Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study.

BACKGROUND: It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016-17), with a focus on population coverage and sample representativeness. METHODS: Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007-08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. RESULTS: For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P < 0.0001), 218 (33%) participants having university qualification vs. 95 (18%) non-participants. The participants seemed having better health perception (p < 0.0001); 455 (70.3%) self-reported good or very good health perception compared to 312 (58.2%) non-participants. The prevalence of obesity (P < 0.0001), hypertension (P < 0.0001), diabetes (P = 0.007), and mean values of related biomarkers were significantly higher among the non-participants. The overall sample (1558 participants) was mainly composed of randomly selected subjects, including 660 from the baseline sample and 455 from other health examination survey sample and 269 from civil registry sample (constituting in total 88.8%), against only 174 volunteers (11.2%), with significantly different characteristics and health status. The ORISCAV-LUX2 sample was representative of national population for geographical district, but not for sex and age; the younger (25-34 years) and older (65-79 years) being underrepresented, whereas middle-aged adults being over-represented, with significant sex-specific difference (p < 0.0001). CONCLUSION: This study represents a careful first-stage analysis of the ORISCAV-LUX2 sample, based on available information on participants and non-participants. The ORISCAV-LUX datasets represents a relevant tool for epidemiological research and a basis for health monitoring and evidence-based prevention of cardiometabolic risk in Luxembourg.

Prevalence and related risk factors of chronic kidney disease among adults in Luxembourg: evidence from the observation of cardiovascular risk factors (ORISCAV-LUX) study.

BACKGROUND: Evidence on stages of renal impairment and related risk factors in Luxembourg is lacking. This study aimed to assess the prevalence of chronic kidney disease (CKD) and identify potential correlates among the general population, using the recent definition suggested by the Kidney Disease Improving Global Outcomes guidelines. METHODS: Data analysed from 1361 participants aged 18-69 years, enrolled in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, 2007-08. Descriptive and multivariable logistic regression analyses were performed to identify demographic, socio-economic, behavioural, and clinical factors associated with CKD, defined as a single estimated glomerular filtration rate (eGFR) measure <60 ml/min/1.73m2 and/or urinary albumin: creatinine ratio (ACR) > 30 mg/g. RESULTS: Overall, 6.3% had CKD, including 4.4% and 0.7% with moderate and severe macroalbuminuria respectively. 0.1% had kidney failure (eGFR < 15 ml/min/1.73 m2). CKD was higher among subjects with primary education and risk increased significantly with age; the odd ratio was more than 2-fold higher among participants aged 50-69 years. Hypertension and diabetes were associated with more than 3-fold and 4-fold higher risks of CKD [adjusted odd ratio (AOR 3.46 (95%CI 1.92, 6.24), P < 0.001] and [AOR 4.45 (2.18, 9.07), P < 0.001] respectively. Increased physical activity measured as total MET-hour/week was independently associated with a lower odds of CKD (P = 0.035). CONCLUSION: The national baseline prevalence estimate of CKD, a neglected public health problem, stresses the benefit of early detection particularly in high-risk subjects with associated cardiovascular pathologies (e.g. hypertension, diabetes), to prevent and defray costs related to eventual complications.

Relationship between self-reported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg.

BACKGROUND: The aim of this study was to assess the relationship between self-reported weight change, socio-economic status, and health-related quality of life (HRQOL) in patients with diabetes, 5 years after they underwent coronary angiography. METHODS: Between 2013 and 2014, 1873 of 4391 patients (319 with diabetes) who underwent coronary angiography between 2008 and 2009 participated in a follow-up study. Three out of four domains of the World Health Organization Quality of Life (WHOQOL)-BREF (physical health, psychological health and social relationships) were surveyed during the follow-up period. To assess the relationship between weight change and HRQOL, generalized linear models were constructed for every dimension of the WHOQOL-BREF, with educational level as a predictor and sex, age, marital status, smoking status, hypertension, cholesterol, ischemic heart disease, acute myocardial infarction, and stable angina pectoris as covariates. RESULTS: The mean age of the patients was 70 years and almost three-quarters of the patients (72.7 %) were men. During the 12 months preceding the follow-up survey, 22.6 % of the patients reported weight loss, 20 % reported weight gain, and 57.4 % reported no weight change. There were significant differences in the HRQOL scores between patients who reported weight loss and those who reported either weight gain or unchanged weight. The most affected domains were physical and psychological health, with higher scores for patients who reported weight loss (54.7 and 67.2, respectively) than those who reported weight gain (46.3 and 58.5, respectively). The generalized linear model confirmed higher HRQOL scores among patients who reported weight loss and revealed an association between the HRQOL score and education level. CONCLUSION: Weight change and education level were associated with HRQOL in patients with diabetes. Self-reported weight loss and no weight change were positively associated with HRQOL in patients with diabetes, while weight gain was negatively associated with HRQOL.

