Effects of rituximab treatment on endothelial dysfunction, carotid atherosclerosis, and lipid profile in rheumatoid arthritis

Increased cardiovascular mortality has been associated with rheumatoid arthritis (RA). There have been reports indicating that tumor necrosis factor blockers may exert favorable but transient effects on lipid profile, flow-mediated vasodilation (FMD) of the brachial artery, and common carotid intima–media thickness (ccIMT) in RA. In this study, we assessed the effects of rituximab on FMD, ccIMT, and lipid profile. Five female RA patients received two infusions of 1000 mg rituximab i.v. High-resolution B-mode ultrasound was used to assess brachial FMD and ccIMT. We also determined plasma total cholesterol (TC), HDL-C, LDL-C, and triglyceride (Tg) levels. Assessments were performed at baseline, as well as at weeks 2, 6, and 16 after the first infusion. Rituximab (RTX) treatment resulted in a rapid and sustained improvement in FMD. The mean improvement was 30%, 22%, and 81% at weeks 2, 6, and 16, respectively. RTX had little effect on atherosclerosis within this short period of time; however, we observed 10%, 9%, and 2% decreases in ccIMT at weeks 2, 6, and 16, respectively. RTX therapy resulted in 3–11% decrease in TC, as well as 14–35% increase in HDL-C levels. Two infusions of RTX exerted early and sustained favorable effects on endothelial dysfunction, as well as plasma TC and HDL-C levels. RTX may also decrease ccIMT; however, longer follow-up is needed to assess the prolonged effects of RTX on vascular function and lipid profile in RA patients.     

阿托伐他汀对不同血脂水平的高血压病患者血管内皮功能的影响

目的研究阿托伐他汀对正常血脂和高血脂的高血压病(EH)患者血管内皮功能的影响。方法采用双盲、随机、对照方法，将正常血脂(NC组)和高血脂(HC组)高血压病患者分为他汀治疗组(阿托伐他汀20mg／d，共8周，NC组，n=22；HC组，n=24)和未用药对照组(NC组n=21；HC组，n=24)；运用无创超声检查技术，观察用药前后颈动脉内-中膜厚度(IMT)及肱动脉内皮依赖性舒张功能(FMD)的变化，同时检测血清一氧化氮(NO)及内皮素-1(ET-1)的浓度水平。结果治疗前NC、HC各组IMT值和血清ET-1水平较健康对照组(n=40)明显升高(P＜0．01)，FMD值和NO水平却显著下降(P＜O．01)，IMT、FMD、NO与LDI-C存在着显著的相关性。治疗8周后，NC、HC各组IMT值和ET-1水平明显降低，FMD和NO水平显著上升。与对照组比较，他汀治疗组的IMT、ET-1降低更明显(P＜O．05)，FMD和NO升高更为显著(P＜O．05)。两他汀治疗组的血脂水平较治疗前均明显下降(P＜O．05，P＜O．01)。结论阿托伐他汀治疗正常血脂和高血脂的高血压病患者，可在有效调脂的同时，发挥其非调脂作用，逆转或延迟颈动脉IMT的进程，改善血管内皮功能。     

Comparisons of short- and intermediate-term effects of pitavastatin versus atorvastatin on lipid profiles, fibrinolytic parameter, and endothelial function

We compared short- and intermediate-term effects on lipid profiles, fibrinolytic parameter, and endothelial function between pitavastatin and atorvastatin. Short-term improvement of endothelial function was superior with pitavastatin compared to atorvastatin therapy. Pitavastatin could be a potentially better therapeutic choice for lipid-lowering and early alterations in endothelial function. Our study provides an important basis on which further trials involving larger numbers of patients may be studied prospectively.     

