondents followed recommendations. Both these subgroups did not differ statistically significantly. Not following dietary recommendations as a risk factor for cardiovascular disease was indicated by 84.79% of the test population, 56.96% of whom followed recommendations. The subgroup not indicating this factor constituted 15.21% of the test group, and 49.44% of these respondents followed recommendations. Both these subgroups did not differ statistically significantly. Too low intensity of LTPA as a factor for cardiovascular disease was indicated by 85.33% of the test population, 47.91% of whom followed recommendations. The subgroup not indicating this factor constituted 14.66% of the test group, and 51.49% of these respondents followed recommendations. Both these subgroups did not differ statistically significantly. Conclusions: Awareness of the significance of MRF in the development of cardiovascular disease does not influence the formation of healthy lifestyle habits in the population of young people. P334 Relation between high sensitivity C-reactive protein and intima media thickness in middle aged men and women K Krystyna Szafraniec1, B Sobien2, M Desvarieux3, JP Touboult4, P Podolec2, A Pajak1 1Jagiellonian University Medical College, Department of Epidemiology & Population Studies, Krakow, Poland, 2Jagiellonian University Medical College (CMUJ), Krakow, Poland, 3Columbia University, New York, United States of America, 4INSERM, Paris, France Other risk factors (Prevention & Epidemiology) Elevated high sensitivity C-reactive protein (hs-CRP) increases risk of stroke and myocardial infarction. Less is known on the relation between hs-CRP and development of atherosclerosis. Goal: to assess the relation between hs-CRP and carotid atherosclerosis intima media thickness index. Design of the study: prospective. Studied group and methods 446 men and 491 women aged 46 to 70 years, residents of Krakow, subsample of the Polish part of the HAPIEE cohort. Hs-CRP was measured at baseline using immunonephelometric method by the BN II Analyser. Intima-media thickness was measured after 4 to 6 years (mean 4.9 years) by ultrasonographic method according to Mannheim consensus. Hs-CRP concentrations were grouped in tertiles and the differences were evaluated by 1-way ANOVA with Bonferroni correction. Results: intima-media thickness was significantly larger on the left side compared with the right (p < 0.01). Mean IMTmax, IMTmin, and IMTmean measured on both sides were significantly higher in men (p = 0.02). There was no significant difference in hs-CRP by gender. After adjustement for age and gender, all three intima-media thickness parameters were lowest in the first tertile of CRP, i.e. below 0.84 mg/l (see figure). Adjustment for smoking, total cholesterol, diabetes mellitus, systolic blood pressure and body mass index did not attenuate the differences between the groups, however, adjustment for SBP and body mass index waved statistical significance. Conclusions: Observed relation between CRP and intima-media thickness was largely influenced by a strong interrelations between SBP, body mass index and intima-media thickness. Open in new tabDownload slide P335 Alcohol consumption patterns in a cohort of patients attending a community based cardiovascular disease prevention programme M Smyth1, M Mc Namara1, I Gibson2, C Kerins2, J Jones3, S Connolly4, J Crowley5, G Flaherty1 1National University of Ireland, Galway, Ireland, 2Croí, West of Ireland Cardiac Foundation, Galway, Ireland, 3Imperial College London, London, United Kingdom, 4Imperial College Healthcare NHS Trust, London, United Kingdom, 5Galway University Hospital, Galway, Ireland Other risk factors (Prevention & Epidemiology) Purpose: Excessive alcohol consumption is a risk factor for the development of cardiovascular disease (CVD). The alcohol consumption patterns of individuals at risk of developing cardiovascular disease have not been well characterised. We describe the alcohol usage profile of individuals attending a 16-week comprehensive cardiovascular disease prevention programme. Methods: A retrospective analysis of data from participants and their partners completing the programme was performed. Participants were at increased or high risk of developing cardiovascular disease or had been diagnosed with type 2 diabetes or peripheral arterial disease. Alcohol intake pre and post programme and also at one year follow-up was examined as well as correlation between alcohol intake and blood pressure, lipids, glycaemia and waist circumference was assessed at baseline. Results: There was a statistically significant reduction in alcohol consumption from initial assessment (IA) to end of programme (EOP, n = 249) and at 1 year (n = 161). Thirty percent of male and 16.2% of female participants reported weekly alcohol usage exceeding recommended levels. Median alcohol consumption for all patients consuming any alcohol reduced from 12 units at IA to 8 units at EOP and 7.5 units at 1 year (p < 0.001). There was a greater reduction in alcohol intake in male patients from IA to EOP (p = 0.001) and from IA to 1 year (p = 0.038). Furthermore, there was a positive correlation between baseline alcohol usage and blood pressure (p = 0.032), triglycerides (p = 0.003), fasting glucose (p < 0.001) and waist circumference (p = 0.016) at the baseline assessment. Conclusion: This study highlights unhealthy alcohol usage patterns in this group as well as correlation with other established cardiovascular risk factors. It also underscores the importance of alcohol education in primary cardiovascular disease prevention programmes. P336 Can a novel community screening and brief intervention initiative achieve lifestyle changes and cardiovascular risk factor reductions in a high-risk population who do not attend general practice? A Houlihan1, I Gibson1, S Hennessey2, L Gaughan3, J Crowley2 1Croí, the West of Ireland Cardiac Foundation, Galway, Ireland, 2University Hospital Galway, Galway, Ireland, 3Mayo Primary, Community and Continuing Care, Mayo, Ireland Other risk factors (Prevention & Epidemiology) Purpose: To identify and target high-risk individuals for cardiovascular disease (CVD) through a community-based comprehensive risk factor screening and brief intervention initiative. Methods: This nurse-led programme offered free 25-minute assessments of cholesterol, glucose, blood pressure, body mass index, waist circumference, physical activity levels and diet in novel community settings such as farmers' marts, community centres etc. The criteria included individuals over 40 years who had not attended their GP for a cholesterol check in the previous year. Individuals not reaching the ESC targets for cholesterol, blood pressure and glucose were referred to their GP and followed up at 6 months. Results: Of the 1541 individuals that were assessed, 78% had not been to their GP for a cholesterol check in over a year. The prevalence of risk factors was high; 49% had raised cholesterol (TC>5mmol/l and/or LDL > 3mmol/l); 40% had raised blood pressure >140/90mmHg; 33% were physically inactive; 33% were obese. 21% of those screened had a cardiovascular disease risk SCORE > 5%. In total, 64% were referred to General Practice for further follow-up, with 61% attending their GP as advised.79% returned for review at 6 months. This brief intervention initiative achieved significant improvements in lifestyle and reductions in risk factors in this high-risk population, with 16% (p < 0.001) reducing their cholesterol to ESC target levels, and 29% (p < 0.001) reducing their blood pressure to target. Self-reported improvements to diet (65%) and exercise (33%) were recorded. 9% were newly diagnosed with Type 2 Diabetes and 8% quit smoking. Conclusion: A high proportion of individuals who do not attend their GP on a regular basis have multiple risk factors for cardiovascular disease. This study demonstrates the success of applying a novel approach to the identification of high-risk individuals outside of the traditional health care setting, resulting in increased follow-up at General Practice and significant improvements in lifestyle and reductions in risk factors at 6 months. P337 Mortality in male and female joggers The Copenhagen City Heart Study, P Schnohr1, JL Marott1, P Lange2, GB Jensen2 1The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark, 2Hvidovre Hospital - Copenhagen University Hospital, Hvidovre, Denmark Other risk factors (Prevention & Epidemiology) Purpose: To investigate if jogging is associated with an increased risk of all-cause mortality in men and women. Until now, only one minor study has found a lower mortality in 96 male joggers compared to 4,335 non-joggers (BMJ 2000;321:602-603). Methods: In a prospective cardiovascular population study comprising a random sample of 23,891 men and women invited to four examinations from 1976 to 2003, 18,974 participated. In this analysis, we excluded participants with a history of coronary heart disease, stroke, or cancer, leaving 17,636 healthy people, 8,145 men and 9,491 women, for analysis. The traditional cardiovascular risk factors including high-sensitivity C-reactive protein were assessed. The joggers were asked about their weekly quantity of jogging (minutes), own perception of pace (slow, average, fast), and number of jogging-sessions per week. Estimates of relative risks of all-cause mortality were calculated using Cox proportional hazards regression analysis with time-dependent covariates and age as underlying timescale and delayed entry accordingly. All models were sex-stratified and adjusted for a) age; b) confounders (age, smoking, education, income, drinking habits, diabetes); c) confounders and leisure time physical activity; d) confounders, leisure time physical activity, and mediators (resting heart rate, cholesterol, body mass index, systolic blood pressure, blood pressure medication). The expected lifetime was calculated by integrating the predicted survival curve estimated in the Cox model. Results: During the follow-up period of maximum 35 years we registered 10,158 deaths among the non-joggers, and 122 deaths among the 1,116 male and 762 female joggers. The age-adjusted hazard ratio (95% CI) of jogging was 0.48 (0.40-0.59) for men and 0.49 (0.35-0.68) for women. Adjusted for confounders the hazard-ratios were 0.62 (0.52-0.75) and 0.54 (0.38-0.76), respectively. Similar results were seen in model c) and d) although overadjustment could be present. All results were highly significant. There was no interaction between jogging and gender. Joggers had lower CRP than non-joggers. There was a strong negative association between jogging pace and CRP (P < 0.001), the faster the pace, the lower CRP. The age-adjusted survival benefit of jogging was 7.9 years in men and 7.4 years in women. Adjusted for confounders the survival benefits were 5.0 years and 5.9 years, respectively. Conclusions: This study showed that jogging in both men and women was associated with significantly lower all-cause mortality and a substantial survival benefit. P338 Conventional cardiovascular risk factors and their prognostic role in a choort of post-menopausal women. The long-term follow-up of the “Bene Essere Donna” patients Y Ylenia Bartolacelli1, E Giubertoni1, G Origliani1, R Rossi1, MG Modena1 1University of Modena & Reggio Emilia, Department of Cardiology, Modena, Italy Other risk factors (Prevention & Epidemiology) Purpose: Conventional major cardiovascular risk factors (cigarette smoking, hypercholesterolemia, hypertension, diabetes, and age) fail to explain nearly 50% of cardiovascular events in the general population. This topic was virtually unexplored in the specific population of postmenopausal women. Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention. The aim of this study was to examine the association between cardiovascular events and the major cardiovascular risk factors in a cohort of initially asymptomatic post-menopausal women. Methods: We conducted a prospective study on 603 post-menopausal women, aged 62 ± 6 years, who voluntary accessed to the “Ben Essere Donna Center”, Clinic born to study, prevent and treat menopause-related disorders. These women were followed-up for a mean period of 82 ± 28 months (range 57 to 108 months). Results: During observation, 59 major adverse events were recorded (9.8% of the entire population). Cox multivariable analysis revealed that, between conventional major cardiovascular risk factors, the only independent predictors of prognosis in postmenopausal women resulted: presence of hypertension (Hazard Ratio:1.26, I.C. = 1.0-1.6; p = 0.04) and, particularly, the number of antihypertensive drugs (rPearson = 0.42; p < 0.001). Conclusions: In post-menopausal women, only the the presence of hypertension, and, particularly the strenght of this affection (expressed by number of drugs used to control blood pressure values) provide independent prognostic information regarding the risk of developing adverse cardiovascular events. Open in new tabDownload slide P339 Chronic kidney disease in Ireland G Gemma Browne1, IJ Perry1, JA Eustace2 1Dept of Epidemiology and Public Health, University College Cork, Cork, Ireland, 2Cork University Hospital, Cork, Ireland Other risk factors (Prevention & Epidemiology) Background: Chronic Kidney Disease (CKD) is an independent predictor for cardiovascular disease and is associated with hypertension, obesity, diabetes and age. This study describes stages of estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR) in Ireland. In Ireland at present the MDRD equation is universally used in clinical practice to estimate renal function. This is the first population based estimate in Ireland. Methods: A population based cross-sectional study of adults was conducted using data from the 2007 Survey of Lifestyle, Attitudes and Nutrition (SLAN). A representative sample of 1,207 adults aged 45 and over, underwent a comprehensive physical examination including serum and urinalysis. Demographically this sample was similar to 2006 national census data. Using regression equations recalibrated MDRD and CKD-EPI, eGFR was calculated from a single serum creatinine. Spot Urine Albumin Creatinine ratio (ACR mg/g) was measured. Results: eGFR <60 ml/min/1.73 m2 based on the CKD-EPI regression equation occurred in 12.1% (95%CI 10.3-14%). ACR >30mg/g occurred in 13.2% (95%CI 11.2-15.2%). ACR >30mg/g varied from 11.1% in GFR Stage 1 to 100% in GFR stage 4-5. Using the MDRD equation, more subjects were categorised as eGFR<60, and similarly more subjects were described as GFR Stage 2 compared to GFR Stage 1 (Table 1). Younger and female subjects were more likely to be categorised as a lower GFR using the MDRD equation. Conclusions: Lower estimates of GFR, which may be dependent on the method of estimation, can impact on the individual and their risk profile. The MDRD equation has widespread use in Ireland and in the UK. The CKD-EPI formula results in higher estimated GFR. Albuminuria, as an additional measure of cardiovascular risk, is prevalent in this population. GFR Stages (G1-5) by CKD-EPI & MDRD ALL N = 1160* (95%CI) GFR Stages CKD-EPI MDRD G1 33.2% (30.9, 36.3%) 19.2% (17, 21.5%) G2 54.22% (51.4, 57.1%) 65.5% (62.8, 68.3%) G3A 9.22% (7.6, 10.9%) 11.98% (10.1, 13.9%) G3B 2.5% (1.6, 3.4%) 2.84% (1.9, 3.8%) G4-5 0.43% (0.05, 0.8%) 0.43% (0.05, 0.8%) ALL N = 1160* (95%CI) GFR Stages CKD-EPI MDRD G1 33.2% (30.9, 36.3%) 19.2% (17, 21.5%) G2 54.22% (51.4, 57.1%) 65.5% (62.8, 68.3%) G3A 9.22% (7.6, 10.9%) 11.98% (10.1, 13.9%) G3B 2.5% (1.6, 3.4%) 2.84% (1.9, 3.8%) G4-5 0.43% (0.05, 0.8%) 0.43% (0.05, 0.8%) * Subjects with an available serum creatinine Open in new tab GFR Stages (G1-5) by CKD-EPI & MDRD ALL N = 1160* (95%CI) GFR Stages CKD-EPI MDRD G1 33.2% (30.9, 36.3%) 19.2% (17, 21.5%) G2 54.22% (51.4, 57.1%) 65.5% (62.8, 68.3%) G3A 9.22% (7.6, 10.9%) 11.98% (10.1, 13.9%) G3B 2.5% (1.6, 3.4%) 2.84% (1.9, 3.8%) G4-5 0.43% (0.05, 0.8%) 0.43% (0.05, 0.8%) ALL N = 1160* (95%CI) GFR Stages CKD-EPI MDRD G1 33.2% (30.9, 36.3%) 19.2% (17, 21.5%) G2 54.22% (51.4, 57.1%) 65.5% (62.8, 68.3%) G3A 9.22% (7.6, 10.9%) 11.98% (10.1, 13.9%) G3B 2.5% (1.6, 3.4%) 2.84% (1.9, 3.8%) G4-5 0.43% (0.05, 0.8%) 0.43% (0.05, 0.8%) * Subjects with an available serum creatinine Open in new tab P340 Association between nitrogen oxide synthase (NOS) single-nucleotide polymorphisms and coronary heart disease and hypertension in the INTERGENE study A Anna Levinsson1, A-C Olin1, L Bjorck2, A Rosengren2, F Nyberg1 1Sahlgrenska Academy, University of Gothenburg, Department of Public Health and Community Medicine, Gothenburg, Sweden, 2Sahlgrenska Academy, University of Gothenburg, Department of Emergency and Cardiovascular Medicine, Gothenburg, Sweden Other risk factors (Prevention & Epidemiology) Purpose: Nitric oxide (NO) is involved in diverse functions throughout the human body and is synthesized by specific nitric oxide synthase (NOS) enzymes, with three distinct isoforms: neuronal nitric oxide synthase (coded by the NOS1 gene), endothelial nitric oxide synthase (NOS3 gene) and inducible nitric oxide synthase (NOS2 gene). Single nucleotide polymorphisms (SNPs) in nitric oxide synthase genes have been associated with cardiovascular pathology and outcomes, including endothelial dysfunction, inflammation and myocardial infarction. Our aim was to investigate which nitric oxide synthase gene variants are most strongly associated with coronary heart disease (CHD) and hypertension (HTN), using a set of tagging SNPs with good coverage across the 3 