Abdominal obesity and low-grade systemic inflammation as markers of subclinical organ damage in type 2 diabetes

AimThis study aimed to explore the associations between abdominal obesity, inflammatory markers and subclinical organ damage in 740 middle-aged patients with type 2 diabetes.MethodsWaist circumference (WC) and sagittal abdominal diameter (SAD) were measured, and blood samples were analyzed for C-reactive protein (CRP) and IL-6. Carotid intima–media thickness (IMT) was evaluated by ultrasonography, and aortic pulse wave velocity (PWV) measured with applanation tonometry.ResultsAbdominal obesity as determined by SAD and WC was significantly correlated with IL-6 (WC: r = 0.27, P < 0.001; SAD: r = 031, P < 0.001), CRP (WC: r = 0.29, P < 0.001; SAD: r = 0.29, P < 0.001), IMT (WC: r = 0.09, P = 0.013; SAD: r = 0.11, P = 0.003) and PWV (WC: r = 0.18, P < 0.001; SAD: r = 0.21, P < 0.001). In multiple linear regressions with IMT and PWV as dependent variables, and age, gender, statin use, systolic blood pressure (SBP), body mass index (BMI), CRP and HbA_1c as independent variables, both SAD and WC remained associated with IMT and PWV. On stepwise linear regression and entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.ConclusionBoth SAD and WC are feasible measures of obesity, and both provide information on inflammation, atherosclerosis and arterial stiffness in type 2 diabetes, while SAD appears to be slightly more robustly associated with subclinical organ damage than WC.     

Microalbuminuria,but not reduced eGFR,is associated with cardiovascular subclinical organ damage in type 2 diabetes

AimThis study explored the association between reduced estimated glomerular filtration rate (eGFR) and microalbuminuria vs. subclinical organ damage in patients with type 2 diabetes.MethodsData from middle-aged patients with type 2 diabetes (n = 706) treated in primary care were analyzed for microalbuminura, defined as a urinary albumin/creatinine ratio (uACR) ≥ 3.0 mmol/mol, and reduced eGFR, defined as < 60 mL/min/1.73 m², in relation to blood pressure, pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima–media thickness (IMT) and lumen diameter (LD).ResultsPatients with microalbuminuria had significantly higher 24-h ambulatory systolic blood pressure (ASBP) compared with subjects with uACR < 3 mg/mmol: 137 vs. 128 mmHg (P < 0.001). There were no differences in ASBP in patients with eGFR < 60 mL/min/1.73 m². However, patients with vs. without microalbuminuria had increased PWV (11.4 vs. 10.1 m/s; P < 0.001), LVMI (134.4 vs. 118.6 g/m²; P < 0.001), LD (7.01 ± 0.93 vs. 6.46 ± 0.74 mm; P < 0.001) and IMT (0.78 vs. 0.74 mm; P = 0.047), respectively. The associations between uACR vs. PWV and LVMI were more robust after adjusting for age, diabetes duration, ASBP, HbA_1c, LDL-cholesterol, and antihypertensive and lipid-lowering therapy compared with uACR vs. IMT. There were no statistically significant differences in PWV, LVMI or IMT between patients with reduced (< 60 mL/min/1.73 m²) vs. normal eGFR.ConclusionLevels of urinary albumin excretion, but not reduced eGFR, were associated with increased arterial stiffness, left ventricular mass and atherosclerosis in patients with type 2 diabetes.     

Relationship between tissue glycation measured by autofluorescence and pulse wave velocity in young and elderly non-diabetic populations