活脉饮对实验性动脉粥样硬化家兔血脂和内皮功能的影响

目的研究活脉饮对动脉粥样硬化的治疗作用。方法2005-03～09对中国医科大学附属第二医院心内科通过股动脉内皮剥脱术和高胆固醇喂养的方法建立的兔动脉粥样硬化模型,观察活脉饮治疗后动脉粥样硬化斑块的范围、血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)及内皮素(ET)、一氧化氮(NO),并与单纯高脂组、辛伐他汀组比较。结果活脉饮高剂量组[12g/(kg·d)]斑块范围较单纯高脂组明显减小(P<0.01),与辛伐他汀组比较差异无显著性(P>0.05),活脉饮低剂量组[g/(kg·d)]与单纯高脂组相比差异无显著性(P>0.05);活脉饮治疗组与辛伐他汀治疗组相比,高活脉饮治疗组的TG与之相当,TC和LDL-C高于辛伐他汀治疗组,但未达到统计学意义。低活脉饮治疗组的TC和LDL-C较辛伐他汀治疗组明显升高(P<0.05),TG亦高于辛伐他汀治疗组,但无统计学意义。与高活脉饮治疗组相比,低活脉饮治疗组TG、TC和LDL-C均较高,但只有LDL-C具有统计学意义(P<0.05)。与高脂饮食组相比,正常饮食组、辛伐他汀治疗组、高活脉饮治疗组和低活脉饮治疗组的NO均较高,但只有高活脉饮治疗组具有统计学意义(P<0.01);上述各组的ET均显著低于高脂饮食组(P<0.01)。活脉饮治疗组与辛伐他汀治疗组相比,NO和ET均有所增高,但无统计学意义。高活脉饮治疗组和低活脉饮治疗组相比前者NO较高且ET较低,但均无统计学意义。结论活脉饮能降低实验性动脉粥样硬化家兔血清TG、TC和LDL-C,改善血脂代谢紊乱,且呈一定程度的剂量依赖性。活脉饮能升高实验性动脉粥样硬化家兔血液中NO,降低ET,且呈剂量依赖性,对血管内皮细胞功能有保护作用。     

Differential effects of short-term lipid lowering with ezetimibe and statins on endothelial function in patients with CAD: clinical evidence for 'pleiotropic' functions of statin therapy.

AIMS: Statin therapy is associated with improved endothelial vasodilator function. The clinical availability of ezetimibe, a potent novel cholesterol absorption inhibitor, enables to differentiate lipid-lowering effects from potential non-lipid-lowering (pleiotropic) mechanisms of statins. METHODS AND RESULTS: Forearm blood flow (FBF) responses to acetylcholine (ACH) and sodium nitroprusside (SNP) were measured by venous occlusion plethysmography in four prospectively defined groups of patients with stable coronary artery disease (CAD) before and after 4 weeks of lipid-lowering therapy. Group A (n=15): de novo monotherapy with 10 mg/day ezetimibe; Group B (n=15): 10 mg/day ezetimibe as an add-on to chronic simvastatin therapy with 20 mg/day; Group C (n=15): dose escalation from chronic 10 to 40 mg/day atorvastatin; and Group D (n=15): de novo monotherapy with 40 mg/day atorvastatin. After 4 weeks of therapy, LDL cholesterol levels were significantly reduced in all four groups. Neither ezetimibe monotherapy (Group A) nor ezetimibe combined with 20 mg simvastatin (Group B) was associated with an increase in ACH-mediated FBF responses after 4 weeks. In contrast, dose escalation of atorvastatin from 10 to 40 mg/day (Group C) or de novo therapy with 40 mg atorvastatin/day (Group D) was associated with a significant increase in ACH-mediated FBF responses (P<0.013). CONCLUSION: Thus, both statins and ezetimibe effectively lower LDL-levels within 4 weeks of therapy. However, only statin therapy is associated with improved endothelial vasodilator function, disclosing the relevance of pleiotropic effects of statins during short-term treatment of patients with CAD.     

