S4 EuroPrevent Congress Abstracts May 2017

Diabetes/Lipids/Obesity
20
Effectiveness of a lifestyle intervention on left ventricular cardiac function in child-
hood obesity
C Charlotte Bjork Ingul1, K Dias2, AE Tjonna1, T Follestad3, M Hosseini1,
A Timilsina1, SM Hollekim-Strand1, p Cain4, GM Leong5, J Coombes2
1
Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Trondheim, Norway,
2
University Of Queensland, School of Human Movement and Nutrition Sciences, Brisbane,
Australia, 3Norwegian University of Science and Technology, Department of Public Health and
General Practice, Trondheim, Norway, 4The Wesley Hospital, Brisbane, Australia, 5University Of
Queensland, Institute for Molecular Bioscience, Brisbane, Australia
Topic: Obesity
Background: Pediatric obesity confers deleterious changes on cardiac structure and myocardial
function. Regular exercise can ameliorate cardiac dysfunction observed in pediatric obesity.
Purpose: We aimed to evaluate the efcacy of high intensity interval training (HIIT), moderate
intensity continuous training (MICT) and nutrition advice for ameliorating cardiac function.
Methods: 100 lean (11.5  2.4 years, 51.0% female, Tanner stage 2) and 99 obese children (
12.0  2.3 years, 53.5% female, Tanner stage 2.50) were included. Obese children were ran-
domised into one of three 12-week interventions, 1) HIIT [n=33, 4x4-min bouts at 8595%
maximum heart rate (HRmax), 3 times/week] and nutrition advice, 2) MICT [n=32, 44 mins
at 6070% HRpeak, 3 times/week] and nutrition advice, and 3) nutrition advice only [n=34].
A full resting echocardiogram was conducted.
Results: Obese children had signicantly lower indexed LV volumes, systolic and diastolic
function compared to lean controls (Table). Exercise stimulated signicant improvements in
both systolic and diastolic function, but only HIIT increased end-diastolic volume (EDV),
stroke volume (SV) and ejection fraction (EF) (Table).
Conclusions: A twelve-week exercise intervention, specically HIIT, was highly effective in
improving a reduced LV cardiac function during rest among obese children.
Methods: We screened 2490 asymptomatic subjects, of which 2136 had no comorbidities, for
CVD risk using ECVDRS, which consists of 10 tests: large (C1) and small (C2) artery stiff-
ness, BP at rest and post mild exercise (PME), CIMT, abdominal aorta and left ventricle
ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP. Comorbidities also
measured, but not factored into the risk score, include abnormal cholesterol, abnormal blood
pressure, and obesity, dened by BMI.
Results: Within obesity classes, subjects who were older exhibited higher levels of structural
and functional CV abnormalities. Notably, among subjects who were overweight, mild or
moderately obese, those in their 70s had risk scores two times as high as those in their 40s.
See table for full results.
Conclusions: Among subjects of the same BMI class, older subjects consistently exhibit more
structural and functional CV abnormalities. This is signicant, as the ECVDRS metrics are
corrected for age. First, this evidence contradicts one of the main claims of the "obesity
paradox" that mild to moderate obesity is protective in older populations. In fact, it appears
to increase the likelihood of having structural and functional CV abnormalities. Second, as
obesity is a disease that begins in childhood, we can conclude that while being obese is a major
risk factor for CVD, the length of time that one is obese is an even bigger risk factor. Thus, we
believe it is crucial to initiate obesity reduction early in life for optimal risk mitigation.