ObjectiveAdvanced glycation end-products (AGEs) and pulse wave velocity (PWV) are pivotal indices of the processes of arterial ageing and damage accumulation. The aim of the present study was to investigate the impact of AGEs, as measured by a non-invasive skin autofluorescence method, on arterial stiffness, estimated by PWV, in two different age groups of non-diabetic subjects.Methods and patientsA total of 116 non-diabetic subjects were classified into two groups, with 55 subjects in the group aged < 65 years and 61 in the group aged ≥ 65 years. AGEs were measured by skin autofluorescence while carotid–femoral PWV was assessed by tonometry.ResultsA significant (positive) association was observed between PWV and AGE skin autofluorescence in the younger age group (r = 0.51; P < 0.0001). However, this association was no longer significant after further adjustments for age and other factors on multiple regression analyses. In contrast, this correlation was not found in the elderly group (r = 0.098; P = 0.454).ConclusionYounger non-diabetic subjects exhibit a different correlation profile between AGEs accumulated in skin and cfPWV as an index of arterial stiffness compared with elderly subjects. AGEs were significantly associated with cfPWV in younger individuals, but not in the elderly. A further study with a larger number of subjects is proposed to confirm the contribution of AGEs, the formation of which is manageable, as a determinant of arterial stiffness in younger subjects.     

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

Background & AimsRecent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients.MethodsWe recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45 years old (median age 31.6 ± 8.1 years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AIx).ResultsTotal cholesterol (P < 0.013) and LDL-cholesterol (P < 0.019) levels were significantly lower in IBD patients compared to controls. Carotid IMT was higher in IBD than in controls (P < 0.047), but there was no statistically significant difference among Crohn's Disease (CD) and Ulcerative Colitis (UC) patients. Moreover, PWV and AIx were significantly higher in patients as compared to controls (P < 0.006 and P < 0.004 respectively). No medication seemed to affect vascular measurements, though stiffness parameters were significantly higher in patients treated with 5-ASA (11.9 (9.7) vs 18.2 (10.2), P < 0.021), suggesting a lack of efficacy of 5-ASA in protecting IBD patients from early atherogenesis.ConclusionsYoung IBD patients show an increase in subclinical markers of atherosclerosis. Future studies need to address whether these markers result in an increased risk of cardiovascular events in these patient.     

Effects of exercise training on indicators of adipose tissue angiogenesis and hypoxia in obese rats

ObjectiveTo investigate the effects of obesity and exercise training on regional adipose tissue angiogenesis and hypoxia markers in rats.MethodsLean (Fa/Fa) and obese (fa/fa) male Zucker rats at 2 months of age were randomly assigned to a sedentary or an exercise training group (lean sedentary: n = 7, lean exercise: n = 8, obese sedentary: n = 7, obese exercise: n = 8). The exercise group walked on a rat treadmill 5 times per week for 8 weeks. Inguinal and epididymal adipose tissue vascular endothelial growth factor A (VEGF-A) and lactate levels were determined.ResultsThere were significant effects of obesity in increasing inguinal (P < 0.001) and epididymal (P < 0.05) adipose tissue VEGF-A, and a significant effect of exercise training in increasing epididymal adipose tissue VEGF-A (P < 0.05). There was a significant effect of obesity in increasing inguinal adipose tissue lactate levels (P < 0.001). Compared to lean sedentary animals, obese sedentary animals had significantly higher epididymal adipose tissue lactate levels (P < 0.001); compared to obese sedentary animals, obese exercise rats had significantly lower epididymal adipose tissue lactate levels (P < 0.05).ConclusionsExercise training increased adipose tissue VEGF-A, an important factor of tissue angiogenesis, and lowered adipose tissue lactate, an indicator of adipose tissue hypoxia in obese rats. However, these effects are depot-specific and only observed in intra-abdominal adipose tissue.     

Évaluation des acquis éducatifs de 73 patients hypertendus par enquête téléphonique à distance du programme HTA Vasc

HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR).MethodA telephone survey (December 2011–July 2012) evaluated the benefits of different workshops “my treatment”, “my blood pressure” and “my nutrition”, more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients.ResultsThe follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP) < 140/90 mmHg] increased from 55.4% to 75.4% (P = 0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P = 0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P = 0.0059) and with a decline in physical activity [89.7% (< 18 months) to 67.5% (≥ 18 months) (P = 0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P < 0.0001); knowledge of the “rule of three” increased from 6.8% (T0) to 74% (TS) (P < 0.0001).ConclusionAn educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.     

