Coronary vasoreactivity is not altered in young people with type 1 diabetes

Background and aimAbnormal coronary microvascular circulation has been demonstrated in diabetes and is associated with increased rate of cardiovascular events. Our objective was to evaluate coronary vasoreactivity in young people with type 1 diabetes with and without microvascular complications.Methods and resultsTwenty-five type 1 diabetic patients without microvascular complications (DC–), 23 with microvascular complications (DC+), and 18 control subjects (C) were studied. Coronary vasoreactivity was assessed by means of coronary flow reserve (CFR). Blood flow velocity in the left anterior descending coronary artery was measured at rest and after high-dose dipyridamole using transthoracic color-guided pulsed Doppler echocardiography. CFR was defined as the ratio of hyperaemic to resting diastolic peak flow velocities.The three groups had similar cardiac function parameters, and also systolic and diastolic blood pressure at rest, which remained unchanged during dipyridamole infusion. Resting coronary flow velocity was comparable in C, DC–, and DC+ (p = ns). Dipyridamole infusion produced a threefold increase in coronary diastolic peak velocity, which reached similar values in C (0.69 ± 0.16 m/s), DC– (0.69 ± 0.18 m/s), and DC+ (0.66 ± 0.11 m/s). Mean CFR ratio was similar in C (3.33 ± 0.66), DC– (3.30 ± 0.51), and DC+ (3.24 ± 0.60). At multiple linear regression analysis, no association was found between CFR and age, sex, HbA_1c, duration of diabetes, and complications.ConclusionCoronary vasodilatory function is preserved in young D patients, even those with early microvascular complications, suggesting that coronary vasoreactivity deteriorates at more advanced stages of microvascular complications and/or in the presence of other cardiovascular risk factors.     

Blood levels of glucose and insulin and insulin resistance in patients with schizophrenia on clozapine monotherapy

ObjectiveWe tested the hypothesis that fasting blood glucose and insulin levels are higher in schizophrenic subjects on clozapine monotherapy compared with healthy controls and they correlate with anthropometric measurements, laboratory tests and body composition.MethodsData for 24 subjects with schizophrenia treated with clozapine and 24 age- and sex-matched healthy volunteers was analyzed.ResultsPatients taking clozapine had higher fasting levels of glucose (103.5 ± 31.6 vs. 87.8 ± 11.7 mg/dL, z = −2.03, p = 0.04), there was no difference for insulin concentrations and markers of insulin resistance. In the clozapine group glucose levels correlated with clozapine dose (R = −0.43, p = 0.03), while insulin levels correlated with weight (R = 0.66, p < 0.001), body mass index (R = 0.54, p = 0.007), abdominal (R = 0.53, p = 0.007) and waist (R = 0.43, p = 0.04) circumference, total body fat (R = 0.51, p = 0.01), and uric acid levels (R = 0.50, p = 0.01). In the clozapine group insulin levels were lower in subjects with body mass index <25 kg/m² (7.0 ± 3.3 vs. 13.4 ± 8.8 μU/mL, p = 0.04) and in subjects without abdominal obesity (6.3 ± 2.4 vs. 13.3 ± 8.6 μU/mL, p = 0.03).ConclusionsWe found higher blood glucose levels in subjects taking clozapine and no differences in blood insulin levels between subjects with schizophrenia and controls. Associations between blood insulin levels and abdominal/waist circumferences support the role of abdominal obesity as an important risk factor of insulin resistance.     

Patterns of serum lipids derangements and cardiovascular risk assessment in patients with primary biliary cholangitis