Mean RRS in Obese without Comorbidities
Obesity class by BMI Mean early CVD risk score in various age ranges
40s 50s 60s 70s
Control Group
(BMI < 25) 2 2 3 6
679 subjects
Overweight
(25-29.9) 3 4 4 7

21 800 subjects
Angina, pre-diabetes, and diabetes related quality of life, physical functioning and Class I
healthcare costs: the Cardiovascular Health Study (30-34.9) 4 4 5 8
1 1 2 1 3 4
N D Nathan Wong , E Schein , JA Delaney , AJ Magyar , CH Hirsch , JM Gardin
1
University of California at Irvine, Heart Disease Prevention Program, Division of Cardiology, 423 subjects
Irvine, United States of America, 2University of Washington, Seattle, United States of America, Class II
3
University of California-Davis, Sacramento, United States of America, 4Hackensack University (35-39.9) 4 5 5 9
Medical Center, Hackensack, United States of America
Funding Acknowledgements: Gilead Sciences 155 subjects
Topic: Diabetes Class III
Background: Angina pectoris (AP), diabetes mellitus (DM), and pre-DM confer cardiovascu- (40+) 5 5 7 6
lar disease (CVD) risk, but the impact of AP in combination with pre-DM and DM on quality
of life (QOL), physical functioning, and healthcare costs are unknown. 79 subjects
Purpose: We examined in older U.S. adults the impact of AP in combination with pre-DM and
DM on quality of life, physical functioning, and healthcare costs.
Methods: We studied 3,667 adults (mean age 75.1 years, 59% female) from the Cardiovascular
Health Study with or without pre-DM (fasting glucose 100-125 mg/dl) or DM (fasting glucose
126 mg/dl or on hypoglycemic therapy) and AP diagnosis. Among participants according to
the presence of AP with and without pre-DM or DM, analysis of covariance, adjusted for age, 23
gender, prior myocardial infarction and other CVD risk factors, was used to examine con- Can exercise improve reduced right ventricle function in obese children?
current quality of life and physical functioning; regression analysis was used to examine the C Charlotte Bjork Ingul1, K Dias2, AE Tjonna1, T Follestad3, M Hosseini1,
adjusted 10-year total, inpatient, and outpatient healthcare costs (relative to those with neither A Timilsina1, SM Hollekim-Strand1, PSW Davies4, GM Leong5, J Coombes2
1
pre-DM, DM or AP). Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Trondheim, Norway,
2
Results: We included six groups, including those without AP: 1) 1,754 (47.8%) without pre- University Of Queensland, School of Human Movement and Nutrition Sciences, Brisbane,
DM or DM, 2) 996 (27.1%) with pre-DM, and 3) 385 (10.5%) with DM, and those with AP: Australia, 3Norwegian University of Science and Technology, Department of Public Health and
4) 267 (7.3%) without Pre-DM or DM, 5) 158 (4.3%) with pre-DM, and 6) 107 (2.9%) with General Practice, Trondheim, Norway, 4University Of Queensland, Childrens Nutrition Research
DM. The table shows quality of life, physical functioning, and 10-year healthcare costs within Centre, Brisbane, Australia, 5University Of Queensland, Institute for Molecular Bioscience,
each of these groups. Persons with the combination of DM and AP had the worst quality of Brisbane, Australia
life, physical functioning, and greatest healthcare costs. Topic: Obesity
Conclusion: Quality of life, physical functioning, and healthcare costs are worse in those with Background: Obesity in children can result in subclinical early changes in right ventricle (RV)
AP and further worsened when DM is also present. systolic and diastolic function as well as in RV structure compared to lean controls. Lifestyle
intervention with weight loss has shown potential to reverse the effects of obesity on RV
diastolic function.
22 Purpose: The aim of the study was to evaluate if exercise in addition to diet could reverse
Decades of obesity even without comorbidities in asymptomatic subjects is asso- subclinical, abnormalities in RV myocardial function and diastolic lling.
