Monday, 1 September 2008 - European Heart Journal

266 Resuscitation resuscitated! / Risk assessment: strengths and weaknesses
resuscitated from cardiac arrest and those without this complication. The higher
mortality rate among resuscitated patients is explained by noncardiac complications.
RISK ASSESSMENT:
STRENGTHS AND WEAKNESSES
1762 Aortic augmentation index: reference values and
association with known cardiovascular risk factors in a
Danish population
J.H. Janner1 , N.S. Godtfredsen2 , P. Lange1 ,J.Vestbo1 ,E.Prescott2 .
1Hvidovre University Hospital, Cardiology and Respiratory Medicine,
Copenhagen, Denmark; 2Bispebjerg University Hospital, Department of
Respiratory Medicine, Copenhagen, Denmark
Background: It has been proposed that aortic augmentation index (AIx) – a measure
of arterial wave reflection – can be used as a surrogate measure of arterial
stiffness. In a selected patient group (end stage renal disease) AIx has been
shown to be a predictor of all-cause mortality. AIx has also been shown to predict
cardiovascular events in patients with hypertension and patients undergoing PCI.
Studies of reference values of AIx are scarce.
Objective: 1) To report reference values of AIx in a population at low risk of CVD
according to Heartscore. 2) To investigate the association between AIx and known
CVD risk factors in a large cohort of the Danish population.
Methods: This population-study is based on 4700 subjects from the Copenhagen
City Heart Study. In those with the lowest risk of CVD as defined by Heartscore
we analysed AIx adjusted for heart-rate and its dependency of sex, age and
height using linear regression. Multivariate linear regression was used to examine
the association between AIx and the following risk factors for CVD – systolic
and diastolic blood pressure, total-cholesterol, LDL cholesterol, HDL cholesterol,
triglycerides, high-sensitive C-reactive protein (hs-CRP), smoking status, years of
smoking, alcohol consumption, diabetes, medication for hypertension, heart disease
or high cholesterol, physical inactivity, familiar history of CVD and education.
All analyses were stratified by sex.
Results: AIx was positively associated with age and negatively with height in
those with lowest risk of CVD in the following manner: Woman: AIx = 26.56 +
0.76 (age) – 0.004 (age 2 ) – 0.19 (height (cm)). Men: AIx = 59.52 + 0.42 (age)
– 0.38 (height (cm)). We found increasing AIx with increasing risk of CVD as
defined by the Heartscore index. In the multivariate analyses AIx was positively
associated with systolic and diastolic blood pressure, hs-CRP and current smoking
and – negatively with weight for both sexes, and positively associated with
total cholesterol for men only. AIx was not associated with other CVD risk factors,
including diabetes.
Conclusions: We propose a novel equation including age, height and sex to
calculate reference values for AIx - based on a large general population sample
with low risk of CVD. AIx is highly dependent on age and both systolic and
diastolic blood pressure, positively associated with hs-CRP and current smoking.
This study is the largest to date evaluating the association between AIx and
known CVD risk factors. We plan to examine AIx as independent predictor for cardiovascular
events and mortality in the Copenhagen City Heart Study – a cohort
with low risk of CVD.
1763 Increased cardiovascular mortality in women with
normal weight obesity
A. Romero-Corral1 , V.K. Somers1 , S. Boarin 2 , J. Sierra-Johnson3 ,
Y. Korenfeld4 , J. Korinek4 , G. Parati 5 , F. Lopez-Jimenez1 . 1Mayo Clinic, Cardiovascular, Rochester, United States of America; 2Mayo Clinic and Istituto Auxologico Italiano, Cardiovascular, Milan, Italy; 3Mayo Clinic
and Karolinska Institute, Cardiovascular, Stockholm, Sweden; 4Mayo Clinic,
Cardiovascular, Rochester, United States of America; 5Istituto Auxologico
Italiano, Cardiovascular, Milan, Italy
Background: We hypothesized that subjects with normal weight obesity (NWO),
defined as those with normal BMI but high body fat (BF) content, in whom we
have previously reported a higher prevalence of metabolic syndrome and cardiovascular
(CV) risk factors, are at higher risk for total and CV mortality.
Methods: We analyzed 2,127 subjects ≥ 20 years of age from the Third National
Health and Nutrition Examination Survey (NHANES III) and mortality study with
normal BMI (18.5-24.9 kg/m 2 ), body composition assessment, fasting morning
blood measurements and CV risk factors data. Survival information was available
for all subjects after 8.7 years of follow-up. We divided our sample into three
groups: low BF (35% in women), defined as NWO. We compared total and
CV mortality across groups.
Results: NWO comprised ∼20% of all subjects with a normal BMI. Table displays
the total and CV mortality rate in men and women according to BF. As BF
increased in men, there was a non-significant increased risk for total and CV mortality.
However, as BF increased in women, there was a significant increased risk
for total and CV mortality. When compared to the low BF group, NWO women
showed a trend towards higher total mortality (HR=1.52; 95%CI, 0.83-2.77), and
after adjustment for age, dyslipidemia, hypertension, diabetes, CV disease and
Total and cardiovascular deaths by BF
Men (n=1,1036) Body fat 25% Age and race adjusted
(n=378) (n=400) (n=248) p-value for trend
Total deaths 39 (5.63%) 42 (6.36%) 37 (12.5%) 0.21
Cardiovascular deaths 15 (2.52%) 20 (2.63%) 13 (4.94%) 0.59 †
Women (n=1,101) Body fat 35%
(n=428) (n=427) (n=246)
Total deaths 20 (3.03%) 31 (5.55%) 22 (8.25%) 0.038
Cardiovascular deaths 5 (0.87%) 12 (2.12%) 12 (4.37%)* 0.044 †
*p-value