Introduction and objectivesPrimary biliary cholangitis (PBC) is a chronic cholestatic autoimmune disease that disrupts the cholesterol metabolism. Our aim was to investigate the frequency of dyslipidemias and to evaluate the risk of cardiovascular events in a historic cohort of patients with PBC.PatientsAll patients attended from 2000 to 2009 with histological diagnosis of PBC were included and were compared with healthy controls. The 10-year cardiovascular risk was estimated by the Framingham risk score.ResultsFifty four patients with PBC were included and compared to 106 controls. Differences in total cholesterol (263.8 ± 123.9 mg/dl vs. 199.6 ± 40, p = 0.0001), LDL-cholesterol (179.3 ± 114.8 vs. 126.8 ± 34.7, p = 0.0001), HDL-cholesterol (62.4 ± 36.2 mg/dl vs. 47.3 ± 12.3, p = 0.0001) and triglycerides (149.1 ± 59.1 mg/dl vs. 126.4 ± 55.4, p = 0.001) were found. Hypercholesterolemia (>240 mg/dl) was found in 52.4% of the patients with PBC vs. 11% in the control group, high LDL-cholesterol (160–189 mg/dl) in 45.2% of the patients with PBC vs. 10% in controls and hyperalphalipoproteinemia (HDL-cholesterol >60 mg/dl) in 45.2% of the patients with PBC vs. 16% in controls. The 10-year cardiovascular risk was 5.3% ± 5.9 in the patients with PBC and 4.1% ± 5.7 in the control group (p = 0.723, IC 95% = 0.637–1.104). Only one cardiovascular event (stroke) in a patient with PBC was registered in a mean follow up time of 57.9 ± 36.5 months.ConclusionsMarked derangements in serum lipids and a high frequency of dyslipidemias are found in patients with PBC, however, these do not increase the risk of cardiovascular events.     

Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients

BackgroundRecent studies showed a high frequency of low bone mineral density (BMD) in HIV-infected patients and no reports have been issued in Turkey. Our aim was to evaluate BMD and risk factors for osteopenia/osteoporosis in HIV-infected patients that attended an outpatient clinic in Istanbul, Turkey.MethodIn order to determine the prevalence of BMD, 126 HIV-infected patients had been studied with dual energy X-ray absorptiometry (DEXA). The association between BMD and age, gender, body mass index (BMI), habits, 25(OH)vitamin D, HIV RNA, CD4 lymphocyte nadir, using and duration of highly active antiretroviral treatment (HAART) were investigated by using multivariate analysis.ResultsMedian age was 40.1 years (range, 20–70); 84% were male; 35.7% patients had AIDS, 63.5% were treated with HAART. Osteopenia and osteoporosis were diagnosed in 53.9% and 23.8%, respectively. Mean plasma HIV RNA was 5.2 (SD 1.0) log₁₀ copies/mL and CD4 lymphocyte nadir was 313.8 (SD 226.2)/mm³. Factors associated with bone loss were high viral load (p = 0.034), using (p = 0.033) and duration of HAART (p = 0.008). No correlation had been seen between sex and osteopenia/osteoporosis (p = 0.794). However, males showed higher rates of osteoporosis than females (p = 0.042).ConclusionsOur results show a very high prevalence of bone mass reduction in Turkish HIV-infected patients. This study supports the importance of both HIV and antiretroviral therapy in low BMD.     

Albuminuria and VEGF as early markers of cardiovascular disturbances in young type 1 diabetic patients

AimsThe aim of the study was to assess myocardial perfusion by means of non-invasive diagnostic methods and measurement of the plasma concentration of vascular endothelial growth factor (VEGF) in patients with long-lasting type 1 diabetes.Methods and resultsThe study was performed on 41 Type 1 diabetic patients (23 females, 18 males), aged 30 ± 7.6 with a duration of disease 15.2 ± 5.5 years. 17 patients exhibited microalbuminuria (10 females, 7 males) and 24 subjects were without microalbuminuria (13 females, 11 males). The methods used included a 24-h ECG tape, an exercise treadmill test, echocardiological evaluation with dobutamine and atropine challenge and single photon emission computer tomography (SPECT) at rest, and after dipyridamol induction of ischemia. All the exercise and stress echocardiography tests were negative. There were significant differences between microalbuminuric and normoalbuminuric subjects in the duration of their exercise tests (586.9 ± 110.5 vs. 664.9 ± 133.2 s, p = 0.027), performed work (11.4 ± 1.6.vs. 12.6 ± 1.8 METs, p = 0.045), achieved pulse limit (89.1 ± 3.6 vs. 92.6 ± 5.2%, p = 0.037), rest ejection fraction (55.8 ± 8.7 vs. 62.0 ± 4.4%, p = 0.040), abnormal changes in SPECT (53 vs. 21%, p = 0.047) and VEGF concentration (101.5 ± 7.8 vs. 75.15 ± 16.5 pg/ml, p < 0.05). The presence of retinopathy increased 12-fold the probability of significant changes in the SPECT (OR 12.1, 95% CI 1.38–105.64, p = 0.02) and nephropathy (OR 4.27; 95%CI 1.09–16.83, p = 0.03).ConclusionAsymptomatic patients with long lasting type 1 diabetes may have disturbances in myocardial perfusion, especially these with microalbuminuria.     