ciated with significant cardiovascular structural and functional abnormalities Methods: 99 obese (12.0  2.3 years, 53.5 % female, Tanner stage 2.50) and 100 lean controls
M Mahfouz El Shahawy1, AS Byju2 (11.5  2.4 years, 51 % female, Tanner stage 2,) were included. The obese children were
1
Sarasota Memorial Hospital, Sarasota, United States of America, 2Cardiovascular Disease randomised into one of three 12-week interventions, 1) high intensity interval training
Assessment Center at Cardiovascular Center of Sarasota, Sarasota, United States of America (HIIT) [n = 33, 4 x 4-min bouts at 85  95 % maximum heart rate (HRmax), interspersed
Topic: Obesity with 3 min of active recovery at 50  70 % HRmax, 3 times/week] and nutrition advice, 2)
Background: Does the decade of obesity presence affect the extent of CV structural and moderate intensity continuous training (MICT) [n = 32, 44 mins at 60  70 % HRpeak, 3
functional abnormalities in asymptomatic subjects without comorbidities? times/week] and nutrition advice, and 3) nutrition advice only [n = 34]. A full resting echo-
Purpose: To determine whether obesity of longer duration in asymptomatic subjects without cardiogram was conducted.
comorbidities is associated with greater CV structural and functional abnormalities than in Results: Obese children had signicantly lower RV systolic (S) and diastolic (e) tissue
the younger cohort, as assessed by the Early CVD Risk Score (ECVDRS) system, also known Doppler velocities, lower longitudinal global strain (GLS) and strain rate (GSR) compared
as the Rasmussen Risk Score (RRS). to lean counterparts (Table). Exercise signicantly improved S, e, GLS and GSR. HIIT

Abstract number:21
QOL, Phys Func, and Healthcare Costs
No Disease/No Angina Pre-DM/No Angina DM/No Angina No Disease/Angina Pre-DM/Angina DM/Angina p-value across groups
Feel about life as a whole 2.32 2.38 2.40 2.36 2.37 2.72 <0.0001
Satisfied with purpose of life 2.98 3.03 3.09 3.00 3.05 3.48 0.13
15 ft. walk time (sec) 5.39 5.53 5.80 5.41 5.56 5.96 0.025
ADL 0.10 0.14 0.18 0.12 0.20 0.22 <0.01
IADL 0.28 0.29 0.36 0.40 0.47 0.53 <0.01
10-year total healthcare costs (US$) Reference +2796 +6740 +15,687** +6435 +19,643*

Healthcare costs represent difference compared to reference group of no disease/no angina. QOL=quality of life, ADL=activities of daily living, IADL=instrumental activities of daily living;
higher scores indicate poorer life satisfaction and worse physical functioning. *p<0.05, **p<0.01 for healthcare costs compared to reference.
 Abstracts S5

Abstract number:20
LV function obese vs. lean
Lean Obese HIIT vs. MICT HIIT vs. nutrition MICT vs. nutrition
Variable MeanSD MeanSD*** EMD 95% CI P EMD 95% CI P EMD 95% CI P
Resting heart rate (BPM) 7011 7812*** 2 -2 to 7 0.30 -1 -6 to 3 0.59 -3 -8 to 1 0.12
VaO2peak(ml/kg/min) 52.08.4 31.65.5*** 2.3 -0.1 to 4.6 0.06 4.1 1.7 to 6.4 0.001 1.8 -0.5 to 4.1 0.12
S (cm/s) 10.21.5 8.61.3*** 0.3 -0.2 to 0.9 0.24 1.0 o.5 to 1.6 <0.001 0.7 0.2 to 1.3 0.001
e (cm/s) 18.12.5 15.12.2*** 0.7 -0.4 to 1.8 0.20 1.5 0.5 to 2.7 0.007 0.8 -0.3 to 1.9 0.15
Global strain (%) -20.02.5 -17.13.0*** -1 -2.1 to 0.0 0.05 -1.7 -2.8 to -0.6 0.002 -0.7 -1.8 to 0.4 0.21
Global strain rate (s-1) -1.00.2 -0.90.2*** -0.03 -0.1 to 0.03 0.35 -0.1 -0.17 to -0.03 0.004 -0.07 -0.14 to 0.0 0.04
