Wednesday June 28, 2000: Read by Title abstracts

T.'W25 Psychosocial Mechanisms in CVD 225

enzymatic method, Lp(a) by Eliza method, tibrinogen and factor VII activity Conclusions: Because abnormal TG level seems to be one of the essential
by fibrinometric method. risk factors for atherosclerosis our results may suggest only a possible role of
Results: The mean plasma levels of fibrinogen, factor VII activity and DHEA-S in this process. The study will be continued.
total cholesterol were significantly higher and HDL-cholesterol lower, among
postmenopausal women P < 0.05, however, no significant difference regarding
serum triglyceride (TG) or Lp(a) levels were observed. I WeT7:W24 / factors in the development of Coronary heart disease
The biochemical-haemostatic interrelationship among premenopausal and in women
postmenopausal women is shown in the following table. J. Dragi~evi61 , V. Drecun 1, M. Babi61 , Z. Vasiljevi62 , M. Drezgi63,
D. Ponomarev 1, V. Biseni~ 1, J. Petrovi64. 1KBC Be~anijska Kosa; 21nstitute
Risk factor Tot-C LDL-C HDL-C TG LP(a)
r p r p r p r p r p for cardiovascular diseases; 3Institute for endocrinology, diabetes and
metabolic diseases, Belgrade; 4ZC "Studenica", Kraljevo, Yugoslavia
Premenopausal Women
Fibfinogen 0.1787 0.25 0,177 0.28 -0.0614 0.69 0.0269 0.86 0.088 0.68 Objective: To determine significant risk factors for development of coronary
FactorVIl 0.2675 0.03 -0.0129 0.93 -0.0714 0.64 -0.1749 0.26 -0.2975 0.15
Postmenopausal Women heart disease (CHD)
Fibrinogen 0.155 0.05 -0.2835 0.30 -0.6328 0,00 0.2558 0.30 0.0728 0.85 Methods: 70 female patients, admitted into Belgrade Emergency Center
FactorVII 0.0033 0.04 -0.0691 0.79 0.2939 0,22 -0.0433 0.86 -0.1515 0.67 Coronary ICU for acute miocardial infarction and unstable angina pec-
toffs, were studied, along with the control group of 20 female patients
Conclusion: In conclusion, the observed differences in fibffnogen and factor without proven CHD. The factors analysed were: age, presence of arterial
VII levels and its relationship to plasma lipids may explain part of the higher hypertension, smoking habit, genetic predisposition, diabetes mellitus, hyper-
prevalence of cardiovascular diseases among postmenopausal compared to lipoproteinaemia, hormonal status and personality type (according to Bortner's
premenopansal women.Ira scale). Statistical processing was performed through discriminational analysis
of the afore mentioned factors.
Results: Discffminational analysis of all the CHD risk factors considered re-
WeT5:W24 ] Hormone replacement therapy and risk factors of
I
vealed as signifficant clasifficators the following: age, menopause, behavioural
cardiovascular disease in postmenopausal women with type A, and decreased serum values of HDL-cholesterol.
non-insulin-dependent diabetes mellitus Conclusions: Prevalence of coronary heart disease in women signifficantly
depends on age, menopause, behavioural type, and the serum levels of
A. Sankova, S. Kozlov, Z. Gabbasov, M. Tvorogova, A. Lyakishev,
HDL-cholesterol.
V. Naumov. Cardiology Research Centre, Moscow, Russia
Objective: To estimate the influence of hormone replacement therapy (HRT)
on biochemistry parameters of lipid and glucose metabolism and hemo-
static factors in postmenopausal women with non-insulin-dependent diabetes
T:W25 PSYCHOSOCIAL MECHANISMS IN CVD
mellitus (NIDDM).
Metods: 25 postmenopausal NIDDM women aged 56 =E 7 years were
treated in 28-day cycles with 2 mg estradiol valerate (EV) daily for 21 days (4
women after hysterectomy) or EV 2 mg for 21 days plus cyproterone acetate
IWeT1:W25 J factors
Blood fibrinogen levels
in turkish adults
and associations with other risk

1 mg for the last 10 days (21 women with intact uterus). 20 controls were
postmenopausal NIDDM women aged 58 + 4 years without HRT.
Results: After 3 months of treatment low-density cholesterol lipoprotein
(LDL-C) decreased 8% (NS), high-density cholesterol lipoprotein (HDL-C)
increased 15% (p < 0.05), triglycerides (TG) increased 3% (NS), plasma
fibrinogen (F) decreased 15% (p < 0.05), spontanueous platelet aggrega-
tion (Aggr.) decreased 14% (p < 0.05), glycosilated haemoglobin (HbAlc)
decreased 4% (p < 0.05).