Higher liver stiffness scores are associated with early kidney dysfunction in patients with histologically proven non-cirrhotic NAFLD

AimThe association between Liver fibrosis (LF), as assessed by either histology or Liver stiffness measurement (LSM), and the presence of Early kidney dysfunction (EKD) was investigated in this study, as was also the diagnostic performance of LSM for identifying the presence of EKD in patients with Non-alcoholic fatty liver disease (NAFLD).Materials and methodsA total of 214 adults with non-cirrhotic biopsy-proven NAFLD were recruited from two independent medical centres. Their histological stage of LF was quantified using Brunt's criteria. Vibration-controlled Transient elastography (TE), using M-probe (FibroScan®) ultrasound, was performed in 154 patients and defined as significant when LSM was ≥ 8.0 kPa. EKD was defined as the presence of microalbuminuria with an estimated glomerular filtration rate ≥ 60 mL/min/1.73 m². Logistic regression modelling was used to estimate the likelihood of having EKD with NAFLD (LSM–EKD model).ResultsThe prevalence of EKD was higher in patients with vs without LF on histology (22.14% vs 4.82%, respectively; P < 0.001) and, similarly, EKD prevalence was higher in patients with LSM ≥ 8.0 kPa vs LSM < 8.0 kPa (23.81% vs 6.59%, respectively; P < 0.05). The area under the ROC curve of the LSM–EKD model for identifying EKD was 0.80 (95% CI: 0.72–0.89). LF detected by either method was associated with EKD independently of established renal risk factors and potential confounders.ConclusionLF was independently associated with EKD in patients with biopsy-proven NAFLD. Thus, TE-measured LSM, a widely used technique for quantifying LF, can accurately identify those patients with NAFLD who are at risk of having EKD.     

Relation entre pression artérielle,fréquence cardiaque et dysfonction autonome cardiaque chez les obèses non diabétiques

RationaleSome studies suggest that a high heart rate (HR) would be predictive of the incidence of an elevated blood pressure (BP). Cardiac autonomic dysfunction (CAD) affects a high proportion of obese patients. CAD could be involved in BP increase. Our aim was to examine the relationship between CAD, HR and BP in obese patients without known diabetes.Patients and methodsWe included 428 overweight or obese patients. CAD was assessed by analyzing HR variations during three standard tests (Valsalva, deep breathing, lying-to-standing), which are mostly dependent on vagal control. An oral load in glucose was performed and the Matsuda index was calculated.ResultsThe population was separated in 4 groups according to the grade of CAD (no or only one abnormal test, 2 or 3 abnormal tests) and HR (< or ≥ 75 bpm). Age was similar in the four groups. Systolic (P = 0.05), diastolic (P < 0.005) and mean BP (P < 0.001) differed significantly between the 4 groups, and was the highest in the group of patients who had 2 or 3 abnormal tests and HR ≥ 75 bpm. Matsuda index differed across the groups (P = 0.018) and was the lowest in this group.ConclusionThese data indicate that among overweight or obese patients with a defect in cardiac vagal activity BP is elevated only in those with a high heart rate, which is indicative of a more marked insulin resistance and probably an excess in sympathetic activity.     

P-wave voltage and peaking on electrocardiogram in patients undergoing head-up tilt testing for history of syncope

BackgroundOnly scanty data are available in the literature on P-wave (PW) morphology at ECG in patients with history of vasovagal syncope undergoing diagnostic functional testing. In this study, we evaluated resting and head-up tilt testing (HUTT) related changes in PW voltage (PWV) and duration (PVD) and their relationship with triggered syncope.Methods55 patients, mean aged 41 ± 19y (35 F), without patent heart disease or neuropathy, underwent potentiated HUTT according to the Italian protocol. Heart rate (HR), blood pressure (BP), PR-interval, PWV and PWD were measured at rest, 15 min from passive position (15-min) and after nitroglycerine (peak-HR). PW peaking (PWP) was calculated as percent increase in PWV than baseline values. Patients were divided into 2 groups based on tilt-positive (group-A) or negative (group-B) response.Results20 patients (36%) entered the group-A, whereas 35 (64%) the group-B. Higher PWV was observed at baseline in group-A (0.147 ± 0.034 mV vs 0.114 ± 0.036 mV in group-B, p = 0.001), with no differences in the remaining ECG measurements. BP was lower in group-A than in B, both at 15-min and peak-HR. HUTT-related PWP in lead II (the most significant among all inferior leads) was 31 ± 30% in group-A vs 95 ± 54% in group-B (p < 0.0001) at 15-min, and 52 ± 44% vs 112 ± 72% at peak-HR, respectively (p = 0.002). 75% of patients with PWP ≤ 50% experienced HUTT-triggered syncope, vs 5% of those with PWP ≥ 100% (p < 0.0001).ConclusionsThis study shows a potential relationship between HUTT-triggered syncope and low or absent PWP, suggesting a role for atrial chamber functional involvement in the mechanisms underlying the vasovagal syncope.     