Cardiovascular health: a cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg).

BACKGROUND: Cardiovascular disease is the number one cause of death in the United States and in most European countries. Cardiovascular health, as defined by the American Heart Association, is comprised of seven health metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). No studies have compared US data with data collected elsewhere, using this index of cardiovascular health METHODS: We performed comparative analyses of cardiovascular health status in participants from 2 study sites in 2 different countries: the Maine-Syracuse Study, conducted in Central New York, USA in 2001-2006 (n=673), and the Observation of Cardiovascular Risk Factors in Luxembourg, conducted in 2007-2009 (n=1145). RESULTS: The Cardiovascular Health Score, the sum of the total number of metrics at ideal levels, was higher in the Luxembourg site than in the Central New York site. Ideal cardiovascular health levels for body mass index, smoking, physical activity, and diet were more prevalent in the Luxembourg site than the Central New York site. Ideal levels for blood pressure were more prevalent in Central New York. Differences between the two sites remained with control for age, gender and socioeconomic indicators. CONCLUSIONS: Cardiovascular health, as indexed by seven health metrics, was higher in the European study site than in the US study site. The largest differences were for the four lifestyle/behavior metrics, namely body mass index, smoking, physical activity, and diet. Preventative and intervention strategies will continue to be important for both countries in order to improve cardiovascular health.

Acculturation, immigration status and cardiovascular risk factors among Portuguese immigrants to Luxembourg: findings from ORISCAV-LUX study.

BACKGROUND: No previous study has examined the prevalence of cardiovascular risk factors and explored the influence of immigration status and acculturation on overweight/obesity among the Portuguese immigrants to Luxembourg. Our objectives were to (1) compare the prevalence of cardiovascular risk factors between native Luxembourgers and Portuguese immigrants, (2) examine the relationship between immigrant generation status, proportion of life spent in Luxembourg and language proficiency or preference (as proxy variables of acculturation) and overweight/obesity among Portuguese immigrants, and (3) elucidate the role of underlying socioeconomic, behavioral and dietary factors in overweight/obesity differences among the two populations. METHODS: Recent national cross-sectional data from ORISCAV-LUX survey 2007-2008, composed of 843 subjects were analyzed. Overweight/obesity was defined as body mass index (BMI) >25 kg/m(2). Acculturation score was measured by using immigrant generation status, proportion of life spent in Luxembourg, and language proficiency or preference. Univariable and multivariable logistic regression analyses were performed to examine the association between acculturation markers and overweight/obesity. Further, a series of successive models were fitted to explore the separated and added impact of potential mediators (socioeconomic status, physical activity, dietary factors) on overweight/obesity among Luxembourgers and Portuguese immigrants. RESULTS: Compared to Luxembourgers, Portuguese immigrants of first and second generation were younger and currently employed. About 68% of first generation Portuguese had only primary school, and about 44% were living below poverty threshold. Although the cardiovascular risk factors were comparable, Portuguese immigrants were more frequently overweight and obese than Luxembourgers, even after age and gender standardization to the European population. Overweight/obesity was significantly higher among Portuguese of first generation compared to second generation (P=0.028). Although we observed a tendency of lower risk with higher acculturation, none of the acculturation markers, both individually and taken together as a score, was statistically significant after controlling for age and gender. Compared to Luxembourgers, odds of overweight/obesity were significantly higher among Portuguese immigrants, in unadjusted model 1 (P=0.043), in age and gender-adjusted model 2 (P<0.0001), in socioeconomic status adjusted model 3 (P= 0.01), in physical activity adjusted model 4 (P=0.007). However, this difference was attenuated and statistically disappeared after controlling for dietary factors (P=0.09). CONCLUSIONS: These findings address a lack of heterogeneity between Portuguese immigrants and Luxembourgers regarding hypertension, hyperlipidemia, diabetes mellitus, physical inactivity, and current cigarette smoking. However, Portuguese immigrants to Luxembourg were more likely to be overweight/obese than Luxembourgers participants. This risk may be explained by different dietary practice. An in-depth comparative assessment of dietary habits of Luxembourgers and Portuguese immigrants is warranted.