Conclusions: 1) HRT in postmenopausal women with NIDDM was as-
sociated with favorable changes in biochemistry parameters of lipid and
glucose metabolism and hemostatic factors. 2) HRT was well tolerated in
postmenopausal women with NIDDM.
WeT6:W24 1 Dehydroepiandrosterone sulphate, lipid profile and
thrombogenic factors in young and middle age men
G. Sypniewska, E. Jendryczka-Madkiewicz, G. Dymek, L. Senterkiewicz.
Dept. of Clinical Chemistry, Medical University, Bydgoszcz, Poland
Objective: Dehydroepiandrosterone sulphate (DHEA-S) is a steroid hormone
synthesized mainly by the adrenal cortex. Decrease of its concentration may
probably influence atherogenesis.
Methods: Study included 60 randomly selected men aged 20-50. Serum
DHEA-S was measured by ELISA, cholesterol (TCH), HDL-CH, triglycerides
(TG) by enzymatic colorimetric assay. Protein C and AT HI were determined
by colorimetric assay and flbrinogen using modification of Clauss method.
Results: Mean TCH was found to be increased whereas markers of anti-
coagulant activity (Protein C and ATIII) as well as fibrinogen values were in
normal range. Mean DHEA-S value was also in the normal range.
G. Hergenq 1 , A. Onat 2 , B. Ytldlnm 3 , A. (~etinkaya3 , O. Uysal3 , V. Sansoy3,
T.U. Yildiz. j Yeditepe Medical Faculty; 2Turkish Cardiology Society;
31stanbul University Cerrahpasa Medical Faculty and Cardiology Institute,
lstanbul, Turkey
Objective: To measure fibffnogen values in Turkish adults and assess associ-
ations of fibffnogen levels with several coronary risk factors investigated.
Methods: In the 1599 men and women of the 2575 adults visited in the
third follow up of the TEKHARF Cohort in 1997/8, plasma fihrinogen and
blood lipids were measured by Behring turbidometry and Bayer Reflotron
respectively and validation of the results were done in a reference laboratory.
Results: Mean fibrinogen levels were 2.68 and 2.88 g/L in men and women
respectively. Median age was 46 for men and 48 for women. Fibrinogen levels
were independent of age in women but increased with age in men (0.1 g/L for
every 5 years; r = 0.29 p < 0.001). Multivariate analysis indicated smoking
as an independent significant marker for fibffnogen levels in both sexes. Waist
circumference, triglyceffdes, and HDL-cholesterol (HDL-C) in women and
waist/hip ratio in men were significant determinants of fibrinogen levels.
HDL-C was borderline significant in men. In the univaffate analysis, physical
activity showed a weak indirect significant association with fibrinogen in both
sexes. Body mass index, systolic and diastolic blood pressures in women and
LDL-C in men showed weak but significant associations with fibrinogen lev-
els. LDL-C/HDL-C showed an indirect association with fibrinogen in women.
Direct association between HDL-C and fibrinogen was again observed hut
was difficult to explain.
Conclusions: Slightly higher fibrinogen levels in Turkish adults compared
to Caucasians are thought to contribute to the coronary heart disease risk in
our population.

TCH HDL-CH TG DHEA-S Prot. C ATIU Fibdnogen WeT2:W25 [ Psyhological features o f patients with ischaemic heart
(mg/dl) (mg/dl) (mg/dl) (#g/ml) (%) (%) (%) disease and coronary behavior type "A"
234:t:56 50-4-15 1614-85 2.83 -t- 0.97 108+17 864-12 2844-67
A.S. Melentyev, V.P. Zaicev, I.A. Melentyev, E.A. Kolesnikova. Russian State
So far, we were not able to show any relationship between DHEA-S level Medical University, Moscow, Russia
and lipid parameters (TCH, HDL-CH) nor between this hormone level and Objective: To study behavioral type "N' at patients with different forms
markers of anticoagulant activity (Prot. C, ATIII) and fibrinogen. However, ischaemic heart disease (IHD).
a trend to decreased DHEA-S with increased TG was noticed. Significant Methods: The computer psychometrical investigation included 83 patients
negative correlation between DHEA-S level and age was found. with angina pectoris (AP) and 120 patients with acute myocardial infarction

Xlhh International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000

 Wednesday June 28, 2000: Read by Title abstracts
226 T: W26 Regulation of Endothelial Function
(MI). The Smishek Test (shows features of character), The Type of Attitude
over Disease Test, Self-Felling - Activity - Mood (SAM) Test were used.
Special attention was given to short JAS (Jenkins Activity Survey) Test that
showed the degree of coronary behavior.
Results: The type B and different degrees of type A behavior were found
in comparable amount of cases among patients after MI was (50.4%, 49.6%).