Angiopoietin-2 as a biomarker for metabolic syndrome and disease activity in rheumatoid arthritis patients

BackgroundThe incidence of metabolic syndrome (MetS) increases in rheumatoid arthritis (RA) patients which increases the risk of cardiovascular disease (CVD). Angiopoietin-2 levels increase in RA and were reported to predict CVD.Aim of the workTo assess the level of angiopoietin-2 in RA patients and study its relation to disease activity and its role in those with MetS.Patients and methodsThe study included 80 RA patients (67 females and 13 males) and 20 healthy age and sex matched controls. The patients were divided into Group 1 (n = 40) with MetS and Group 2 (n = 40) without. Data were collected throughout history, basic clinical examination and investigation. Disease activity score (DAS-28) was assessed in all patients. Enzyme linked immunosorbent assay was used for the estimation of angiopoietin-2.ResultsThe age and disease duration of those with MetS (40.7 ± 7.23 years and 9.63 ± 6.73 years respectively) and those without (38.6 ± 9.2 and 8.65 ± 5.52 years respectively) were comparable (p = 0.26 and p = 0.48 respectively). The disease activity (DAS-28) was also similar in both groups (5.12 ± 0.77 and 5.01 ± 0.96 respectively; p = 0.56). There was a significant increase in the angiopoietin-2 levels in RA patients with MetS (5.31 ± 0.56 ng/ml) than those without (4.93 ± 0.44 ng/ml) (p < 0.001). The levels were significantly higher than those of the control (4.44 ± 0.29 ng/ml) (p < 0.001). The angiopoietin-2 level significantly correlated with the DAS-28 (r = 0.23, p = 0.045), systolic (r = 0.36, p = 0.001) and diastolic blood pressure (r = 0.35, p = 0.001), fasting blood sugar (r = 0.29, p = 0.009) and triglycerides (r = 0.24, p = 0.03).ConclusionsAngiopoietin-2 can be used as a biomarker of MetS and disease activity in RA patients. This could point to those RA patients at risk of developing CVDs.     

Survival of HIV patients with tuberculosis started on simultaneous or deferred HAART in the THRio cohort,Rio de Janeiro,Brazil

BackgroundThe timing of highly active antiretroviral therapy (HAART) after a tuberculosis diagnosis in HIV-infected patients can affect clinical outcomes and survival. We compared survival after tuberculosis diagnosis in HIV-infected adults who initiated HAART and tuberculosis therapy simultaneously to those who delayed the start of HAART for at least two months.MethodsThe THRio cohort includes 17,983 patients receiving HIV care in 29 public clinics in Rio de Janeiro, Brazil. HAART-naïve patients at the time of a new TB diagnosis between September 2003 and June 2008 were included. Survival was measured in days from diagnosis of TB. We compared survival among patients who initiated HAART within 60 days of TB treatment (simultaneous – ST) to those who started HAART >60 days of TB treatment or never started (deferred – DT). Kaplan–Meier plots and Cox proportional hazards regression analyses were conducted.ResultsOf 947 patients diagnosed with TB, 572 (60%) were HAART naïve at the time of TB diagnosis; 135 were excluded because of missing CD4 count results. Among the remaining 437 TB patients, 56 (13%) died during follow-up: 25 (10%) among ST patients and 31 (16%) in DT group (p = 0.08). ST patients had lower median CD4 counts at TB diagnosis than DT patients (106 vs. 278, p < 0.001). Cox proportional hazards utilizing propensity score analysis showed that DT patients were more likely to die (adjusted HR = 1.89; 95% CI: 1.05–3.40; p = 0.03).ConclusionHAART administered simultaneously with TB therapy was associated with improved survival after TB diagnosis. HAART should be given to patients with HIV-related TB as soon as clinically feasible.     

