The Münster Heart Study (PROCAM)

Objectives: We aimed (1) to construct a modified PROCAM risk algorithm, which incorporates BMI/waist circumference in a model for predicting coronary events; (2) to evaluate how accurate this and the previously established PROCAM risk algorithm predict coronary risk in individuals with metabolic syndrome. Design: Prospective Cardiovascular Münster (PROCAM) Study, a prospective study of men and women at work in the northwest of Germany. Subjects: A total of 7134 men aged 35-65 years at study entry. Measurements: On the basis of 404 major coronary events (defined as nonfatal MI and coronary deaths), which occurred within 10 years of follow-up, a modified PROCAM risk algorithm was constructed by incorporating BMI/waist circumference as fixed variable in a Cox proportional hazards model for predicting coronary events. The metabolic syndrome was defined according to the latest recommendations proposed by the NCEP-ATP III Panel. Results: Men who were classified as having the metabolic syndrome (n ¼ 2325, prevalence: 32.6%) were 2.59-fold more likely to experience a major coronary event within 10 years of follow-up than men not having the metabolic syndrome. In men with metabolic syndrome, the observed major coronary event rate of 9.6% corresponded well with their estimated global risk according to the modified BMI-based PROCAM risk algorithm (10.2%). Comparative calculations performed with the previously published fully adjusted PROCAM algorithm yielded very similar results. Conclusion: Both PROCAM algorithms provide very accurate means to ascertain coronary risk in male patients with metabolic syndrome.

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“…Study design and recruitment of participants Recruitment to the PROCAM Study 10,11 was started in 1979.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study

2008

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“…Evaluation of the lipoprotein and apolipoprotein ratios, which frequently are associated with changes in cardiovascular risk, 6 showed that the LDL/HDL cholesterol ratios and apoA-I/B ratios in control subjects were both in the normal range …”

Section: Clinical Characteristics Of Participating Subjectsmentioning

confidence: 99%

“…2 All carriers are heterozygous for the mutation 3 and share a lipoprotein disorder characterized by very low plasma levels of HDL cholesterol with moderate hypertriglyceridemia, 4 a condition that has been associated with a high risk of premature coronary heart disease in numerous epidemiological studies. 5,6 The clinical status of the apoA-I M carriers has been generally associated with a reduced cardiovascular risk. This conclusion was essentially based on historical data pertaining to the whole Limone sul Garda population and, in particular, to a prior study investigating the clinical conditions of the apoA-I M carriers.…”

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confidence: 99%

Cardiovascular Status of Carriers of the Apolipoprotein A-I _Milano Mutant

et al. 2001

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Background-Carriers of the apolipoprotein A-I Milano (apoA-I M ) mutant present with very low plasma HDL cholesterol and moderate hypertriglyceridemia, apparently not leading to premature coronary heart disease. The objective of this study was to establish whether this high-risk lipid/lipoprotein profile is associated with structural changes in the carotid arteries and heart, indicative of preclinical atherosclerosis. Methods and Results-Twenty-one A-I M carriers were compared with age-and sex-matched control subjects from the same kindred and with 2 series of matched subjects with primary hypoalphalipoproteinemia (HA). Structural changes in the carotid arteries were defined as the intima-media thickness (IMT) measured by B-mode ultrasound. HA subjects, both recruited among patients attending our Lipid Clinic and blood donors, showed significant thickening of the carotids (average IMT, 0.86Ϯ0.25 and 0.88Ϯ0.29 mm, respectively) compared with control subjects (average IMT, 0.64Ϯ0.12 mm); the apoA-I M carriers instead showed normal arterial thickness (average IMT, 0.63Ϯ0.10 mm). Moreover, a significantly higher prevalence of atherosclerotic plaques was found in patients and blood donors with HA (both 57%) compared with apoA-I M carriers (33%) and control subjects (21%). Echocardiographic findings and maximal treadmill ECG did not differ significantly between apoA-I M carriers and control subjects, apart from a slight increase in left ventricular end-diastolic dimension in the carriers. Conclusions-Despite severe HA, carriers of the apoA-I M mutant do not show structural changes in the arteries and heart, in contrast to HA subjects, who are characterized by a marked increase in carotid IMT and increased prevalence of atherosclerotic plaques.

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“…It was shown in multiple large prospective studies of cardiovascular risk factors that reduced plasma levels of HDL-cholesterol (HDL-C) are associated with an increased risk of coronary artery disease (CAD) (Castelli et al 1986;Cullen et al 1997;Di Angelantonio et al 2009;Gordon et al 1977;Sharrett et al 2001). Multiple biological functions of HDL have been identified, whereby HDL may exert antiatherogenic effects (Annema and von Eckardstein 2013;Barter et al 2004;Mineo et al 2006;Rader 2006;, e.g., HDL from healthy subjects has been shown to directly promote endothelial antiapoptotic, anti-inflammatory, and antithrombotic effects (Mineo et al 2006;Nofer et al 2004;Rye and Barter 2008;Tall et al 2008;Yuhanna et al 2001).…”

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confidence: 99%

Dysfunctional HDL: From Structure-Function-Relationships to Biomarkers

Riwanto

Rohrer

Eckardstein

et al. 2014

Handbook of Experimental Pharmacology

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Reduced plasma levels of HDL-C are associated with an increased risk of CAD and myocardial infarction, as shown in various prospective population studies. However, recent clinical trials on lipidmodifying drugs that increase plasma levels of HDL-C have not shown significant clinical benefit. Notably, in some recent clinical studies, there is no clear association of higher HDL-C levels with a reduced risk of cardiovascular events observed in patients with existing CAD. These observations have prompted researchers to shift from a cholesterol-centric view of HDL towards assessing the function and composition of HDL particles. Of importance, experimental and translational studies have further demonstrated various potential antiatherogenic effects of HDL. HDL has been proposed to promote macrophage reverse cholesterol transport and to protect endothelial cell functions by prevention of oxidation of LDL and its adverse endothelial effects. Furthermore, HDL from healthy subjects can directly stimulate endothelial cell production of nitric oxide and exert anti-inflammatory and antiapoptotic effects. Of note, increasing evidence suggests that the vascular effects of HDL can be highly heterogeneous and HDL may lose important anti-atherosclerotic properties and turn dysfunctional in patients with chronic inflammatory disorders. A greater understanding of mechanisms of action of HDL and its altered vascular effects is therefore critical within the context of HDL-targeted therapies.

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The Münster Heart Study (PROCAM)

Abstract: The increase in mortality at low levels of total and LDL cholesterol among middle-aged men in the Münster Heart Study is explained by an increase in smoking-related cancer deaths among smokers.

Cited by 122 publications

References 69 publications

Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study

Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study

Cardiovascular Status of Carriers of the Apolipoprotein A-I _Milano Mutant

Dysfunctional HDL: From Structure-Function-Relationships to Biomarkers

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The Münster Heart Study (PROCAM)

Abstract: The increase in mortality at low levels of total and LDL cholesterol among middle-aged men in the Münster Heart Study is explained by an increase in smoking-related cancer deaths among smokers.

Cited by 122 publications

References 69 publications

Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study

Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study

Cardiovascular Status of Carriers of the Apolipoprotein A-I Milano Mutant

Dysfunctional HDL: From Structure-Function-Relationships to Biomarkers

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Product

Resources

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Cardiovascular Status of Carriers of the Apolipoprotein A-I _Milano Mutant