EDVi (mL/m2) 83.315.5 64.619.1*** 4.8 -2.1 to 11.7 0.76 5.5 -1.4 to 12.3 0.12 0.7 -5.9 to 7.3 0.85
EF (%) 62.56.3 57.08.2*** 4.0 0.1 to 8.0 0.04 6.2 2.3 to 10.1 0.002 2.2 -1.8 to 6.0 0.28
Stroke volume index (mL/m2) 54.811.3 39.99.1*** 6.8 2.7 to 10.9 0.001 6.9 2.7 to 11.1 0.001 0.1 -3.9 to 4.0 0.96
Cardiac output (L/min) 5.31.6 5.51.4 -0.1 -0.7 to 0.6 0.80 0.0 -0.7 to 0.6 0.91 0.0 -0.6 to 0.7 0.89
E/e 5.31.0 6.41.3* -0.03 -0.12 to 0.07 0.55 -0.06 -0.16 to 0.04 0.24 -0.03 -0.13 to 0.07 0.54
E/A 2.10.5 1.90.5*** -0.08 -0.2 to 0.04 0.20 -0.01 -0.13 to 0.12 0.12 0.89 -0.05 to 0.19 0.24

Obese vs. lean *p<0.05, ***p<0.001; EMD, estimated mean difference; CI, confidence interval, S systolic tissue velocity, e early diastolic tissue velocity

Abstract number:23
Right ventricular data obese vs. lean
Lean controls Obese HIIT vs. MICT HIIT vs. nutrition MICT vs. nutrition
Variable EMD 95%CI P-value EMD 95%C P-value EMD 95%C P-value
Resting heart rate (bpm) 7011 7812*** 2 -2 to 7 0.30 -1 -6 to 3 0.59 -3 -8 to 1 0.12
S (cm/s) 14.42.1 13.12.1*** 0.7 -0.4 to 1.8 0.20 1.2 0.1 to 2.3 0.03 0.5 -0.6 to 1.6 0.40
e (cm/s) 16.93 14.82.8*** 2.1 0.5 to 3.6 0.009 2.2 0.7 to 3.8 0.005 0.2 -1.4 to 1.7 0.83
A (cm/s) 8.32 9.32.8** 1.1 -0.3 to 2.4 0.12 1.1 -0.3 to 2.4 0.12 0 -1.4 to 1.4 0.99
GLS (%) -25.25.6 -20.34.8*** -3 -5.5 to -0.5 0.02 -4.3 -6.9 to -1.7 0.001 -1.3 -3.8 to 1.2 0.31
GSR (1/s) -1.40.5 -1.20.4*** -0.1 -0.3 to 0.1 0.46 -0.4 -0.6 to -0.2 0.001 -0.3 -0.5 to -0.1 0.005
TAPSE mm 24.34 23.54.2* 0.6 -1.3 to 2.6 0.53 1.2 -0.8 to 3.1 0.25 0.5 -1.4 to 2.4 0.60
E/A tricuspid 1.90.5 1.80.5 0.1 -0.2 to 0.3 0.59 0.1 -0.1 to 0.4 0.39 0 -0.2 to 0.3 0.74

EMD, estimated mean difference; CI, confidence interval;*p<0.05, *p<0.01,***p<0.001 obese vs. lean

improved e and GLS signicantly more than MICT (Table).
Conclusions: Reduced systolic and diastolic RV function in obese children could be improved
by a 12-week lifestyle intervention. However, HIIT was superior compared to MICT and
restored the impaired RV function. Diet alone had no effect.
24
Circulating endothelial-derived and mononuclear progenitor cells in patients with
metabolic syndrome and diabetes mellitus
A Alexander E Berezin1, A Kremzer1, T Berezina2, A Zulli3, p Kruzliak4, L Gaspar5,
I Mozos6
1
State Medical University, Zaporozhye, Ukraine, 2Private medical center VitaCenter, Zaporozhye,
Ukraine, 3Victoria University, The Centre for Chronic Disease Prevention and Management,
Melbourne, Australia, 4University of Veterinary and Pharmaceutical Sciences, 8Laboratory of
Structural Bilogy and Proteomics, Brno, Czech Republic, 5Comenius University Hospital, Internal
Medicine, Bratislava, Slovak Republic, 6University of Medicine Victor Babes, Timisoara, Romania
Topic: Diabetes
Introduction: Metabolic disorders remain a leading contributor to cardiovascular mortality
worldwide. Circulating endothelial progenitor cells (EPCs) are decreased in metabolic dis-
orders, thus identifying the different populations of EPCs could assist in prognosis. This
study was conducted to investigate the population of circulating endothelial progenitor cells
(EPCs) in patients with type two diabetes mellitus (T2DM) or metabolic syndrome (MetS).