Comparison between left atrial features in well-controlled hypertensive patients and normal subjects assessed by three-dimensional speckle tracking echocardiography

BackgroundThree-dimensional speckle tracking echocardiography (3D-STE) has a major advantage in the improvement of accuracy in the evaluation of cardiac chamber volume without any geometrical assumption. Thus, the aim of this study was to use 3D-STE to elucidate the features of left atrial (LA) volume and function that are altered by hypertension (HTN) by comparing well-controlled HTN patients with normal subjects.MethodsConventional echocardiographic parameters and LA phasic volume and function were measured from apical view by 3D-STE in 40 patients with well-controlled HTN [systolic blood pressure (BP) <140 and diastolic BP <90 mmHg for more than one year] and 40 normotensive subjects.ResultsThe passive LA emptying function (EF) in the patients with well-controlled HTN significantly decreased (16 ± 7% vs. 22 ± 8%, p = 0.0013) and the active LAEF in patients with well-controlled HTN significantly increased (35 ± 10% vs. 30 ± 9%, p = 0.029) compared with the values in normotensive subjects. Multivariate logistic regression analysis revealed that E/e′ was an independent determinant of well-controlled HTN. The maximum LA volume index was correlated with elevated E/e′ (r = 0.30, p = 0.0064), whereas the maximum LA volume index was not correlated with LV mass index or systolic BP. This change was independent of age.ConclusionsThese results suggest that LV diastolic dysfunction occurs before structural changes of left atrium and left ventricle even in patients with well-controlled HTN.     

Prevalence of masked and nocturnal hypertension in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is considered as a risk factor for the development and worsening of compensation of arterial hypertension and other cardiovascular diseases. Prevalence of masked and nocturnal hypertension can have a significant negative impact on these patients and these prevalences are not well known.AimTo evaluate the prevalence of masked and nocturnal hypertension in patients with OSA.Materials and methodsIn this study, 97 (88 men) patients were enrolled, average age 53.9 ± 9.7 years. OSA was diagnosed with polysomnography and the continuous positive airway pressure therapy has been indicated according to current guidelines. Then were evaluated parameters of OSA (apnea-hypopnea index (AHI), oxygen desaturation index (ODI), % of sleep time <90% SpO₂, average night SpO₂). Patients also underwent physical examination including office blood pressure measurement, 24 h blood pressure monitoring (ABPM) and measurement of anthropometric parameters.ResultsFollowing average values were present in OSA patients (mean value and standard deviation): AHI 54.6 ± 22.7, ODI 58.3 ± 24, % of sleep time < 90% SpO₂ 35.4 ± 25.1, average night SpO₂ 88.8 ± 5. Masked hypertension was present in 55 (56.7%) patients, nocturnal hypertension in 79 (81.4%) patients. Arterial hypertension was appropriately compensated in only 15 (15.5%) patients. Results have not shown any statistically significant correlation between prevalence of nocturnal hypertension and AHI (p = 0.059), % of sleep time <90% SpO₂ (p = 0.516), average night SpO₂ (p = 0.167). ODI was significantly higher in patients with nocturnal hypertension (p = 0.002). No correlation between prevalence of masked hypertension and AHI (p = 0.841), ODI (p = 0.137), average night SpO₂ (p = 0.991) and % of sleep time <90% SpO₂ (p = 0.896) has been present.ConclusionThis study has demonstrated high prevalence of masked and nocturnal hypertension in patients with OSA, which can considerably increase risks of cardiovascular diseases in these patients.     

Evaluation of spleen stiffness in healthy volunteers using point shear wave elastography

Introduction and ObjectivesThis study aims to measure the values of spleen stiffness (SS) in healthy subjects, the inter-operator agreement in SS measurement, and to detect statistically significant correlations between SS and age, sex, weight, BMI, portal vein dynamics and splenic dimensions.Materials and methodsThe study included 100 healthy volunteers who had no substantial alcohol intake (<30 g/daily for man, <20 g/daily women), were negative on hepatitis B, hepatitis C, HIV blood serology, and had any history of lymphoproliferative disorders. Abdominal ultrasound, liver and spleen elastography were performed on each patient to search for focal splenic lesions, bile tract or portal vein dilatation, moderate/severe liver steatosis, and to measure liver and spleen stiffness.ResultsThe mean value was 18.14 (±3.08) kPa. In the group of men (n = 49), the mean was 17.73 (±2.91) kPa, whereas in the group of women (n = 51) it was 16.72 (±3.32) kPa. Statistical analyses showed no correlation between spleen stiffness and sex, age, weight, and BMI. Regarding their splenoportal axis, statistically significant differences in SS were found in the means of the two subgroups of subjects stratified by their portal flow velocity (p = 0.003) and spleen area (p < 0.001).Spearman's rank showed a weak association between SS and portal flow velocty (r = 0.271) and splenic area (r = −0.237). ICC showed excellent (0.96) inter-operator agreement and Bland–Altman plot demonstrated no systematic over/under-estimation of spleen stiffness values.ConclusionsOur results may serve as a reference point in the evaluation of SS especially in patients affected by advanced liver disease.     