Type B prevailed among patients with AP (62.5% and 37.5%, p < 0.02). Type
A correlated with the degree of fiery and demonstrationality in disposition
of personality among patients with AP (r = 0.41 and r = 0.40) as well as
among patients after MI (r = 0.38 and r = 0.38). It reflected impulsive and
demonstrative behavior and tendency to forcing out anxiety. Type A among
patients with AP was connected with apathetic, spiteful and suspicious types
of attitude over disease (r = 0.40) that showed in passive accordance with
treatment, suspicious relation to medical manipulations and irritancy towards
the medical staff. Type A among patients after MI was connected with the
anxious type of attitude over disease (r = 0.61) that showed in anxious mood,
"craving" for information about disease, unstoppable search for "authorities"
and new treatment methods in combination with high activity (SAM Test, r =
0.33).
Conclusions: Patients with type A, especially after MI, needs rational and
explanative psychotherapy to fill in the information deficit and thus to decrease
the emotional tensity. This must be kept in mind while creating behavioral
trainings for patients with IHD.
T:W26 REGULATION OF ENDOTHELIAL FUNCTION
WET1 :W26 [J Bezaflbrate reduces heart rate and blood pressure in
patients with hypertriglyceridemia
LJ.A.M. Jonkers I , EH.A.E de Man 2, A. van der Laarse2, M. Fr61ich 3,
A.H.M. Smelt I . 1Leiden University Medical Center, Dept of General Internal
Medicine; 2Cardiology," 3Clinical Chemistry, Leiden, The Netherlands
Objective: To determine whether bezafibrate affects hemodynamics in hy-
pertriglyceridemic (HTG) patients and to assess whether insulin resistance,
elevated non-esterified free fatty acids (FFA) and cGMP (endothelial function)
are involved in this regulation.
Methods: The effects of bezafibrate (six weeks 400 mg once daily) on
heart rate (HR) and BP in relation to plasma lipids, insulin, FFA, aldosteron,
catecholamines, 24 h urinary sodium excretion and urinary catecholamlnes
were investigated in 17 endogenous HTG patients in a double-blind placebo-
controlled cross-over fashion, eGMP was measured as a marker for NO
production. At the end of both treatment periods, fasting blood samples were
drawn and BP and HR were measured automatically for 30 min at 2-min
intervals.
Results: Bezafibrate therapy significantly decreased plasma total TG
(-61%) and total cholesterol (-25%). Hemodynamic parameters decreased
upon bezafibrate therapy: HR from 69.4 4- 2.5 to 66.3 4- 2.6 per min (p =
0.009), SBP from 137.4 4- 5.4 to 132.2 4- 5.3 mmHg (p = 0.01), DBP from
81.3 4- 2.7 to 79.0 4- 2.6 mmHg (p = 0.07) and MBP from 101.6 4- 3.7 to
98.7 4- 3.9 mmHg (p = 0.06). Both FFA and insulin decreased significantly
upon bezafibrate therapy ( - 5 5 % and - 5 7 % respectively), cGMP significantly
increased upon bezafibrate therapy (+24%, p = 0.008)), whereas the other
parameters were not affected.
Conclusion: Bezafibrate reduces HR, BE insulin and FFA in HTG patients.
These improved hemodynamics might be caused by improved endothelial
function.
/
WeT2:W26 1 Reduced levels of no in patients with uncomplicated type
II diabetes metiitns
E Costantini, A. Consoli, S.D. Pierdomenico, F. Cipollone, B. Calabrese,
M. Di Gioacchino, A. Mezzetti. "G. D'Annunzio" University, School of
Medicine, Chieti, Italy
Objective: It has been reported that poor glycemic control is associated with
endothelial dysfunction in type II diabetes mellitus. The enhanced oxidative
stress showed in diabetes could contribute to endothelial dysfunction. The
present study was designed to evaluate the effect of metabolic control on
circulating nitric oxide (NO) levels and on systemic oxidative stress.
Methods: Serum nitrite and nitrate (NO 2 + NO~-) concentration, an indirect
index of circulating NO, LDL susceptibility to oxidation, vitamin C and E
plasma content, LDL vitamin E levels, were assessed in 50 uncomplicated
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
type II diabetic subjects, 25 in poor metabolic control (HbAlc > 8.0%) and 25
in longstanding good metabolic control (HbAlc < 7.5%) as compared to 25
well matched healthy subjects. Following baseline determination, 13 diabetic
subjects in good metabolic control were randomly assigned to receive vitamin
E (300 mg b.i.d.) for 4 weeks whereas 12 subjects of the same group received
placebo.
