High prevalence of apolipoprotein B dyslipoproteinemias in non-alcoholic fatty liver disease: The lifelines cohort study

ObjectiveCardiovascular disease (CVD) is a major adverse consequence of non-alcoholic fatty liver disease (NAFLD). The association of NAFLD with various apolipoprotein B (apoB) dyslipoproteinemias is unclear. We determined the prevalence of specific apoB dyslipoproteinemias in subjects with suspected NAFLD.MethodsThis study was conducted among 22,865 fasting adults living in the northern part of the Netherlands (Lifelines Cohort Study). Six apoB dyslipoproteinemias were defined using an algorithm derived from apoB, total cholesterol and triglycerides. NAFLD was defined as Fatty Liver Index (FLI) ≥ 60. Advanced hepatic fibrosis was defined as NAFLD fibrosis score (NFS) ≥ 0.676.Results4790 participants (20.9%) had an FLI ≥ 60. NAFLD subjects were older, more likely to be men, more obese and more often had diabetes and metabolic syndrome (P < 0.001 for each). Among NAFLD subjects, any apoB dyslipoproteinemia was present in 61.5% vs. 16.5% in subjects without NAFLD (P < 0.001). Elevated chylomicrons were not observed in NAFLD. In univariate analysis, NAFLD was associated with a higher prevalence of each apoB dyslipoproteinemia vs. subjects with an FLI < 60 (P < 0.001), except for low density lipoprotein (LDL) dyslipoproteinemia. Additionally, each apoB dyslipoproteinemia was independently associated with NAFLD in age- and sex-adjusted logistic regression analysis, including the apoB dyslipoproteinemias together (P < 0.001). The prevalence of apoB dyslipoproteinemias was not altered in subjects with NFS ≥ 0.676.ConclusionsNAFLD rather than advanced hepatic fibrosis is independently associated with increased prevalence of chylomicrons + very low-density lipoproteins (VLDL) remnants, VLDL, LDL and VLDL + LDL dyslipoproteinemias. ApoB dyslipoproteinemias may contribute to increased CVD risk associated with NAFLD.     

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.     

Effect of cardiovascular autonomic neuropathy (CAN) on left ventricular function in normotensive type 1 diabetic patients: A study by pulsed wave tissue Doppler echocardiography

Background and aimPatients with diabetes mellitus are at increased risk for cardiovascular diseases. Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes, as it can contribute in the pathogenesis of diabetic cardiomyopathy (DCM) and has been weakly linked with left ventricular diastolic dysfunction. Our aim was to investigate the effect of presence or absence of cardiovascular autonomic neuropathy (CAN) on systolic and diastolic LV function in normotensive type 1 diabetic patients by using both conventional and tissue Doppler echocardiography.Subjects and methodsFifty two type 1 diabetic patients entered this study. They were divided into two groups. The first group included 24 patients with evidence of cardiovascular autonomic neuropathy. The second group included 28 patients without evidence of cardiovascular autonomic neuropathy. In addition to 18 healthy normal weights non diabetic subjects as a control group. Complete clinical examination, routine laboratory investigations, lipid profile, urinary albumin excretion, HbA1c and 12 leads ECG were done to all participants. Conventional and tissue Doppler indices of systolic and diastolic left ventricular function were recorded.ResultsHeart rate was significantly higher in diabetic patients with CAN compared to both diabetic patients without CAN and normal control subjects (P < 0.001, <0.001, respectively). Glycemic control as assessed by HbA1c was more worse in diabetic patients with CAN compare to diabetic patients without CAN (P < 0.001). As regard conventional echo-Doppler, there were a significant difference in A wave velocity and E/A ratio in diabetic patients with or without CAN compared to control (P < 0.001, <0.001, <0.001, <0.001, respectively). Tissue Doppler indices show a significant difference at the lateral annular side in Em and Am velocity and Em/Am ratio in diabetic patients with or without CAN vs. control (P < 0.001, <0.001, <0.001, <0.05, <0.05, <0.01, respectively) and also, between diabetic patients with CAN vs. diabetic patients without CAN (P < 0.001, <0.05, <0.01, respectively). Also, tissue Doppler indices show a significant difference at the septal annular side in Em and Am velocity and Em/Am ratio in diabetic patients with or without CAN vs. control (P < 0.001, <0.001, <0.001, <0.01, <0.05, <0.05, respectively) and also, between diabetic patients with CAN vs. diabetic patients without CAN (P < 0.001, <0.05, <0.01, respectively). Contrary to that, no significant differences were found in LV systolic function parameters measured by either conventional or tissue Doppler imaging among the three groups.ConclusionOur results demonstrated that, LV diastolic function was impaired in normotensive type 1 diabetic patients and, the presence of CAN is associated with more deterioration in diastolic function. Systolic function is seems to be unaffected. TDI should be the preferred modality in evaluation of LV function as it can detect minimal changes in diastolic function much earlier than conventional echo-Doppler.     

