Gui De Backer

Amplification of the Pressure Pulse in the Upper Limb in Healthy, Middle-Aged Men and Women

Central-to-peripheral amplification of the pressure pulse leads to discrepancies between central and brachial blood pressures. This amplification depends on an individuals hemodynamic and (patho)physiological characteristics. The aim of this study was to assess the magnitude and correlates of central-to-peripheral amplification in the upper limb in a healthy, middle-aged population (the Asklepios Study). Carotid, brachial, and radial pressure waveforms were acquired noninvasively using applanation tonometry in 1873 subjects (895 women) aged 35 to 55 years. Carotid, brachial, and radial pulse pressures were calculated, as well as the absolute and relative (with carotid pulse pressure as reference) amplifications. With subjects classified per semidecade of age, carotid-to-radial amplification varied from ≈25% in the youngest men to 8% in the oldest women. Amplification was higher in men (20±14%) than in women (13±12%; P<0.001) and decreased with age (P<0.001) in both. Amplification over the brachial-to-radial path contributed substantially to the total amplification. In univariate analysis, the strongest correlation was found with the carotid augmentation index (−0.51 in women; −0.47 in men; both P<0.001). In a multiple linear regression model with carotid-to-radial amplification as the dependent variable, carotid augmentation index, total arterial compliance, and heart rate were identified as the 3 major determinants of upper limb pressure amplification (R2=0.36). We conclude that, in healthy middle-aged subjects, the central-to-radial amplification of the pressure pulse is substantial. Amplification is higher in men than in women, decreases with age, and is primarily associated with the carotid augmentation index.

Validity of Parentally Reported Weight and Height for Preschool-Aged Children in Belgium and Its Impact on Classification Into Body Mass Index Categories

OBJECTIVE. The aim of this study was to evaluate the validity of parentally reported weight and height values for preschool-aged children (3–7 years of age) in Belgium and the accuracy of BMI classifications using those data. METHODS. The subjects were 297 preschool-aged children (157 boys and 140 girls). A questionnaire with questions about height and weight was distributed to the children and completed by their parents. Nurses of the Centres for Pupils Counselling conducted anthropometric measurements by following standardized procedures. National and international age- and gender-specific BMI cutoff values were used to determine BMI categories. RESULTS. Mean differences between reported and measured values for weight (−0.57 kg) and BMI (−0.51 kg/m2) were statistically significant, although small. For height, the mean difference (0.14 cm) was not statistically significant. When national and international BMI cutoff values for overweight were used, sensitivity values were 47% and 44%, respectively, and specificity values were 94% and 95%. Among all children requiring nutritional advice on the basis of being overweight or obese, more than one half of the overweight children and >75% of the obese children would be missed with the use of parentally reported weight and height values. Conversely, 70% of the children being classified as underweight with the use of these reported data could be encouraged wrongly to gain weight. The bias of parent-reported BMI values was significantly greater when weight and height were both guessed, rather than being measured at home. CONCLUSIONS. Our results show the inaccuracy of parentally reported weight and height values in Belgium for classifying preschool-aged children into BMI categories. Therefore, accurate measurements of weight and height should be encouraged in studies in which BMI of children is a variable of interest.

Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators:

Background: Although cardiovascular disease (CVD) is the biggest global cause of death, CVD mortality is falling in developed countries. There is concern that this trend may be offset by increasing levels of obesity. Design: We used the Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships between body mass index (BMI), conventional risk factors and CVD mortality. Methods: The SCORE data set comprises data from 12 European cohort studies. The relationship between BMI and CVD mortality was examined in each BMI category using univariable and multivariable (Cox) analyses. The SCORE population was also divided into gender and age strata: under 40, 40–49, 50–59, and over 60. The rate of CVD mortality in each BMI category was calculated within each gender and age stratum. Relationships between BMI and other CVD risk factors were also examined. Results: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders. Each 5-unit increase in BMI was associated with an increase in CVD mortality of 34% in men and 29% in women. The hazard ratios remained significant when adjusted for age, self-reported smoking status, total cholesterol, and systolic blood pressure (SBP). On additional adjustment for diabetes and high-density lipoprotein cholesterol (HDL), the association between BMI and CVD mortality did not persist. In all age groups except those over 60 there were significant relationships between increased BMI and CVD mortality. In the over-60 age group the only significant relationships with mortality were in underweight and severely overweight women and mildly obese men. After adjustment for age, each 1-unit increase in BMI was associated with a 1.14 mmHg increase in SBP, 0.055 mmol/l increase in total cholesterol, and a 0.024 mmol/l decrease in HDL in men. Figures were slightly lower in women. Conclusions: Overall, overweight and obesity relate to CVD mortality in a strong and graded manner. The effects are greater in women and markedly so in younger persons. It is likely that a substantial part of the BMI-associated risk of CVD mortality is mediated through other known CVD risk factors. This increases the public health importance of BMI as both a simple indicator and mediator of CVD risk.