Low ankle-brachial index is an independent predictor of poor functional outcome in acute cerebral infarction

ObjectiveOur study aimed to evaluate the effects of psoriasis (Pso) on coronary microvascular function and whether there is a relationship between disease activity scores and coronary blood flow abnormalities.Methods56 young patients (pts) with Pso (42 M, aged 37 ± 3 years) without clinical evidence of cardiovascular diseases, and 56 controls matched for age and gender were studied. Coronary flow velocity in the left anterior descending coronary artery was detected by transthoracic echocardiography at rest and during adenosine infusion. Coronary flow reserve (CFR) was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤ 2.5 was considered abnormal.ResultsIn pts with Pso, CFR was lower than in controls (3.2 ± 0.9 vs. 3.7 ± 0.7, p = 0.02). CFR was abnormal (≤2.5) in 12 pts (22% vs. 0% controls, p < 0.0001). Moreover, in pts with CFR ≤ 2.5, Psoriasis Area Severity Index (PASI), a clinical score for Pso severity, was higher (11 ± 6 vs. 7 ± 3, p = 0.006) compared to pts with CFR > 2.5. At multivariable analysis PASI remained the only determinant of CFR ≤ 2.5 (p = 0.02).ConclusionCFR in young pts with severe Pso without coronary disease is reduced suggesting a coronary microvascular dysfunction, independently related to the severity and extension of Pso. This early microvascular impairment might be hypothesized as the consequence of prolonged and sustained systemic inflammation and might explain the increased cardiovascular risk conferred by Pso.     

Adipose tissue is influenced by hypoxia of obstructive sleep apnea syndrome independent of obesity

AimsObstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular risk and diabetes independent of obesity. We investigated whether adipose tissue dysfunction is exacerbated due to increased tissue hypoxia.MethodsAdipose tissue (AT) oxygenation was measured with a Clarke-type electrode (p_ATO₂) in 16 men with OSAS before and after 4 months of continuous positive airway pressure therapy (CPAP) and in BMI-matched controls. Oxygenation was simultaneously monitored in arterial blood by pulse oximetry (SaO₂); mixed blood in AT microcirculation by reflectance spectroscopy (S_ATO₂) along with blood flow. Markers of hypoxia, adipo- and angiogenesis, inflammation and fibrosis were analysed in AT and serum.ResultsOSAS subjects were more insulin resistant. Despite lower arterial SaO₂ (95.4 ± 1.3% vs. 97.1 ± 1.6%, P = 0.013) in subjects with OSAS, there was no difference in the oxygen content of AT microcirculation (61.6 ± 18.4 vs. 72.2 ± 7.0%, P = 0.07) or p_ATO₂ (49.2 ± 7.5 vs. 50.4 ± 14.7 mmHg, P = 0.83) between groups. Resting AT blood flow was higher in OSAS compared to controls (108.5 ± 22.7 vs. 78.9 ± 24.9 au, P < 0.005) and strongly associated with inflammation markers IL-6 and MCP-1. AT of OSAS subjects showed increased inflammation (TNFA P = 0.049) and fibrosis (COL3A1 P = 0.02), a trend of higher HIF1A expression (P = 0.06) and reduced adipogenesis (PPARG P = 0.006). After CPAP, only expression of the lipid deposition marker LPL increased (30%, P = 0.047).ConclusionsAdipose tissue of awake OSAS subjects appears no more hypoxic than adipose tissue of BMI-matched controls despite daytime hypoxaemia. Increased adipose tissue blood flow may be explained by an increased inflammatory response. We observe features of adipose dysfunction in subjects with OSAS, which attribute to increased cardiometabolic risk associated with this condition.     