genes. Methods: coronary heart disease cases (n = 606; 29% women) and randomly selected population controls (n = 2797; 53% women), from the greater Gothenburg area in Sweden, were genotyped at 58 SNPs in the three nitric oxide synthase genes. Hypertensives were defined as individuals in the population control sample with systolic blood pressure (SBP) ≥ 140, diastolic blood pressure (DBP) ≥ 90 or on antihypertensive medication. Each of the 58 SNPs was coded to each of the additive, recessive and dominant genetic models. Stepwise logistic regression model selection was used to select the SNPs most strongly associated with coronary heart disease and HTN, and to determine the best-fitting genetic model for each selected SNP when accounting for other selected SNPs in a multi-SNP model. We estimated odds ratios (OR) with 95% confidence intervals (CI). Final models were adjusted for age, sex, low-density lipoprotein, high-density lipoprotein, body mass index, diabetes status, smoking status, and for coronary heart disease also for SBP. Results: In the population control sample, 41.5% (n = 1158) were hypertensive. NOS1 showed most consistent association with both phenotypes, the T-allele of the NOS1 SNP rs3782218 being associated with both coronary heart disease and HTN, OR 0.62 (95%CI) (0.46-0.82) and 0.80 (0.67-0.96), respectively. For coronary heart disease, another NOS1 SNP (rs2682826) also showed independent effect, and for HTN additional associations were seen for two NOS3 SNPS (rs3918226, previously associated with HTN in GWAS data, and rs3918227) and NOS2 SNP rs2255929. Conclusions: We found a strong previously unreported association between NOS1 SNP rs3782218 and both coronary heart disease and HTN, and confirmed NOS1 as the most important nitric oxide synthase risk gene for coronary heart disease. Variants in all three nitric oxide synthase genes were seen to be associated with HTN. P341 Clinical characteristics and course of patients entering cardiac rehabilitation with chronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation (ISYDE) ISYDE - 2008 Investigators, F Francesco Giallauria1, F Fattirolli2, R Tramarin3, R Griffo4, M Ambrosetti5, C Riccio6, PL Temporelli7, C Vigorito1 1University Hospital Federico II, Naples, Italy, 2Careggi University Hospital, Department of Critical Care Medicine and Surgery, Florence, Italy, 3Cardiac Rehabilitation Unit, Fondazione Europea di Ricerca Biomedica - Onlus, Cernusco S/N (MI), Italy, 4ASL 3 Genovese, La Colletta Hospital, Cardiac Rehabilitation Unit, Arenzano, Italy, 5Le Terrazze Clinic, Cardiovascular Rehabilitation Unit, Cunardo, Italy, 6S. Anna-S. Sebastiano Hospital, Department of Cardiology, Caserta, Italy, 7Salvatore Maugeri Foundation, IRCCS, Division of Cardiology Rehabilitation, Veruno, Italy Other risk factors (Rehabilitation & Implementation) Purpose: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide insight into the characteristics and clinical course of patients with chronic kidney disease (CKD) admitted to Cardiac Rehabilitation (CR) programs. Methods: Data from 165 CR units were collected online from January 28th to February 10th, 2008. Results: The study cohort consisted of 2281 patients (66.9 ± 11.8 yrs); 200 (71.3 ± 12.2 yrs, 66% male) CKD patients and 2081 (66.3 ± 11.6 yrs, 74% male) non-CKD patients. Compared to non-CKD, CKD patients were older and their admission diagnosis of acute myocardial infarction, myocardial revascularization or heart failure was more frequent. They also showed more cardiac and non cardiac comorbidities, mostly diabetes, chronic obstructive lung disease and cognitive impairment. During the course of CR, CKD patients had reduced access to exercise functional evaluation, more complications (particularly atrial fibrillation, worsening of chronic kidney disease and anaemia) requiring more intense medical treatment, and longer length of in-hospital stay. CKD patients were less likely discharged at home (88% versus 91%, p = 0.05), were more likely transferred to the intensive care units (8% versus 4%, p = 0.005), and had higher death rate during CR programs (2.0% versus 0.5%, p = 0.02). After adjusting for age, ejection fraction, comorbidities (acute myocardial infarction, percutaneous coronary intervention, cardiac surgery, carotid artery critical lesions, peripheral artery disease, respiratory insufficiency, heart failure, diabetes, stroke and cognitive impairment), and complications during CR program (atrial fibrillation and severe ventricular arrhythmias), multivariate logistic analysis showed that heart failure (OR 1.6, 95% CI, 1.1 to 2.4, p = 0.04), respiratory insufficiency (OR 2.4, 95% CI, 1.4 to 4.0, p = 0.0007), and cognitive impairment (OR 4.5, 95% CI, 2.5 to 8.1, p < 0.0001) were significant predictors of death during the CR program in CKD patients. Conclusions: This subanalysis of the ISYDE-2008 survey provided a detailed snapshot of the clinical characteristics, complexity and more severe clinical course of patients admitted to CR presenting with CKD. P342 Adaptation to intermittent hypoxia-hyperoxia as cardio-protective technology in patients with coronary artery disease O Oleg Glazachev1, YU Pozdnyakov2, A Urinskiy2, A Platonenko3, G Spirina3 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, 2Moscow Regional Cardiological Center, Moscow, Russian Federation, 3AI Mediq Company, Luxembourg, Luxembourg Other risk factors (Rehabilitation & Implementation) Objectives: Adaptation to intermittent hypoxia (IHT) is known to be effective in rehabilitation of patients with CAD, hypertension, chronic obstructive pulmonary disease. We have proposed a new mode of IHT, in which repeated hypoxic episodes (11-12% O2) interspersed with hyperoxic (35% O2) episodes instead normoxic periods as in “traditional” IHT. In experimental studies adaptation to hypoxia-hyperoxia has been evidenced to evoke more pronounced cardio-protective effects due to higher intensity of redox-signalling without hypoxia deepening than IHT (Arkhipenko Yu.V., Sazontova T.G., 2008), that increased physical endurance, preventing excessive ROS production in rats myocardium in swmming stress-tests. Purpose: The study was designed to test adaptation to intermittent hypoxia-hyperoxia in patient with CAD, stable angina 2-3 class. Methods: 24 patients (men, 61,9 ± 6,9 years) were randomized to receive 15 sessions of intermittent hypoxic-hyperoxic training (IHHT group, n = 15) or normoxia (placebo, n = 9) within 25 days. In IHHT group each session consisted of 4-7 hypoxic periods (4-6 min) with 3-min hyperoxic intervals. Duration of hypoxic episodes was set up individually, following the results of the prior hypoxic test (on a feed-back principle from SaO2 min, Reoxy-Mediq device). All the patients additionally have received within 4 wk equal treatments, diet, physical exercising. Before and after the IHHT program we measured body composition, blood lipids, lipoproteins and glucose, patients performed submaximal incremental treadmill runs with control of oxygen uptake (VO2), lactate, time to fatigue, peak power output. Results: The IHHT group showed pronounced increase (versus placebo) in exercise tolerance, which were correlated with enhance of hemoglobin and lower lactate concentrations in submaximal exercise tests. IHHT group showed increase in time to fatigue (+21.1% versus 9.6%, p < 0.04), PPO(METs + 12.8% versus 5.4%), 42% decrease of angina attack as a reason to stop treadmill run. While nutrient intake and daily trainings were similar, total cholesteroll, triglycerides decreased in both groups. Low density lipoprotein levels decreased in IHHT group (−4.9% versus −1.8%, p < 0.05). All the patients perceived IHHT sessions without side-effects, only 3 cases of angina without electrocardiogram changes were reported. Conclusion: Adaptation to intermittent hypoxia-hyperoxia of patients with CAD was associated with significant improvements in exercise tolerance and cardiometabolic risk factors. IHHT is more efficient in cardio-protection (versus IHT, as was shown in our previous studies) and may have the potential in CAD treatment and in long-term rehabilitation. P343 Increase in maximal oxygen uptake in the fight against inactivity? K.G. Jebsen Center of Exercise in Medicine, T Karlsen1, N Zisko1, K Hordnes1, Ä Rognmo1, U Wisloff1, D Stensvold1 1Norwegian University og Science and Technology, Trondheim, Norway Other risk factors (Rehabilitation & Implementation) Cross-sectional studies have previously shown that there is a positive association between maximal oxygen uptake (VO2max) and non-exercise activity thermogenesis (NEAT). However data on how an increase in VO2max affects NEAT or total daily energy expenditure in a sedentary population are scarce. Purpose: The primary aim of this study was to investigate the effect of 6 weeks of high intensity interval training on VO2max and daily total energy expenditure in initially sedentary normal weighted men. Methods: Thirty healthy sedentary male (39.1 ± 5.9 yrs and body mass index 25.5 ± 2.6 kg/m2) performed aerobic endurance training on treadmills three times per week for a total of six weeks. The subjects were randomized to one of the following protocols: one interval (4 minutes) of high intensity training (HIIT-1) performed at 85-95% of maximal heart rate (HRmax), four intervals (each lasting 4 minutes) of high intensity training (HIIT-4) performed at 85-95% HRmax and a control group performing moderate continuous training (47 minutes) at 70% HRmax (MCT). Daily total energy expenditure (TEE), number of steps (Senswear, armband), VO2max and body composition were measured before and after the intervention. Results: There was a significant increase in VO2max after HIIT-1 (from 44.5 ± 6.6 mL·kg−1·min−1 to 47.7 ± 7.7 mL·kg−1·min−1) and HIIT-4 (from 43.1 ± 5.4 mL·kg−1·min−1 to 47.1 ± 5.7 mL·kg−1·min−1) with no change in the MCT group. No change in daily energy expenditure or number of steps was observed after HIIT-1 and HIIT-4. However, daily total energy expenditure was increased by 14% after MCT (from 2557 ± 312 calories to 2921 ± 394 calories). Six weeks of HIIT-4 and MCT induced a significantly decreased in body fat (from 22.4 ± 8.4 to 20.7 ± 8.4 after HIIT-4 and from 22.9 ± 4.2 to 21.1 ± 2.7 after MCT). Conclusion: In the initial phase of structured exercise training, an increase in VO2max has no effect on daily activity level in untrained men. Importantly, this study shows that short bouts of high intensity interval training may be just as effective as longer interval training to increase VO2max for sedentary middle-aged men. P344 Risk factors in remote period after myocardial infarction: prevalence, control, prognostic value. A V Andriy V Yagensky1, I Sichkaruk1, L Dukhnevych1, N Sydor1, S Indyka2 1Lutsk City Hospital, Lutsk, Ukraine, 2Instute of Human Development, Lutsk, Ukraine Other risk factors (Rehabilitation & Implementation) Objectives: to assess the prevalence and control of main risk factors (RF) in patients (pts) after remote myocardial infarction (MI) and identify predictors of cardiovascular (CV) events at 5-years period. Methods: representative sample of 333 pts (69,6% men, age 62,5 ± 9,8 years) was randomly selected from 2229 patients discharged in 2000-2005 with MI in Lutsk City (Ukraine). Mean time after discharge was 2,5 ± 1,6 years. Home-based interviewing of pts with 67 points questionnaire, blood pressure (BP), anthropometric measurements as well as lipid spectrum, plasma glucose level, hs-CRP, electrocardiogram were performed at baseline. Prognosis was assessed in 5-years prospective observation. Results: Prevalence of arterial hypertension (AH) was 84,1%, obesity - 58,0%, diabetes mellitus (DM) - 13,8%, hypercholesterolemia - 55,4%, smoking - 18,3%, hypodynamia - 21,6%. 61,9% pts had three and more RFs. Prevalence of AH, hypercholesterolemia, diabetes mellitus, obesity, abdominal obesity and multiply RFs was higher in women. Recommended goals of blood pressure reached only 20,4% of pts with AH, total cholesterol levels - 23,8%. Only half of pts took beta-blockers (49,8%), ACE inhibitors (52,6%), aspirin (51,1%), 10,5% pts used statins. 15,6% pts did not take any medications. RF control became worse with extension of period after MI. This fact was associated with decreasing of adherence and less use of beta-blockers, statins and aspirin. Five-years CV mortality rate was 17,4%, recurrent MI occurred in 6,6% pts, stroke - in 8,1% pts with no gender difference. Pts who died were older (66,0 ± 8,1 vs 61,7 ± 10,0 years, p = 0,003), had higher body mass index (30,7 ± 6,2 vs 29,3 ± 4,6 kg/m2, p = 0,046), systolic blood pressure (158,6 ± 30,3 vs 149,1 ± 28,1 mm Hg, p = 0,02), HR (75,5 ± 12,0 vs 71,0 ± 12,9 bpm, p = 0,02), plasma glucose level (7,3 ± 4,0 vs 5,8 ± 2,2 mmol/l, p < 0,01). CV mortality was significantly higher in pts with uncontrolled AH (20,6% vs 7,0%, p = 0,02), smokers (26,2% vs 15,4%; p = 0,04) and pts with diabetes mellitus (34,8% vs 14,6%, p < 0,01). In Cox proportional multiple regression analysis age (β = 0,04; p = 0,02, HR =  2,3), diabetes mellitus (β = 0,8; p = 0,03, HR =  3,1), smoking (β = 0,7; p = 0,02, HR =  2,0) were independent predictors for CV mortality. Combined endpoint (CV death, MI/stroke) was reached in 26,7% pts. Age (β = 0,06; p < 0,001, HR =  3,3), smoking (β = 0,7; p = 0,01, HR =  1,7) and beta-blockers non-using (β=−0,5; p = 0,048, HR =  1,4) were found as independent predictors for combined CV endpoint. Conclusions: RFs are highly prevalent and poorly controlled in pts after MI. Treatment are at unacceptably low level. Main predictors of CV events are age, smoking, diabetes mellitus and beta-blockers non-use. Active efforts are needed to improve this situation. P345 Do patients change their intention to attend cardiac rehabilitation and what factors influence any change? G Mckee1, S O'donnell1, F O'brien1, M Mooney1, DK Moser2 1Trinity College, Dublin, Ireland, 2University of Kentucky, Lexington, United States of America Other risk factors (Rehabilitation & Implementation) Purpose: Patients' decisions about attendance at cardiac rehabilitation programmes are complex and influenced by many factors. The purposes of this study were to determine whether patients' intentions to attend cardiac rehabilitation were congruent with their subsequent actions and if there was a lack of congruence what factors were related to their change of mind. Methods: Post event or procedure patients who had an MI and were eligible for rehabilitation were recruited to this longitudinal 5 site study. At baseline they completed a questionnaire that recorded clinical and sociodemographic profiles, their intentions of participating in Phase III cardiac rehabilitation and their attitudes to cardiac disease. Twelve months later they completed a second questionnaire indicating if they had attended cardiac rehabilitation. Chi square tests were used to determine the relationship of gender, employment, education, fitness level, type of MI or mode of referral with a lack of congruence between intention to attend cardiac rehabilitation and their subsequent actions. T tests were use to examine the influence of age, body mass index and attitudes. Results: A sample of 1172 MI patients were recruited at baseline. The mean age was 62.5 ± 11.8, 74% were male, mean body mass index was 27.4 ± 8 and 43.7% had had an ST-segment elevation MI. A total of 985 (84%) said they intended to participate in cardiac rehabilitation and 187 (16%) said no. At 12 months there was a 62% response rate. There was no significant difference in the profile of patients who responded at 12 month compared to baseline. Of those that originally intended to attend cardiac rehabilitation and responded at 12 month (n = 533): 80% attended, 13% did not attend and 7% dropped out of cardiac rehabilitation. Lower education level (p = 0.044) or a lower attitude score (p = 0.012) was associated with lack of congruence between intentions to attend cardiac rehabilitation and actions in this group. By 12 months of those that did not intend to attend cardiac (n = 68); 44% had attended, 15% had dropped out, and 41% did not attend cardiac rehabilitation. Lower education level (p = 0.024) was associated with lack of congruence between intentions to attend cardiac rehabilitation and actions in this group. Conclusion: Patients do change their mind about attending cardiac rehabilitation. Further encouragement particularly of those with lower education levels and further approaches to those who have initially indicated that they did not intend to attend cardiac rehabilitations may assist in optimising recruitment cardiac rehabilitation and ultimately patient prognosis. P346 Lower extremity functional electrical stimulation isometric contractions augment arm cycling peak oxygen uptake in spinal cord injured individuals B Berit Brurok1, T Torhaug1, GL Leivseth1, TK Karlsen1, JH Helgerud1, J Hoff1 1Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway Other risk factors (Rehabilitation & Implementation) Functional electrical stimulation (FES) cycling augment arm cycling (ACE) peak oxygen uptake (VO2peak) in spinal cord injured (SCI) individuals, but high resource demands limits its access. Thus equally effective but less resource demanding training modalities are needed. Purpose: To determine if FES lower extremity isometric muscle contractions augments ACE VO2peak in individuals with SCI. Methods: Cross sectional single-subject design. Fifteen individuals with C4 to T12 SCI, and ASIA Impairment scale A, mean age of 40.2 (13.6) years were recruited and divided into two groups; injury above (SCI-high n = 8) or below (SCI- low n = 7) the T6 level. VO2peak was measured during and compared between; 1) ACE combined with FES isometric contractions (FES iso hybrid), 2) ACE combined with FES cycling (FES hybrid cycling), and 3) ACE alone. Results: In the SCI-high group, FES iso hybrid and FES hybrid cycling increased VO2peak compared to ACE alone from 17.6 (± 5.0) to 23.6 (± 3.6) mL·kg−1·min−1 and from 17.6 (± 5.0) to 24.4(± 4.1) (P = 0.001) respectively. VO2peak and related parameters were not different between the two FES hybrid modalities. In the SCI-low group, there was no difference in VO2peak and related parameters between the three test modalities. Conclusions: FES lower extremity isometric contractions and FES cycling augmented arm cycling VO2peak in individuals with SCI high level injuries in the present study. However a portable FES apparatus may serve as a less resource demanding alternative to stationary FES cycling. These findings may have important implications for training compliance and exercise prescription for SCI P347 Impact of early physical exercise at rehabilitation stage on endothelial function in patients undergone coronary artery bypass grafting S Svetlana Pomeshkina1, IV Borovik1, IN Sizova1, TY Sergeeva1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Kemerovo, Russian Federation Atherosclerosis/CAD (Rehabilitation & Implementation) Objective: Evaluate the impact of early physical rehabilitation program on endothelial function in patients undergone coronary artery bypass graft surgery (CABG). Materials: 92 males with coronary artery disease (CAD) scheduled for coronary artery bypass grafting were examined. The mean age was 55.8 ± 5.3 years. The mean number of haemodynamically significant coronary lesions was 3.1 ± 1.2. The patients were randomized into two clinically comparable groups: the treatment group (45 patients) and the control group (47 patients). The treatment group patients did early bicycle exercises along with a standard rehabilitation program. The patients enrolled in the study were examined 5-7 days before coronary artery bypass grafting and at day 35-36 after coronary artery bypass grafting (the end of the rehabilitation period). Statistica 6.0. package was used for statistical processing of the data. Methods: Duplex scanning of the brachial artery with flow-mediated vasodilation assessment by reactive hyperemia test and Doppler linear blood flow velocity assessment with 〈〈ALOKA ProSound SSD-α´10〉〉 (Japan). Results: 81 (88%) patients had endothelial dysfunction. 