Materials and Methods: The study retrospectively involved 101 patients (54 subjects with T2DM
and 47 patients with MetS) and 35 healthy volunteers. We enrolled dysmetabolic disorder subjects
without angina pectoris and without existing coronary artery disease (negative contrast-enhanced
multispiral tomography angiography). All patients have given their informed written consent for
participation in the study. T2DM was diagnosed with revised criteria provided by American
Diabetes Association when source documents were reviewed. MetS was diagnosed based on
the National Cholesterol Education Program Adult Treatment Panel III criteria. Flow cytometry
was used for detecting EPCs using CD45, CD34, CD14, Tie-2, and VEGFR2 (CD309) markers,
which were measured at the beginning of the study. The Fluorescence Minus One Control (FMO
control) was used to properly interpret ow cytometry data.
Results: There is a signicant difference between the median total number and frequency of
CD14/CD309+ and CD14/CD309/Tie2+ in patients with dysmetabolic disorders vs control.
CD14/CD309+ and CD14/CD309/Tie2+ EPCs were 19% and 14% higher among MetS sub-
jects in comparison with T2DM patients. Osteoprotegerin (OPG) and hs-C-reactive protein (hs-
CRP), signicantly improvedthe predictive model based on T2DM + number of multiple car-
diovascular risk factors (MCRFs)>3 for both subsets of EPCs. Among patient study population
for category-free NRI, 5% of events and 11% of non-events were correctly reclassied by the
addition of hs-CRP and OPG to the base model for decreased absolute number of circulating
EPCs labeled CD14+CD309+. Therefore, 6% of events and 14% of non-events were correctly
reclassied using category-free NRI for depleted CD14+CD309+Tie2+ EPCs
In conclusion, we suggest that inammatory biomarkers (hs-CRP, OPG) could be a predictor for
decreased CD14+CD309+ and CD14+CD309+Tie2+ EPCs among dysmetabolic patients,
without preexisting atherosclerotic lesions of coronary arteries.
25
Obesity and increased premature death from circulatory disease: a comparison of
populations from the United States and Sweden
M Scribani1, M Norberg1, K Lindvall1, L Weinehall1, J Sorensen2, p Jenkins2
1
Umea University, Department of Public Health and Clinical Medicine, Epidemiology and Global
Health Unit, Umea, Sweden, 2Bassett Healthcare Network, Research Institute, Cooperstown, New
York, United States of America
Funding Acknowledgements: New York State Department of Health (USA);
Vasterbotten County Council (Sweden)
Topic: Obesity
Background: Understanding the impact of obesity on premature mortality is critical for pre-
vention planning. While studies from across the globe have shown associations between
obesity and increased overall mortality, few published studies directly compare patterns of
the relationship between obesity and premature mortality between countries.
Purpose: To utilize two longitudinal datasets to contrast the relationship between obesity and
premature death due to circulatory causes in rural New York State (U.S.) and Northern
Sweden.
Methods: Data on baseline height, weight, education, and smoking status were obtained for
U.S. subjects via county health surveys in 1989 and/or 1999. Mortality data for U.S. subjects
were obtained from death certicates, medical records, and other public sources. Swedish
subjects had height and weight measured as part of a county-wide intervention program,
with mortality data obtained from the Swedish National Board of Health and Welfare. The
outcome of premature death was dened as death occurring before life expectancy (as deter-
mined by the subjects sex and year of birth). Sex and country-specic incidence densities of
premature death (per 100,000 person-years) from any circulatory cause were calculated. Time
to premature death from any circulatory cause was compared across groups of body mass
index (normal=18.5-24.9 kg/m2; overweight=25.0-29.9 kg/m2; obese=30.0-34.9 kg/m2;
severely obese 35.0 kg/m2) using multivariable Cox Proportional Hazards regression.