Levels of plasma cell-free DNA and its correlation with disease activity in rheumatoid arthritis and systemic lupus erythematosus patients

BackgroundCell free deoxyribonucleic acid (cf-DNA) is now emerging as a useful tool for non-invasive diagnostic methods related to a wide range of clinical conditions including autoimmune diseases.Aim of the workTo estimate the concentration of plasma cf-DNA in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients compared with healthy subjects and to correlate the results with clinical and laboratory parameters of disease activity.Patients and methodsThe study included 30 RA patients, 35 SLE patients and 25 matched control. Plasma cf-DNA was estimated by real-time quantitative PCR. Disease activity parameters for each disease were assessed; Disease Activity Score-28 (DAS28) was used for RA and SLE disease activity index 2000 (SLEDAI-2K) for SLE patients.ResultsThe RA patients (F:M 4:1) had a mean age of 36.8 ± 9.6 years and disease duration of 8.3 ± 1.1 years while the SLE patients (F:M 7.75:1) had a mean age of 35.6 ± 8.8 years and disease duration of 8.1 ± 0.87 years. There was a highly significant increase in the cf-DNA level in SLE patients (17.33 ± 2.4 ng/ml) and RA patients (11.15 ± 2.3 ng/ml) compared to the level in the control (4.15 ± 1.4 ng/ml) (p = 0.0005). The cf-DNA significantly correlated with the erythrocyte sedimentation rate (ESR) (p = 0.04), C-reactive protein (p = 0.04) and the DAS28 (p = 0.005) in the RA patients and with the ESR (p = 0.03), anti-ds-DNA (p = 0.008), complement-4 (p = 0.04) and SLEDAI-2K (p = 0.002).ConclusionThe increased cf-DNA implicates a possible role in the pathogenesis of both RA and SLE and appears to be a useful marker of disease activity in addition to other laboratory tests.     

Independent inverse relationship between serum lycopene concentration and arterial stiffness

ObjectiveEmerging evidence suggests a role of lycopene in the primary prevention of cardiovascular disease. This study aimed to investigate the association of serum lycopene concentration with brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness and markers of oxidative stress and inflammation.Methodshealthy women (n = 264, 31–75 yrs) were classified into tertiles according to serum lycopene concentration. Multivariate linear regression analyses were used to assess the relationship between serum lycopene and baPWV.ResultsSubjects in middle tertile (T2) and upper tertile (T3) had lower baPWV (1263 ± 23 and 1265 ± 14 cm/s vs. 1338 ± 21 cm/s; p = 0.009) and lower oxidized LDL (oxLDL) (53 ± 3 and 55 ± 3 U/L vs. 66 ± 3U/L; p < 0.001) than those in lower tertile (T1). Subjects in T3 showed higher LDL particle size (24.3 ± 0.08 nm vs. 24.0 ± 0.07 nm, p = 0.005) and lower C-reactive protein (hs-CRP) (0.80 ± 0.25 mg/dL vs. 1.27 ± 0.24 mg/dL, p = 0.015), compared with those in T1. Logistic regression analysis showed that baPWV decreased with the increment of lycopene concentration; log baPWV decreased by 0.21 cm/s (95% CI ?0.168;?0.045, p = 0.001) per unit change in lycopene. After adjustment for age, BMI, smoking, drinking, menopause and blood pressure, the estimated effect was attenuated by 35%, but remained statistically significant [?0.13 cm/s (95% CI ?0.112;?0.018, p = 0.006)]. Further adjustment for β-carotene, α-tocopherol, oxLDL, LDL particle size, and hs-CRP increased the strength of the association [β = ?0.221 (95% CI ?0.215;?0.012, p = 0.029)].ConclusionThis study supports the presence of an independent inverse relationship between circulating lycopene and baPWV. Additionally, reduced oxidative modification of LDL may be one of mediators on the mechanisms how lycopene reduces arterial stiffness.     