EURObservational research programme: EUROASPIRE.

The aim of the Joint European Societies (JES) Guidelines on cardiovascular disease prevention (CVD) prevention is to improve the practice of preventive cardiology through development of national guidelines and their implementation in everyday clinical practice. Patients with coronaryorotheratheroscleroticdisease are the highest clinical priority for prevention with defined lifestyle, medical risk factor, and therapeutic targets. Diabetes is a major risk factor in patients with coronary artery disease and patients with both diagnoses have a two-fold higher mortality than coronary patients without diabetes, making them a group at particularly high risk for a subsequent cardiovascular event or premature death. Four European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) cross-sectional surveys, starting in 1995–96, have evaluated guideline implementation in everyday clinical practice across Europe. The most recent EUROASPIRE IV survey was carried out in 2012–13 in 24 countries: Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Finland, France, Germany, Greece, Ireland, Latvia, Lithuania, the Netherlands, Poland, Romania, Russia, Serbia, Slovenia, Spain, Sweden, Turkey, Ukraine, and the UK. The survey was undertaken under the auspices of the European Society of Cardiology, EURObservational Research Programme and incorporated the Euro Heart Survey on Diabetes to create the first European Survey of CVD Prevention and Diabetes. 11 The main objectives of EUROASPIRE IV were to identify risk factors in coronary patients with and without diabetes, describe their management through lifestyle and use of drug therapies and provide an objective assessment of clinical implementation of current scientific knowledge on prevention across Europe.

Regular exercise behaviour and intention and symptoms of anxiety and depression in coronary heart disease patients across Europe: Results from the EUROASPIRE III survey

Background Regular exercise lowers the risk of cardiovascular death in coronary heart disease (CHD) patients. We aimed to investigate regular exercise behaviour and intention in relation to symptoms of anxiety and depression in CHD patients across Europe. Design This study was based on a multicentre cross-sectional survey. Methods In the EUROpean Action on Secondary and Primary Prevention through Intervention to Reduce Events (EUROASPIRE) III survey, 8966 CHD patients <80 years of age from 22 European countries were interviewed on average 15 months after hospitalisation. Whether patients exercised or intended to exercise regularly was assessed using the Stages of Change questionnaire in 8330 patients. Symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. Total physical activity was measured by the International Physical Activity Questionnaire in patients from a subset of 14 countries. Results Overall, 50.3% of patients were not intending to exercise regularly, 15.9% were intending to exercise regularly, and 33.8% were exercising regularly. Patients with severe symptoms of depression less frequently exercised regularly than patients with symptoms in the normal range (20.2%, 95% confidence interval (CI) 14.8–26.8 vs 36.7%, 95% CI 29.8–44.2). Among patients not exercising regularly, patients with severe symptoms of depression were less likely to have an intention to exercise regularly (odds ratio 0.62, 95% CI 0.46–0.85). Symptoms of anxiety did not affect regular exercise intention. In sensitivity analysis, results were consistent when adjusting for total physical activity. Conclusions Lower frequency of regular exercise and decreased likelihood of exercise intention were observed in CHD patients with severe depressive symptoms. Severe symptoms of depression may preclude CHD patients from performing regular exercise.