Results: 60,600 Swedish subjects (28,947 male, 31,653 female) and 31,198 U.S. subjects (14,884
S6 EuroPrevent Congress Abstracts May 2017

male, 16,314 female) were included, contributing 943,555 and 409,804 person-years of follow-
up in Sweden and the U.S., respectively. Swedish males with normal BMI had a lower Table 1
absolute risk of premature circulatory death (60 deaths/100,000 person-years) as compared Characteristics Model 1 Model 2
to US males (73 deaths/100,000 person-years); this relationship reversed for the obese (226/ OR IC95% p OR IC95% p
100,000 Sweden, 154/100,000 U.S.) and severely obese (332/100,000 Sweden, 268/100,000 High LDL-c (mg/dL) 1.51 0.97-2.36 0.066 1.54 0.98-2.42 0.059
U.S.). Swedish males in the obese and severely obese groups had signicantly increased Low HDL-c 2.42 1.51-3.86 * 2.95 1.82-4.79 *
hazards (adjusted HR=3.02 and 4.91 respectively) of premature circulatory death relative High triglycerides levels 2.44 1.51-3.96 * 2.60 1.59-4.26 *
to their normal weight counterparts, as did obese and severely obese Swedish females
(adjusted HR=1.70 and 3.11 respectively). For severely obese U.S. subjects, there was also Model 1: Raw model; Model 2: Fixed model (age, sex, socioeconomic level, physical activity,
a signicantly increased hazard, albeit more modest, for both sexes (adjusted HR=3.18 males, breastfeeding background); OR: Odds Ratio; IC 95%: Trust interval 95%; p value: *<0.00001
adjusted HR=3.04 females). LDL-c: Low density lipoproteins; HDL-c: High density lipoproteins
Conclusions: Relative to normal weight individuals, the increased risk of premature circulatory
death associated with obesity among Swedish males was markedly greater than the corre-
sponding increased risk for U.S. males, a pattern not duplicated among females. Investigation
into the factors underlying this phenomenon among males may provide further understanding 27
of the mechanisms of obesity-related premature mortality. Positive and negative predictors of LDL-C goals achievement in patients at moder-
ate to very high cardiovascular risk on lipid-lowering drug therapy (CEPHEUS II)
CEPHEUS II , YU Khomitskaya1, NA Logunova1, SA Boytsov2
26 1
AstraZeneca company, Medical, Moscow, Russian Federation, 2National Research Center for
Lipid profile alterations and its relation with waist-to-height ratio in children
Preventive Medicine, Moscow, Russian Federation
population
Funding Acknowledgements: AstraZeneca
CL Clara Lucia Dominguez Urrego1, SK Romero Rondon1, EM Gamboa Delgado2,
Topic: Lipids
DC Quintero Lesmes3
1 Background/Introduction: CEPHEUS II is a non-interventional study in real clinical practice
Cardiecol, Proyecto SIMBA II, Floridablanca, Colombia, 2Universidad Industrial de Santander,
in Russia.
Escuela de Nutricion y Dietetica, Bucaramanga, Colombia, 3Fundacion Cardiovascular de Colombia,
Purpose: The primary objective of this study was to estimate the proportion of patients at
Centro de Investigaciones, Floridablanca, Colombia
moderate to very-high cardiovascular (CV) risk on lipid lowering therapy (LLT) who achieved
Funding Acknowledgements: Departamento Administrativo de Ciencia, Tecnologa e
the low-density lipoprotein cholesterol (LDL-C) goals according to the Fifth Joint European
Innovacion-COLCIENCIAS
Task Force guidelines (EAS 2012 guidelines). Secondary objectives were to determine the
Topic: Lipids
percentage of responders in sub-populations of primary and secondary prevention patients
Background and Aim: dyslipidemia is a recognized risk factor for development of cardiovas-
and to identify determinants for reaching the LDL-C goals.