纳豆激酶对动脉粥样硬化家兔凝血和纤溶功能的影响

目的:观察家兔口服纳豆激酶(NK)对血液凝血和纤溶功能的影响.方法:32只新西兰白兔随机分为4组,每组8只,包括空白对照组(A组)、模型组(B组)、低剂量NK组(C组)和高剂量NK组(D组),常规高脂饮食构建动脉粥样硬化模型.采用凝固法测定血浆凝血酶原(PT)、部分凝血活酶时间(APTT)和凝血因子Ⅰ(Fg)浓度;ELISA法测定血液纤溶酶原激活剂(tPA)和纤溶酶原激活剂抑制物(PAI-1)浓度、RT-PCR法检测主动脉组织tPA和PAl-1 mRNA的表达、免疫组化法检测主动脉组织PAI-1蛋白表达.结果:与A组相比,B组的PT明显缩短,C、D组的APTT明显延长,Fg含量明显下降(P＜0.01),以D组更明显;D组的tPA浓度明显增加[(0.91±0.17):(1.25±0.23)μg/L,P＜0.05],B组的PAI-1显著增加[(2.00±0.45):(2.75±0.84)pg/L,P＜0.05];C、D组的tPA mRNA表达较B组明显增加(分别为1.22±0.23和1.33±0.16:0.64±0.10,P＜0.01),PAI-1 mRNA则显著减少(分别为1.34±0.17和1.31±0.09:1.90±0.18,P＜0.01);免疫组化染色显示A组、B组、C组和D组的单位面积动脉内膜及中膜PAI-1阳性染色标记物的平均A值分别为(155.86±28.19)、(190.49±19.80)、(148.52±9.86)和(138.80±3.13),P＜0.05或P＜0.01.结论:NK可明显提高血液纤溶活性、降低凝血活性,显著增加动脉硬化组织tPA mRNA的表达、减少PAI-1 mRNA和蛋白的表达.     

The effect of garlic on lipid profile and glucose parameters in diabetic patients: A systematic review and meta-analysis

Purpose

Several studies have been published about the effect of garlic on lipid profile and blood glucose in diabetic patients. Which, the results mostly contradict with each other. This study aimed to investigate the effect of garlic on lipid profile and serum glucose levels in diabetic patients using a systematic review and meta-analysis.

血脂和内皮功能异常在微血管性心绞痛发病学中的意义

目的　研究血脂紊乱和血管内皮功能失调在微血管性心绞痛患者发病学中的意义。方法　测定 2 1例微血管性心绞痛患者血脂水平并同时采用高分辨超声技术检测其血管内皮舒张功能 ,与 2 4例正常人 (对照组 )作比较。结果　 (1 )微血管性心绞痛组血脂异常主要表现为总胆固醇(TC)、低密度脂蛋白 胆固醇 (LDL C)、载脂蛋白B1 0 0 (ApoB1 0 0 )和脂蛋白 (a) [Lp(a) ]明显升高 (P值均 <0 0 5 ) ;(2 )微血管性心绞痛组肱动脉血流介导性内皮舒张功能较对照组明显减退 [(4 7± 1 9) %比(1 2 8± 3 7) %,P <0 0 0 1 ],而两组对硝酸甘油的反应差异无显著性意义 [(1 9 7± 8 1 ) %比 (2 1 2±6 6 ) %,P >0 0 5 ];(3 )微血管性心绞痛组肱动脉内皮依赖性舒张与血清LDL C和Lp(a)水平呈显著的负相关 (r=- 0 5 1 2 5和 - 0 42 71 ,P均 <0 0 0 1 )。按血流介导的肱动脉舒张程度将两组合并后分为A、B两组 (A组≤ 4 %,B组 >4 %) ,结果显示 :A组LDL C水平升高显著 [(4 0 9± 0 6 5 )mmol/L比 (2 5 9± 0 49)mmol/L ,P <0 0 5 ]。结论　 (1 )微血管性心绞痛患者血脂异常以TC、LDL C、ApoB1 0 0 和Lp(a)升高为主 ,同时存在明显的血管内皮依赖性舒张功能障碍 ,提示血脂紊乱和内皮功能异常在其发病中起重要作用 ;(2     