57 (62%) patients showed insufficient vasodilator response and 24 (26%) patients showed no increase in brachial artery diameter or pathological vasoconstriction. The rest 11 (12%) patients demonstrated >10% vasodilation compared to baseline. Baseline parameters did not differ significantly in either group. By the end of the rehabilitation period there was a significant increase in brachial artery diameter during compression in the treatment group (by 10% (from 4.21 ± 0.54 cm to 4.67 ± 0.73 cm)), p < 0.01, while the control group showed a 6% increase of the same parameter (from 4.18 ± 0.52 cm to 4.47 ± 0.63 cm), p < 0.05. Linear blood flow velocity during reactive hyperemia test and compression increased from 83.63 ± 14.27 cm/s to 96.64 ± 21.42 cm/s (p < 0.01) in the treatment group and from 86.13 ± 14.84 to 105.32 ± 20.71 cm/s (p < 0.05) in the control group that points out insufficient vasodilator response in the control group patients. The number of the treatment group patients with endothelial dysfunction decreased from 38 to 16 (by 49%) and there was no vasoconstriction found in those with remaining endothelial dysfunction. The tests showed that the number of the control patients with endothelial dysfunction also decreased from 44 to 35 (by 19%) with 8 patients having the signs of vasoconstriction. Conclusion: early physical exercise in patients undergone coronary artery bypass grafting can significantly improve endothelial function and should constitute a required part of rehabilitation programs. P348 Telephone support oriented by accelerometric measures enhances adherence to physical activity recommendations in non-compliant patients after a CRP T Thibaut Guiraud1, R Granger2, V Gremeaux3, M Bousquet2, L Richard2, L Soukarie2, M Labrunee1, L Bosquet4, A Pathak1 1Inserm-UPS U1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France, 2Clinic Saint-Orens, Cardiovascular and Pulmonary Rehabilitation Centre, Saint Orens de Gameville, France, 3Montreal Heart Institute, Montreal, Canada, 4University of Poitiers, Faculty of Sport Sciences, Poitiers, France Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: To assess in stable cardiac patients the efficacy of a strategy, using phone support based on accelerometric recordings, on the adherence to physical activity (PA) recommendations in non-compliant patients. Methods: Twenty-nine non-compliant stable cardiac patients (weekly moderate-intensity PA < 150 min) who benefited from a CRP were included. They were randomized in intervention group (IG, n = 19; coaching) and in control group (CG, n = 10). The IG wore an accelerometer during 8 weeks to assess the active energy expenditure (EE, in Kcal) and the time spent in light, moderate or intense levels (min). Every 15 days, telephone feedback on amount of PA and support were provided. The CG wore the accelerometer only during 8th week of the intervention. Results: In the IG, weekly time spent at moderate intensity PA increased from 95.6 ± 80.7 to 137.2 ± 87.5 min between the 1st and 8th week (p = 0.002). At the end of the intervention, the total weekly active EE averaged 543.7 ± 144.1 kcal and 266.7 ± 107.4 kcal in the IG and CG, respectively (p = 0.004). The time spent within the light-intensity range PA was 301.3 ± 116.3 and 259.4 ± 112.8 min, and the time spent within the moderate-intensity range averaged 137.2 ± 87.5 and 45.7 ± 43.4 min (p = 0.002) per week for the IG and CG, respectively. In IG, 53.6% of the sample achieved the targeted level of 150 minutes/week of moderate-intensity PA. Conclusion: In this cohort of non-compliant cardiac patients, telephone support based on accelerometric recordings appeared to be a simple and effective strategy to improve the adherence to physical activity. P350 Transient heart failure occurring in the acute and/or rehabilitative phase after coronary revascularization as a determinant of 1-year prognosis On behalf of the ICAROS investigators, M Ambrosetti1, R Griffo2, F Fattirolli3, R Tramarin4, S De Feo5, A Vestri6, P Temporelli7 1Le Terrazze Clinic, Cardiovascular Rehabilitation Unit, Cunardo, Italy, 2ASL 3 Genovese, La Colletta Hospital, Cardiac Rehabilitation Unit, Arenzano, Italy, 3University of Florence, Department of Critical Care Medicine, Cardiac Rehabilitation Unit, Florence, Italy, 4European Foundation for Biomedical Research - Onlus, Cardiac Rehabilitation Unit, Cernusco, Italy, 5Dr. Pederzoli Clinic, Peschiera del Garda, Italy, 6Sapienza University, Dept. of Public Health and Infectious Diseases, Rome, Italy, 7Salvatore Maugeri Foundation, IRCCS, Division of Cardiology, Veruno, Italy Atherosclerosis/CAD (Rehabilitation & Implementation) Transient heart failure (THF) after cardiac events is associated to worsen cardiovascular prognosis, however little is known about THF occurring in the acute and rehabilitative phase following coronary artery bypass grafting and percutaneous coronary intervention interventions. To answer, patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analysed for time of onset, associated factors, and outcome of THF. ICAROS was a prospective, multicentre registry involving 1,262 patients discharged from 62 cardiac rehabilitation (CR) facilities nationwide, comprehensive of risk factors, lifestyle habits, drug treatments, and major cardiovascular events (MACE) during a 1-year follow-up. THF was defined either as signs and symptoms consistent with decompensation or patients presenting both cardiogenic shock or pulmonary oedema. Overall, 96 (7.6%) patients developed THF after coronary revascularization, with 69.8% of cases in acute wards, 22.9% during CR, and 7.3% in both settings. THF affected more frequently patients with chronic heart failure or long history of coronary artery disease (42.7% versus 30.6% in patients without chronic cardiac condition, p < 0.005). Age ≥ 75 years (33.3%), chronic obstructive pulmonary disease (19.8%), and chronic renal failure (17.7%) were also significantly more represented in the THF group. At the end of CR, THF patients were prescribed more diuretics (78.9% not potassium sparring, 36.8% potassium sparring) insulin (17.9%), and anticoagulants (32.3%). During follow-up, THF patients maintained similar rates of ongoing cardioprotective drugs as compared to controls, with a less prescription of statins (64.6% versus 82.2%, p < 0.001). The case crossover comparison between the end of CR and after one year showed good persistence of renin-angiotensin-aldosterone system modulators (90.6%) and beta-blockers (83.3%). Mortality (8.3% versus 1.6%, p < 0.001) and MACEs (21.9% versus 8.1%, p < 0.001) occurred more frequently among THF patients; further episodes of decompensated heart failure (10.4 versus 2.4%, p < 0.001) were the most represented events. THF independently predicted adverse outcome with a OR for recurrent events of 2.451 (CI 1.403-4.282), as compared to patients without THF. THF is a major determinant of prognosis after coronary revascularization, with a good predictive value also for episodes occurring during the CR program. P349 Predictors of drop-out from cardiac rehabilitation programs in Europe The EuroCaReD Study Group, W Benzer1, B Rauch2, E Koudi3, AD Zwisler4, NE Pogosova5, P Dendale6, JP Schmid7, C Davos8, EG Porrero9, H Mc Gee10 1Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria, 2Center for Outpatient Rehabilitation at the Hospital, Ludwigshafen, Germany, 3Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Thessaloniki, Greece, 4Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark, 5National Research Center for Preventive Medicine, Moscow, Russian Federation, 6Heart Centre, University, Hasselt, Belgium, 7Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland, 8Biomedical Research Foundation, Academy of Athens, Athens, Greece, 9Cardiac Rehabilitation Centre, City Hospital, Leon, Spain, 10Royal College of Surgeons in Ireland, Dublin, Ireland Atherosclerosis/CAD (Rehabilitation & Implementation) Background: Substantial numbers of patients participating in cardiac rehabilitation (CR) do not complete their programs prescribed because of early discontinuation. The purpose of this study was to assess reasons and predictors of drop-out from different CR programs focused on European countries. Methods: European Cardiac Rehabilitation Database (EuroCaReD) was introduced to get information on service provision and outcomes in CR across Europe. In 8 European countries 1.236 patients participating in a CR program could be enrolled into the database in October and November 2010. Datasets of 360 patients (mean age 64 years; 26% female) did include drop-out numbers and reasons and were suitable to be included into the study. P- values and Odds ratios (95% CI) were calculated to assess the strength of the differences between patients who completed their prescribed CR program and those who dropped out. Results: 273 patients (76%) of 360 completed their CR program whereas 87 patients (24%) did not. The main reason of drop-out was patient non-compliance (26.4%), recurrent event within the CR program timeframe (5.6%) and others not specified (64.4%). Recurrent events were most frequently the need of percutaneous coronary intervention (22%) followed by death from non-cardiovascular disease (11%). Relevant comorbidities could be detected as predictors of drop-out from CR programs (renal failure: p < 0.05, OR 0.24 (0.06-0.9); history of stroke: p < 0.05, OR 0.29 (0.09-0.90)). Higher body weight (p < 0.05), higher blood pressure (p < 0.01) and lower METs achieved at program start (p < 0.05) were predictors of early drop-out from a CR program. Age, gender, and initiating event did not influence the drop-out rate. Conclusions: In European countries ¼ of patients referred for CR did not complete their programs as prescribed. This result identifies the need for measures to reduce drop-out rates in CR. Patients who have to interrupt their program because of interventions most frequently percutaneous coronary intervention should be readmitted as soon as possible. Because of the drop-out risk in patients with special comorbidities, particularly renal failure and history of stroke and in patients with higher cardiovascular risk burden and lower exercise capacity, these subgroups should receive special attention. The high percentage of patients with unspecified reasons of CR program interruption needs further investigation. P351 An italian program of secondary cardiovascular prevention and rehabilitation: medium-term effects on a real-life setting. MP Donataccio1, G Menegatti1, L Trevisani1, P Pasoli1, D Nicolis1, M Buttarelli1, S Al Zeer1, C Vassanelli1 1University of Verona, Department of Cardiology, Verona, Italy Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: secondary prevention decreases morbidity and mortality after myocardial infarction. We examined whether improvement of cardiovascular risk factors (CVRFs) and lifestyle (LS) changes obtained by a Secondary Cardiovascular Prevention and Rehabilitation Program (SCPRP), including men (M) and women (F) with a recent Acute Coronary Syndrome (ACS), persisted over medium-term (MT) follow-up (FU) in a real-world setting. Methods: the study included 168 patients (p) with acute coronary syndrome, 138 M and 30 F (82 vs 18%), mean age 60.6 ± 11 years (y), enrolled from April 2008 to February 2009. Discharge (D) diagnosis were: Unstable Angina (25%,42 p), non ST-elevation myocardial infarction (30.9%,52 p) and ST-elevation myocardial infarction (44.1%,74 p). F were older than M (66.5 ± 9.3 vs 59.4 ± 10.9 y, p = 0.001). The 12-months SCPRP was based on lifestyle counseling, multispecialistic visits (with serial blood samples assessed at D, at 6 and 12 months) and controlled training. Telephonic FU interviews were performed after the end of SCPRP (median time 942.2 ± 108.4 days after hospital admission). Results: after 1 year of SCPRP the majority of CVRFs had improved: the prevalence of arterial hypertension (AH) decreased from 18.6% to 8.4% (p < 0.01), that of cigarette smoking (CS) decreased by 21.9% (p < 0.01), lipid profile improved (hypercholesterolemia from 31.5 to 15.1%, p < 0.01). These effects persisted over time and improved in the real life setting at MT FU: further reduction was observed for AH (−3.8%) and CS (−2.3%). Data on LS behavior showed that physical inactivity decreased by 35.7% at 1 year, by further 7% at FU. Discontinuation of medication (Rx) after acute events is frequent and occurs early after D. In our study there was a good adherence to Rx prescribed at D: more than 90% of p was taking antiplatelet drugs and statins at MT FU, without any difference between age (≤74 and >74 y) and sex groups. At FU the rehospitalization rates for myocardial ischaemia and for percutaneous coronary intervention were 6.6% and 4.2% respectively, without any significant gender difference. Despite similar cardiac events at the FU, fewer F reported a subjective well-being when compared to M (50 vs 82%). Patients presenting with ST-elevation myocardial infarction, compared to those affected by non ST-elevation myocardial infarction, and those without any history of prior acute coronary syndrome at admission had fewer ischaemic recurrence (p = 0.012 and p = 0.01 respectively). Conclusions: cardiac p after an acute coronary syndrome require counseling to prevent event recurrence, by adhesion to a medication plan and adoption of a healthy LS. Our study showed short-term efficacy and persisting MT benefits of a SCPRP. Further studies including more p and longer FU periods are needed to confirm these results. P352 Analysis of reasons for refusal and drop-out of cardiac rehabilitation among the patients with ischaemic heart disease T Tatsiana Mikkelsen1, KK Thomsen1 1Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark Atherosclerosis/CAD (Rehabilitation & Implementation) The purpose of our study was to clarify the reasons of patients' refusal or drop out of cardiac rehabilitation. Methods: 412 consecutive patients were contacted by questionnaire within 1 year after an acute myocardial infarction and /or coronary revascularization about their experience of rehabilitation and reasons for the refusal or drop-out of it. The rehabilitation includes clinical consultations within 1 and 3 months and in 1 year after discharge from the hospital, education about atherosclerotic heart disease and risk factors, physical exercises, offered at two levels according to patients' physical condition, twice a week for 8-14 weeks. The analysis is based on 352 responses. Results: 21% of all respondents reported to have dropped the physical exercises, 12.5% had dropped the education and 3% had dropped the consultations. While answering about the reasons for refusal or drop-out of rehabilitation the patients could choose between several options shown in Table. Among both women and men the most frequent reasons were: inappropriate physical condition and lack of time. Women also point out long distance from their residence as an obstacle. The