Results: Circulating NO levels were significantly reduced and oxidative
stress significantly increased in both diabetic groups as compared to healthy
subjects. However serum NO 2 + NO 3 content was significantly lower and ox-
idative stress significantly enhanced in poorly controlled than in well controlled
diabetic subjects. Interestingly, serum NO 2 + NO 3 levels were significantly
and inversely related to HbAlc in poorly controlled NIDDM whereas in
well-controlled diabetic patients they were significantly and inversely related
to native-LDL lipid peroxide content. Vitamin E supplementation normalizes
serum NO 2 + NO 3 levels.
Coclusioas: Although good metabolic control can significantly increase
serum NO~ + NO 3 content an antioxidant treatment with vitamin E is
necessary to normalize NO levels in type II diabetes mellitus.
I WeT3:W26 [ Relation between endothelial dysfunction and laboratory
parameters in patients with combined hyperlipidemia
J. Mal~, V. Melenovsk2~, D. Wichterle, J. Simek, R. (~e~ka. 3 'a Department of
Medicine, General University Hospital, Prague, Czech Republic
Objective: Impaired endothelial function (EF) has been described in hyper-
cholesterolemic and hypertriglyceridemic subjects. The purpose of this study
was to determine any relation between EF and several metabolic parameters
in men with combined hyperlipidemia.
Population: Twenty-nine non-smoking otherwise healthy men with non-
treated combined hyperlipidemia, aged 47.4 4- 7.8 years (mean 4- SD), with
body-mass index 27.7 4- 2.69, systolic blood pressure (sBP) 125.5 4- 11.4
and diastolic blood pressure (dBP) 83 4- 7.6 mmHg, participating in the
Fenofibrate versus Atorvastatin Trial (FAT).
Methods: Flow-mediated dilation (FMD) and laboratory parameters men-
tioned below were measured. FMD was assessed in brachial artery using a
linear 7.5 MHz ultrasound-probe. Laboratory parameters included serum lev-
els of total cholesterol (C), HDL-C, LDL-C, LDL particle size, triglycerides
(TG), fibrinogen (FBG), ferritin (FER), glycemia (G), C-reactive protein
(CRP), apolipoprotein AI (Apo-AI), apolipoprotein B (Apt-B), lipoprotein(a)
(Lp(a)), homocyst(e)ine (Hc), uric acid (UA), and oxidative stress markers
- malonyldialdehyde (MDA) and superoxidedismutase (SOD). A statistical
correlation (Pearson) between FMD and each of the laboratory values was
calculated, p < 0.05 was considered as significant.
Results: are expressed as mean 4- SD. The FMD was 2.17 4- 2.0%, total
C 7.53 4- 1.22 retool/L, HDL-C 1.25 4- 0.32 mmol/L, LDL-C 4.39 4- 0.89
mmol/L, LDL particle size 24.7 4- 0.7 nm, TG 5.40 4- 4.66 mmol/L, FBG 2.73
4- 0.50 g/L, FER 192 4- 185/zg/L, G 5.27 4- 0.54 mmol/L, CRP 1.21 4- 0.71
mg/L, Apo-AI 1.33 4- 0.24 g/L, Apo-B 1.35 4- 0.25 g/L, Lp(a) 2.0 4- 2.6 g/L.
Hc 12.4 4- 2.6 #mol/L, UA 415 4- 202 #mol/L, MDA 4.07 4- 1.94 #mol/L,
SOD 1.11 4- 0.22 U. The only statistically significant correlation between
FMD and any of the other variables (including age, BP and BMI) was found
for CRP (r = 0.42, p = 0.039).
Conclusion: Endothelial dysfunction in subjects with combined hyperlipi-
demia is caused by interaction of many factors and can not be easily predicted
by any of the above mentioned individual laboratory parameters. A correlation
was found between FMD and CRP level. It could be explained, at least in part,
by a role of the vessel wall inflammation in the process of atherosclerosis.
WeT4:W26] Plasma markers of endothelial dysfunction in
dyslipidaemic patients: Outcome after a 3-months
treatment
J. Constans, A.D. Blann, M. Renard, V. Gu6rin, M.R. Boisseau, C. Conri.
Vascular Medicine, Haematology, CHRU Bordeaux, France; Vascular
Biology Unit, Birmingham, UK
A negative impact of dyslipidaemias on vascular endothelium has been pre-
viously suggested and the positive effect of statins might in part come from
an improvement of vascular endothelium function. To assess this hypothesis,
we measured biological markers of endothelial dysfunction before and upon
treatment of dyslipidaemias.
Soluble markers of endothelial dysfunction were performed in 2 populations
of patients: 10 hypercholesterolaemic (HC) (TC > 6.5 mmol/l and TG < 3
mol/1), and 13 hypertriglyceridaemic (HTG) (TG > 1.9 mmol/l). All were free