Les protéines purifiées à partir de sardines améliorent les chiffres tensionnels,l’équilibre glycémique,les voies métaboliques anti-athérogènes et la capacité anti-oxydante,chez le rat obèse

Aim of the studyThe effects of sardine by-products (SBy-P) and fillet proteins (SF-P) were compared to casein (Cas) ; these effects were assessed on blood pressure, glycemic control, reverse cholesterol transport, lipid peroxidation and total antioxidant capacity in obese rats.Materials and methodsEighteen male Wistar rats were subjected for three months, to a high-fat diet. The obese rats were divided into three groups and consumed the same high-fat diet for 28 days after addition of either, 20% SBy-P, SF-P or Cas.ResultsThe sardine proteins (SBy-P and SF-P) compared respectively to Cas, reduced diastolic (−14%, −11% P < 0.05) and systolic pressures (−12%, −8% P < 0.05), blood glucose (−24%, −21% P < 0.05), glycated hemoglobin (−28%, −21% P < 0.05), insulinemia (−29%, −18% P < 0.05) and HOMA-IR index (−29%, −18% P < 0.05). They improve the reverse cholesterol transport by increasing the lecithin: cholesterol acyltransferase (LCAT) activity (+43%, +30% P < 0.05) and high-density lipoproteins in cholesterol esters (+108%, +88% P < 0.05), and decreasing the atherogenicity ratios and membrane fluidity (P < 0.05). Furthermore, SBy-P and SF-P induced a reduction of reactive thiobarbituric acid substances concentrations in heart (−45%, −25% P < 0.05), aorta (−62%, −41% P < 0.05), liver (−40%, −21% P < 0.05) and adipose tissue (−50%, −37% P < 0.05) with an improvement in antioxidant capacity.ConclusionSardine proteins, in particular those extracted from by-products, because of their hypotensive, hypoglycemic, anti-atherogenic and antioxidant properties, may have protective effects against the cardiovascular risk associated with obesity.     

Adiposity and the relationship between vitamin D and blood pressure

ObjectiveCirculating vitamin D (25OHD) concentrations are negatively associated with blood pressure (BP) but little is known about the mechanisms for this relationship. Adiposity is positively associated with BP and inversely with circulating 25OHD concentrations but no studies have assessed the relationship between plasma 25OHD and adiposity on BP. The goal of this study is to investigate if the association between plasma 25OHD and BP is mediated by adiposity.Materials/MethodsThe relationship between plasma 25OHD, systolic and diastolic BP, and adiposity [BMI, waist circumference, visceral adipose tissue (VAT)] was assessed in a multi-ethnic cross-sectional study of Aboriginal (n = 151), Chinese (n = 190), European (n = 170), and South Asian (n = 176) participants by linear regression models.ResultsPlasma 25OHD concentrations were negatively associated with systolic (standardized B = ? 0.191, P < 0.001) and diastolic BP (standardized B = ? 0.196, P < 0.001) in models adjusted for age, sex, ethnicity, family history of CVD, smoking status, alcohol consumption, and physical activity. The negative relationship between plasma 25OHD concentrations and systolic and diastolic BP was attenuated after the addition of BMI, waist circumference, and VAT to the models, but the relationship remained significant. Plasma 25OHD concentrations accounted for 0.7% and 0.8% of the variance in systolic and diastolic BP, respectively.ConclusionThese findings suggest that the relationship between vitamin D and BP is independent of adiposity. Further studies are required to determine the mechanisms by which vitamin D affects BP.     