dominant reason among the working patients was lack of time. Patients aged 76 years and older blamed their inadequate physical condition. The patients who live alone refuse or drop out from rehabilitation as they perceive their physical condition as inappropriate and their travel distance as too far. The patients who live with a partner refuse or drop out of the rehabilitation mostly because of lack of time. Conclusion: Time, perceived reduced physical condition, long distance from home and transport problem, lack of understanding of the rehabilitation benefit could be the causes why patients refuse or drop out from cardiac rehabilitation. Reasons for drop out from rehabilitation % among all pt inappropriate to patients physical condition 11 times problem 10 long distance residence 7 unnecessary 5 transport problem 4 dissatisfied with treatment 2 other reasons 7 % among all pt inappropriate to patients physical condition 11 times problem 10 long distance residence 7 unnecessary 5 transport problem 4 dissatisfied with treatment 2 other reasons 7 Open in new tab Reasons for drop out from rehabilitation % among all pt inappropriate to patients physical condition 11 times problem 10 long distance residence 7 unnecessary 5 transport problem 4 dissatisfied with treatment 2 other reasons 7 % among all pt inappropriate to patients physical condition 11 times problem 10 long distance residence 7 unnecessary 5 transport problem 4 dissatisfied with treatment 2 other reasons 7 Open in new tab P353 Refusal of cardiac rehabilitation among patients with ischemic heart disease T Mikkelsen1, KK Thomsen1 1Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: Our study analyses the refusal and drop-out of cardiac rehabilitation among patients with ischemic heart disease. Methods: 412 consecutive patients were contacted with a questionnaire within 1 year after acute myocardial infarction and/or after coronary revascularization to conduct a survey on their choice of cardiac rehabilitation. The rehabilitation includes 3 consultation visits in the clinic: 1. within one month after discharge from the hospital with participation from the dietician, the nurse and the doctor; 2. within 3 months the nurse consultation; after 1 year a final follow-up is held with the nurse and doctor. Education about atherosclerotic heart disease and risk factors is offered as 1.5 hours lessons 3 times. Physical exercises are offered divided in proportion to patients' needs and physical condition in 2 teams with training twice a week for 8-14 weeks. The analysis is based on 352 responses (84% rate response). The statistical evaluation is based on a χ2-test analysis, p < 0,05. Results: In 98% of responses has been confirmed that they have been offered rehabilitation. 46% of the patients chose the entire rehabilitation program, 22% chose the clinic consultations and physical exercises, 18% chose only the consultations, 6% chose the consultations and education, 7% have refused the entire offer, 1% has not participated, because it has not been offered. The analysis among male and female patients did not show significant difference in the preferences of any part of rehabilitation. The patients, who are still on the labour market, have accepted more often the consultations with education, while patients without it chose most the consultations with physical exercises. The analysis of marital status shows that the patients, who live alone, are more likely to have the clinic consultations only. The analysis of drop-out from the rehabilitation shows, that 21% of all respondents have dropped physical exercises, 12.5% have dropped out of the education, 3% have dropped the consultations. More women than men dropped out of the education. The analysis among patients in different age groups shows that more patients in the older group (> 76 years) dropped out of the physical exercises, while patients in the younger group (under 50 years) more frequently dropped out of the consultations and education (51-65 years). The analysis of the group of patients, who refused the whole rehabilitation offer shows, that 78% of them live alone. Conclusion: Such factors as gender, age, marital status, labour market attachment each play a role in the patient's refusal and drop-out of cardiac rehabilitation. P354 Accelerometer as a tool to assess sedentarity and adherence to physical activity recommendations after CRP T Thibaut Guiraud1, R Granger2, V Gremeaux3, M Bousquet2, L Richard2, L Soukarie2, M Labrunee1, L Bosquet4, A Pathak1 1Inserm-UPS U1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France, 2Clinic Saint-Orens, Cardiovascular and Pulmonary Rehabilitation Centre, Saint Orens de Gameville, France, 3Montreal Heart Institute, Montreal, Canada, 4University of Poitiers, Faculty of Sport Sciences, Poitiers, France Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: To objectively assess, in stable cardiac patients, the adherence to physical activity (PA) recommendations using an accelerometer at two or 12 months after the discharge of cardiac rehabilitation program (CRP). Methods: Eighty cardiac patients wore an accelerometer at two months (group 1, n = 41) or one-year (group 2, n = 39) after a CRP including therapeutic education about regular PA. PA was classified as 〈〈light〉〉 (1.8-2.9 METs), 〈〈moderate〉〉 (3-5.9 METs), or 〈〈intense〉〉 (>6METs). Energy expenditure (EE, in Kcal) and time (min) spent in these three different levels were measured during a one-week period with the MyWellness Key actimeter (MWK). Motivational readiness for change was also assessed at the end of CRP. Patients were considered as physically active when a minimum of 150 min of moderate PA during the one-week period was achieved. Results: The total weekly active EE averaged 676.7 ± 353.2 kcal and 609.5 ± 433.5 kcal in group 1 and 2, respectively. The time spent within the light-intensity range PA was 319.4 ± 170.9 and 310.9 ± 160.6 min, and the time spent within the moderate-intensity range averaged 157.4 ± 115.4 and 165 ± 77.2 min per week for group 1 and 2, respectively. Fifty-three percent and 41% of patients remained active in both groups respectively. Conclusion: About half of the patients are non-compliant to PA after CRP and do not reach target levels recommended by physicians. The first two months following the discharge of CRP seem to be decisive for lifestyle modifications maintenance. P355 Is cardiac rehabilitation useful to old coronary patients? B Bruno Pavy1, A Tisseau1, M Caillon1 1centre hospitalier Loire Vendée Océan, machecoul, France Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: If cardiac rehabilitation (CR) benefits are well known for coronary patients, the question remains: Is there an age limit? The aim of this work was to compare results of a CR programme in two populations of different age. Methods: A group 1 (G1) with 103 patients < 65years old was compared to a group 2 (G2) with 99 patients ≥ 65 years old, all consecutive coronary patients admitted to a French CR department between 2007 and 2009. All patients participated in a CR programme which consists of a physical training and a patient therapeutic education, with an assessment at six months of a Physical Activity Score (PAS) on a 5 to 40 scale, a Cardioprotective Dietary Score (CDS) on a −17 to +19 scale, and a 6-Minute Walk Test (6MWT). Results: After the completion of the CR programme, maximal effort capacity increased by 25 ± 19% (5.4 to 6.6 METs or Metabolic Equivalent Task) in G1 and 25 ± 18% (4.5 to 5.6 METs) in G2 (p = 0.75). Improvement in 6-minute walk distance was 19 ± 17% (469 to 550m) in G1 and 23 ± 23% (393 to 472m) in G2 (p = 0.32). Six months later, the 6MWT was 549m (0.9 ± 11%) in G1 and 483m (3.4 ± 14%) in G2 (p = 0.25), CDS increased by 14 ± 15% (7.2 to 12.2) in G1 and 12 ± 10% (8.6 to 12.8) in G2 (p = 0.19) and PAS by 12.3 ± 15% (15.3 to 19.7) in G1 and 10.2 ± 15% (15.7 to19.2) in G2 (p = 0.35). Conclusion: In this coronary population, Cardiac Rehabilitation seems beneficial without age limit. P356 Mapping the patient's experience: assessment of user needs, preferences and barriers for self management services in coronary artery disease SANDRA Vosbergen1, J Janzen2, PJ Stappers3, MCB Van Zwieten4, HM Kemps5, RA Kraaijenhagen6, NB Peek1 1Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands, 2VU University Medical Center, Amsterdam, Netherlands, 3Delft University of Technology (TU), Delft, Netherlands, 4Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, 5Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands, 6NDDO Institute for Prevention and Early Diagnostics, Amsterdam, Netherlands Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: Although web-based self-management services are considered a promising solution to deal with the growing healthcare demand, the utilization of these services is disappointing. Critics of existing self-management services state that they are insufficiently adapted to the needs of patients and their daily routines. The aim of this study was to obtain insight into the daily lives and identify the needs of patients with coronary artery disease (CAD) with respect to web-based self-management services. Methods: We applied qualitative research techniques which originate from the field of product design and are characterized by the use of creative processes to address tacit and latent knowledge. Participants received a preparatory package which they used to document their disease history, health routines, and social environment. Subsequently, participants were interviewed or took part in focus group meetings. Transcripts of the interviews and focus group meetings were analysed qualitatively. Results: Three groups of patients were recruited:(1) six patients with early-stage CAD (hypertension or hypercholesterolemia only), (2) five patients that were hospitalized for a cardiac event or intervention less than 6 months ago, and for the first time; and (3) eight patients that were hospitalized for these reasons more than 6 months ago and/or more than once. Emerging themes in both focus group meetings and interviews were:(1) the sudden and unexpected nature of disease and the perceived inability to prevent recurrence, (2) fear for recurrent events and disability, (3) poor recognition of cardiac events by medical professionals, (4) the desire to continue living without daily thoughts about the disease, and; (5) a need for information that is tailored to personal needs. Conclusions: Cardiovascular events have a large emotional impact and induce fears. Patients with CAD dislike being reminded of their disease and have the desire to lead a normal life, not being reminded of their disease. Furthermore, they do not experience an internal locus of control regarding their disease progression. Our findings suggest that self-management services should be (1) tailored to a patient's information needs (2) support patients to exert control over their health and well-being; and (3) manage expectations regarding the progression of their disease. P357 An intensive cardiovascular rehabilitation programme improves maximal oxygen uptake and quality of life in Danish patients with ischaemic heart disease J Skov1, JJ Sidelmann1, SFM Pedersen1, AV Fournaise1, EM Bladbjerg1 1Unit for Thrombosis Research, IST, University of Southern Denmark, Esbjerg, Denmark Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: To test the hypothesis that an intensive cardiovascular rehabilitation programme has additional effects on health-related behaviour, physical fitness level and markers of cardiovascular risk compared with standard treatment. Methods: Forty consecutive patients (36 men; median age 59 years) with ischaemic heart disease (acute myocardial infarction or coronary disease leading to bypass surgery or angioplasty) were randomized to an intervention group and a control group 6 weeks after the event or procedure. The control group received the standard treatment offered to Danish patients in 2005, consisting of group counselling on healthy lifestyle and pharmacological treatment. The intervention group participated in an additional 14 week rehabilitation programme comprising supervised physical training twice a week, individual dietary counselling and smoking cessation counselling if relevant. The outcome variables covered health-related behaviour (24-hour diet recall, physical activity level, smoking status), self-reported quality of life, anthropometric measurements, maximal oxygen uptake (work test), flow-mediated vasodilation, C-reactive protein and metabolic biomarkers and they were recorded at baseline, 14 and 41 weeks after inclusion (no intervention took place in the last 27 weeks). Results: The intervention group had a statistically significant improvement in maximal oxygen uptake (median change 3.5 ml/kg/min = 1 MET) between inclusion and the end of the intervention period. The change in maximal oxygen uptake was significantly larger than that observed for the control group (P < 0.01). After 41 weeks, the improvement in maximal oxygen uptake for the intervention group was only 2.45 ml/kg/min (0.7 MET) compared with the time of inclusion and not significantly different from that observed in the control group. The intervention group reported a higher quality of life after both 14 (P < 0.01) and 41 weeks (P = 0.03), compared with the control group. Conclusions: The intensive cardiovascular rehabilitation programme increased physical performance capacity to a greater extent than conventional treatment after an intervention period of 14 weeks. The improvement was substantial, clinically relevant and may explain the better self-reported quality of life in the intervention group. Nevertheless, it remains challenging to maintain the achieved improvement in physical performance following the completion of the intensive rehabilitation programme. Future studies should investigate how the durability of the beneficial effects of supervised physical training can be increased. P358 Impact of diabetes on muscle mass, muscle strength, and exercise tolerance in elderly patients after coronary artery bypass grafting M Nishitani1, K Shimada1, A Kume1, K Fukao1, E Sai1, H Ohmura1, T Onishi1, H Sato1, A Amano1, H Daida1 1Juntendo University School of Medicine, Tokyo, Japan Atherosclerosis/CAD (Rehabilitation & Implementation) Aim: Patients with diabetes (DM) have a 2-4 times higher risk of developing coronary artery disease (CAD) and mortality. Elderly CAD patients with diabetes mellitus also have huge increased risks for future cardiovascular events. However, exercise training can be more difficult for elderly subjects even with diabetes mellitus. In addition, the diagnosis for diabetes mellitus is negatively associated with the improvement in exercise capacity. The purpose of this study was to assess the impact of diabetes mellitus on muscle mass, muscle strength, and exercise tolerance in elderly patients after coronary artery bypass grafting (CABG). Methods: We enrolled 187 consecutive elderly patients received cardiac rehabilitation (CR) after coronary artery bypass grafting (mean age 72 yrs, diabetes mellitus 87 pts, non-diabetes mellitus 100 pts). We measured lean body weight, mid-upper arm muscle area (AMA), and power of handgrip (HG). We performed isokinetic strength test of the knee extensor (Ex) and flexor (Flex) muscles, and cardiopulmonary exercise test at the beginning of CR. Results: There were no significant differences of age, gender, number of diseased vessels, or ejection fraction between the two groups. There was no significant differences of exercise tolerance, but the levels of muscle strength of Ex and Flex (p < 0.05) were significantly lower in the diabetes mellitus group than in the non-diabetes mellitus group. Peak oxygen uptake, AMA and thigh circumference correlated with muscle strength of Ex, Flex, and HG (all p < 0.01). There were no significant differences of muscle mass, muscle strength and exercise tolerance in patients with insulin therapy than in those without insulin therapy. Interestingly, a negative and significant correlation between glucose level and muscle strength of Ex (r = −0.37, p < 0.005) and Flex (r = −0.37, p < 0.005) were observed in the diabetes mellitus group. Conclusions: This study demonstrated that elderly diabetes mellitus patients had lower muscle strength than elderly non-diabetes mellitus patients. These data suggest that a high glucose level may affect these deteriorations even in elderly diabetes mellitus patients after coronary artery bypass grafting. P359 Beneficial effects of water exercise in cardiac rehabilitation M Marina Deljanin Ilic1, S Ilic1, D Simonovic1, V Stoickov1, S Simic1, S Ignjatovic1 1Institute of Cardiology, University of Nis, Niska Banja, Serbia Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: To investigate the effects of water exercise, added to regular exercise training program, on exercise capacity (EC) and double product (DP) during exercise test, lipid profile, glucose levels, hs-CRP and acidum uricum in patients (pts) with coronary artery disease (CAD). Methods: 60 pts with CAD (50 after myocardial infarction and 10 after coronary artery bypass grafting) were enrolled in the study. At baseline and after three weeks in all pts exercise test was performed and values of fasting glucose, hs-CRP, acidum uricum and lipid profile were determined. After the initial study, pts were randomized to exercise group (E, n = 35; 31 men) and exercise plus water exercise (EW, n = 25; 24 men) group. Patients in E group underwent a supervised 3 weeks exercise training (40 minutes of exercise training daily in the 10 to 15 min training session) at residential centre, while pts in EW group underwent the same supervised 3 weeks exercise training program plus water exercise (swimming and water walking, 15 min daily) in homeotherm water in swimming pool at residential centre. There were not significant differences in regard to age, sex and medicament therapy between E and EW group. Results: After 3 weeks EC increased significantly in both groups: in EW (from 5.28 ± 1.05 to 6.01 ± 1.11 METS, P < 0.0005) and in E group (from 5.05 ± 0.87 to 5.46 ± 0.82 METs, P < 0.0005) with significantly higher EC in EW than in E group on second exercise test (P = 0.029). At the end of the study, duration of exercise test was significantly higher than at the initial test in both groups (P < 0.0005 both), with significantly longer duration of second exercise test in EW than in E group (P = 0.037). Value of DP during the second exercise test, at the level on which the first exercise test was ended was significantly lower in both groups (P < 0.0005 both), however it was significantly lower in EW than in E group (P = 0.022). After 3 weeks, laboratory findings showed decreased of total cholesterol, low-density lipoprotein cholesterol, triglicerides and acidum uricum in both groups, without significant difference between groups. Glucose level and hs-CRP also decreased in both groups, and at the end of the study they were significantly lower in EW than in E group (P < 0.05 and P = 0.006). All pts tolerated exercise training and water exercise well without side effects. Conclusions: In selected group of pts with CAD water exercise in homeotherm water is safe and in combination with regular exercise training program leads to more favorable improvement of exercise capacity, DP, glucose and hs-CRP levels than exercise training alone. P360 Role of Ranolazine in the rehabilitation of patients with ischemic heart disease after aorto-coronary bypass grafting G Giuseppe Caminiti1, M Volterrani1, M Miano2, A Cerrito1, G Marazzi1, A Franchini1, G Cascelli1, G Rosano1 1IRCCS San Raffaele Pisana Hospital, Rome, Italy, 2University of medicine, cardiology departement, Catania, Italy Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: To determine whether the administration of ranolazine enhances the effects of exercise training on functional recovery of patients with ischemic heart disease (IHD) undergoing cardiac rehabilitation early after aorto-coronary bypass grafting (CABG). Methods: Sixty CHF patients, (50 men and 10 women, age 67.1+/10) with ischaemic heart disease admitted to the rehabilitation department in the early phase (<1 week) after coronary artery bypass grafting were recruited. Patients were randomly assigned to receive ranolazine 1gr/die (N = 30) (R group) or placebo (P group) for 4 weeks. At baseline and after four weeks, patients underwent a 6-minutes walking test (6MWT), echocardiogram, non-invasive haemodynamic evaluation, ECG-Holter monitoring and insulin resistance assessment by homeostasis model. All patients underwent an intensive 4-week program of aerobic exercise training (ET) at 50-60% oxygen uptake. Results: Distance walked at 6MWT significantly improved in the R group (+247+/28m) compared to P group (206+/23m) (between-groups p 0.02). Cardiac output (+13%) and cardiac index (+16%) increased in the R group while remained unchanged in the P group. There was a trend trough a higher increase of E/A ratio in the R group compared to P (between-groups p 0.06). Ventricular ectopic beats were significantly reduced in the R compared to P (−31% vs −12% respectively; p 0.01), while supraventricular ectopic beats were reduced in both groups without between-groups differences. The homeostasis model was significantly reduced in the R group in comparison with the P group (−16.5% vs −5%, respectively; p 0.001). No side effects requiring discontinuation of R were detected. Conclusion: The addition of ranolazine to ET seems to determine greater improvement of functional capacity in ischaemic heart disease patients. It seems also to play further favourable effects by reducing ventricular arrythmias and improving glucose metabolism. P361 Adherent and Non-adherent Coronary Heart Disease Patients' Perceptions About Medicines and Healthcare Services Adherence to Secondary Prevention Medicines by Coronary Heart Disease Patients , R Rani Khatib1, A Hall1, C Morrell1, C Forrest1, J Silcock2, K Marshall2 1Leeds General Infirmary, Yorkshire Heart Centre, Institute for Cardiovascular Research, Leeds, United Kingdom, 2University of Bradford, Bradford, United Kingdom Atherosclerosis/CAD (Rehabilitation & Implementation) Background: Non-adherence to evidence based secondary prevention medicines (SPM) by coronary artery disease (CAD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. Improving adherence can improve patients' health and reduce demands for healthcare. We explored the perception that adherent and non-adherent CAD patients have about their medicines in order to inform practice and improve adherence. Methods: A specially designed survey, assessed self-reported adherence using the Morisky Medicines Adherence 8 items Scale (MMAS-8) and the Single Question Scale (SQ). Patients were asked to provide comments on their medicines-taking behaviour. A purposive sample of 696 patients with long established CAD and who were on SPM for at least 3 months was surveyed using a postal questionnaire. Ethical approval was granted by the local ethics committee. Results: 502 (72%) patients completed the questionnaire. Of those, 221 (44%) patients elaborated on their medicines taking behaviour. 84 comments were made by 82 adherent patients and 222 comments by 139 non-adherers. Thematic analysis was conducted on all comments and major themes and frequencies were summarised in table 1. Discussion & conclusion: Non-adherent patients provided more comments which indicated that they had more issues and concerns they wanted to discuss. Five themes were identified. Non-adherers had more concerns about their SPM and general concerns about medicines and healthcare professionals. Adherent patients were more likely to report satisfaction with their medicines and healthcare services. Non-adherent patients had many suggestions to help address their concerns and improve their adherence. Conducting frequent medicines reviews which explore and address patients' concerns about their medicines and healthcare services and enable them to make suggestions will better inform practice and may improve adherence. Table 1. Themes of comments (n = 306) Themes No. of comments adherent non-adherent Specific concerns about SPM 97 13(13%) 84(87%) General concerns about medicines 117 32(27%) 85(73%) General concern about healthcare professionals 11 0(0%) 11(100%) Satisfaction & happiness related to medicines & healthcare services 50 35(70%) 15(30%) Suggestions related to medicines & medicines related services 31 4(13%) 27(87%) Themes No. of comments adherent non-adherent Specific concerns about SPM 97 13(13%) 84(87%) General concerns about medicines 117 32(27%) 85(73%) General concern about healthcare professionals 11 0(0%) 11(100%) Satisfaction & happiness related to medicines & healthcare services 50 35(70%) 15(30%) Suggestions related to medicines & medicines related services 31 4(13%) 27(87%) Open in new tab Table 1. Themes of comments (n = 306) Themes No. of comments adherent non-adherent Specific concerns about SPM 97 13(13%) 84(87%) General concerns about medicines 117 32(27%) 85(73%) General concern about healthcare professionals 11 0(0%) 11(100%) Satisfaction & happiness related to medicines & healthcare services 50 35(70%) 15(30%) Suggestions related to medicines & medicines related services 31 4(13%) 27(87%) Themes No. of comments adherent non-adherent Specific concerns about SPM 97 13(13%) 84(87%) General concerns about medicines 117 32(27%) 85(73%) General concern about healthcare professionals 11 0(0%) 11(100%) Satisfaction & happiness related to medicines & healthcare services 50 35(70%) 15(30%) Suggestions related to medicines & medicines related services 31 4(13%) 27(87%) Open in new tab P362 Implementation of aerobic interval training in cardiac rehabilitation: a randomized clinical study I-L Aamot1, SH Forbord2, V Lockra2, K Gustad3, A Stensen3, AT Berg2, H Dalen3, T Karlsen1, A Stoylen1 1Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway, 2St.Olavs University Hospital, Trondheim, Norway, 3Levanger Hospital, Levanger, Norway Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: to assess efficiency of implementation of aerobic interval training (AIT) in cardiac rehabilitation (CR), and whether organisation of exercise influences outcome. Methods: 90 patients (80 men/10 women, mean age 57 ± 8,) referred to CR at two Norwegian hospitals, diagnosed myocardial infarction (MI) or had undergone revascularisation, were included. They were randomized to AIT on treadmills (TE, n = 34), in group exercise classes (GE, n = 28) or to home-based exercise training (HE, n = 28) for 12 weeks, twice a week. AIT was equally performed in the groups as 4x4 minutes at 85-95% of HRpeak with 3 minutes active breaks between. Cardiopulmonary exercise test was performed before and after intervention. All participants were instructed in use of heart rate (HR) monitors. Main outcome measure was VO2peak. Results: 83 persons (92%) completed the programme with no adverse events registered. 7 persons (1 female) dropped out (2 TE, 3 GE, 2 HE) due to orthopaedic problems (3), GI problem (1) or withdrawal of consent (n = 3). Exercise adherence was high as median exercise sessions pr group was 24 (range 7-24 in TE, 18-24 in GE and 10-24 in HE). THR was achieved by all except one. Test results are shown in table 1. Conclusion: AIT can be efficiently implemented in a CR programme, both as outpatient hospital exercise groups or as home-based CR. Test results before and after AIT Treadmill Exe Group Exe Home-based Exe n = 32 n = 25 n = 26 VO2peak BL 12w BL 12w BL 12w ml/kg/min 34.7 ± 7.3 39.0 ± 8.0 32.7 ± 6.5 36.0 ± 6.2 34.4 ± 4.8 37.2 ± 5.2 L/min 2.95 ± 0.67 3.28 ± 0.7 2.92 ± 0.58 3.19 ± 0.54 3.0 ± 0.58 3.25 ± 0.56 RER 1.1 ± 0.06 1.09 ± 0.06 1.1 ± 0.06 1.1 ± 0.05 1.1 ± 0.06 1.09 ± 0.06 HRpeak beats/min 164 ± 17 164 ± 16 162 ± 17 164 ± 17 164 ± 12 164 ± 14 Resting HR beats/min 59 ± 9 57 ± 8 60 ± 9 59 ± 8 59 ± 9 54 ± 7 Body weight kg 86.1 ± 14.2 85.2 ± 14.5 89.7 ± 13.8 88.8 ± 12 89.2 ± 14.6 88.6 ± 14.6 BP mmHg systolic 137 ± 20 134 ± 14 144 ± 23 138 ± 16 137 ± 17 135 ± 14 diastolic 83 ± 10 81 ± 8 89 ± 12 87 ± 8 84 ± 11 83 ± 8 p=0.05 between groups VO2peak; peak oxygen uptake, RER; respiratory exchange ratio, HR; heart rate, BP; blood pressure Treadmill Exe Group Exe Home-based Exe n = 32 n = 25 n = 26 VO2peak BL 12w BL 12w BL 12w ml/kg/min 34.7 ± 7.3 39.0 ± 8.0 32.7 ± 6.5 36.0 ± 6.2 34.4 ± 4.8 37.2 ± 5.2 L/min 2.95 ± 0.67 3.28 ± 0.7 2.92 ± 0.58 3.19 ± 0.54 3.0 ± 0.58 3.25 ± 0.56 RER 1.1 ± 0.06 1.09 ± 0.06 1.1 ± 0.06 1.1 ± 0.05 1.1 ± 0.06 1.09 ± 0.06 HRpeak beats/min 164 ± 17 164 ± 16 162 ± 17 164 ± 17 164 ± 12 164 ± 14 Resting HR beats/min 59 ± 9 57 ± 8 60 ± 9 59 ± 8 59 ± 9 54 ± 7 Body weight kg 86.1 ± 14.2 85.2 ± 14.5 89.7 ± 13.8 88.8 ± 12 89.2 ± 14.6 88.6 ± 14.6 BP mmHg systolic 137 ± 20 134 ± 14 144 ± 23 138 ± 16 137 ± 17 135 ± 14 diastolic 83 ± 10 81 ± 8 89 ± 12 87 ± 8 84 ± 11 83 ± 8 p=0.05 between groups VO2peak; peak oxygen uptake, RER; respiratory exchange ratio, HR; heart rate, BP; blood pressure Open in new tab Test results before and after AIT Treadmill Exe Group Exe Home-based Exe n = 32 n = 25 n = 26 VO2peak BL 12w BL 12w BL 12w ml/kg/min 34.7 ± 7.3 39.0 ± 8.0 32.7 ± 6.5 36.0 ± 6.2 34.4 ± 4.8 37.2 ± 5.2 L/min 2.95 ± 0.67 3.28 ± 0.7 2.92 ± 0.58 3.19 ± 0.54 3.0 ± 0.58 3.25 ± 0.56 RER 1.1 ± 0.06 1.09 ± 0.06 1.1 ± 0.06 1.1 ± 0.05 1.1 ± 0.06 1.09 ± 0.06 HRpeak beats/min 164 ± 17 164 ± 16 162 ± 17 164 ± 17 164 ± 12 164 ± 14 Resting HR beats/min 59 ± 9 57 ± 8 60 ± 9 59 ± 8 59 ± 9 54 ± 7 Body weight kg 86.1 ± 14.2 85.2 ± 14.5 89.7 ± 13.8 88.8 ± 12 89.2 ± 14.6 88.6 ± 14.6 BP mmHg systolic 137 ± 20 134 ± 14 144 ± 23 138 ± 16 137 ± 17 135 ± 14 diastolic 83 ± 10 81 ± 8 89 ± 12 87 ± 8 84 ± 11 83 ± 8 p=0.05 between groups VO2peak; peak oxygen uptake, RER; respiratory exchange ratio, HR; heart rate, BP; blood pressure Treadmill Exe Group Exe Home-based Exe n = 32 n = 25 n = 26 VO2peak BL 12w BL 12w BL 12w ml/kg/min 34.7 ± 7.3 39.0 ± 8.0 32.7 ± 6.5 36.0 ± 6.2 34.4 ± 4.8 37.2 ± 5.2 L/min 2.95 ± 0.67 3.28 ± 0.7 2.92 ± 0.58 3.19 ± 0.54 3.0 ± 0.58 3.25 ± 0.56 RER 1.1 ± 0.06 1.09 ± 0.06 1.1 ± 0.06 1.1 ± 0.05 1.1 ± 0.06 1.09 ± 0.06 HRpeak beats/min 164 ± 17 164 ± 16 162 ± 17 164 ± 17 164 ± 12 164 ± 14 Resting HR beats/min 59 ± 9 57 ± 8 60 ± 9 59 ± 8 59 ± 9 54 ± 7 Body weight kg 86.1 ± 14.2 85.2 ± 14.5 89.7 ± 13.8 88.8 ± 12 89.2 ± 14.6 88.6 ± 14.6 BP mmHg systolic 137 ± 20 134 ± 14 144 ± 23 138 ± 16 137 ± 17 135 ± 14 diastolic 83 ± 10 81 ± 8 89 ± 12 87 ± 8 84 ± 11 83 ± 8 p=0.05 between groups VO2peak; peak oxygen uptake, RER; respiratory exchange ratio, HR; heart rate, BP; blood pressure Open in new tab P363 Aims of a cardiac rehabilitation program in young patients after acute coronary syndrome F De Torres Alba1, N Montoro Lopez1, R Cadenas Chamorro1, S Garcia Blas1, L Blazquez2, A Iniesta Manjavacas1, S Valbuena Lopez1, 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 Atherosclerosis/CAD (Rehabilitation & Implementation) Objectives: Lifestyle related factors have a clear impact on the onset of premature coronary disease. In order to define the priorities of a cardiac rehabilitation program for young patients, we analysed the risk profile of a cohort of patients younger than 45 years with a recent admission for acute coronary syndrome. Material and methods: We studied 51 patients, mean age 39.4 years, 90.2% were male. 75.5% had presented ST-elevation myocardial infarction, 25.5% non ST-elevation myocardial infarction, and 98% underwent percutaneous coronary intervention. Smoking was the most prevalent risk factor, followed by sedentarism, dyslipidemia and obesity. In addition to 23% of patients who were obese, 43% were overweight. 45% of patients accumulated 3 or more risk factors. Regarding the lipid profile, it is of note that 42% had HDL <35 mg/dl, and 48% triglycerides > 150 mg/dl. A ratio TG/HDL ≥ 3.5 (indicator of insulin resistance) was found in 77%. 25% had abdominal obesity. 92% achieved more than 7 METs during exercise testing at the beginning of the program. In view of these results the intervention on smoking cessation, correcting dietary habits and exercise recommendation were considered as priority objectives, in addition to usual pharmacologic measures for secondary prevention. Results: The program lasted 8 weeks and a follow-up visit was scheduled at 6 months. Smoking abstinence (confirmed by co-oximetry) at 3 months was 73%, 66% at 6 months, and 24% required drugs for smoking cessation. Despite diet and exercise recommendations, only 20% of overweight patients lost weight (average gain of 0.5 kg at 3 months, 2.5 kg at 6 months, partly justified by the smoking cessation). 84% of patients improved their functional capacity (average gain of 2.7 METS between the initial and final stress test). 24% left the program prematurely and telephone follow-up was performed. Drug treatment adherence at 6 months was optimal in 90%. Conclusions: Patients with premature coronary heart disease have a high prevalence of modifiable risk factors, so the primary objective of cardiac rehabilitation should be lifestyle modification, with special emphasis on smoking cessation, diet and physical exercise. A multidisciplinary approach is necessary to promote adherence to recommendations in these patients, and thus slow the progression of atherosclerosis. Distribution of risk factors HT DM Dyslipidemia Smoking Inactivity Obesity N° of RF 27.5% 17.6% 51.0% 80.4% 58.8% 23% 2.6 HT DM Dyslipidemia Smoking Inactivity Obesity N° of RF 27.5% 17.6% 51.0% 80.4% 58.8% 23% 2.6 RF: risk factors. Open in new tab Distribution of risk factors HT DM Dyslipidemia Smoking Inactivity Obesity N° of RF 27.5% 17.6% 51.0% 80.4% 58.8% 23% 2.6 HT DM Dyslipidemia Smoking Inactivity Obesity N° of RF 27.5% 17.6% 51.0% 80.4% 58.8% 23% 2.6 RF: risk factors. Open in new tab P364 Effects of a Cardiac Rehabilitation Program on Diastolic Filling Properties and Functional Capacity in Patients with Myocardial Infarction A Golabchi1, M Sadeghi2, F Basati3, M Kargarfard3 1Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 2Isfahan University of Medical Sciences, Isfahan Cardiovascular Research Center, Isfahan, Iran (Islamic Republic of), 3Isfahan university, Isfahan, Iran (Islamic Republic of) Atherosclerosis/CAD (Rehabilitation & Implementation) Background: Cardiac rehabilitation and secondary prevention is an integral part of the treatment of patient with cardiovascular disease to date, however the effect of this programs on systolic and diastolic function is controversial. The aim of this study was to evaluate the effect of 8 weeks cardiac rehabilitation program on diastolic function and functional capacity in patients with myocardial infarction. Methods: twenty-nine post myocardial patient enrolled in this study, which was completed in cardiac rehabilitation group (15 men) and control group (14 men). Echocardiographic measures of diastolic filling and functional capacity by symptom limited exercise test based on naughton protocol on treadmill were performed at baseline and after 8 weeks of training. Data were analysed using repeated analysis of covariance (ANCOVA) in P < 0.05 level. Finding: After 8 weeks cardiac rehabilitation program, diastolic filling indicators did not change significantly (E velocity, A velocity, E/A ratio and deceleration time). But functional capacity increase significantly in cardiac rehabilitation group. But, functional capacity, resting HR and maximal HR improved significantly in the training group compared to the control group. Conclusion: This study revealed that Cardiac rehabilitation program for 8 weeks significantly improves functional capacity in post myocardial patients but diastolic function did not change significantly. It seems likely that the improvement in functional capacity largely pertain to non cardiac effects. P365 Intensity of six-month cardio training in modification of vagal tone in patients with ischemic heart disease D Kalka1, Z A Zygmunt Antoni Domagala2, L Rusiecki1, W Marciniak3, P Koleda1, A Bieolus Wilk1, A Janocha4, J Wojcieszczyk5, J Adamus3, W Pilecki1, W Pilecki1 1Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland, 2Wroclaw Medical University, Wroclaw, Poland, 3Ostrobramska Medical Center, Magodent, Department of Cardiology, Warsaw, Poland, 4Wroclaw Medical University, Department of Physiology, Wroclaw, Poland, 5University School of Physical Education, Departament of Physiotherapy in Preventive and Surgical Med, Wroclaw, Poland Atherosclerosis/CAD (Rehabilitation & Implementation) Introduction: The dynamics of heart rate recovery (HRR) is related to the balance in the autonomic nervous system, and its value (HRR60) measured in the first minute is considered as the parameter of vagal tone useful for the assessment of the risk of sudden cardiac death. HRR intensity changes under the influence of intensification of physical activity (PA) conducted as part of cardiac rehabilitation (CR). Purpose: Assessment of the influence of a six-month CR cycle at outpatient clinics on the change of HRR60 intensity, taking into account the influence of strength training intensity on HRR60 intensity in a group of patients with ischemic heart disease (IHD). Materials and methods: The study was conducted on a group of 286 patients treated invasively for ischaemic heart disease. Altogether, 251 patients (average age 61.39 ± 9.69) of the study group were subjected to a CR cycle. The control group consisted of 35 patients (average age 62.91 ± 6.76) not subjected to CR. The CR cycle was conducted for six months and included 120 trainings (strength exercises 3 times a week and general exercises twice a week). Loads of the cycle ergometers were set at 4-minute intervals and were interrupted by 2-minute rest periods with maintained load of 5-10 W. Each training session lasted 45 minutes. The intensity of strength exercises was presented using parameters describing the size of the load used. The value of the mean work and of the delta of training works were analysed. In six months, all patients from the test group and the control group were subjected to a treadmill test twice. The initial and final HRR60 values were analysed and the ΔHRR60 as the difference between the final and the initial value of this parameter. Results: A comparative analysis of HRR60 mean values from the initial test between the study group and the control group has not shown any statistically significant differences. After a six-month observation, in the study group there was a statistically significant increase of the HRR60 value, which was not observed in the control group (22.72 ± 6.75/min vs 18.00 ± 6.25/min, p < 0.01). Mean work of the cardio training undergone by patients from the test group was 77.73 ± 20.02 kJ and it was not statistically significantly correlated with ΔHRR60 (r = −0.075, NS). Mean absolute increase of the training work was 22.64 ± 11.84 kJ in the test group and it was not statistically significantly correlated with ΔHRR60 (r = −0.029, NS). Conclusions: A six-month CR cycle has significantly increased the dynamics of HRR, however the intensity of cardio training has not influenced the change of HRR60 intensity caused by effort. P366 The value of telerehabilitation in encouraging coronary artery disease patients to stay active after the acute rehabilitation phase. I Frederix1, D Hansen2, K Bonne2, T Alders2, N Van Driessche3, J Berger2, P Dendale4 1Catholic University of Leuven, Leuven, Belgium, 2Virga Jesse Hospital, Rehabilitation and Health Centre, Hasselt, Belgium, 3Hasselt University, Hasselt, Belgium, 4Jessa Hospital, Hasselt, Belgium Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: The aim of this study was to evaluate whether the addition of a motion sensor with automated feed-back by SMS to the conventional rehabilitation program could result in an increase in daily activity among coronary artery disease patients. Methods: 20 coronary artery disease patients were included in this randomized, controlled trial after admission for percutaneous coronary intervention or coronary artery bypass grafting (target population of the study n = 80). All patients were included during phase II of the cardiac rehabilitation program. Patients with a defibrillator, important arrhythmias or severe heart failure (NYHA class III and IV) were excluded from the trial. The patients in the intervention group (n = 14) were asked to wear the motion sensor continuously during the day for 6 weeks. Each week they uploaded their step data on the web and received new step goals for the next week. The feed-back program was designed to gradually increase the patients' activity level. In the control group (n = 6), the patients wore the motion sensor two times for one week for measurement purposes only (week 1 and 6). All patients performed a maximal cardiopulmonary exercise test at week 1 and 6 to determine their peak oxygen uptake (VO2 peak). The primary hypothesis of the trial was that the addition of a telerehabilitation program to the conventional cardiac rehabilitation program results in a sustained, increased amount of daily activity outside the rehabilitation centre. The secondary hypothesis was that this also would translate into a greater increase in oxygen uptake peak. The Wilcoxon and Mann-Whitney test were used to test these hypotheses. Results: For the intervention patients, the Wilcoxon test showed a significant increase in daily activity between week 1 and week 6 (P = 0.0009) and a significant increase in oxygen uptake peak (P = 0.0098). In the control group, the respective P values were 0.219 and 0.375. The Mann-Whitney test comparing the increase in walking steps from week 1 to week 6 between the intervention and control group did also show a trend toward larger increase in the intervention group (P = 0.054). Conclusions: The addition of an internet-based telerehabilitation program to conventional cardiac rehabilitation resulted in a significant increase in daily activity level and oxygen uptake peak after 6 weeks, as compared to conventional rehabilitation alone. This observation was promising, because it has proven difficult to encourage cardiac patients to stay active or to increase their daily physical activity level. An internet-based telerehabilitation intervention that uses motion sensors might be a valuable instrument to overcome this difficulty. P367 Cardiac rehabilitation after acute coronary intervention: the patients view J Joep Perk1, G Burell2, R Carlsson3, K Hambraeus4, P Johansson5, J Lisspers6 1Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden, 2Uppsala University, Department of Public Health and Caring Science, Uppsala, Sweden, 3Swedish percutaneous coronary intervention AB, Karlstad, Sweden, 4Falun Hospital, Department of Cardiology, Falun, Sweden, 5Heart and Lung Patients Association, Stockholm, Sweden, 6Division of Psychology, Mid Sweden University, Sundsvall, Sweden Atherosclerosis/CAD (Rehabilitation & Implementation) Introduction: The land winnings of modern interventional cardiology have dramatically improved the outcome after an acute coronary event (ACS), but it is less clear if cardiac rehabilitation and prevention programmes have been adapted to this rapidly changing face of acute cardiology. What are the needs, demands and expectations of patients after an acute myocardial infarction with a short hospital stay and limited loss of cardiac function? Aim and methods: In collaboration with the Swedish Heart and Lung Patients Association a questionnaire has been sent to 10% of all acute percutaneous coronary intervention patients annually in Sweden, including 1800 patients at 28 both interventional and non-interventional centres. Patients' experience of post-percutaneous coronary intervention information has been investigated with special focus on lifestyle recommendations. Questions on adherence to lifestyle counselling have been included. Result: (based upon 50% of the 1800 questionnaires, complete results available at EuroPrevent 2012) The post acute percutaneous coronary intervention population consisted of 26% women, 74% men, av. age 66yrs, 82% replied within 8 weeks after percutaneous coronary intervention. As the major cause of acute coronary syndrome 51% of the patients rated heredity, 45% stress and 39% aging. Conventional and changeable risk factors (smoking, food habits, physical activity) were not deemed as important. Patient information was seen as valuable but as few as 26% received information together with their nearest relative/partner. Patients underestimated overweight as compared to body mass index data and 61% had not changed food habits, even if there was a clear need for a change. Three out of four had not yet started a physical training programme, half of those who had continued smoking had not received smoking cessation counselling. Stress management was only offered to 16%. Conclusion: In this large cohort of post-percutaneous coronary intervention patients less than one out of four patients had reached the target levels for a cardioprotective lifestyle, thus showing an urgent need for adaptation of the current cardiac rehabilitation practice and lifestyle counselling to modern interventional cardiology P368 Changes in heart rate/work rate relationship and cardiorespiratory fitness following short-term rehabilitation in patients with cardiovascular disease L Lee Ingle1, C Tsakirides1, S Carroll2 1Leeds Metropolitan University, Leeds, United Kingdom, 2University of Hull, Hull, United Kingdom Atherosclerosis/CAD (Rehabilitation & Implementation) Introduction: The aim of our study was to determine the changes in both the heart rate (HR)/work rate (WR) (HR/WR), and HR/estimated oxygen uptake (VO2) (HR/VO2) relationship during submaximal exercise testing following short-term cardiac rehabilitation (CR) in a large, representative sample of patients with cardiovascular disease (CVD). Methods: At baseline, patients performed a submaximal exercise test up to 85% of age-predicted maximum heart rate, or a “hard” level of effort (rating of perceived exertion = 17 for those on beta-blockers) to measure cardiorespiratory fitness (CRF). The HR/WR and HR/VO2 relationships were plotted for each two minute stage of the Lehmann protocol until test termination. The intercept and slope for HR/WR and HR/VO2 relationships were calculated using linear regression. Patients undertook 3 months of structured circuit-based CR (a minimum of 2 training sessions per week). A subsequent submaximal exercise test was performed at 3 months and HR/WR and HR/VO2 relationships were re-examined using repeated measures analysis of variance. Results: 139 cardiac patients, mean (SD) (79% males; mean age 62 (8) years; body mass index 28 (4) kg·m−2; 62% beta-blockers) were recruited. HR/VO2 and HR/WR showed no change in the slope of the relationship between the variables from baseline to 3 months. However, we found a significant decrease in the intercept between HR/VO2 (66.0 ± 18.2 v 58.5 ± 15.9; P < 0.0001), and HR/WR (77.8 ± 19.2 v 72.3 ± 17.6; P < 0.0001) following adjustment for changes in body mass. Following a sub-analysis of patients on and off beta-blockers, we found no interaction between HR/WR slope and use of beta-blockade (P = 0.854) indicating that the changes in the intercept were independent of beta-blocker medication. There was a significant association between changes in sub-maximal exercise duration and changes in the intercept of HR/VO2 (r = 0.28; P = 0.001), and changes in the intercept of HR/WR (r = 0.34; P = 0.0001) following 3 months of CR. Conclusion: Significant changes were evident in the elevation of the linear HR/WR and HR/VO2 relationships during submaximal exercise, after adjustment for changes in body mass, and were independent of beta-blockade usage, following 3 months of CR in a large, representative sample of patients with cardiovascular disease. These changes were related to improvements in submaximal treadmill duration. In the absence of maximal testing protocols and respiratory gas analysis, clinical CR staff should consider measuring temporal changes in the HR/WR relationship in order to track changes in CRF during patient risk stratification. P369 Exercise training versus percutaneous coronary intervention - Ventilatory anaerobic threshold in patients with stable coronary artery disease S Hoppe1, C Walther1, S Erbs1, A Linke1, K Lenk1, S Gielen1, R Hambrecht2, G Schuler1, S Moebius-Winkler1 1Heart Centre, Department of Cardiology, Leipzig, Germany, 2Hospital Links der Weser, Department of Cardiology and Angiology, Bremen, Germany Atherosclerosis/CAD (Sports Cardiology) Purpose: The PET-trial by Hambrecht et al.1 has shown that a 12-month physical exercise training compared with percutaneous coronary intervention (PCI) with stenting in selected patients with stable coronary artery disease (CAD) resulted in superior exercise capacity and reduced rehospitalizations and repeat revascularizations. Furthermore previous studies showed no effects on mortality by using a stent in patients with stable CAD. The aim of this study was the comparison of the ventilatory anaerobic threshold (VAT) of the two groups from the PET-Study to detect a patient-independent parameter for the exercise capacity and to evaluate difference in the aerobic capacity. Methods: A subgroup of 65 male patients aged ≤ 70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to percutaneous coronary intervention. At baseline and after 12 months asymptom-limited ergospirometry was performed. The VAT was quantified by the Dmax-method2. Results: The VAT increased in the exercise-group (T) after 12 month (104 ± 25W in T baseline versus 125 ± 27W in T after 12 month; p < 0,001). There was no change in the VAT in the percutaneous coronary intervention-group (P) after 12 month (92 ± 18W in P baseline versus 98 ± 17W in P after 12 month, p = n.s.). Therefore the VAT elevate in T about 19,7%. Conclusions: In the present subgroup analysis, we found that in patients with stable CAD amenable for percutaneous coronary intervention, a 12-month exercise-training program resulted in an increased VAT as a patient-independent parameter. Both percutaneous coronary intervention and exercise training were equally effective in improving symptom-free exercise tolerance but only the exercise training is associated with a significantly improvement of the aerobic reserve and leads to a discharge of the cardiovascular system. The present study adds a piece of evidence to the results of the PET-trial. 1 Hambrecht R, Walther C, Möbius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004;109(11): 1371-1378. 2 Cheng. A new approach for the determination of ventilatory and lactate thresholds. Int J Sports Med 1992; 13: 518-522. P370 Incidence of lone atrial fibrillation in men and women after long practice of the breath hold and/or SCUBA diving A Stuto1, G Bottaro1, P Ramirez1, A Lo Giudice1, G Basile1 1"STEAL WHEALTH TEAM" Cardiac Prevention and Rehabilitation, Siracusa, Italy Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Some studies have shown that subjects who practice endurance sports are at approximately five times higher risk of lone atrial fibrillation (LAF) than those who are sedentary. The aim of present study was to determine if this increased risk concerns also subjects practicing breath hold or SCUBA diving. Methods: A group of divers (242) and a population-based sample of sedentary men and women (244) recruited in 1997-1998, were contacted in 2007-08 and invited to attend an outpatient clinic to identify suggestive symptoms of having experienced an arrhythmia requiring medical attention. In those with suggestive symptoms of atrial fibrillation, medical records were reviewed. Finally, LAF was diagnosed on the basis of the presence of atrial fibrillation in an electrocardiographic recording. In all subjects, an echocardiogram was performed at inclusion and at the end of the study. Furthermore was performed a genetic testing for atrial fibrillation. The follow-up lasted 10 +/− 0.7 years. Results: Forty divers and forty two controls dropped out during the follow-up. In the residual the annual incidence rate of LAF among divers and sedentary men was 0.33% and 0.12%, respectively. In 75% of the divers were detected increased right atrial diameters and volume, and in 5% was detected also an increased left atrial infer- superior diameter and left atrial volume. In this last group the LAF incidence was little higher (0.44%) than in divers with isolated increase of the right atrial diameters and volume. The genetic tests results were positive in 40% of subjects who developed LAF independently of the age in male, but were inconclusive in women. Conclusion: on the basis of the above results we can conclude that subjects who practice either breath hold or SCUBA diving are at approximately three times higher risk of symptomatic lone atrial fibrillation (LAF) than those who are sedentary. The genetic tests results were positive in forty percent (40%) of male subjects who developed LAF, but any association was detected in female divers. P371 Incidence of lone atrial fibrillation in men and women after long practice of the breath hold and/or scuba diving A Stuto1, G Bottaro1, P Ramirez1, A Lo Giudice1, G Basile1 1"STEAL WHEALTH TEAM" Cardiac Prevention and Rehabilitation, Siracusa, Italy Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Some studies have shown that subjects who practice endurance sports are at approximately five times higher risk of lone atrial fibrillation (LAF) than those who are sedentary. The aim of present study was to determine if this increased risk concerns also subjects practicing breath hold or SCUBA diving. Methods: A group of two hundred forty two (242) divers and a population-based sample of two hundred forty four (244) sedentary men and women recruited in 1997-1998, were contacted in 2007-08 and invited to attend an outpatient clinic to identify suggestive symptoms of having experienced an arrhythmia requiring medical attention. In those with suggestive symptoms of atrial fibrillation, medical records were reviewed. Finally, LAF was diagnosed on the basis of the presence of atrial fibrillation in an electrocardiographic recording. In all subjects, an echocardiogram was performed at inclusion and at the end of the study. Furthermore was performed a genetic testing for atrial fibrillation. The follow-up lasted 10 +/− 0.7 years. Results: Forty divers and forty two controls dropped out during the follow-up. In the residual the annual incidence rate of LAF among divers and sedentary men was 0.33% and 0.12%, respectively. In 75% of the divers were detected increased right atrial diameters and volume, and in 5% was detected also an increased left atrial infer- superior diameter and left atrial volume. In this last group the LAF incidence was little higher (0.44%) than in divers with isolated increase of the right atrial diameters and volume. The genetic tests results were positive in 40% of subjects who developed LAF independently of the age in male, but were inconclusive in women. Conclusion: on the basis of the above results we can conclude that subjects who practice either breath hold or SCUBA diving are at approximately three times higher risk of symptomatic lone atrial fibrillation (LAF) than those who are sedentary. The genetic tests results were positive in forty percent (40%) of male subjects who developed LAF, but any association was detected in female divers. P372 Brugada electrocardiogram- pattern type 2 and 3 recorded with V1 and V2 in the third intercostal space is relatively common in young athletes A Andrea Menafoglio1, F Sartori1, G Moschovitis2, A Gallino1, M Di Valentino1 1Hospital of San Giovanni, Department of Cardiology, Bellinzona, Switzerland, 2Lugano Regional Hospital, Lugano, Switzerland Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: The prevalence of Brugada electrocardiogram-pattern is about 1/2000, mostly of type 2 and 3. In some circumstances, type 2 and 3 can convert in type 1 pattern, the only diagnostic pattern. Registering electrocardiogram with V1 and V2 in the third intercostal space (3IC) can raise the sensibility of recording a Brugada electrocardiogram-pattern and the prognostic value seems to be similar as the standard electrocardiogram. The aim of this study is to analyse the prevalence of Brugada electrocardiogram-pattern in a cohort of young athletes recording electrocardiogram also in the 3IC to raise the sensibility to detect this electrocardiogram-pattern. This should add more information about the management of this young population with this electrocardiogram feature. Methods: electrocardiogram was analysed as part of a prospective ongoing study about the impact of cardiovascular screening with electrocardiogram in young (14-35 years) competitive athletes. Besides a standard tracing, electrocardiogram was recorded with V1 and V2 in the 3IC. The prevalence of Brugada electrocardiogram-pattern type 1, 2 and 3 was analysed. Results: electrocardiogram of 359 athletes (70% males, age 20.8 ± 6.5 years) was analysed. No single standard electrocardiogram tracing had a Brugada-pattern. In electrocardiogram recorded in the 3IC there were 12 (3,3%) Brugada type 2 and type 3, no type 1 was recorded. Of these 12 athletes, 11 were males (prevalence in males 4,3%), 1 was a female (prevalence in females 0,9%). Of 11 males, 7 had a Brugada type 3 pattern (2,8% of males), 4 had a type 2 pattern (1,5%). The female had a tape 3 pattern. No athlete took medications known to elicit a Brugada electrocardiogram-pattern. No athlete with Brugada electrocardiogram-pattern had a history of syncope of undetermined origin or a family history of premature sudden death. Conclusions: Brugada electrocardiogram- pattern type 2 and 3 in the 3IC is relatively common in young athletes, particularly males. This should be taken into account before drawing conclusion about risk stratification in this young healthy population. P373 Application of current esc recommendations for 12-lead resting ecg interpretation in professional football players P Philipp Bohm1, R Ditzel1, H Ditzel1, A Urhausen2, T Meyer1 1Department for Sports Medicine and Prevention, Saarbrücken, Germany, 2Centre of Sports Medicine, Luxembourg, Luxembourg Rhythm Disorders/Sudden death (Sports Cardiology) Introduction: The prevention of sudden cardiac death represents an important goal in sports cardiology, and resting electrocardiogram interpretation is a useful screening tool for this purpose. To distinguish between abnormal electrocardiogram patterns and physiological effects of training it is important to know which electrocardiogram abnormalities are common in healthy athletes, and how often they occur. Methods: Data of 566 professional male football players (56 of them with African origin) with an age of at least 16 years were screened retrospectively (age: 20.9 ± 5.3 years; body mass index: 22.9 ± 1.7 kg/m2, training history: 13.8 ± 4.7 years). All included players were in good cardiac health and eligible for elite sport based on the results of medical history, physical examination, echocardiography (in 546 cases), exercise electrocardiogram (in 459 cases) as well as further examinations (24-hour electrocardiogram, Cardio-MRT) if necessary. The resting electrocardiograms were analysed and classified according to the most current categorization of the European Society of Cardiology (2009). Results: 5.3% of the football players showed a first-degree AV block, 0.2% a Mobitz Type I (Wenckebach) second-degree AV block, no higher degree AV block was observed. 55% had a sinus bradycardia. 1.1% presented with a left-, 1.2% with a right-axis deviation. Atrial changes (P sinistro-/dextroatriale) were seen in 9.2% of the electrocardiograms, pathological Q-spikes in 0.5%. 44% had an incomplete- and 0.7% a complete right bundle branch block. The Sokolow-Lyon-Index for left-ventricular hypertrophy was positive in 33.4%. 64% of the football players showed an early repolarisation pattern (ST-segment elevation of 2 mm in ≥ 2 leads). Flat T-wave inversions were existent in 2.3%, deep T-wave inversions in 1.2% of the players. According to the classification of the ESC, 33.7% showed uncommon electrocardiogram-patterns which cannot be assessed as training-related and should be further investigated. 67.9% of all African players showed either mildly (48.2%) or distinctly (19.6%) abnormal electrocardiogram-patterns. Conclusion: Resting electrocardiogram-changes amongst professional football players are common. Knowledge about those changes and their frequency in apparently healthy athletes can contribute to a more specific interpretation of the resting electrocardiogram as a screening tool. Differences observed between ethnic groups have to be taken into account. Such findings might be taken into account when ESC recommendations are revised. P374 The impact of gender and training volume on autonomic modulations in non-elite endurance athletes. M Wilhelm1, M Fuerholz1, L Roten1, H Tanner1, JP Schmid1, H Saner1 1Bern University Hospital and University of Bern, Bern, Switzerland Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: The risk of sudden death is increased in athletes with a striking male predominance. Sympathetic activation precipitates ventricular arrhythmias, whereas vagal tone suppresses their occurrence. We studied the impact of gender and training volume on autonomic modulation in endurance athletes. Methods: Amateur athletes participating in the Grand Prix of Bern, a 10 Mile race, were invited. 873 runners applied, of whom 70 female and 70 male athletes were randomly selected. Athletes were stratified according to their average weekly training hours in a low volume (=4 hours) and a high volume (>4 hours) training group. Echocardiography and 24 hour Holter monitoring with frequency domain analysis of heart rate variability was performed. The low frequency (LF)/high frequency (HF) power ratio reflects the sympatho-vagal balance and was calculated for hourly 5 minutes segments and averaged for daytime and nighttime. Results: 114 healthy athletes were included. Mean age was 42 ± 7 years. There were no gender differences for age, average training hours, and race time. Left ventricular function was normal in all athletes. The LF/HF ratio showed a circardian pattern (Figure 1) and was significantly lower in female athletes during daytime (4.2 ± 2.3 versus 6.1 ± 2.9; P < 0.001) and nighttime (2.4 ± 1.3 versus 4.4 ± 7.6; P = 0.009). In female athletes, a higher training volume was associated with a significantly lower LF/HF power ratio at nighttime (3.8 ± 1.8 versus 2.1 ± 1.9; P = 0.008), while in male athletes, the same was true at daytime (7.1 ± 3.1 versus 5.4 ± 2.5; P = 0.021). Conclusions: For a comparable amount of training and performance, female athletes showed a higher vagal tone, possibly protecting against ventricular arrhythmias. Female and male athletes showed a different circadian pattern of training-related increase in vagal tone. Open in new tabDownload slide P375 Prevalence of autonomic trigger mechanisms and athletic activity in patients undergoing ablative treatment for highly symptomatic atrial fibrillation A Muessigbrodt1, S Richter1, A Bollmann1, G Hindricks1 1University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany Rhythm Disorders/Sudden death (Sports Cardiology) Background: The influence of the autonomic nervous system triggering arrhythmia is known in physically active and non-active patients with atrial fibrillation. Existing data focus on the influence of intensive endurance training in older male athletes. There is no evidence yet for an enhanced prevalence of atrial fibrillation in younger male athletes and in female athletes. In literature, the prevalence of atrial fibrillation seems to have an U-shaped dose dependency in relation to athletic activity. Methods: We studied the pattern of autonomic nervous system triggering arrhythmia in 84 consecutive patients (43 males, 57,1 +/−10,8 years, 31 females 61,5 +/−8,3 years) with highly symptomatic paroxysmal and persistent atrial fibrillation after circumferential isolation of the pulmonary veins. Kind and quantity of sport activities and their influence on atrial fibrillation were studied, too. A questionnaire concerning athletic habits and the influence of the autonomic nervous system triggering arrhythmia was filled out. Results: In this observational study, in 29 of 43 male patients (67,4%) and 29 of 31 female patients (93,5%) seem to exist autonomic trigger mechanisms for atrial fibrillation. 21 of 43 (48,8%) of male patients show vagal trigger mechanisms. Adrenergic trigger mechanisms show 19 of 43 (44,2%) male patients. 22 of 31 (71%) of female patients show vagal trigger mechanisms. Adrenergic trigger mechanisms show 22 of 31 (71%) female patients. Interestingly, 10 of 43 male patients (23,3%) and 14 of 31 female patients (45,2%) show both, vagal and adrenergic trigger mechanisms. In contrast to common knowledge, with autonomic trigger mechanisms existing predominantly for young and male patients, we found autonomic trigger mechanisms in the majority of patients. An athletic history with sports > 3 h/week was found in 22 of 43 male patients, but only in 2 of 31 female patients. Conclusion: From 84 consecutive patients with circumferential isolation of the pulmonary veins for highly symptomatic paroxysmal and persistent atrial fibrillation 69% seemed to have autonomic trigger mechanisms. Since autonomic trigger mechanisms exist in physically active and non-active patients, any conclusions linking autonomic nervous system and athletic activity could not been drawn from this observational study. P376 Pro-atrial natriuretic peptide and atrial remodelling in marathon and non-marathon runners M Wilhelm1, JM Nuoffer1, I Wilhelm1, JP Schmid1, H Saner1 1Bern University Hospital and University of Bern, Bern, Switzerland Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Long-term endurance sports is associated with atrial remodelling and an increased risk of atrial fibrillation (AF) and atrial flutter. Pro-atrial natriuretic peptide (proANP) is a marker of atrial wall tension and elevated in patients with atrial fibrillation. We hypothesized that atrial remodelling would be perpetuated by repetitive episodes of atrial stretching during strenuous competitions, reflected by elevated levels of proANP. Methods: We performed a cross-sectional study on non-elite runners scheduled to participate in the 2010 Grand Prix of Bern, a 10 Mile race. Four-hundred and ninety-two marathon and non-marathon runners applied for participation, 70 were randomly selected, and 56 entered the final analysis. Subjects were stratified according to former marathon participations: control group (non marathon runners, n = 22), group 1 (1 to 4 marathons, n = 16), group 2 (≥ 5 marathons, n = 18). Results were adjusted for age, training years and average weekly endurance training hours. Results: Mean age was 42 ± 7 years. Compared to the control group, marathon runners in group 1 and group 2 had larger left atria (25 ± 6 versus 30 ± 6 versus 34 ± 7 ml/m2; p = 0.002) and larger right atria (27 ± 7 versus 31 ± 8 versus 35 ± 5 ml/m2; p = 0.024). ProANP levels at baseline were higher in marathon runners (1.04 ± 0.38 versus 1.42 ± 0.74 versus 1.67 ± 0.69; p = 0.006). ProANP increased significantly in all groups after the race (Figure 1). In multivariate regression analysis, marathon participation was an independent predictor of left atrial (beta 0.427, P < 0.001) and right atrial (beta 0.395; p = 0.006) size. Conclusions: Marathon running was associated with progredient left and right atrial remodelling, possibly induced by repetitive episodes of atrial stretching. The altered left and right atrial substrate may facilitate the occurrence of atrial arrhythmias. Open in new tabDownload slide P377 Exercise tests in liver transplantation candidates R Renata Glowczynska1, M Pierscinska1, ME Starczewska1, U Oldakowska-Jedynak2, D Rzymski1, M Medrzycka1, M Kwiecien1, KJ Filipiak1, G Opolski1 1Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland, 2Medical University of Warsaw, Department of General and Transplantation Surgery, Warsaw, Poland Other risk factors (Exercice & Translational Science) Background: There are some particular changes in cardiovascular system in subjects with end-stage liver disease such as increased circulating inflammatory mediators, increased cardiac output, bradycardia and impairment in chronotropic response to exercise. Purpose: The purpose of this study was to assess profile of cardiovascular response in electrocardiogram exercise test in liver transplantation candidates. Methods: We performed exercise tests in 62 consecutive patients (31 women, 31 men) with cirrhosis who were candidates for liver transplantation. We excluded 2 pts from analysis due to huge ascites. Every exercise test was performed on the treadmill using Bruce protocol (56 pts) or modified Bruce protocol (4 pts). Results: Mean age was 47,3+/−12 years. Among the most common aetiology of cirrhosis there were hepatitis type B and C, previous alcohol intake and primary sclerosing cholangitis. 31 (51,7%) pts took beta-blockers, mainly Propranolol in prevention of bleeding from oesophageal varices. All pts had normal left ventricular ejection fraction (mean 62,6+/−4,9%). Mean value of exercise time was 5 minutes 49 seconds. 