氨氯地平/阿托伐他汀复方制剂对初发高血压伴边缘血脂异常患者血管内皮功能的影响

目的观察氨氯地平/阿托伐他汀复方制剂对初发高血压合并边缘高胆固醇血症患者的血管内皮和动脉壁功能与解剖,以及Framingham心血管发病风险的影响。方法前瞻性入选2012年2¹2月在北京大学第三医院心内科门诊就诊的57例初发112月在北京大学第三医院心内科门诊就诊的57例初发1²级高血压合并边缘高胆固醇血症的患者,予以氨氯地平/阿托伐他汀钙片5 mg/10 mg治疗,剔除治疗4周后血压仍≥140/90 mmHg的患者,最终40例患者入选。观察治疗对血压及常规生化指标、双侧颈动脉内膜中层厚度、肱踝脉搏波速度及踝臂指数和血管内皮功能标志物一氧化氮(NO)、一氧化氮合酶(eNOS)和内皮素1水平的影响。结果患者年龄262级高血压合并边缘高胆固醇血症的患者,予以氨氯地平/阿托伐他汀钙片5 mg/10 mg治疗,剔除治疗4周后血压仍≥140/90 mmHg的患者,最终40例患者入选。观察治疗对血压及常规生化指标、双侧颈动脉内膜中层厚度、肱踝脉搏波速度及踝臂指数和血管内皮功能标志物一氧化氮(NO)、一氧化氮合酶(eNOS)和内皮素1水平的影响。结果患者年龄26⁶5岁,平均(48.5±9.5)岁,男性25例(62.5%)。1级高血压患者30例(75%),2级10例(25%)。与基线相比,氨氯地平/阿托伐他汀5 mg/10 mg复方制剂治疗12周和24周时的收缩压[(127.54±10.02)mmHg和(124.21±9.50)mmHg比(141.74±11.64)mmHg,均为P<0.01],舒张压[(77.50±10.78)mmHg和(75.16±8.23)mmHg比(89.63±6.12)mmHg,P=0.02,0.00],TC[(4.17±0.64)mmol/L和(4.37±0.66)mmol/L比(5.46±0.69)mmol/L,均为P<0.01],LDL-C[(2.46±0.57)mmol/L和(2.47±0.58)mmol/L比(3.46±0.66)mmol/L,均为P<0.01],TG[(1.57±0.77)mmol/L和(1.62±0.90)mmol/L比(2.04±1.50)mmol/L,P=0.07,0.01],高敏C反应蛋白[(2.14±2.11)mg/L和(2.11±1.36)mg/L比(4.17±3.18)mg/L,P=0.03,0.00]均有明显下降。随治疗时间的延长(0周,4周,12周,24周),血清NO[(19.00±1.57)nmol/ml,(20.78±1.35)nmol/ml,(22.67±1.37)nmol/ml,(25.23±1.42)nmol/ml],eNOS[(17.70±1.67)U/ml,(19.04±1.19)U/ml,(24.06±1.68)U/ml,(25.61±1.70)U/ml]水平逐渐升高,内皮素1[(94.73±3.74)pg/ml,(87.74±0.56)pg/ml,(76.89±8.15)pg/ml,(66.71±8.39)pg/ml]水平逐渐下降,各时间点间差异有统计学意义(均为P<0.01)。治疗24周时颈动脉内膜中层厚度[右侧:(0.71±0.15)mm比(0.83±0.22)mm,P<0.01;左侧:(0.76±0.18)mm比(0.84±0.23)mm,P=0.02],肱踝脉搏波速度[右侧:(1 319±241)m/s比(1 572±295)m/s,P<0.01;左侧:(1 316±208)m/s比(1 574±256)m/s,P<0.01]较基线值也有显著下降,但双侧踝臂指数没有明显改变。此外,治疗24周后,再次评估Framingham 10年心血管病风险显著下降(5.8%±6.5%比10.0%±10.1%,P<0.01)。结论初发165岁,平均(48.5±9.5)岁,男性25例(62.5%)。1级高血压患者30例(75%),2级10例(25%)。与基线相比,氨氯地平/阿托伐他汀5 mg/10 mg复方制剂治疗12周和24周时的收缩压[(127.54±10.02)mmHg和(124.21±9.50)mmHg比(141.74±11.64)mmHg,均为P<0.01],舒张压[(77.50±10.78)mmHg和(75.16±8.23)mmHg比(89.63±6.12)mmHg,P=0.02,0.00],TC[(4.17±0.64)mmol/L和(4.37±0.66)mmol/L比(5.46±0.69)mmol/L,均为P<0.01],LDL-C[(2.46±0.57)mmol/L和(2.47±0.58)mmol/L比(3.46±0.66)mmol/L,均为P<0.01],TG[(1.57±0.77)mmol/L和(1.62±0.90)mmol/L比(2.04±1.50)mmol/L,P=0.07,0.01],高敏C反应蛋白[(2.14±2.11)mg/L和(2.11±1.36)mg/L比(4.17±3.18)mg/L,P=0.03,0.00]均有明显下降。随治疗时间的延长(0周,4周,12周,24周),血清NO[(19.00±1.57)nmol/ml,(20.78±1.35)nmol/ml,(22.67±1.37)nmol/ml,(25.23±1.42)nmol/ml],eNOS[(17.70±1.67)U/ml,(19.04±1.19)U/ml,(24.06±1.68)U/ml,(25.61±1.70)U/ml]水平逐渐升高,内皮素1[(94.73±3.74)pg/ml,(87.74±0.56)pg/ml,(76.89±8.15)pg/ml,(66.71±8.39)pg/ml]水平逐渐下降,各时间点间差异有统计学意义(均为P<0.01)。治疗24周时颈动脉内膜中层厚度[右侧:(0.71±0.15)mm比(0.83±0.22)mm,P<0.01;左侧:(0.76±0.18)mm比(0.84±0.23)mm,P=0.02],肱踝脉搏波速度[右侧:(1 319±241)m/s比(1 572±295)m/s,P<0.01;左侧:(1 316±208)m/s比(1 574±256)m/s,P<0.01]较基线值也有显著下降,但双侧踝臂指数没有明显改变。此外,治疗24周后,再次评估Framingham 10年心血管病风险显著下降(5.8%±6.5%比10.0%±10.1%,P<0.01)。结论初发1²级高血压患者接受联合降压调脂治疗,可能有助于改善血管内皮功能,延缓动脉粥样硬化进展。     