cular disease which has been identied at early ages of life. Waist-to-Height Ratio (WHtR) is
Methods: CEPHEUS II (NCT02230241), a multicenter observational study in out-patient
an anthropometric index that concerns both longitudinal growth and central adiposity and
setting. A total of 2704 patients were enrolled at 77 clinical sites located in different regions
has emerged as a practical and useful indicator for identifying cardiovascular risk factors in
of Russia. In order to evaluate the association between achievement of the LDL-C goals,
child and adolescent population. This study evaluated the association between lipid prole
patients and physicians characteristics, the multivariate logistic regression model was devel-
alterations and WHtR in children population.
oped.
Methods: Analytical cross-sectional study. A total of 1282 children aged 6 to 10 years parti-
Results: The mean age of patients was 62.7 (10.0) years. There were 1436 (53.1%) men and
cipating in a population-based study were included. Dyslipidemia was dened as: *impaired
(46.9%) in 1267 women the study. Hypertension occurred in 92.2% of patients. More than
triglycerides: 0-9 years:  100 mg/dL. * HDL cholesterol alterations: < 40 mg/dL. *LDL
third of the enrolled patients (35.6%) had nearest relatives with early onset of coronary heart
cholesterol alterations:  130 mg/dL. The independent variable was Waist-to-Height Ratio
disease (CHD); diabetes mellitus was reported in 24.0% of the patients. 18.2% of study
and dependent variable was dyslipidemia. WHtR value was obtained from the equation:
patients were tobacco smokers. In total, 91.2% of study participants were classied as very-
Waist (cm)/Height (cm). Values 0.5 for WHtR were considered high. The association
high CV risk patients. All patients were on LLT and 99.7% received statins as a monotherapy
between dependent and independent variable was evaluated using logistic regression
or in combination with other LLT agents. The mean LDL-C level was 2.76 (1.016) mmol/l.
models. Data analyzed in Stata 12.0.
Only 17.4% (95%CI:15.9 %, 18.8 %) of full study population achieved LCL-C goals. The
Results: 9.77% of the children presented a high WHtR (95% CI: 8.19 to 11.52). After adjust-
difference between the patients measured LDL-cholesterol level and his/her individual target
ment for age, sex, socioeconomic status and physical activity, WHtR was signicantly asso-
goal didnt exceed 1 mmol/l. In 71.9% of patients this difference didnt exceed 1.5 mmol/l.
ciated with lower HDL levels and higher levels of triglycerides (OR=2.95 IC 95% :1.82 a 4.79,
Patients who take LLT for primary prevention (n=943) have demonstrated signicantly
OR=2.60 IC 95%: 1.59 a 4.26, respectively) (Table. 1). No signicant associations were found
higher achievement rate of LDL-C goals than secondary prevention patients (n=1760)
between high LDL cholesterol and WHtR in this study.
(19.7% vs 16.1%, o=0.017). Positive predictors of the LDL-C goals achievement includes
Conclusion: Waist-to-Height Ratio was a useful tool to identify lipid prole alterations in
patients satisfaction with the current LLT (p=0.034) and high patients compliance (no
children population with a cut point of WHtR  0.5. However, we recommend further
missed doses) (o <0.001). Negative predictors of the LDL-C goals achievement were family
exploration of the use of WHtR and its optimal cut-offs points for identify cardiovascular
history of early CHD (o=0.015), presence of CHD (o<0.001), patients concern about the
risk factors in children in this age group.
current LLT (o=0.034) and patients opinion about acceptable frequency of missed doses
(o=0.044). Analysis of patients compliance survey showed that the majority of patients
(89.8%) took the prescribed LLT daily. Only 7.8% of patients miss to take LLT.
Conclusion: Less than 20% achieved LDL-C goals. Primary prevention patients had achieved
LDL-C goals signicantly more often than secondary prevention patients. The probability of
the LDL-C goals achievement was higher in satised and adherent patients without family
history of early CHD and current CHD.