Association between circadian rhythm of blood pressure and glucose tolerance status in normotensive,non-diabetic subjects

AimsTo examine whether circadian rhythm of blood pressure (BP) is associated with glucose tolerance status in normotensive, non-diabetic subjects.MethodsA cross-sectional study recruited normotensive and non-diabetic subjects, aged 35–79 years. A 75 g oral glucose tolerance test (OGTT) and 24-h ambulatory blood pressure monitoring (24-h ABPM) were performed.ResultsAmong 31 impaired glucose tolerance (IGT) and 36 normal glucose tolerance (NGT) study subjects, the mean (±S.D.) diurnal–nocturnal differences of average systolic BP (SBP) were 7.1 ± 6.9 and 9.9 ± 6.2 mm Hg, respectively (p = 0.086). In a linear mixed-effects regression model, however, taking each measurement of BP as the outcome, nighttime reduction of SBP in the IGT group was 7.19 mm Hg, which was significantly smaller compared to a reduction of 9.80 mm Hg in the NGT group (p-value for IGT: nighttime interaction = 0.0014). The prevalence of non-dipping BP pattern was 77.4% in the IGT group which was significantly higher than 52.8% of the NGT group (p = 0.036). Logistic regression revealed a significant effect of IGT for predicting non-dipping pattern with an adjusted odds ratio of 3.71 (95% CI: 1.09, 12.66, p = 0.029).ConclusionsAmong normotensive, non-diabetic subjects, the decreased nocturnal BP reduction was associated with impaired glucose tolerance status.     

Prehypertension is associated with peripheral arterial disease and low ankle-brachial index

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI < 0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality.The aimof this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects.MethodsWe included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study.Statistical analysis was performed with odds ratio and student t-test.ResultsThe ABI values in normotensive subjects were 1.023 ± 0.21, whereas prehypertensive patients significantly had lower ABI (0.90 ± 0.14p = 0.00012).We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC₉₅ 1.5–7.0, p = 0.0023).A regression analysis failed to show any independent association between ABI values and any other clinical parameter.ConclusionsPrehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.     

Increased level of resistin predicts development of atrial fibrillation

BackgroundResistin is a peptide hormone that is secreted from lipid cells and is linked to type-2 diabetes, obesity, and inflammation. Being an important adipocytokine, resistin was proven to play an important role in cardiovascular disease. We compared resistin levels in patients with and without atrial fibrillation (AF) to demonstrate the relationship between plasma resistin levels and AF.MethodOne hundred patients with AF and 58 control patients who were matched in terms of age, gender, and risk factors were included in the trial. Their clinical risk factors, biometric measurements, echocardiographic work up, biochemical parameters including resistin and high-sensitivity C-reactive protein (hs-CRP) levels were compared.ResultsIn patients with AF, plasma resistin levels (7.34 ± 1.63 ng/mL vs 6.67 ± 1.14 ng/mL; p = 0.003) and hs-CRP levels (3.01 ± 1.54 mg/L vs 2.16 ± 1.28 mg/L; p = 0.001) were higher than control group. In subgroup analysis, resistin levels were significantly higher in patients with paroxysmal (7.59 ± 1.57 ng/mL; p = 0.032) and persistent AF (7.73 ± 1.60 ng/mL; p = 0.006), but not in patients with permanent AF subgroups (6.86 ± 1.61 ng/mL; p = 0.92) compared to controls. However, hs-CRP levels were significantly higher only in permanent AF patients compared to control group (3.26 ± 1.46 mg/L vs 2.16 ± 1.28 mg/L; p = 0.02). In multivariate regression analysis using model adjusted for age, gender, body mas index, hypertension, diabetes mellitus, and creatinine levels, plasma resistin levels [odds ratio (OR): 1.30; 95% confidence interval (CI): 1.01–1.70; p = 0.04] and hs-CRP levels (OR: 1.44; 95% CI: 1.12–1.86; p = 0.004) were the only independent predictors of AF.ConclusionThe elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group.     

Serum insulin-like growth factor binding protein-1 (IGFBP-1) phosphorylation status in subjects with and without ischaemic heart disease