阿托伐他汀对扩张型心肌病患者心功能及心率变异性的影响

目的 :观察阿托伐他汀对扩张型心肌病 (DCM )患者心功能及心率变异性的影响。方法 :选择 4 5例DCM患者 ,随机分为常规治疗组 (2 2例 )及阿托伐他汀治疗组 (2 3例 ) ,后者在常规治疗基础上合用阿托伐他汀10mg/d ,疗程 12周。采用心脏彩色多普勒超声测定左室射血分数 (LVEF)、左室收缩末期容量指数 ,动态心电图测定心率变异性 ,同时测定血浆丙二醛、一氧化氮 (NO)、肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )及基质金属蛋白酶 9(MMP 9)。结果 :阿托伐他汀使血浆丙二醛、TNF α、IL 6及MMP 9明显降低 ,NO增加 (P <0 .0 1) ,LVEF增加、左室收缩末期容量指数降低 (P <0 .0 5 ) ,正常R R间期标准差 (SDNN)、低频成分增加 (P <0 .0 1)。LVEF增加与NO增加不相关 (r =0 .2 7,P >0 .0 5 ) ,与丙二醛、TNF α、IL 6及MMP 9降低呈负相关 (r =- 0 .4 0 ,- 0 .4 6 ,- 0 .4 8,- 0 .4 3,P <0 .0 5 )。SDNN增加与LVEF增加呈正相关 (r =0 .5 7,P <0 .0 1) ,与左室收缩末期容量指数降低呈负相关 (r =- 0 .5 8,P <0 .0 1)。结论 :阿托伐他汀改善DCM患者心功能的同时改善心率变异性 ,心功能改善可能与抗氧化及抗炎有关。     

