Stefan Kiechl (Austria)
Medical University of Innsbruck NeurologyAuthor Of 4 Presentations
ADOLESCENT LIPOPROTEIN SUBCLASS PROFILE AND CAROTID INTIMA-MEDIA THICKNESS: PROSPECTIVE COHORT STUDY
Abstract
Background and Aims
Assessment of comprehensive lipoprotein subclass profiles in adolescents and their relation to vascular disease may enhance our understanding of the development of dyslipidemia in early life and inform early vascular prevention.
Methods
Nuclear magnetic resonance was used to measure lipoprotein profiles, including lipids (cholesterol, free cholesterol, triglycerides, phospholipids) and apolipoproteins (apoB-100, apoA1, apoA2) of 17 lipoprotein subclasses (from least dense to densest: VLDL-1 to -6, IDL, LDL-1 to -6, HDL-1 to -4) in n=1776 14- to 19-year olds (56.6% female) and n=3217 25- to 85-year olds (51.5% female), all community-dwelling. Adolescent lipoprotein profiles were related to carotid intima-media thickness (cIMT) as ascertained by sonography.
Results
Adolescents compared to adults had lower triglycerides, total, LDL, and non-HDL cholesterol, and apoB, and higher HDL cholesterol. They showed 27.2 to 60.5% lower triglyceride content of all lipoprotein subclasses and 21.7 to 50.0% lower VLDL lipid content. Concentrations of dense LDL-4 and LDL-5 were 40.7 to 47.3% lower, with markedly lower levels also of LDL-6 and LDL-3, but 24.3% higher HDL-1 ApoA1. In adolescents, LDL-3, LDL-4, and LDL-5 subclasses but not VLDL or HDL were associated with cIMT (difference in cIMT for a 1-SD higher concentration, 4.76 to 5.93μm).
Conclusions
Adolescents showed a markedly different and more favorable lipoprotein profile compared to adults. Dense LDL subclasses were the only subclasses associated with cIMT, implicating them as the potential preferred therapeutic target for primary prevention of cardiovascular disease in adolescents.
TRENDS OF FUNCTIONAL OUTCOME IN ACUTE STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS – AN ANALYSIS OF THE AUSTRIAN STROKE UNIT REGISTRY
Abstract
Background and Aims
Intravenous thrombolysis substantially improves outcome in patients with acute stroke. Over time the use of rtPA has been increasing. We aim to assess whether there is an associated trend of increasing frequencies of good functional outcome in rtPA-treated patients.
Methods
We analyzed data of rtPA-treated patients during the period of 2006-2019 in the Austrian Stroke Unit Registry. Frequencies of good functional outcome, defined as modified Rankin Scale (mRS) 0-2, were assessed for the overall population and prespecified subgroups; logistic regression analysis was calculated to assess associations of baseline characteristics and outcome.
Results
In 9409 patients who were treated with rtPA between 2006 and 2019, frequencies of good functional outcome increased from 45.9% to 57.0%. Patients >70 years, patients with wake-up stroke/unknown time from symptom onset and patients without atrial fibrillation showed a more pronounced increase. We observed lower numbers of mRS 0-2 in women compared to men during the whole study period. On logistic regression analysis advancing time(OR 1.04, p<0.001) and premorbid independency(OR 6.9, p<0.001) were positively associated with good outcome whereas older age(age 61-70: OR 0.66, p<0.001, age 71-80: OR 0.4, p<0.001, age >80: OR 0.2, p<0.001), moderate-to-severe strokes(OR 0.2, p<0.001), large artery atherosclerosis(OR 0.5, p<0.001) and cardioembolic etiology(OR 0.7, p=0.006), prior stroke(OR 0.8, p=0.024), diabetes mellitus(OR 0.6, p<0.001) and atrial fibrillation(OR 0.7, p<0.001) were negatively associated.
Conclusions
Frequencies of good functional outcome in patients with acute ischemic stroke treated with rtPA have been increasing over time but some subgroups are still less likely to achieve good outcome and deserve particular attention.
HIGH PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN ADOLESCENTS OF THE GENERAL POPULATION
Abstract
Background and Aims
A significant proportion of the burden of non-communicable disease in adults has its roots in adolescence and this is particularly true for cardiovascular disease and stroke. Detection of risk factors, early stages of disease and laboratory abnormalities at young ages may aid disease prevention and management.
Methods
We systematically assessed the frequency of yet unknown medical conditions that require further diagnostic work-up or intervention (life-style counselling or pharmacotherapy) in 2088 adolescents sampled from the general population considering previously diagnosed physician-confirmed diseases. The easy-to-administer health screening included medical history taking, fasting blood analysis, and blood pressure and body measurements, and was performed at schools.
Results
Adolescents were on average 16.4 (SD 1.1) years old and 56.4 percent were female. The health screening newly detected relevant medical conditions in 45.4 [95% CI, 43.3–47.6] percent (55.8 [95% CI, 52.5–59.0] percent in boys and 37.4 [95% CI, 34.6–40.2] percent in girls). The most prevalent previously unknown medical conditions were vascular risk factors like elevated blood pressure (16.7%) and hypertension (10.2%), metabolic syndrome (3.0%), hypercholesterolemia (7.6%) and hypertriglyceridemia (9.6%). On the other hand, impaired fasting glucose and pre-diabetes were rare in this community-based sample of adolescents as were endocrine and other abnormalities (all <1.0%) except for subclinical hypothyroidism (5.7%) and hyperuricemia (7.8%).
Conclusions
Health screening in adolescence has a high diagnostic yield for previously unknown vascular risk factors, is feasible in the school setting, and may provide an opportunity for guideline-recommended targeted prevention in the young.
THE ASSOCIATION BETWEEN DEPHOSPHO-UNCARBOXYLATED MATRIX GLA-PROTEIN AND INCIDENT CARDIOVASCULAR DISEASE AND MORTALITY IN THE PROSPECTIVE POPULATION-BASED BRUNECK STUDY
Abstract
Background and Aims
Vascular calcification is assumed to contribute to cardiovascular disease and mortality. Matrix Gla protein, a vitamin K-dependent protein, is a potent inhibitor of vascular calcification. This study aims to investigate whether circulating desphospho-uncarboxylated MGP (dp-ucMGP) reflecting insufficient vitamin K status is associated with incident cardiovascular disease and mortality in the general population.
Methods
Plasma dp-ucMGP was measured in samples taken in 2000 from 685 participants of the prospective population-based Bruneck Study (age, mean±SD, 66.1±10.2; 51.8% female). Cox proportional hazard models were employed to assess the association between dp-ucMGP and incident CVD and all-cause mortality, and to determine potential interactions with predicted 10-year CVD risk according to the Framingham Risk Score.
Results
During a 10-year follow-up, 118 participants experienced a CVD event (17.3%) and 153 (22.4%) participants died. In fully adjusted models, circulating dp-ucMGP levels were significantly associated with higher CVD risk, with an HR per SD of 1.34 (95%CI: 1.08-1.65; p=0.008), and all-cause mortality (HR per 1-SD of 1.54; 95% CI: 1.27–1.86; p<0.001). The effect of dp-ucMGP on CVD was stronger in individuals with low predicted cardiovascular risk as compared to those with high predicted cardiovascular risk (p value for interaction =0.004). For the outcome all-cause mortality, a formal interaction test was nonsignificant (p value for interaction =0.192).
Conclusions
Plasma level of dp-ucMGP is associated with incident CVD and all-cause mortality in the general community. Future studies should determine the impact of vitamin K supplementation on dp-uc-MGP levels and CVD risk.