First nationwide survey on cardiovascular risk factors in Grand-Duchy of Luxembourg (ORISCAV-LUX).

BACKGROUND: The ORISCAV-LUX study is the first baseline survey of an on-going cardiovascular health monitoring programme in Grand-Duchy of Luxembourg. The main objectives of the present manuscript were 1) to describe the study design and conduct, and 2) to present the salient outcomes of the study, in particular the prevalence of the potentially modifiable and treatable cardiovascular disease risk factors in the adult population residing in Luxembourg. METHOD: ORISCAV-LUX is a cross-sectional study based on a random sample of 4496 subjects, stratified by gender, age categories and district, drawn from the national insurance registry of 18-69 years aged Luxembourg residents, assuming a response rate of 30% and a proportion of 5% of institutionalized subjects in each stratum. The cardiovascular health status was assessed by means of a self-administered questionnaire, clinical and anthropometric measures, as well as by blood, urine and hair examinations. The potentially modifiable and treatable risk factors studied included smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Both univariate and multivariate statistical analyses used weighted methods to account for the stratified sampling scheme. RESULTS: A total of 1432 subjects took part in the survey, yielding a participation rate of 32.2%. This figure is higher than the minimal sample size of 1285 subjects as estimated by power calculation. The most predominant cardiovascular risk factors were dyslipidemia (69.9%), hypertension (34.5%), smoking (22.3%), and obesity (20.9%), while diabetes amounted 4.4%. All prevalence rates increased with age (except smoking) with marked gender differences (except diabetes). There was a significant difference in the prevalence of hypertension and of lipid disorders by geographic region of birth. The proportion of subjects cumulating two or more cardiovascular risk factors increased remarkably with age and was more predominant in men than in women (P<0.0001). Only 14.7% of men and 23.1% of women were free of any cardiovascular risk factor. High prevalence of non-treated CVRF, notably for hypertension and dyslipidemia, were observed in the study population. CONCLUSION: The population-based ORISCAV-LUX survey revealed a high prevalence of potentially modifiable and treatable cardiovascular risk factors among apparently healthy subjects; significant gender and age-specific differences were seen not only for single but also for combined risk factors. From a public health perspective, these preliminary findings stress the urgent need for early routine health examinations, preventive interventions and lifestyle behavioural changes, even in young asymptomatic adults, to decrease cardiovascular morbidity and mortality in Luxembourg.

Cell therapy for severe chronic heart failure: the Luxembourg experience.

Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in post infarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end stage heart failure has not been studied. In this small pilot study, eleven patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class NYHA III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post CTX and maximum systolic strain (msyepsilon), peak systolic strain rate (psysr) and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0+/-0.1 pre and 2.7+/-0.2 post CTX, p=0.06). The EF did not improve after CTX. The wall motion score index (WMSI) did not change at rest but decreased significantly during exercise (1.48+/-0.16 vs. 1.44+/-0.17, p=0.01). In conclusion, CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.

[Lucky National Registry (Luxembourg Acute Myocardial Infarction Registry). Are women much better taken care of than men?]. / Registre National de l'Infarctus LUCKY (Luxembourg Acute Myocardial Infarction Registry): Les femmes moins bien soignées que les hommes?