代谢综合征患者餐后血脂对血管内皮功能的损害及其机制研究

目的 探讨代谢综合征(MS)患者餐后血脂与血管内皮功能损害的关系及其机制.方法 选择36名健康人为正常对照组,73例MS患者分为两组:空腹甘油三酯(TG)正常组(MS1)和空腹TG升高组(MS2).MS符合2004年中华医学会糖尿病学分会提出的诊断标准.收集受试者一般资料,于空腹及脂肪餐后4 h,分别采静脉血测血脂、一氧化氮(NO)、内皮素(ET);分别测血管内皮功能.结果 MS1、MS2在脂肪餐后4 h内皮依赖性血管舒张功能较空腹时明显降低(P<0.05,P<0.01).偏相关分析显示:内皮依赖性血管舒张功能与总胆固醇、TG、低密度脂蛋白-胆固醇呈负相关,偏相关系数依次为-0.41、-0.68、-0.36(P<0.01);与高密度脂蛋白-胆固醇呈正相关,偏相关系数为0.44(P<0.01).结论 (1)餐后血脂代谢紊乱,尤其是TG水平升高与MS患者血管内皮功能损害密切相关.(2)MS患者餐后血脂,特别是TG可能通过直接或间接途径导致血管内皮NO与ET失衡,从而引起血管内皮功能的损害.     

Differential effects of low-carbohydrate and low-fat diets on inflammation and endothelial function in diabetes

Objective

To characterize acute (postprandial) and chronic (after a 6-month period of weight loss) effects of a low-carbohydrate vs. a low-fat diet on subclinical markers of cardiovascular disease (CVD) in adults with type 2 diabetes.

Design

At baseline and 6 months, measures of C-reactive protein (CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule (sICAM) and soluble E-selectin were obtained from archived samples (n=51) of participants randomized in a clinical trial comparing a low-carbohydrate and a low-fat diet. In a subset of participants (n=27), postprandial measures of these markers were obtained 3 h after a low-carbohydrate or low-fat liquid meal. Endothelial function was also measured by reactive hyperemic peripheral arterial tonometry during the meal test. Paired t tests and unpaired t tests compared within- and between-group changes.

Results

There were no significant differences observed in postprandial measures of inflammation or endothelial function. After 6 months, CRP (mean±S.E.) decreased in the low-fat arm from 4.0±0.77 to 3.0±0.77 (P=.01). In the low-carbohydrate arm, sICAM decreased from 234±22 to 199±23 (P=.001), and soluble E-selectin decreased from 93±10 to 82±10 (P=.05.) A significant correlation between change in high-density lipoprotein and change in soluble E-selectin (r=−0.33, P=.04) and with the change in ICAM (r=−0.43, P=.01) was observed.

Conclusions

Low-carbohydrate and low-fat diets both have beneficial effects on CVD markers. There may be different mechanisms through which weight loss with these diets potentially reduces CVD risk.     

The relationship between lipid profile and severity of liver damage in cirrhotic patients

Background and Aims

An impaired lipid metabolism is often observed in patients with chronic liver diseases. To determine lipid profile in patients with cirrhosis and to asses if it relates to the severity of the cirrhosis.

Materials and Methods

In an analytical cross-sectional study, 50 patients with cirrhosis (case) and 50 age- and sex matched healthy normolipidemic patients (comparison) were studied. A questionnaire including personal characteristics,etiology of cirrhosis, pathologic criteria of CHILD and MELD and lipid profile (total, LDL, and HDL cholesterol and triglyceride) was completed for each patient.

Results

In patients with cirrhosis, there was a significant decrease in serum triglyceride, total, LDL and HDL cholesterol levels compared to the comparison group (mean of 82 vs 187, 138 vs 184, 80 vs 137, and 40 vs 44 mg/dL, respectively; all p<0.05). Comparison of lipid profile with pathologic progression of cirrhosis revealed that except for serum triglyceride level, serum lipid levels diminishe linearly with progression of liver damage.

Conclusions

Serum total, LDL and HDL cholesterol level in patients with cirrhosis is inversely correlate with severity of cirrhosis.     