BackgroundInsulin-like growth factor binding protein-1 (IGFBP-1) modulates the activity of IGF-I. It exists in serum as phosphorylated and less phosphorylated forms. We wished to measure serum levels of both these forms of IGFBP-1, using a novel assay, in subjects with, or without ischaemic heart disease (IHD).MethodsWe measured serum concentrations of the phosphorylated and less phosphorylated forms of IGFBP-1 in 75 subjects (36 with and 39 without IHD). Two immunoassays were used, one which detects non-, and less-phosphorylated forms (LpIGFBP-1), and another which specifically detects the serine phosphorylated form of IGFBP-1 (pIGFBP-1).ResultsLpIGFBP-1 concentrations were significantly higher in subjects without IHD than in those with IHD (5.3 ± 0.5 μg/L vs. 2.7 ± 0.4 μg/L, p < 0.001). pIGFBP-1 levels were also significantly higher in subjects without IHD compared to those with IHD (33.3 ± 2.0 μg/L vs. 25.3 ± 2.2 μg/L, p < 0.01). The correlation between LpIGFBP-1 and pIGFBP-1 for all subjects was (r = 0.71, p < 0.001). This association was stronger in subjects without IHD (r = 0.76, p < 0.001) than for those with IHD (r = 0.60, p < 0.001). A significant negative association was observed between IGF-I and the ratio between the two forms (r = ?0.45, p < 0.0001). Receiver-Operating Characteristic (ROC) curve showed the highest area under the curve for LpIGFBP-1 (0.75) [95% CI: 0.63–0.86] and optimum cut-off value of 2.83 μg/L with 75% sensitivity and 74% specificity.ConclusionsWe propose that low serum concentrations of IGFBP-1 forms could be a marker of coronary risk, and the LpIGFBP-1:pIGFBP-1 ratio may be an index of biologically active IGF-I.     

The correlation between sclerostin and bone mineral density in renal transplant recipients

IntroductionSclerostin is an anti-anabolic protein synthesized by osteocytes that may cause osteoporosis by inhibiting bone formation. The aim of our study was to investigate the correlation between sclerostin and bone mineral density (BMD) reduction in renal transplant recipients (RTRs) with more than 1 year after transplantation.Material and methodsThis cross-sectional study was conducted on 80 patients (38 (47.5%) male/42 (52.5%) female) RTRs with a mean age of 44.68 ± 10.39 years. Patients were compared with an age and sex-matched control group of 40 healthy individuals. BMD was measured by dual-energy X-ray absorptiometry. The levels of sclerostin were determined using enzyme-linked immunosorbent assay.ResultsThe mean sclerostin was 3.77 ± 0.3 pg/mL in patients and 3.81 ± 0.21 pg/mL in healthy individuals. The mean T score of femoral trochanter (FT) (FT-T), femoral neck (FN) (FN-T), lumbar vertebrae (L1-4) (L1-4-T) were −0.81 ± 0.86, −1.08 ± 1.09 and −0.8 ± 1.2, respectively. The mean Z score of FT (FT-Z), FN (FN-Z), L1-4 (L1-4-Z) were −0.6 ± 0.73, −0.32 ± 0.9 and −0.54 ± 1.13, respectively. FT-Z and L1-4-Z were lower in patients than healthy subjects (p = 0.009, p = 0.021 respectively). Serum creatinine (p < 0.001), intact parathyroid hormone (p < 0.001) were higher and phosphate (p < 0.001), was lower in patients than healthy subjects. Patients with a log₁₀ sclerostin of >3.84 pg/mL had higher FT-T (p = 0.040), FT-Z, FN-T (p = 0.018), FN-Z (p = 0.006) than those with a log₁₀ sclerostin of ≤3.84 pg/mL. There was a significant correlation between log₁₀ sclerostin and FN-T (r = −0.296, p = 0.009) and FN-Z (r = −0.269, p = 0.019). In linear regression analysis, high sclerostin was found to be correlated with male gender, lower FN-T and lower FN-Z independently of other risk factors.ConclusionThe levels of sclerostin can predict reduction of proximal femur BMD and development of mineral and bone disorder in RTRs. There was no difference in sclerostin levels between RTRs and healthy individuals.     

Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension

Background and study aimPortal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension.Patients and methodsIn this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2–4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12 months.ResultsGoligher’s grades of internal haemorrhoids improved significantly (p = 0.018) 12 weeks after SH (from 2.9 ± 0.8 to 0.4 ± 0.5; p = 0.001) and after EBL (from 2.8 ± 0.8 to 1.1 ± 0.8; p = 0.001). Symptom (bleeding and prolapse) scores significantly improved 4 weeks after both EBL (from 1.6 ± 0.8 to 0.6 ± 0.8; p < 0.001 and from 1.6 ± 0.9 to 0.5 ± 0.5; p = 0.002, respectively) and SH (from 1.8 ± 0.8 to 0.2 ± 0.4; p = 0.002 and from 1.5 ± 0.9 to 0.2 ± 0.4; p = 0.001, respectively). The differences after 4 weeks between EBL and SH were not significant (p = 0.168 and p = 0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p = 0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH.ConclusionFor portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis.