M D'Addario

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs). Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs. Main outcome measures: Intensity and frequency of PA. Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).

Psychological determinants of target organ damage in hypertensive patients: Focus on Pulse Wave Velocity and depression

s 71 and diabetes. However, scanty data are available on the role of psychological factors on arterial stiffness. The aim of the current cross-sectional study was to evaluate the association between depression, anxiety, perceived stress, Type A personality, and Type D personality and Pulse Wave Velocity (PWV) in a cohort of hypertensive patients, using baseline examination data of the TIPICO project. Methods: A total of 259 outpatients (ages 18e80 years) followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension were recruited. Aortic stiffness was evaluated by c-f PWV. Moreover, anamnestic data, clinical BP, and laboratory data were evaluated. Patients were asked to complete a battery of psychological questionnaires under the guidance of a psychologist. Results: At T0 mean age was 55.9 10.1years, SBP/DBP were 135.6 17.7/ 82.5 9.1 mmHg and PWV was 8.6 2.1m/s. The multivariate stepwise linear regression analysis showed that age (betaZ 0.284, p< 0.001), pulse pressure (betaZ 0.369, p< 0.001), dyslipidemia (betaZ 0.130, pZ 0.012), family history of CV disease (betaZ 0.123, pZ 0.017), and depression (betaZ 0.126, pZ 0.014) were significantly and independently associated with PWV. Conclusion: Among psychological factors, higher levels of depression is related to higher PWV, while anxiety, perceived stress, Type-A personality and Type-D personality are not. Depression assessment and target intervention to reduce it should be recommended in hypertensive patients. P61 PSYCHOLOGICAL DETERMINANTS OF TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS: FOCUS ON TYPE A PERSONALITY AND LEFT VENTRICULAR MASS INDEX Andrea Greco , Alessandro Maloberti , Paola Sormani , Giulia Colombo , Luca Giupponi , Stephan Laurent , Pierre Boutouyrie , Massimo D’Addario , Anna Maria Annoni , Antonella Moreo , Cristina Giannattasio , Patrizia Steca 1 Department of Psychology, University of Milan-Bicocca, Milan, Italy Medicine and Surgery Department, University of Milano-Bicocca, Milan, Italy Cardiology IV Unit, “A. De Gasperis” Department, Ospedale Niguarda Ca’ Granda, Milan, Italy Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U970, Paris, Cardiovascular Research Centre (PARCC), Cardiovascular and epidemiology and Sudden Death Team, Paris, France AP-HP, Hopitaux Universitaires Paris Ouest, Department of Pharmacology, Paris, France Background: Increased Left Ventricular Mass Index (LVMI) is a well known risk factor for cardiac morbidity and mortality. Furthermore, it is widely recognized that clinical evolution and progression of established CV diseases Table 1. Changes in measure carotid properties with 3.5-year follow-up. nZ 147 DcPWV [m/s] DRWT [ ] DYoung’s-modulus [MPa] Mean sd p Mean sd p Mean sd p DecreasedDBP (nZ 53) 0.1 1.4 0.72 0.00 0.04 0.38 0.01 0.32 0.87 ConstantDBP (nZ 67) +0.6* 1.4 <0.001 0.00 0.04 0.18 +0.10* 0.26 <0.001 IncreasedDBP (nZ 27) +0.5* 1.5 0.029 0.02*,** 0.04 0.002 +0.19* 0.35 <0.001 Ds calculated as follow-up e baseline. *: p< 0.05 compared to decreasedDBP. **: p< 0.05 compared to constantDBP. The bold indicates that there is a statistically significant difference between follow-up and baseline. are related to a range of psychological characteristics, which may partially explain the spread and recurrence of these diseases. Little is known about LVMI and its association with psychological characteristics in arterial Hypertension (HT) patients. The aim of the current crosssectional study was to evaluate the association between psychological characteristics and LVMI in a cohort of hypertensive patients. Methods: A total of 244 outpatients (age 18e80 years) followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension were recruited. Anamnestic data, clinical BP, and laboratory data and LVMI were evaluated. Patients were asked to complete a battery of psychological questionnaires under the guidance of a psychologist. Results: At T0 the mean age was 55.9 10.1years, SBP and DBP were 135.6 17.7 and 82.5 9.1 mmHg and PWV was 8.6 2.1m/s. The multivariate stepwise linear regression analysis showed that sex (betaZ 0.252, p< 0.001), age (betaZ 0.135, p< 0.037), mean BP (betaZ 0.178, pZ 0.003), family history of CV disease (betaZ 0.129, pZ 0.027), and Type-A personality (betaZ 0.148, pZ 0.014) were significantly and independently associated with LVMI. Conclusion: Among psychological factors, higher levels of Type-A personality is related to higher LVMI, while Type-D personality, anxiety, depression and stress are not associated.

Discovering typologies and tailoring communication: new tools in promoting lifestyle change among coronary artery disease patients

Abstracts from the 11th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 14–16 March 2013s from the 11th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 14–16 March 2013 Springer International Publishing Switzerland 2013 1. PROGNOSTIC EFFICACY OF HIGH-DOSE STATINS IN PATIENTS WITH STEMI E. Rauseo, A. Azzano, A. Romano, S. Giannuzzi, S. Budassi, V. Paravati, C. Gaudio Department of Cardiovascular, Respiratory, Geriatry and Nephrology Sciences, Policlinico Umberto 1, University of Rome Sapienza, Viale del Policlinico 155, 00161 Rome, Italy INTRODUCTION: The pleiotropic effects of statins have demonstrated to provide protective effects in terms of cardiovascular events in patients with acute coronary syndrome (ACS). AIM: To compare the incidence of major cardiovascular events (MACE) and the percentage reduction of C-reactive protein (CRP) and low-density lipoprotein (LDL) cholesterol in patients with ST-segment elevation myocardial infarction (STEMI), who were treated with either highdose or low-dose statin during a follow-up to 6 months. METHODS: In this prospective study we included 52 patients (mean age 67 years) with the following inclusion criteria: 1) diagnosis of STEMI, 2) atorvastatin-based treatment, 3) not previous treatment with any other lipid lowering agent. All patients underwent PCI with drug-eluting stent implantation. Subsequently the sample group was stratified according to the dosage of statin administered into two groups, matched for age, sex, risk factors, and concomitant therapy. All patients have been periodically evaluated for inflammatory markers (CRP levels) and lipid profile monitoring. RESULTS: Study population was stratified into two groups: A) 26 patients treated with atorvastatin 80 mg/die; B) 26 patients treated with atorvastatin 10 mg/die. During the follow-up period, in the group A (high-dose statin) none MACE was observed and a -15 % average reduction of CRP and -14 % average reduction of LDL cholesterol compared to basal levels were reported, whereas in the group B (low-dose statin) 5 MACE were observed and a -6 % average reduction of CRP and -9 % average reduction of LDL cholesterol were reported. Those patients who experienced MACE showed lower reductions of CRP levels and higher reductions of LDL cholesterol levels compared to the average reductions within the same group. It have been observed greater reductions of CRP and LDL cholesterol levels (-5 and -9 %, respectively) in group A than in group B. CONCLUSIONS: Anti-inflammatory effect has been observed with high doses of statins compared to low doses. At the lipid target, a better control of the inflammatory atheromatous plaque is able to reduce MACE. CRP levels are related to the pro-inflammatory state and represent a prognostic-marker useful to identify patients who should be treated more aggressively. During lipid-lowering therapy, CRP levels may represent a marker of therapeutic efficacy and identify those patients that maintain a subclinical proinflammatory state, requiring a closer follow up. 2. RELATIONSHIPS BETWEEN MASKED HYPERTENSION, PRE-HYPERTENSION AND LEFT VENTRICULAR MASS IN DIABETIC PATIENTS A. Ascione 1, A. Sciarappa 1, M. Borgia 2, E. Attena 1, M. Aversa 1, V. M. Parato 3 1) Buon Consiglio Fatebenefratelli Hospital, Naples, Italy; 2) ItalyAORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy; 3) S.Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy INTRODUCTION: Masked hypertension (MHT) and prehypertension (PHT) are both associated with an increased cardiovascular disease (CVD) risk compared to sustained normotension. AIM: To examine the diagnostic overlap between MHT and PHT in diabetic patients and their relationships with left ventricular (LV) mass index (LVMI), a marker of cardiac organ damage. High Blood Press Cardiovasc Prev (2013) 20:93–114 DOI 10.1007/s40292-013-0017-0