The national LUCKY registry (Luxembourg Acute Myocardial Infarction Registry) confirms for Luxembourg that transfer of patients with acute myocardial infarction for primary percutaneous coronary intervention (PCI) is very effective. However, while mortality is low after PCI, a third of the patients with acute myocardial infarction develop severe left ventricular dysfunction. This may in part be explained by relatively long time delays between onset of symptoms and opening of the infarct-related artery, despite short distances between hospitals (time is myocardium). Surprisingly, in comparison with men, women are younger, have a higher body mass index and receive less evidence-based therapies such as statins before and after myocardial infarction. In conclusion, PCI has substantially improved the treatment of acute myocardial infarction in Luxembourg, but all actors including the patient have to keep efforts high to minimize time delays.

Persistence of socioeconomic inequalities in the knowledge of cardiovascular risk factors five years after coronary angiography.

BACKGROUND: Cardiovascular diseases are important causes of death, morbidity, and years of potential life lost in most developed countries. AIMS: The purpose of this study was to assess trends in knowledge of cardiovascular risk factors among patients five years after coronary angiography and to investigate the impact of educational level on knowledge level. METHODS: The study included 1289 of 4391 patients admitted for cardiac events in 2008/2009 at the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg. A follow-up study was conducted by post five years later (2013/2014). Data were obtained from 1837 of the contacted patients (with 548 reported deaths) (response rate=42%). Logistic regression models were used to evaluate the association between educational level and knowledge of cardiovascular risk factors. Educational level was used as a surrogate for socioeconomic status. RESULTS: In total, 39.9% of patients could list at least three risk factors in 2013/2014, a much higher percentage than the 8.5% observed during the initial survey. In both sexes, knowledge of cardiovascular risk factors increased between 2008/2009 and 2013/2014. Patients with higher educational levels were more likely (odds ratio=2.33, 95% confidence interval: 1.63-3.34) to cite at least three risk factors than patients with lower education levels. CONCLUSION: Knowledge level was associated with educational level, and improved for all educational groups five years after coronary angiography. Educational differences in knowledge persisted, but the gaps decreased. Improving knowledge of cardiovascular risk factors among patients with cardiovascular disease will help increase awareness and promote lifestyle changes.

Is strength training the more efficient training modality in chronic heart failure?

PURPOSE: An open, randomized, controlled study was designed to study the effects of exclusive strength training (ST) in patients with severe chronic heart failure (CHF) in comparison with conventional endurance (ET) and combined ET-ST training (CT). The hypothesis was that ST would at least be equal to ET or CT, because peripheral muscle atrophy and weakness play a key role in exercise limitation in CHF patients. METHODS: Three groups of 15 patients underwent ST, ET, or CT during 40 sessions, three times a week, for 45 min. Fifteen patients served as control group. Before and after intervention, left ventricular ejection fraction (LVEF), peak oxygen consumption (VO2peak), peak workload, thigh muscle volume, knee extensor strength, endurance, and quality of life (QoL) were assessed. RESULTS: All measured parameters improved significantly in the three training groups, except for knee extensor strength in ET. Training outcome was superior in all three training groups compared with the control group, but statistical significance was only reached for VO2peak and peak workload, thigh muscle volume, and knee extensor endurance. In contrast, knee extensor strength, LVEF, and QoL did not reach statistical significance. None of the training modalities proved to be superior to any other, although small differences between the three groups were observed. CONCLUSION: Independently of the training modality, intensive exercise training is efficient in increasing cardiac function, exercise capacity, peripheral muscle function, and QoL in CHF patients.

Geographic Variations in Cardiometabolic Risk Factors in Luxembourg.

Cardiovascular disease (CVD) and associated behavioural and metabolic risk factors constitute a major public health concern at a global level. Many reports worldwide have documented different risk profiles for populations with demographic variations. The objective of this study was to examine geographic variations in the top leading cardio metabolic and behavioural risk factors in Luxembourg, in order to provide an overall picture of CVD burden across the country. The analysis conducted was based on data from the nationwide ORISCAV-LUX survey, including 1432 subjects, aged 18-69 years. A self-reported questionnaire, physical examination and blood sampling were performed. Age and sex-adjusted risk profile maps were generated using multivariate Bayesian geo-additive regression models, based on Markov Chain Monte Carlo techniques and were used to evaluate the significance of the spatial effects on the distribution of a range of cardio metabolic risk factors, namely smoking, high body mass index (BMI), high blood pressure, high fasting plasma glucose, alcohol use, high total cholesterol, low glomerular filtration rate, and physical inactivity. Higher prevalence of smoking was observed in the northern regions, higher overweight/obesity and abdominal obesity clustered in the central belt, whereas hypertension was spotted particularly in the southern part of the country. Maps revealed that subjects residing in Luxembourg canton were significantly less likely to be hypertensive or overweight/obese, whereas they were less likely to practice physical activity of ≥8000 Metabolic Equivalent of Task (MET)-min/week. These patterns were also observed at the municipality level in Luxembourg. Statistically, there were non-significant spatial patterns regarding smoking, diabetes, total serum cholesterol and low glomerular filtration rate risk distribution. This comprehensive risk profile mapping showed remarkable geographic variations in cardio metabolic and behavioural risk factors. Considering the prominent burden of CVD this research provides opportunities for tailored interventions and may help to better fight against this escalating public health problem.

Matrix metalloproteinase-9 is a marker of heart failure after acute myocardial infarction.

BACKGROUND: Matrix metalloproteinases (MMPs) have been associated with the development of left ventricular remodeling after myocardial infarction (MI). We sought to determine whether peripheral levels of MMPs can be used as a risk marker for the development of congestive heart failure (CHF) after acute MI. METHODS AND RESULTS: Plasma levels of MMP-2, MMP-9, C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha), and pro-brain natriuretic peptide (pro-BNP) were measured in 109 consecutive patients with acute MI treated with primary mechanical reperfusion. Echocardiographic assessment of left ventricular wall motion index was performed during admission. Patients were followed for the development of CHF. Left ventricular function and volumes were determined after 2 years with radionuclide ventriculography. During 2-year follow-up, 15 patients developed congestive heart failure (CHF). Using multivariate analysis, MMP-9 levels were the only circulating factor predictive of late onset CHF. Patients who had high MMP-9 levels had a significant risk of late onset CHF (OR of 6.5, P < or = .006) and left ventricular remodeling (DeltaEF = -9%, P = .03, and Deltaend-diastolic volume = +13 mL, P = .03). MMP-2, TNF-alpha, hs-CRP, creatine kinase, and pro-BNP were not predictive of late onset CHF. CONCLUSION: MMP-9 levels may hold prognostic significance in MI patients.

Improvement of exercise-induced cardiac deformation after cell therapy for severe chronic ischemic heart failure.

BACKGROUND: Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in postinfarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end-stage heart failure has not been studied. METHODS AND RESULTS: In this small pilot study, 11 patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class New York Heart Association (NYHA) III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post-CTX and maximum systolic strain (msyepsilon), peak systolic strain rate (psysr), and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0 +/- 0.1 pre- and 2.7 +/- 0.2 post-CTX, P = .06). The EF did not improve after CTX. The wall motion score index did not change at rest but decreased significantly during exercise (1.48 +/- 0.16 versus 1.44 +/- 0.17, P = .01). In patients with non-viable areas, msyepsilon, psysr, and ERO were not affected by CTX. However, in patients with viable areas, msyepsilon and psysr appeared to increase during exercise and ERO appeared to decrease from 19 +/- 5 to 16 +/- 5 mm(2). This effect was not apparent at rest and more pronounced with inferior viability. CONCLUSION: CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.

Strength/endurance training versus endurance training in congestive heart failure.

PURPOSE: The aim of this study was to compare the effects of endurance training alone (ET) with combined endurance and strength training (CT) on hemodynamic and strength parameters in patients with congestive heart failure (CHF). METHODS: Twenty male patients with CHF were randomized into one of two training regimens consisting of endurance training or a combination of endurance and resistance training. Group ET had 40-min interval cycle ergometer endurance training three times per week. Group CT combined endurance and strength training with the same interval endurance training for 20 min, followed by 20 min of strength training. Left ventricular function was assessed at baseline and after 40 training sessions by echocardiography and radionuclide ventriculography. Work capacity was measured with cardiopulmonary exercise test (CPX) and lactate determination. Strength was measured with an isokinetic dynamometer. RESULTS: After 40 sessions, the ET group improved functional class, work capacity, peak torque, and muscular endurance. However, peak O2 remained unchanged. Left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased, whereas left ventricular end-diastolic diameter (LVED) increased. The CT group improved NYHA score, working capacity, peak O2, and peak lactate; peak torque and muscular endurance, LVEF, and FS increased, whereas LVED decreased. Compared with ET, CT was significantly (P < 0.05) better in improving LV function. CONCLUSION: Combined endurance/strength training was superior to endurance training alone concerning improvement of LV function, peak VO2, and strength parameters. It appears that for stable CHF patients, a greater benefit can be derived from this training modality.

Social inequality in awareness of cardiovascular risk factors in patients undergoing coronary angiography.

BACKGROUND: In order to improve their risk profile, individuals need to be aware of the existence of cardiovascular (CV) risk factors. The awareness of CV risk factors has not yet been studied in patients undergoing coronary angiography. PATIENTS AND METHODS: A total of 4,500 patients undergoing coronary angiography were asked to complete a questionnaire before the procedure. The patients were asked about their economic status, their education, their source of health information and were also asked to name CV risk factors. RESULTS: The prevalence of coronary artery disease (CAD) (87%) and CV risk factors was high. Hypertension and hypercholesterolemia were the two most common CV risk factors and were found in two thirds of the patients. There were significant differences in the awareness of risk factors across the different levels of education. Only 8% of the men and 7% of the women could cite at least three risk factors. This percentage ranged from 4% of the patients with primary level of education to 11% and 20% of the patients with secondary and university levels of education, respectively (p < 0.001). More than 1 out of 10 patients did not know any CV risk factor. Smoking and hypercholesterolemia were the best identified CV risk factors in contrast to diabetes and hypertension. The primary care physician was the major source of information across all levels of education. CONCLUSION: Awareness of CV risk factors is low in this high-risk population and associated with strong social inequalities. This information is alarming and will have to be addressed in order to improve outcomes in patients with CAD.

Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxembourg: findings from ORISCAV-LUX study.

BACKGROUND: In the absence of evidence-based information, assessment of population awareness and management of diabetes, hypertension and dyslipidemia (treatable and preventable cardiovascular risk factors) are important to halt coronary and cerebrovascular diseases and to improve public health. METHODS: The analysis was based on a nationally representative sample of 1432 adult subjects, recruited for the ORISCAV-LUX survey (2007-2008). Descriptive and multivariable logistic regression analyses were performed. The 10-year Framingham risk score was calculated for each participant who classified at low, intermediate and high risk. RESULTS: Among the diagnosed cases, 32%, 60%, and 85% were respectively unaware of their diabetes, hypertension and dyslipidemia. Increasing age and BMI were the strongest protective factors against unawareness of hypertension and dyslipidemia. Having a family history decreased the risk of unawareness of hypertension (OR = 0.57; 95% CI 0.36, 0.92; P = 0.021), whereas, not having a family doctor increased double-fold the odd of being unaware of hypertension (P = 0.048). Poor health perception reduced significantly the risk of unawareness of dyslipidemia (OR = 0.27; 95% CI 0.11, 0.68). Concerning the management, diabetes was markedly better treated than hypertension and dyslipidemia. Among diabetic subjects (constituting 4% of the population), 3% were treated vs. 1% not treated. In contrast, 22% of the hypertensive participants (35% of the population) were not treated vs. 13% treated. Concerning dyslipidemia, only 9% of those with lipid disorder (70% of the population) were under medication vs. 61% not treated. For the treated cases of these pathologies, almost only one-third was under control. Framingham risk of developing CHD within 10 years was moderate to high among 62%, 27%, and 17% of the unaware/untreated diabetic, hypertensive, and dyslipidemic participants, respectively. CONCLUSION: The considerable lack of awareness and insufficient management underscore the urgent need for intensive efforts to reduce the gap in prevention strategies, and control of cases according to explicit clinical guidelines.

Relationship between pulse transit time and blood pressure is impaired in patients with chronic heart failure.