Autonomic modulation in gestational diabetes mellitus

AimsThe aim of this study was to evaluate the influence of gestational diabetes mellitus (GDM) and positional aortocaval compression on cardiovascular autonomic nervous system (ANS) function in late pregnancy.MethodsPregnant women with (n = 31) and without (n = 12) GDM were evaluated at 30–35 weeks gestation and 2–3 months postpartum. Measures of ANS function included power spectral analysis (performed sitting) and RR-variation during deep breathing (performed supine). Time-related changes (late pregnancy versus 2–3 months postpartum) for measurements of cardiovascular ANS function were analyzed using multivariate analysis of variance for repeated measures.ResultsBaseline characteristics were similar for both groups. Comparing ANS measures for GDM + versus GDM − women during pregnancy and postpartum revealed no significant differences. Time related changes indicated that during late pregnancy total spectral power, low frequency (LF) power, high frequency (HF) power, and RR-variation during deep breathing were significantly reduced (p < 0.001 for all). The LF/HF ratio, however, was not significantly affected during late pregnancy (p = 0.678).ConclusionsOur results suggest decreased activity in both branches of the ANS during mid-third trimester pregnancy, but no significant change in sympathovagal balance. Aortocaval compression appears to affect ANS function whether tests were performed sitting or supine for GDM + and GDM − women.     

Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study

BackgroundArterial stiffness (AS) is an independent predictor of cardiovascular risk, and could be used as a surrogate marker of improvement in cardiovascular risk following bariatric surgery. The aim of this study was to compare AS before and after surgery.MethodsOne hundred and thirty-four patients undergoing bariatric surgery between May 2016 and January 2019 were prospectively included. AS was measured on pulse wave velocity (PWV) with the pOpmètre® device pre- and postoperatively. The main endpoint was change in PWV between baseline and 3 months post-surgery.ResultsOverall, mean PWV was 6.87 m/s preoperatively and 6.71 m/s at 3 months (P = 0.7148). Patients with pathologic PWV (> 2 standard deviations from expected value for age) showed significant improvement at 3 months (31 patients; 10.1 m/s preoperatively vs 7.5 m/s at 3 months; P = 0.007). These results did not correlate with improvement in other clinical or biological parameters following surgery (excess weight loss, mean blood pressure, fasting blood glucose, waist circumference, body composition).ConclusionThese results suggest that pathological arterial stiffness may resolve following bariatric surgery independently of the other factors influencing cardiovascular risk in obesity.     

Beneficial effect of splenic artery ligation on bacterial translocation after major liver resection in rats

ObjectiveIn major liver resection, bacterial translocation appears to be an important mechanism in the pathogenesis of spontaneous infection. This study was designed to investigate the effects of splenic artery ligation on bacterial translocation after major liver resection.Materials and methodsRats were divided into three groups: the sham operation group (SO group), the two-thirds partial hepatectomy group (PHx group) and the two-thirds partial hepatectomy plus splenic artery ligation group (PHx + Sp group). Bacterial translocation, endotoxemia, d-lactic acid and intestinal histology were analyzed among three groups.ResultsThe rate of bacterial translocation was higher in the PHx rats than in the SO rats (65.0% vs. 6.67%; P = 0.001), so that in the PHx + Sp rats (25.0%; P = 0.011). Endotoxemia was not evident in the SO rats (0 pg/ml) and blood endotoxin levels decreased in the PHx + Sp rats (1.47 pg/ml) compared with the PHx rats (4.05 pg/ml, P < 0.001). d-lactic acid was also higher in both the PHx and PHx + Sp rats compared with the SO rats (39.09 mg/ml, 23.36 mg/ml, and 1.68 mg/ml; P < 0.01).ConclusionSplenic artery ligation enhanced intestinal barrier function and diminished blood endotoxin levels and bacterial translocation in rats with major liver resection.     