The impact of systemic sclerosis on arterial wall stiffness parameters and endothelial function

Systemic sclerosis (SSc) is characterized by thickening and fibrosis of skin and internal organs that is associated with vascular damage. SSc may lead to arterial dysfunction and premature aging of the arteries. However, its relationship with parameters of arterial wall dysfunction has not been fully explored. To determine if carotid–radial pulse wave velocity (PWV), aortic augmentation index (AIx) and endothelial function are altered in SSc patients, 17 consecutive patients with SSc and 34 age- and gender-matched controls were included in our study. PWV and AIx were assessed non-invasively by applanation tonometry. The endothelium-dependent flow-mediated dilatation (FMD) test in a brachial artery was performed by the ultrasound system. The blood investigations included serum lipid profile, glucose, and high-sensitivity CRP (hsCRP) measurements. As compared to controls, SSc patients had significantly higher medians of the AIx (p = 0.002) and the PWV (p = 0.04) and the median of the FMD was significantly lower (p = 0.001). Stepwise linear regression including comorbid factors showed that SSc was a significant independent predictor of all arterial wall parameters measures. SSc patients have increased AIx and PWV and lower FMD as compared to control subjects. The relationship between SSc and measures of arterial wall parameters still remains unclear. Though replication of the results presented here is required, we conclude that SSc has a great impact on large and conduit arteries damage.     

Effect of atorvastatin on plasma levels of asymmetric dimethylarginine in patients with non-ischaemic heart failure

BACKGROUND: Elevated plasma levels of asymmetric dimethylarginine (ADMA), an endothelial nitric oxide synthase (eNOS) inhibitor, may contribute to endothelial dysfunction in chronic heart failure (CHF). Since statins upregulate eNOS and ameliorate endothelial dysfunction in non-ischaemic CHF, we hypothesized that this may be in part through modification of ADMA. AIM: To evaluate the effect of atorvastatin on the relationship between ADMA and endothelial function in non-ischaemic CHF. METHODS: Twenty-four patients with CHF (ejection fraction <40%, New York Heart Association Functional Classes II and III) were randomised to atorvastatin treatment (40 mg) or placebo once daily for 6 weeks in a double-blinded, placebo-controlled crossover study. Plasma ADMA and l-arginine levels were measured by HPLC. Endothelial function was assessed by flow-mediated dilatation and invasive forearm plethysmography. RESULTS: Post-statin therapy, endothelial function was improved (p<0.05) independent of LDL-cholesterol reductions, but no changes were observed in ADMA levels or the l-arginine to ADMA ratio. There was a trend for ADMA to inversely correlate with endothelial function at baseline. CONCLUSIONS: Short-term atorvastatin treatment in non-ischaemic CHF improves endothelial function but has no effect on ADMA or the l-arginine to ADMA ratio. Our finding suggests that the observed statin-induced improvements in endothelial function are likely mediated via alternative pathways.     

厄贝沙坦氢氯噻嗪片对老年高血压患者血管内皮功能的短期影响

目的 评价厄贝沙坦氢氯噻嗪片对老年高血压患者血管内皮功能的短期影响.方法 选择轻、中度原发性高血压患者106例,分为氢氯噻嗪组50例及厄贝沙坦氢氯噻嗪组56例,两组患者每日晨起分别口服氢氯噻嗪片25 mg及厄贝沙坦氢氯噻嗪片1片,连续12周,检测治疗前后患者的血压、血生化、高敏C反应蛋白（hs-CRP）、血管性血友病因子（vWF）等指标,以及肱动脉内皮依赖性舒张功能（EDD）和颈动脉内膜中层厚度（IMT）的变化.结果 与治疗前比较,氢氯噻嗪组患者治疗后收缩压、舒张压、血钾明显降低（P ＜0.05或P＜0.01）,尿酸明显升高（P＜0.01）,治疗前后vWF、EDD、IMT比较差异无统计学意义（P＞0.05）;厄贝沙坦氢氯噻嗪组患者治疗后收缩压、舒张压、hs-CRP及vWF均明显降低（P＜0.05或P＜0.01）,EDD明显提高（P＜0.05）,治疗前后IMT比较差异无统计学意义（P＞0.05）.两组患者治疗后比较,vWF、EDD比较差异有统计学意义（P＜0.05）.结论 老年轻、中度原发性高血压患者的血管内皮功能的损伤可以逆转,厄贝沙坦氢氯噻嗪片在降压同时可以改善受损的血管内皮功能.     