AIMS: Pulse transit time (PTT), the interval between ventricular electrical activity and arrival of the peripheral pulse wave, has been used to detect changes in autonomic tone during sleep and anesthesia. The purpose of this study was to evaluate PTT in patients with chronic heart failure (HF). METHODS AND RESULTS: Pulse transit time was measured with R-wave gated photoplethysmography in 24 healthy volunteers and in 112 patients with chronic HF and ejection fraction (EF) <40%. PTT was mildly elevated in patients with HF (468 ± 12 vs. 430 ± 23 ms, p = 0.001). In healthy volunteers, PTT was directly proportional to blood pressure (BP): when BP increased, PTT shortened, and vice versa. This relationship between PTT and BP (PTTi) was altered in patients with HF and particularly in the 26 patients with decompensated HF (3.6 ± 0.4 vs. 4.2 ± 0.9, p = 0.04). PTTi did not correlate with functional NYHA class and levels of pro-BNP, epinephrine or norepinephrine. There was a modest correlation between PTTi and EF (p = 0.01, r = -0.48) and PTTi tended to correlate with microvascular flow measured with Laser Doppler (p = 0.08). However, there was an excellent correlation between PTTi and systolic time intervals, left ventricular ejection time (LVET) (p = 0.0014, r = -0.75) and pre-ejection time/LVET (p = 0.006, r = 0.80). The latter ratio reflects ventricular-arterial coupling. CONCLUSION: The relationship between PTT and BP is altered in severe HF and may indicate impaired ventricular-arterial coupling. It merits further investigation as both parameters can be easily determined and used for serial monitoring in HF.

Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure.

PURPOSE: Most training studies in patients with chronic heart failure (CHF) do not consider CHF aetiology in the interpretation of the results. About 60% of the patients in those studies have ischemic CHF (IHF) and 40% non-ischemic CHF (NHF). Recently, we conducted a randomized controlled trial to study three different training modalities in 60 patients with severe CHF, with a similar distribution of IHF and NHF patients. In the present post hoc analysis we compared the differences in training results between ischemic and non-ischemic patients. METHODS: Left ventricular ejection fraction (EF), end diastolic volume (EDV), end systolic volume (ESV), measured with radionuclide ventriculography (RNV) and echocardiography, NT-pro BNP, peak oxygen uptake (peak V(O)(2)), working capacity and muscular volume were analyzed before and after training in 45 patients training for 40 sessions, 3 times per week. Fifteen patients served as control group. The outcome was analyzed considering the aetiology of CHF, either ischemic or non-ischemic. RESULTS: There were no significant differences in improvements of peak V(O)(2), working capacity and muscular volume between IHF and NHF patients. In NHF patients, EF increased while EDV and ESV decreased after training. These parameters remained unchanged in IHF patients after training. NT-pro BNP decreased significantly in NHF patients and increased in IHF patients after training. In the control group, patients showed a mild improvement of EF and a decrease of NT-pro BNP. CONCLUSION: This post hoc analysis shows that training intervention is associated with significant reverse remodelling in NHF, but not in IHF patients, whereas V(O)(2) peak and muscle volume improve regardless of CHF aetiology. Future prospective studies are needed to confirm our findings.

Percutaneous coronary interventions in Europe 1992-2003.

AIMS: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. METHODS AND RESULTS: Questionnaires were distributed yearly to delegates of all national societies of cardiology represented in the European Society of Cardiology to collect the case numbers of all local institutions and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684,000 to 1,993,000 (from 1,250 to 3,500 per million inhabitants). The respective numbers for percutaneous coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from 184,000 to 733,000 (from 335 to 1,300) and from 3,000 to 610,000 (from 5 to 1,100), respectively. Germany has been the most active country for the past years with 653,000 angiographies (7,800), 222,000 angioplasties (2,500), and 180,000 stenting procedures (2,200) in 2003. The indication has shifted towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial infarction over the last decade. The procedures are more readily performed and safer, as shown by increasing rate of "ad hoc" PCI and decreasing need for emergency coronary artery bypass surgery (CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is reported with the highest rate in Portugal (55%). CONCLUSION: Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid growth in the eastern European countries. A number of new coronary revascularization procedures introduced over the years have all but disappeared. Only stenting has experienced an exponential growth. The same can be forecast for drug-eluting stenting.