http://clinicaltrials.gov. Unique identifier: NCT01700244.

Study objective: To ascertain, whether, conventional risk factors and readiness of coronary patients to modify their behaviour and to comply with recommended medication were associated with education in patients with established coronary heart disease. Design and methods: EUROASPIRE II was a cross sectional survey undertaken in 1999-2000 in 15 European countries to ascertain how effectively recommendations on coronary preventions are being followed in clinical practice. Consecutive patients, men and women (71 years who had been hospitalised for acute coronary syndrome or revascularisation procedures, were identified retrospectively. Data were collected through a review of medical records, interview, and examination at least six months after hospitalisation. The education reached was ascertained at the interview. Main results: A total of 5556 patients (1319 women) were evaluated. Significantly more patients with ischaemia had only primary education, in contrast with the remaining diagnostic groups. Body mass index and glucose were negatively associated with educational level, while HDL-cholesterol was positively associated. Men with highest education had significantly lower systolic blood pressure and total cholesterol. The prevalence of current smoking decreased significantly from primary to secondary and high education only in men. Both men and women with primary educational level were more often treated with antidiabetics, and antihypertensives, but less often with lipid lowering drugs. The effectiveness of treatment was virtually the same in all education groups. Conclusions: Patients with higher education had lower global coronary risk, than those with lower education. This should be considered in clinical practice. Particular strategies for risk communication and counselling are needed for those with lower education status. S ocioeconomic status (SES) is believed to be important in influencing the development of coronary heart disease (CHD). SES is a very complex phenomenon predicted by a broad range of variables, mainly combining the influences of education and occupation.1 Higher education virtually enables to reach higher SES and access to positive, social, cultural, psychological, and economic resources. Over time, education has become the most commonly used measure of SES in epidemiological studies.2-5 These studies have shown an inverse relation between education and lifestyle related risk factors, as well as long term risk of CHD, cardiovascular disease, and all cause mortality.2 6 7 It has been also shown, that among such measures of SES, as education, income and occupation, low level of education was most consistently associated with higher coronary risk.2 3 High SES has been supposed as a predictor of good health.1 The influence of education on coronary risk factors and their control after acute coronary syndromes has not yet been thoroughly studied. Diagnostic studies in patients with CHD mostly included social support, job control demands, anxiety, depression, hostility and anger, as SES measure...

Hypothyroidism in coronary heart disease and its relation to selected risk factors Introduction: Hypothyroidism (HT) has been found a predictor of cardiovascular diseases. We aimed to ascertain the prevalence of HT in patients with manifest coronary heart disease (CHD), and to establish its association with conventional risk factors. Methods: 410 patients, 6-24 months after hospitalization for acute coronary syndrome, and/or revascularization, were included into the cross-sectional study. Results: The prevalence of thyroid dysfunction was found in males and females as follows: overt HT, ie, thyroid stimulating hormone (TSH) > 3.65 mIU/L and free thyroxine (fT4) < 9 pmol/L and/or L-thyroxine substitution, in 2.6% and 8.4%, respectively; subclinical HT (TSH >3.65, fT4 9-23 and no substitution) in 4.3% and 15.0%, respectively. Higher prevalence of HT was found in females with hypercholesterolemia, and in males and females with concomitant positive thyroid peroxydase antibodies. Hypothyroid subjects had higher total homocysteine in both genders and von Willebrand factor in males only. Hypothyroid females had higher total and LDL cholesterol, and were more often treated for diabetes. Conclusions: HT was found highly prevalent in patient with clinical coronary heart disease, mainly in females, and was associated with several cardiovascular risk factors.

Objective: Mild hyperhomocysteinemia is a signi®cant and independent risk factor for vascular diseases. Blood total homocysteine concentration (tHcy) is considered to be the product of an interaction between genetic and nutritional factors notably intake of folate, vitamin B 12 and pyridoxine. The aim of the study was to determine whether regular intake of beer containing large amount of folate and other vitamins in¯uences the tHcy blood concentrations. Design: Cross-sectional population-based survey. Setting: Adult population, residents of Pilsen (Czech Republic) and vicinity. Subjects: Population series included 292 males and 251 females aged 35 ± 65 y, mean age 53.4 y. All subjects were examined by a standard protocol for clinical, anthropometrical and laboratory estimations. Main outcome measures: tHcy was measured by high-pressure liquid chromatography with¯uorescent detection, blood folate and B 12 levels immunochemically using commercial kits. Results: Beer intake was associated with blood folate and vitamin B 12 concentrations positively and with tHcy concentration negatively. By categories of beer intake, subjects with intake of 1 l daily or more had signi®cantly lower tHcy and higher folate concentrations than those reporting lower daily beer intake. Conclusion: Moderate beer consumption may help to maintain the tHcy levels in the normal range due to high folate content. Folate from beer may thus contribute to the protective effect of alcohol consumption on cardiovascular disease in population with generally low folate intake from other nutrients.

The LCP demonstrates very stable performance and reassuring safety results during intermediate-term follow-up. These results support the use of the LCP as a promising alternative to conventional pacemaker systems. Continued evaluation is warranted to further characterize this system. (Evaluation of a New Cardiac Pacemaker; NCT01700244).

Total homocysteine (tHcy) level was identified as a strong and independent predictor of cardiovascular events. We investigated the association between tHcy and mechanical properties of large arteries in a random, general population-based sample of 251 subjects (mean age 48 years). Large artery properties, such as aortic and peripheral (lower-limb) pulse wave velocity (PWV), and augmentation index of radial artery were measured using semi-automatic Sphygmocor s device. Aortic PWV (APWV) positively correlated with tHcy (r ¼ 0.28, Po0.0001), and a significant increasing trend of APWV was found by tHcy quartiles (P ¼ 0.0003 by ANOVA). This association remained significant after adjustment for conventional cardiovascular risk factors (age, gender, smoking, overweight, hypertension, dyslipidaemia and impaired glucose metabolism) and for usual homocysteine confounders (folate, B 12 , renal function). Subjects with mild hyperhomocysteinaemia (i.e. with tHcy X15 lmol/l) had 2.74 times higher risk of having their APWV over 8.42 m/s (i.e. in the top quartile). No such association was found either for PWV measured at lower extremity or for radial augmentation index. In conclusion, in our series of subjects from general population, we found a strong and independent relationship between homocysteine concentration and APWV, a parameter of stiffness of central arteries.

The results of the mortality follow-up of the EUROASPIRE I patients underline the importance of smoking and diabetes in the secondary prevention of CHD. Failure to find statistically significant associations between other classical risk factors, such as blood pressure and plasma lipid levels, and mortality may be related to the extensive use of antihypertensive and lipid-lowering drugs in this cohort.

Folate treatment resulted not only in tHcy decrease, but also in an improvement of hypercoagulation, oxidative stress and endothelial dysfunction. The sufficiently high dose of folate seems to be able to decrease plasma tHcy in all three individual MTHFR polymorphism groups, to almost the same post-treatment concentrations.