丹红注射液对动脉粥样硬化家兔脂代谢及血管内皮功能的影响

目的观察丹红注射液对动脉粥样硬化(AS)家兔模型脂代谢及血管内皮功能的影响,探讨丹红注射液抗AS作用及可能机制。方法36只新西兰雄性白兔随机均分为正常对照组、高胆固醇组(HC组)、高胆固醇加氟伐他汀组(FC组)和高胆固醇加丹红注射液组(DC组);组织形态学分析AS斑块/内膜面积比值及斑块最厚处内膜厚度/中膜厚度比值;酶法检测血脂;酶法测定血清一氧化氮(NO)和血浆内皮素(ET)水平。结果DC组与HC组比较,血清TC、LDL-C明显降低(P<0.05);血管AS病变显著减轻(P<0.05),血清NO水平显著增高(P<0.05);血浆ET水平显著降低(P<0.05)。结论丹红注射液对实验性AS具有抑制作用,其作用机制可能为①降低血清TC和LDL-C水平,延缓AS斑块的形成;②调节血管内皮细胞生成和释放NO、ET,保护血管内皮细胞功能,进而产生抗AS作用。     

High sensitivity C-reactive protein and endothelial function in Chilean patients with history of Kawasaki disease

Kawasaki disease (KD) produces endothelial inflammation, which may lead to dilatation and aneurysms of coronary and peripheral arteries. Previous studies have suggested that these patients can present endothelial dysfunction that can predispose to coronary vascular events late after KD. The purpose of this study was to determine the cardiovascular risk profile and endothelial function of Chilean children with history of KD. In a prospective case-control study, 11 patients with history of KD (age 10.6 +/- 2.0 years, interval from initial episode 8.1 +/- 3.6 years) and 11 healthy, age-, gender-, and BMI z score-matched controls were evaluated with blood pressure (BP), a fasting lipid profile, high sensitivity C-reactive protein (hsCRP), and flow-mediated dilatation of the brachial artery (FMD). One KD patient (9.1%) had persistent coronary aneurysms. There was a significant difference of mean and log-transformed concentrations of hsCRP between case and control groups (2.3 +/- 3.0 vs 0.5 +/- 0.3 mg/l, P = 0.045). None of the patients with elevated hsCRP had persistent coronary arterial lesions. No difference was found in systolic BP z score between the case and control groups. Diastolic BP z score was significantly higher in cases than controls (P = 0.039). There were no significant differences of FMD between cases and controls. Mean fasting total cholesterol, high-density and low-density lipoprotein, and triglycerides in cases were normal, with no significant difference vs controls. This study shows that Chilean children with history of KD have increased levels of hsCRP, possibly reflecting persistent low-grade inflammation. The prognostic value of hsCRP in KD patients deserves further investigation.     

The effects of green coffee bean extract supplementation on lipid profile in humans: A systematic review and meta-analysis of randomized controlled trials

Background and aimThis systematic review and meta-analysis aimed to assess the effects of green coffee bean extract (GCBE) supplementation on lipid profile in adults.Methods and resultsThe PubMed/Medline, Scopus, Web of sciences, and Google Scholar were systematically searched for randomized controlled trials available in English and published before February 2019. The meta-analysis was conducted using fixed effects models, and between-study heterogeneity was assessed by Cochran's Q test and I². A total of 17 effect sizes were included in the meta-analysis. Combined effect sizes on serum total cholesterol concentrations revealed significant effects of GCBE supplementation on serum total cholesterol [weighted mean difference (WMD): −4.51 mg/dL, 95% confidence interval (CI): −6.89, −2.12, p < 0.001], low density lipoprotein-cholesterol (LDL-C) (WMD: −4.38 mg/dL, 95% CI: −6.44, −2.31, p < 0.001), and high density lipoprotein-cholesterol (HDL-C) (WMD: 2.63 mg/dL, 95% CI: 2.20, 3.07, p < 0.001) compared to controls. Nevertheless, no significant changes were observed in serum triglycerides levels (WMD: −4.34 mg/dL, 95% CI: −9.00, 0.32, p = 0.068).ConclusionThe evidence from available studies suggests that the GCBE supplementation leads to significant reductions in total cholesterol, HDL-C, and LDL-C levels, and has modest, but, non-significant effects on triglycerides levels.