The Consumption of Fast Food Favors Weight Increase in Young Hellenic Navy Personnel: A 10-Year Follow-Up Study.

Introduction: Dietary habits and physical exercise have independently been recognized as important contributors to weight loss. However, the relative effect of diet and exercise on body weight is still unclear and warrants further investigation. We investigated the causes related to changes in body mass index (BMI) in a sample of young adult Greek Navy recruits over 10 years. Materials and Methods: We conducted a single-center prospective observational study, including consecutive healthy young adult officers and sailors (>18 years) at the Salamis Naval Base, Salamis, Attiki, Greece. BMI was calculated at the baseline visit. A questionnaire was selected to gather data regarding daily food consumption and daily physical exercise. The participants were followed up for 10 years (2005-2014). Results: Two hundred eighty-four young adults [mean age 31.1 ± 3.1 years; 25 (8.8%) females and 259 (91.2%) males] were included. Baseline median BMI was 24.1 kg/m2, while 10 years later, median BMI was 24.8 kg/m2 (P < 0.001). Physical activity was not significantly related to BMI change (P = 0.153). Multivariate logistic regression analysis showed a significant correlation between BMI increase and frequent fast food consumption (P = 0.044). Conclusions: Frequent fast food consumption is linked with a significant BMI increase, irrespective of physical activity. This has obvious dietary implications and needs to be examined in the general population.

Noninvasive estimation of Fraction Flow Reserve (FFR): The first real-time FFRangio™ application in Greece.

We report the first case of real-time FFRangio™ application in Greece applied in a patient with tandem lesions in the proximal segment of the left anterior descendent artery.

The -174 G>C Interleukin-6 Gene Polymorphism is Associated with Angiographic Progression of Coronary Artery Disease over a 4-Year Period.

BACKGROUND: Inflammation is a key process underlying the clinical course of coronary artery disease (CAD). C-reactive protein (CRP) and interleukin-6 (IL-6) contribute to its pathophysiology and act as biomarkers. We sought to examine whether known single nucleotide polymorphisms (SNPs) impact CAD progression, reflecting increased inflammation. METHODS: We retrospectively evaluated coronary angiographies of patients with established CAD who were re-investigated for stable/unstable angina after a time interval of >12 months. We defined progression of CAD as the emergence of a new plaque or a ≥20 % increase of a formerly non-significant lesion. We genotyped patients for the 1846 C>T CRP and -174 G>C IL-6 SNPs. The probability of CAD progression among the Mendelian randomization groups was evaluated using the Kaplan-Meier method. Data were analyzed using a Cox model that included relevant clinical factors. RESULTS: A total of 157 patients were included. The serum levels of CRP and IL-6 differed significantly between genotypes. The genotype frequencies of IL-6 were consistent with Hardy-Weinberg equilibrium, whereas those for CRP were excluded from our conclusions. At 48 months, 83 patients (52.9 %) with the IL-6 C allele versus 74 (47.1 %) with the G allele exhibited CAD progression. Patients with the IL-6 C allele had a 52.8 % probability for progression versus 13.3 % for those with the G allele (p=0.005). The results were confirmed by multivariate analysis; dyslipidemia, family history, and IL-6 SNP emerged as significant factors. CONCLUSION: Patients with established CAD who carried the -174 C allele of the IL-6 gene demonstrated an increased risk for the progression of coronary plaques over a four-year period. Further studies will be needed to validate these findings.

Ranolazine reduces angina frequency and severity and improves quality of life: Observational study in patients with chronic angina under ranolazine treatment in Greece (OSCAR-GR).

OBJECTIVE: Primary objectives were to evaluate tolerability, compliance, and perception of ranolazine effectiveness for chronic stable angina in a routine clinical setting. The secondary objective was safety evaluation. METHODS: Prospective, multi-centre, observational, study with a 6-month follow-up and study visits at baseline, 3- and 6 months in patients with chronic stable angina. Ranolazine was administered according to the summary of product characteristics and investigator discretion. Data was collected on patient and disease characteristics, concomitant therapy, angina frequency and severity, quality of life (QoL), perception of effectiveness, compliance, and adverse events. RESULTS: Between July 2010 and July 2012, 189 patients were enrolled at 20 centres. Ranolazine decreased the proportion of patients experiencing angina attacks from 88.4% at baseline to 26.5% at 6 months (p<0.001). Heart rate and blood pressure were not appreciably affected. The proportion of patients without symptoms on normal exertion (Canadian Cardiovascular Society grading class I) increased from 22.3% to 75.3% (p<0.001); patients reporting limitations in daily activities decreased from 80.4% to 35.5%. (p<0.001). Patient- and physician-assessed QoL improved (both p<0.001). Therapeutic efficacy was rated "good" or "very good" in 67.7% of cases by physicians, and by 63.5% of the patients. Physicians rated compliance "good" or "very good" in 73.5% of cases. Adverse events were consistent with previous reports, and consisted of 40 events in 24 patients; 12 were serious. CONCLUSIONS: Ranolazine was associated with decreased angina frequency and severity, and improvements in QoL. The benefits provided by ranolazine in controlled clinical trials are maintained in the clinical setting.

Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents.

BACKGROUND: New-generation drug-eluting stents have demonstrated the mid-term efficacy and safety, but possible differences between stents may emerge in a long-term period. We compared long-term outcomes of patients with chronic stable angina and an isolated de-novo lesion in the proximal left anterior descending artery that underwent percutaneous coronary intervention with Endeavor-zotarolimus eluting stents (E-ZES) and everolimus eluting stents (EES). METHODS: We prospectively enrolled 600 patients. Of these, 180 underwent E-ZES and 420 underwent EES implantation. Clinical follow-up was performed up to 7 years (median follow-up 61 months). The evaluated clinical outcomes were Target Lesion Failure (TLF), a composite of cardiac death, myocardial infarction and Target Lesion Revascularization (TLR), the Patient-Related Outcome (PRO) and stent thrombosis. Differences between groups evaluated with the Kaplan-Meier method and possible independent predictors with Cox proportional hazard regression. RESULTS: At 5 years, the cumulative probability for outcomes was: TLF: 13.8% versus 7.5%, p=0.025, cardiac death: 3.1% versus 2.5%, p=0.937, myocardial infarction: 1.2% versus 1.8%, p=0.829, TLR: 10% versus 3.3%, p=0.003, PRO: 19.6% versus 13.8%, p=0.528, ST: 2.5% versus 2.7%, p=0.965, for E-ZES and EES respectively. Differences between stents increased after 30 months. In multivariate analysis predictors of TLF adjusted for stent type were Diabetes mellitus and estimated Glomerular Filtration Rate (eGFR). CONCLUSION: Both stents provided a favorable safety profile, with EES demonstrating better effectiveness. There was a late emergence in difference of endpoints after 30 months. Diabetes mellitus and eGFR predicted TLF.

The impact of new generation drug-eluting stent implantation on patients with chronic kidney disease and a single lesion in the proximal segment of the left anterior descending artery.

INTRODUCTION: The impact of drug-eluting stents (DES) has not been extensively investigated in patients with moderate to severe renal dysfunction, as these patients are consistently excluded from randomised studies. We sought to assess prospectively the effectiveness and safety of the new-generation DES in patients with moderate chronic kidney disease (CKD) and an isolated de novo lesion in the proximal segment of the left anterior descending artery (pLAD). METHODS: We evaluated 400 consecutive patients with a pLAD lesion. There were 96 patients with moderate CKD (estimated glomerular filtration rate 59 ml/min/1.73 m2) and 304 without CKD. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction and target lesion revascularisation (TLR). Clinical or telephone follow up was performed. RESULTS: There was a significantly higher incidence of mortality in patients with CKD (n=4) as compared with non-CKD (n=2) (4.16% versus 0.65%, respectively, p=0.03). The rate of non-fatal myocardial infarction was similar in the 2 cohorts (p=0.59), as was the TLR rate (p=0.99). Overall, there were no significant differences regarding MACE between the 2 groups of patients (p=0.19) during the 13.62 ± 6.22 month follow-up period. The rate of angiographic stent thrombosis was 2.08% in the CKD group versus 0.98% in the non-CKD group (p=0.59). CONCLUSIONS: New generation DES implantation in patients with CKD and a pLAD lesion is effective and safe, with rates of TLR and stent thrombosis comparable to those in patients with normal renal function. However, the higher mortality in patients with CKD needs further evaluation.

The dominant role of the systolic component of nondipping status on target-organ damage in never-treated hypertensives.

BACKGROUND: Blood pressure (BP) nondipping has been associated with target-organ damage (TOD) and adverse outcomes in hypertension. Diverse definitions of nondipping status appear in the literature, regarding the BP components taken into account. Aim of this study was to compare the effects of isolated nondipping of systolic, diastolic and combined systolic and diastolic BP on various indices of TOD. METHODS: From 630 consecutive subjects with never-treated essential hypertension stage I-II, we selected 279 subjects who were consistently isolated systolic nondippers (SND, n=76) isolated diastolic nondippers (DND, n=64) and combined systolic and diastolic nondippers (SDND, n=139) in two ambulatory BP monitoring sessions. All three subgroups were subjected to echocardiographic examination, carotid-femoral pulse wave velocity (PWV(c-f)) and albumin-to-creatinine ratio (ACR) determination. Metabolic profile was determined in a morning blood sample. RESULTS: SND compared to DND and SDND exhibited higher left ventricular mass/height(2.7) (42.4 ± 9.9 vs. 38.0 ± 9.1 vs. 40.9 ± 11.0 g/m(2.7), P < 0.05), higher log(10)(PWV(c-f)) (0.94 ± 0.07 vs. 0.86 ± 0.05 vs. 0.91 ± 0.07 m/s, P < 0.005), and higher log(10)(ACR) (1.2 ± 0.5 vs. 0.9 ± 0.3 vs. 1.1 ± 0.4 mg/g, P < 0.05). Isolated systolic BP nondipping was an independent determinant of all the studied indices of TOD whereas isolated diastolic BP nondipping was not. CONCLUSIONS: Isolated systolic as compared to diastolic and to combined systolic/diastolic BP nondipping is associated with higher left ventricular mass, stiffer arteries, and pronounced urinary albumin excretion.