Un nouvel index pour évaluer le vieillissement artériel indépendamment de la pression artérielle : pOpscore®

AimPulse wave velocity does not correlate to age in the upper limb but in the aorta and lower limb. We studied the link between ageing and pulse wave transit time (PWtt) indexes at the toe and finger.Patients and methodsMeasurements were performed in 300 patients in occupational medicine and primary care after 5 minutes supine rest using the device studied (pOpmètre^®, Axelife SAS, France). It measures transit time between R-ECG and finger or toe pulse signal (ttf or ttt respectively). We define as follows three indexes: difference between transit times: Dtf = ttt ? ttf; pulse wave velocity PWVft = k*subjects height/Dtf (m/s); and the pOpscore^® as the ratio of toe PWV/fingerPWV.ResultsOf the 300 tested patients, 147 were analysed using univariate correlation: age (P < 10^?4), SBP (P < 10^?4), DBP (P < 0.02) and BMI (P < 0.04) correlated to Dtf, PWVtf and pOpscore^®. Using stepwise regression analysis with Age, BMI, SBP, DBP, MBP: Dtf was dependent with age (P < 10^?4) and SBP (P < 0.01); PWVtf with age (P < 0.0001), SBP (P < 0.01) and DBP (P < 0.05); pOpscore^® was dependent only to age (P < 10^?4).ConclusionIn this study, in contrast with the other vascular indexes studied dependent to age and blood pressure, pOpscore^® was dependent only to ageing. pOpmètre^® is a promising technique for routine determination of arterial stiffness and pOpscore^® appears to be appropriate to study the structural vascular ageing in outpatient.     

Lipase maturation factor 1: Its expression in Zucker diabetic rats,and effects of metformin and fenofibrate

AimHigh triglyceride (TG) levels are a risk factor for cardiovascular diseases, and TG concentrations depend on the balance between its appearance in and clearance from plasma. TG clearance is controlled mainly by lipoprotein lipase (LPL), the maturation and activity of which are dependent on lipase maturation factor 1 (LMF1) protein. The present study aimed to investigate LMF1 expression in hypertriglyceridaemia and the regulation of its expression, as little is currently known of these processes.MethodsWe measured LMF1 expression (mRNA) in Zucker diabetic rats (ZDF) throughout the development of obesity, insulin resistance and diabetes, and compared it with that of control rats. We also determined whether fenofibrate and metformin, agents with TG-lowering activities, have an effect on LMF1 expression in ZDF rats.ResultsAt 7 weeks, the ZDF rats were obese, insulin-resistant and hypertriglyceridaemic, and their LMF1 mRNA levels were – whichever tissue was investigated – comparable to those of the control rats. Diabetic ZDF rats (14 and 21-week-old) also had high TG levels, but the presence of diabetes had no effect on LMF1 expression; mRNA levels remained comparable to those in the controls. Although fenofibrate and metformin both decreased plasma TG levels, fenofibrate had no effect on LMF1 expression, whereas metformin increased LMF1 mRNA in heart tissue (14- and 21-week-old ZDF rats; P < 0.01), and induced a trend towards increases in adipose tissue (14-week-old ZDF rats) and muscle (14- and 21-week-old ZDF rats).ConclusionLMF1 expression was not altered in this experimental animal model of obesity, insulin resistance and diabetes in the presence of raised TG levels. However, metformin increased LMF1 expression in the heart, suggesting that stimulation of LMF1 may play a part in its TG-lowering action.     

Différences induites par la définition des périodes diurnes et nocturnes sur la pression artérielle et le dipping lors d’une mesure ambulatoire de la pression artérielle

Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined.ObjectiveTo compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods.Patients and methodABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband^®) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7 a.m.–10 p.m.) and nighttime (10 p.m.–7 a.m.) periods.ResultsData from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08 ± 4.50 mmHg; diastolic BP: 1.84 ± 2.99 mmHg, P < 0.05) and dipping was more marked (systolic BP: 1.54 ± 3.76%; diastolic BP: 2.27 ± 3.48%, P < 0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07 ± 2.81 mmHg; diastolic BP: 1.34 ± 2.50 mmHg) than daytime BP defined by a fixed period.ConclusionDiurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.     

The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome

ObjectiveMetabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS.MethodsEighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) ≥15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters.ResultsFifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS?OSA). Compared with MS?OSA patients, MS+OSA patients had higher levels of IMT (661 ± 117 vs. 767 ± 140 μm), PWV (9.6 ± 1.0 vs. 10.6 ± 1.6 m/s), and CD (6705 ± 744 vs. 7811 ± 862 μm) (P < 0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R² = 0.42); AHI and systolic blood pressure (R² = 0.38); and AHI, age, abdominal circumference and systolic blood pressure (R² = 0.45), respectively. The R² of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively.ConclusionsOSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.     