39 (65%) pts could perform exercise more intense than 7 METS. Mean level of effort was 7,7+/−2,3 METS. Exhaustion seemed to be the main cause for terminating the test. Only 27 (45%) pts approached predicted 85% of maximal heart rate (HR). Mean percentage of predicted maximal HR was 77,7+/−13,4%. Maximal HR was 134,2+/−25 bpm. HR at rest 84,7+/−18,8 bpm, but 15 (25%) pts had tachycardia before exercise. HR Recovery was 106,1+/−21,2bpm and 93,8+/−19 bpm at 1st and 2nd minute of Recovery, retrospectively. That means that 57 (95%) pts had proper response of sympathetic system. Only 1 patient gained electrocardiographic criteria for positive exercise test. Conclusions: electrocardiogram exercise test in patients with cirrhosis has some limitations such as difficulties in motion due to ascites and beta-blockers intake. Despite of good ejection fraction, we observed poor exercise capacity. In pts who didn't take beta-blockers we noted good chronotropic response and even tachycardia at rest. P378 Metabolomic profile of human myocardial ischaemia assessed by nuclear magnetic resonance spectroscopy of peripheral blood serum. A translational study based on transient coronary occlusion models. C Clara Bonanad1, V Bodi1, J Sanchis1, JM Morales2, V Marrachelli1, J Nunez1, MJ Forteza1, F Chaustre1, C Gomez1, FJ Chorro1 1University Hospital Clinic, Department of Cardiology, Valencia, Spain, 2University of Valencia, Valencia, Spain Atherosclerosis/CAD (Exercice & Translational Science) Objectives: Biochemical detection of myocardial ischaemia (MIS) is a major challenge. Validation of novel biosignatures is of utmost importance. We sought to investigate the metabolomic profile of acute MIS using nuclear magnetic resonance (NMR) spectroscopy of peripheral blood serum of swine and patients undergoing angioplasty balloon-induced transient coronary occlusion. Methods and results: We applied high resolution nuclear magnetic resonance spectroscopy to profile 32 blood serum metabolites obtained (before and after controlled ischaemia) from swine (n = 9) and patients (n = 20) undergoing transitory MIS in the setting of planned coronary angioplasty. Additionally we sequentially profiled blood serum of control patients (n = 10). A preliminary clinical validation of the developed metabolomic biosignature was undertaken in patients with spontaneous acute chest pain (n = 30). Striking differences were detected in the blood profile of swine and patients immediately after MIS. MIS induced an early increase (10min) of circulating glucose, lactate, glutamine, glycine, glycerol, phenylalanine, tyrosine and phosphoethanolamine, a decrease in choline-containing compounds and triacylglycerols and a change in the pattern of total, esterified and non-esterified, fatty acids. Creatine increased 2 hours after ischaemia. Using multivariate analyses, we developed a biosignature that accurately detected patients with MIS both in the setting of angioplasty-related MIS (area under the curve 0.94) and in patients with acute chest pain (negative predictive value 95%). Conclusions: This study is, to our knowledge, the first metabolic biosignature of acute MIS developed under highly controlled coronary flow restriction. Metabolic profiling of blood plasma appears as a promising approach for an early detection of MIS in patients. P379 Duration of second window of cardioprotection of preconditioning with periodic acceleration (pGz) A Jose Adams1, A Uryash1, J Bassuk1, P Kurlansky2, M Sackner1 1Mount Sinai Medical Center, Miami Beach, United States of America, 2Florida Heart Research Institute, Miami, United States of America Atherosclerosis/CAD (Exercice & Translational Science) Purpose: Chronic preconditioning for minimizing myocardial damage following an unexpected acute myocardial infarction by either long-term ischaemic or pharmacologic means is impractical and non-sustainable. Exercise has the potential to provide chronic preconditioning, but less than 10% of the general population complies with the recommendations of the American Heart Association for exercise. Further, physical limitations also limit compliance with exercise. There is need for a technology that can be used in the home in sedentary or individuals with physical limitations who are at high risk for myocardial infarctions. Whole body periodic acceleration (pGz aka WBPA) is a non-invasive, passive procedure that involves repetitive, sinusoidal head-foot movements of the horizontal body with a motorized motion platform. It increases pulsatile vascular shear stress to the endothelium to stimulate endothelial nitric oxide synthase (eNOS). This increase release of nitric oxide (NO) into the circulation as demonstrated in pigs, sheep, rats, mice, isolated perfused aorta, and humans. It provides early preconditioning in pigs prior to whole body ischaemia reperfusion injury induced by ventricular fibrillation. pGz also produces a second window of protection (SWOP) in a rat model of focal myocardial ischaemia reperfusion (I/R) injury that simulates an acute myocardial infarction. The purpose of this study was to ascertain the duration of SWOP as measured by infarct size after 3 days of preconditioning with pGz. Methods: Twenty five conscious, restrained, male rats (310 ± 9 g) were preconditioned with 1 hr pGz daily for 3 days at 360 cycles per minute to produce Gz ± 3.4 m/s2 or served as a control without pGz (CONT). I/R injury was induced by left coronary artery ligation for 30 min followed by 120 min of reperfusion. Focal I/R injury was done 24, 48, and 72 hours after the third day of pGz. Electrocardiogram, and aortic pressure were monitored and infarct size of the left ventricle (LV) at autopsy was calculated as % area at risk. Results: Compared to CONT, preconditioning with pGz for 3 days significantly decreased infarct size of left ventricle from 53% (12) in CONT to 12%(5), 22%(6), and 12%(4) when I/R was carried out at 24, 48, and 72 hours, respectively. (p < 0.001). Conclusions: pGz preconditioning provides significant cardioprotection as SWOP in rats that extends to at least 72 hrs after the third day of daily pGz. Provided that the observations in this study on rats are validated in humans, pGz offers the potential for chronic preconditioning to lower the risk of unplanned I/R injury to the heart. P380 Prediction of exercise capacity by submaximal test in patients with coronary artery disease MP Tulppo1, AM Kiviniemi1, AJ Hautala1, HV Huikuri2 1Verve Research, Department of Exercise and Medical Physiologic, Oulu, Finland, 2Institute of Clinical Medicine, University of Oulu, Oulu, Finland Atherosclerosis/CAD (Exercice & Translational Science) Purpose: Maximal exercise capacity is an independent predictor of mortality in coronary artery disease patients (CAD). The measurement of maximal exercise capacity is not always possible for a variety of clinical and practical reasons. Submaximal test based on linearity between heart rate and work load during exercise is able to predict maximal exercise capacity in healthy subjects but not in CAD patients due to the use of cardiac medication particularly β-blokades. We hypothesized that rating of perceived exertion scale (RPE) during submaximal exercise can be used to predict maximal exercise capacity in CAD patients. Methods: The study included 121 patients with angiographically documented CADs (62 ± 5 years, 77% males, 55% type 2 diabetes and 85% on β-blockade) who underwent symptom-limited maximal exercise test by bicycle ergometer starting from 20 and 30 W for women and men with the work rate increasing at a rate of 10 and 15 W every 1 min until exhaustion. RPE values were asked at every second load at the scale from 6 to 20. Maximal exercise capacity (METs) was predicted with stepwise linear regression using the following parameters: Age, sex, body mass index (BMI), hip and waist size, smoking history, use of β-blockade, type 2 diabetes, heart rate before cycling and submaximal Mets/RPE ratio at work loads 60 and 75 W for women and men, respectively. Results: The measured maximal exercise capacity was 7.1 ± 1.9 Mets. The submaximal Mets at the work load of 60/75 W was 4.0 ± 0.5 (59 ± 12% of measured maximal Mets) and the corresponding RPE was 11.8 ± 2.1. The most powerful predictor of maximal METs was submaximal Mets/RPE ratio (r = 0.67, p < 0.0001). The final stepwise regression model correlated strongly with the measured maximal METs after including the parameters in the following order: Submaximal Mets/RPE ratio, body mass index, sex, heart rate before cycling, smoking history, age and use of β-blockade (r = 0.86, p < 0.0001). Conclusions: RPE at the submaximal exercise intensity is closely related to measured maximal exercise capacity in CAD patients. Regression model based on easily measured variables at rest and during “warm-up” exercise can be used to predict maximal exercise capacity, in patients with CAD in whom maximal exercise test is not feasible and in repeated assessments of exercise capacity after therapeutic interventions, e.g. during rehabilitation programs. P381 Respiratory compensation point and heart rate turning point precede the second lactate turning point in patients with chronic heart failure P J M Beckers1, NM Possemiers1, EM Van Craenenbroeck1, AM Van Berendoncks1, K Wuyts1, CJ Vrints1, VM Conraads1 1Antwerp University Hospital, Edegem, Belgium Heart Failure (Exercice & Translational Science) Purpose: Exercise training (ET) efficiently improves peak oxygen uptake (VO2peak) in patients with chronic heart failure (CHF). To optimise training-derived benefit, higher exercise intensities are being explored. The correct identification of the anaerobic threshold (AT) is important to allow safe and effective exercise prescription. Methods: During 48 cardio-pulmonary exercise tests (CPET), obtained in patients with CHF (59.6 ± 11 years; left ventricular ejection fraction 27.9 ± 9%), ventilatory gas analysis and lactate measurements were collected. Three technicians independently determined the respiratory compensation point (RCP), the heart rate turning point (HRTP) and the second lactate turning point (LTP2). Thereafter, exercise intensity (target heart rate [THR] and workload) was calculated and compared between the 3 methods applied. Results: Patients had significantly reduced maximal exercise capacity (68 ± 21% of predicted VO2peak) and chronotropic incompetence (74 ± 7% of predicted peak HR). Heart rate, workload and oxygen uptake at HRTP and at RCP were not different, but at LTP2, these parameters were significantly (p < 0.0001) higher. Mean THR and target workload calculated using the LTP2 were 5 and 12% higher, compared to HRTP and RCP. Calculation of THR based on LTP2 was 5 and 10% higher in 12/48 (25%) and 6/48 (12.5%) of patients, respectively, compared to the other 2 methods. Conclusions: In patients with CHF, RCP and HRTP, determined during CPET, precede the occurrence of LTP2. Target heart rates and workloads used to prescribe tailored ET in CHF patients based on LTP2 are significantly higher than those derived from HRTP and RCP. P382 Comparison of carbohydrate and lipid oxidation during continuous and intermittent exercise in patients with chronic systolic heart failure. P Meyer1, E Normandin2, A Nigam2, M Juneau2, M Gayda2 1University Hospital of Geneva, Geneva, Switzerland, 2Montreal Heart Institute, Cardiovascular Prevention Centre (Centre EPIC), Montreal, Canada Heart Failure (Exercice & Translational Science) Purpose: The aim of this study was to compare carbohydrate (CHO) and lipid oxidation during moderate intensity continuous exercise (MICE) and high intensity interval exercise (HIIE) in patients with chronic systolic heart failure (CHF). Methods: Eighteen males with CHF (60 ± 9 years, LVEF = 26 ± 7%, VO2peak = 17.4 ± 5.5 mL/min/kg) performed in random order a single session of HIIE corresponding to 2 × 8 min of 30s intervals at 100% of peak power output (PPO) interspersed with 30s passive recovery intervals and one week later to a 22 min isocaloric MICE at 60% of PPO. Gas exchange, electrocardiogram and blood pressure were monitored continuously. Oxygen uptake and energy expenditure were assessed from gas exchange and CHO and lipid oxidation using the Frayn equation. Endpoints were CHO and lipid oxidation measured during the last 2 minutes of HIIE blocks and the same exercise time period during MICE. Results: Table. Conclusion: CHO and lipid oxidation was similar during 2 isocaloric bouts of MICE and HIIE in patients with CHF. Metabolic variables during MICE and HIIE - Parameters - - Rest - - First block - - Second block - - Recovery - - ANOVA P value - VO2 (mL/min) - MICE 361 ± 77 1208 ± 289 1263 ± 311 872 ± 158 a = 0.1050, b<0.0001, c=0.0172 - HIIE 369 ± 69 1048 ± 239 1074 ± 238 952 ± 255 EE (kcal/min) - MICE 1.78 ± 0.36 6.08 ± 1.45 6.29 ± 1.53 4.76 ± 1.27 a = 0.1037, b<0.0001, c=0.0267 - HIIE 1.78 ± 0.34 5.26 ± 1.21 5.37 ± 1.28 4.36 ± 0.82 CHO oxidation (g/min) - MICE 0.30 ± 0.12 1.66 ± 0.48 1.46 ± 0.37 1.17 ± 0.37 a = 0.0906, b<0.0001, c=0.1292 - HIIE 0.24 ± 0.11 1.39 ± 0.45 1.20 ± 0.39 1.07 ± 0.31 Lipid oxidation (g/min) - MICE 0.07 ± 0.04 0.05 ± 0.06 0.10 ± 0.09 0.06 ± 0.06 a = 0.6350, b<0.0001, c=0.6425 - HIIE 0.09 ± 0.03 0.06 ± 0.05 0.11 ± 0.06 0.06 ± 0.04 - Parameters - - Rest - - First block - - Second block - - Recovery - - ANOVA P value - VO2 (mL/min) - MICE 361 ± 77 1208 ± 289 1263 ± 311 872 ± 158 a = 0.1050, b<0.0001, c=0.0172 - HIIE 369 ± 69 1048 ± 239 1074 ± 238 952 ± 255 EE (kcal/min) - MICE 1.78 ± 0.36 6.08 ± 1.45 6.29 ± 1.53 4.76 ± 1.27 a = 0.1037, b<0.0001, c=0.0267 - HIIE 1.78 ± 0.34 5.26 ± 1.21 5.37 ± 1.28 4.36 ± 0.82 CHO oxidation (g/min) - MICE 0.30 ± 0.12 1.66 ± 0.48 1.46 ± 0.37 1.17 ± 0.37 a = 0.0906, b<0.0001, c=0.1292 - HIIE 0.24 ± 0.11 1.39 ± 0.45 1.20 ± 0.39 1.07 ± 0.31 Lipid oxidation (g/min) - MICE 0.07 ± 0.04 0.05 ± 0.06 0.10 ± 0.09 0.06 ± 0.06 a = 0.6350, b<0.0001, c=0.6425 - HIIE 0.09 ± 0.03 0.06 ± 0.05 0.11 ± 0.06 0.06 ± 0.04 CHF: chronic heart failure, HIIE: high intensity intermittent exercise, MICE: moderate intensity continuous exercise, EE = energy expenditure, CHO = carbohydrate. a = mode effect, b = time effect, c = interaction effect (mode × time). Open in new tab Metabolic variables during MICE and HIIE - Parameters - - Rest - - First block - - Second block - - Recovery - - ANOVA P value - VO2 (mL/min) - MICE 361 ± 77 1208 ± 289 1263 ± 311 872 ± 158 a = 0.1050, b<0.0001, c=0.0172 - HIIE 369 ± 69 1048 ± 239 1074 ± 238 952 ± 255 EE (kcal/min) - MICE 1.78 ± 0.36 6.08 ± 1.45 6.29 ± 1.53 4.76 ± 1.27 a = 0.1037, b<0.0001, c=0.0267 - HIIE 1.78 ± 0.34 5.26 ± 1.21 5.37 ± 1.28 4.36 ± 0.82 CHO oxidation (g/min) - MICE 0.30 ± 0.12 1.66 ± 0.48 1.46 ± 0.37 1.17 ± 0.37 a = 0.0906, b<0.0001, c=0.1292 - HIIE 0.24 ± 0.11 1.39 ± 0.45 1.20 ± 0.39 1.07 ± 0.31 Lipid oxidation (g/min) - MICE 0.07 ± 0.04 0.05 ± 0.06 0.10 ± 0.09 0.06 ± 0.06 a = 0.6350, b<0.0001, c=0.6425 - HIIE 0.09 ± 0.03 0.06 ± 0.05 0.11 ± 0.06 0.06 ± 0.04 - Parameters - - Rest - - First block - - Second block - - Recovery - - ANOVA P value - VO2 (mL/min) - MICE 361 ± 77 1208 ± 289 1263 ± 311 872 ± 158 a = 0.1050, b<0.0001, c=0.0172 - HIIE 369 ± 69 1048 ± 239 1074 ± 238 952 ± 255 EE (kcal/min) - MICE 1.78 ± 0.36 6.08 ± 1.45 6.29 ± 1.53 4.76 ± 1.27 a = 0.1037, b<0.0001, c=0.0267 - HIIE 1.78 ± 0.34 5.26 ± 1.21 5.37 ± 1.28 4.36 ± 0.82 CHO oxidation (g/min) - MICE 0.30 ± 0.12 1.66 ± 0.48 1.46 ± 0.37 1.17 ± 0.37 a = 0.0906, b<0.0001, c=0.1292 - HIIE 0.24 ± 0.11 1.39 ± 0.45 1.20 ± 0.39 1.07 ± 0.31 Lipid oxidation (g/min) - MICE 0.07 ± 0.04 0.05 ± 0.06 0.10 ± 0.09 0.06 ± 0.06 a = 0.6350, b<0.0001, c=0.6425 - HIIE 0.09 ± 0.03 0.06 ± 0.05 0.11 ± 0.06 0.06 ± 0.04 CHF: chronic heart failure, HIIE: high intensity intermittent exercise, MICE: moderate intensity continuous exercise, EE = energy expenditure, CHO = carbohydrate. a = mode effect, b = time effect, c = interaction effect (mode × time). Open in new tab P383 The role of extended electrical myostimulation in the treatment of chronic heart failure F Frank Van Buuren1, B Koerber1, C Prinz1, A Fruend1, N Bogunovic1, J Gilis-Januszewski1, A Raethling1, M Vlachojannis1, D Horstkotte1, KP Mellwig1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Heart Failure (Exercice & Translational Science) Purpose: Electromyostimulation (EMS) of thigh and gluteal muscles has found to be a strategy to increase exercise capacity in patients with chronic heart failure (CHF). Aim of this study was to investigate the effects of a new dedicated stimulation suit that provides also the involvement of trunk and arm muscles (extended electro myostimulation (exEMS)). Methods: 48 individuals joined the exEMS training-program in a prospective randomized trial. 22 patients (20 males, mean age 59.95 ± 13.16 years) with stable CHF and NYHA-class II-III, 26 were in the healthy control group (CG). Eight major muscle groups (upper arm, chest, shoulder, upper and lower back, abdominal, gluteal, hip region including the pelvic floor, upper legs) were activated simultaneously by the stimulation suit. The training was performed for 10 weeks twice a week for 20 minutes, the level of daily activity kept unchanged. All individuals were examined right before randomisation and within 1 week after finishing the training programme. Effects on exercise capacity, oxygen uptake, left-ventricular function (EF) and biomarkers of CHF were evaluated. Results: At follow-up there was a significant increase of oxygen uptake at aerobic threshold from 13.7 ± 3.9 to 17.6 ± 21.6 ml/kg/min in the EMS group (+28.46%, p < 0.001) (CG 15.0 ± 4.9 to 17.0 ± 6.4 ml/kg/min (+13.3%, p = 0.005)). Peak oxygen consumption increased by 22.84% in the EMS group (p < 0.001) (CG + 4.3%, p = 0.48), left-ventricular ejection fraction increased from 38.3 ± 8.4 to 43.4 ± 8.8 (+13.3%, p = 0.001) (CG 53.9 ± 6.7 to 53.7 ± 3.9, p = 0.18). N terminal-pro brain natriuretic peptide levels decreased by 33.5% in the EMS group (465 ± 979 to 309 ± 388 pg/dl, p = 0.551). Conclusion: Extended electromyostimulation improves physical performance and left-ventricular function in CHF patients. © 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 2
JF - European Journal of Preventive Cardiology
DO - 10.1177/2047487312448007
DA - 2012-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-2-0aHML8d0JQ
SP - S34
EP - S65
VL - 19
IS - 1_suppl
DP - DeepDyve
ER -