Everolimus- and zotarolimus-eluting stents for bare metal stent in-stent restenosis treatment: a prospective study.

BACKGROUND: Treatment of in-stent restenosis (ISR) is a challenging clinical problem. Recent studies have verified the safety and efficacy of first-generation DES for the treatment of ISR. The safety and effectiveness of new-generation drug-eluting stents (nDES) for ISR has not been previously investigated. The aim of the present study was to prospectively evaluate the clinical outcomes after treatment with nDES implantation in patients with bare metal stent (BMS) ISR. METHODS: Consecutive patients with ISR after BMS implantation were included. Primary end-point was a major adverse cardiac event (MACE), defined as death, myocardial infarction (MI), or target vessel revascularization (TVR). The incidence of stent thrombosis was also evaluated. RESULTS: A total of 46 consecutive patients were enrolled for the treatment of ISR, 23 patients from ZES and 23 from EES group. There were two (8.7%) cases of TVR in ZES cohort due to proliferative ISR at 6 and 7 months after DES implantation, and none in EES. One (4.3%) patient underwent percutaneous coronary intervention and the other (4.3%) was treated surgically. Neither acute nor subacute thrombosis was observed during the 13.3+/-6.3 months follow-up period. In all other patients, stress test was negative for ischemia at 6 months. CONCLUSIONS: In this prospective study, we showed that direct nDES implantation is highly effective for ISR and seems to be a promising management for the treatment of ISR.

A preliminary experience report: Drug-eluting stents versus coronary artery bypass surgery in patients with a single lesion in the proximal left anterior descending artery suffering from diabetes mellitus and chronic stable angina.

INTRODUCTION: Treatment of lesions located in the proximal segment of the left anterior descending artery (pLAD), either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention, in patients with diabetes mellitus has been associated with an unfavourable outcome. The aim of the present study was to compare the long-term clinical outcome of drug-eluting stents (DES) vs. CABG with a left internal mammary artery (LIMA) graft in patients with a pLAD lesion who suffered from chronic stable angina and diabetes mellitus. METHODS: We studied 77 consecutive patients suffering from chronic stable angina, diabetes mellitus, and with an isolated pLAD lesion. Thirty-nine patients underwent DES implantation and 38 LIMA grafting. Primary endpoints were the occurrence of major adverse cardiac events, defined as death, myocardial infarction, and target vessel revascularisation. Secondary endpoints included the length of stay in hospital, in-hospital complications, and the recurrence of chest pain. RESULTS: More in-hospital complications were observed in the CABG group than in the DES group. The mean duration of hospitalisation after CABG was 7.76 +/- 2.82 days vs. 1.17 +/- 1.15 days after DES. The mean follow-up period was 19.7 +/- 6.3 months for the DES group and 19.7 +/- 7.4 months for the surgical group. The incidence of major adverse cardiac events was similar in the two groups. There were two re-interventions in the DES group and none in the surgical group. Recurrent angina occurred in 2 patients in the DES group and 3 patients in the CABG group. CONCLUSIONS: The present study demonstrates that patients with diabetes mellitus, chronic stable angina, and single vessel disease in the pLAD have an excellent long-term outcome with both DES implantation and LIMA anastomosis. The surgical approach, however, was associated with more in-hospital complications and a longer hospitalisation.

Drug eluting stents versus coronary artery bypass surgery in patients with isolated proximal lesion in left anterior descending artery suffering from chronic stable angina.

OBJECTIVE: To compare the efficacy of drug eluting stents (DES) compared with bypass surgery (CABG) with left internal mammary artery (LIMA) in patients with single vessel disease suffering from chronic stable angina. BACKGROUND: There are a limited number of studies investigating this group of patients. METHODS: We included 257 consecutive patients with isolated lesion in the proximal segment of left anterior descending artery (LAD). All patients suffered from chronic stable angina or from stress-induced ischemia. Of 257 patients, 147 underwent DES implantation and 110 CABG with LIMA. All patients were followed-up clinically for major adverse cardiac events. RESULTS: The baseline demographic and angiographic characteristics were similar between the two groups. In the DES group we used sirolimus-, paclitaxel-, and ABT-578-eluting stents. The mean duration of hospitalization after CABG was 7.86 +/- 3.84 days vs. 1.02 +/- 0.19 days after PCI (P < 0.01). The incidence of MACE was 2.72% in the DES and 2.72% in the surgical group during a mean follow-up period of 18.71 +/- 6.27 months for PCI and 18.70 +/- 7.31 months for CABG (P = 0.99). There was one cardiac related death in the DES group and two in the surgical group (P = 0.58). There were three reinterventions in the DES group versus none in the surgical group (P = 0.26). Recurrence of angina was observed in 4.08% of pts in the DES group versus 6.36% in the CABG group (P = 0.57). CONCLUSIONS: The present study demonstrated that patients suffering from chronic stable angina with isolated lesion in the proximal segment of LAD have excellent long-term outcome in both surgical and DES treatment.