Short term effects of energy restriction and dietary fat sub-type on weight loss and disease risk factors

Background and aimsDecreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease.Methods and resultsOne-hundred and fifty overweight men and women were randomized into a 3 month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with 10% polyunsaturated fatty acids (LF-PUFA); (3) low calorie (LF-LC) (?2 MJ); (4) low calorie with 10% PUFA (LF-PUFA-LC). Primary outcomes were changes in body weight and body fat and secondary outcomes were changes in fasting levels of leptin, insulin, glucose, lipids and erythrocyte fatty acids. Changes in dietary intake were assessed using 3 day food records. One-hundred and twenty-two participants entered the study and 95 completed the study. All groups lost weight and body fat (P < 0.0001 time effect for both), but the LC groups lost more weight (P = 0.026 for diet effect). All groups reduced total cholesterol levels (P < 0.0001 time effect and P = 0.017 intervention effect), but the LC and PUFA groups were better at reducing triacylglycerol levels (P = 0.056 diet effect). HDL increased with LF-LC and LF-PUFA but not with LF-PUFA-LC (0.042 diet effect). The LF and LF-LC groups reported greater dietary fat reductions than the two PUFA groups (P = 0.043).ConclusionEnergy restriction has the most potent effect on weight loss and lipids, but fat modification is also beneficial when energy restriction is more modest.     

Study of main arteries stiffness in patients with coronary heart disease depending on prevalence of atherosclerosis

ObjectiveTo study the vascular wall stiffness in patients with coronary artery disease based on the prevalence of atherosclerotic lesion.Materials and methodsThe study involved 90 patients diagnosed with unstable angina class II B, the control group consisted of 27 healthy individuals. By using the SphygmoCor (AtCor Medical, Australia) apparatus, stiffness indicators, like pulse wave velocity (PWV) and augmentation index (AIx) were studied by means of the applanation tonometry method. Coronary angiography was performed on the Allura CV-20 (Philips, The Netherlands) unit, the state of the carotid arteries was studied by duplex ultrasonography, involvement of femoral arteries was evaluated based on ankle-brachial index <0.9. In case of doubt, the patients underwent ultrasound duplex scanning. In the main group, patients were divided into 3 subgroups: subgroup A covered patients with isolated coronary lesion; subgroup B covered patients with bifocal atherosclerosis (combined lesion of coronary and carotid arteries or coronary and femoral arteries); subgroup C was represented by multifocal atherosclerosis patients who had atherosclerosis lesion in three vascular basins: carotid, coronary and femoral arteries.ResultsValues of PWV (11.2 ± 1.5 m/s) and AIx (19.8 ± 5.0%) in patients with coronary heart disease were 1.5 (p < 0.001) and 2.4 (p < 0.001) times higher than in those in healthy individuals. During the analysis carried out within the groups, the PWV in all three subgroups was accelerated with maximal values in the subgroup C (13.3 ± 1.5 m/s), which with sufficient level of confidence exceeds the value of this index in the subgroups A (10.1 ± 0.6, p < 0.01) and B (11.0 ± 0.9, p < 0.05). The value of augmentation index AIx was also highest in the subgroup C (26.8 ± 6.4%), relative to the subgroups A (13.7 ± 2.9%, p < 0.001) and B (18.9 ± 4.3%, p < 0.01).ConclusionPatients with coronary heart disease, have demonstrated growing vascular wall stiffness, which is manifested in higher pulse wave velocity (p < 0.001) and augmentation index (p < 0.001) compared with healthy individuals. Whereas in the multifocal atherosclerosis (coronary, carotid and peripheral arteries) were higher AA (p < 0.05), AIx (p < 0.001), PWV (p < 0.01) and the age of patients (p < 0.01). That allows to consider the studied parameters of vascular stiffness as surrogate markers to assess prevalence and progression of atherosclerosis, as well as the effectiveness of pharmacological interventions.