Lifestyle behaviour and risk factor control in coronary patients: Belgian results from the cross-sectional EUROASPIRE surveys

Abstract Objective: The aim of this study was to assess lifestyle behaviour as well as risk factor management across Belgian coronary patients who participated in the cross-sectional European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) surveys. Methods: Analyses are based on a series of coronary patients by combining data from the Belgian participants in the EUROASPIRE III (328 patients; in 2006–2007) and EUROASPIRE IV (343 patients; in 2012–2013) surveys. Four hospitals located in the Ghent area participated in the surveys. Patients included in the analyses were ≥18 years old and had been hospitalised for a coronary event. Information on cardiovascular risk factors, lifestyle behaviour and medical treatment were obtained. Results: Overall, the proportion of smokers was 11% with 40% persistent smokers. Adequate physical activity levels were reported by 17%, 28% of patients were obese, 47% was central obese and known diabetes was prevalent in 21% of patients. Hypertension was observed in 46% of patients and 20% had a total cholesterol ≥5 mmol/L. About 80% had participated in a cardiac rehabilitation programme and the majority of patients were treated with blood pressure (92%) or lipid-lowering drugs (92%). Anxiety and depressive symptoms were reported by 30% and 24%, respectively. Differences between EUROASPIRE III and IV were limited. Conclusions: Compared to the overall EUROASPIRE results in Europe, Belgian CHD patients seem to do slightly better. However, tackling obesity, physical inactivity, hypertension and psychosocial distress remains an important challenge in the management of coronary patients.

Registration of acute coronary events in Flanders, Belgium comparing the MONICA and the Universal case definition of myocardial infarction

BOOK EuroPRevent 2013 Rome, Italy

Risk factors for cardiovascular disease in the general population of Ghent, Belgium: awareness and treatment for hypertension and/or hypercholesterolemia

BOOK EuroPRevent 2013 Rome, Italy

483 PREVALENCE OF ELEVATED C-REACTIVE PROTEIN LEVELS IN A PRIMARY CVD PREVENTION POPULATION IN EUROPE: THE EURIKA STUDY

PREVALENCE OF ELEVATED C-REACTIVE PROTEIN LEVELS IN A PRIMARY CVD PREVENTION POPULATION IN EUROPE : THE EURIKA STUDY

EUROASPIRE III: lifestyle, risk factor and therapeutic management in people at high risk of developing cardiovascular disease: cross-sectional survey in 12 European countries

Introduction: Patients (pts) with non ST elevation acute coronary syndromes (NSTE-ACS) frequently have non obstructive coronary artery disease (NO-CAD). Aim: Develop and validate a risk score (RS) to predict NO-CAD and events in patients with NSTE-ACS. Methods: 6874 pts with NSTE-ACS included in a registry were randomly divided in two cohorts. In the first cohort pts were stratified according to absence or presence of NO-CAD (defined as stenosis ,50%). A regression model was used to derive a RS aiming to identify the presence of NO-CAD. The RS was validated in the second cohort and tested to predict in-hospital and 6-month death or infarction. Results: Eight independent predictors of NO-CAD were identified: age#50 (OR 1.58, CI 1.05–2.36); female gender (OR 2.47, CI 1.85–3.31); absence of diabetes, hyperlipidemia or smoking (OR 2.09, CI 1.57–2.78); no prior history of myocardial infarction, coronary angioplasty or CABG (OR 1.68, CI 1.16–2.43); only one episode of chest pain on admission (OR 1.96, CI 1.43–2.70); no ST depression or negative T waves (OR 1.64, CI 1.23–2.19); negative troponin (OR 1.41, CI 1.00–1.99); and no heart failure (OR 1.65, CI 1.135–2.40). A RS was created by the sum of points, assigning female sex 2 points and the remaining 1 point. There was a graded association between the RS and the prevalence of NO-CAD in the validation cohort. A decrease in adverse events was seen with an increasing score from 9.9% (score50) to 0% (score.7) for in-hospital death or infarction (p,0.001) and from 20.5% (score50) to 4.0% (score.7) for 6-month death or infarction (p,0.001). Conclusion: In NSTE-ACS eight variables may be used to identify pts with NO-CAD and with a lower risk of events.