Sarcopenia is associated with non-alcoholic fatty liver disease in men with type 2 diabetes

AimsRecent epidemiological studies have suggested an association between sarcopenia and non-alcoholic fatty liver disease (NAFLD) in the general population, prompting our investigation into the gender-specific association between sarcopenia and NAFLD in patients with type 2 diabetes mellitus (T2DM).MethodsIn this cross-sectional study, 4210 patients with T2DM were recruited from the Seoul Metabolic Syndrome Cohort. Appendicular skeletal muscle mass (ASM) was estimated from bioimpedance analysis measurements, and the skeletal muscle mass index (SMI) was calculated by dividing the sum of ASM by body weight. Sarcopenia was defined as a gender-specific SMI value > 2 standard deviations (SDs) below the mean for healthy young adults. NAFLD was defined as the presence of hepatic steatosis on ultrasonography with no other causes of chronic liver disease.ResultsAmong the entire study population (mean age: 57.4 ± 10.8 years), 1278 (30.4%) had NAFLD and 1240 (29.5%) had sarcopenia, and the prevalence of NAFLD was significantly higher in those with sarcopenia: 46.2% vs 25.1% (P < 0.001) in men; 38.3% vs 25.4% (P < 0.001) in women. Sarcopenia was significantly associated with higher risk of NAFLD in men (adjusted odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.15–2.17), whereas the association was attenuated in women after adjusting for clinical risk factors.ConclusionSarcopenia is independently associated with NAFLD in men with T2DM, which suggests that sarcopenia may be a risk factor for NAFLD in men with T2DM.     

Resultados intrahospitalarios tras tratamiento percutáneo frente a quirúrgico en pacientes con estenosis aórtica y enfermedad arterial coronaria concomitante

Introduction and objectivesConcomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD.MethodsUsing discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission.ResultsMatching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P < .001) as was periprocedural stroke (0.9% vs 2.2%; P = .004), acute kidney injury (4.3% vs 16.0%, P < .001), blood transfusion (9.6% vs 21.1%, P < .001), and hospital-acquired pneumonia (0.1% vs 1.7%, P = .001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P < .001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P < .001) and SAVR/CABG (8.3 vs 6.8%, P < .001). Thirty-day cardiovascular readmission did not differ between groups.ConclusionsIn this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.     

Low 25-hydroxyvitamin D level is independently associated with non-alcoholic fatty liver disease

Background and aimsWe sought to explore associations between serum 25-hydroxyvitamin D [25(OH)D] levels and non-alcoholic fatty liver disease [NAFLD] in an integrated healthcare delivery system in the U.S.Methods and resultsSix hundred and seven NAFLD cases were randomly matched 1:1 with controls for age, sex, race and season of measurement. Conditional logistic regression was used to evaluate if serum 25(OH)D levels were associated with increased odds of NAFLD (diagnosed by ultrasound) after adjusting for body mass index and history of diabetes, renal, peripheral vascular and liver diseases (model 1) and also for hypertension (model 2). Mean (SD) serum 25(OH)D level was significantly lower in the group with NAFLD as compared with that in the matched control group (75 ± 17 vs. 85 ± 20 nmol/L [30 ± 7 vs. 34 ± 8 ng/mL], P < 0.001). Inadequate 25(OH)D status progressively increased the odds of NAFLD when classified categorically as sufficient (25(OH)D 75 nmol/L [>30 ng/mL], reference group), insufficient (37–75 nmol/L [15–30 ng/mL]; adjusted odds ratio [OR]: 2.40, 95% confidence interval [CI]: 0.90–6.34) or deficient (<37 nmol/L [<15 ng/mL]; adjusted OR: 2.56, 95% CI: 1.27–5.19). When modeled as a continuous variable, increased log₁₀ 25(OH)D was inversely associated with the risk of prevalent NAFLD (adjusted OR: 0.25, 95% CI: 0.064–0.96, P = 0.02).ConclusionCompared with matched controls, patients with NAFLD have significantly decreased serum 25(OH)D levels, suggesting that low 25(OH)D status might play a role in the development and progression of NAFLD.     

Prognostic value of cystatin C in relation to other markers of renal function in early prediction of hospital mortality and major cardiac adverse events in patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

IntroductionCystatin C has been implicated as a prognostic marker in cardiovascular diseases. The aim of prospective study was to evaluate the benefits of measuring cystatin C for prognostic stratification to predict hospital mortality and the rates of major cardiac adverse events (MACE) in ST elevation myocardial infarction (STEMI) patients and to compare cystatin C to other markers of renal function and Global Registry of Acute Coronary Events (GRACE) score.MethodsA total of 659 consecutive patients (479 men, mean age 65 years) from a prospective study on acute STEMI treated by primary percutaneous coronary intervention (PCI) were evaluated. Standard laboratory tests including cystatin C, troponin T, NT-terminal fragment of brain natriuretic peptide (NT-proBNP), markers of renal function were assessed on admission in all patients. Using c-statistic, the ability of cystatin C, other biomarkers and GRACE score to predict hospital mortality and MACE (acute coronary syndrome recurrence, stroke event, definite in-stent thrombosis and mortality) rate was evaluated.ResultsAll-cause hospital mortality and MACE occurrence were 4% (n = 26) resp. 6.8% (n = 45). Cystatin C, creatinine, urea, glomerular filtration rate, troponin T, NT-proBNP and GRACE on admission were identified as significant prognostic risk markers.Serum cystatin C level and GRACE score were significantly higher in non-survivors (1.65 ± 0.91 vs. 0.97 ± 0.41 mg/mL; P < 0.001 resp. 138 ± 43 vs. 99 ± 31; P < 0.001). The area under the curve (AUC) values for mortality and MACE rate prediction for cystatin C and GRACE score were 0.83 and 0.88, respectively 0.66 and 0.72 (all P < 0.001) with optimal cut-off values of 1.3 mg/mL for cystatin C and 136 for GRACE score.Cystatin C above cut-off >1.30 mg/L was associated with the highest adjusted odds ratio (OR) 3.85 (95% confidence interval 2.36–6.38; P < 0.001), and predicted in-hospital mortality with 77% sensitivity and 86% specificity. The addition of cystatin C to the GRACE score (OR 1.05, 95% confidence interval 1.04–1.07; P < 0.001) was not significantly associated with improved risk stratification.ConclusionsCystatin C is a predictor of early outcome comparable with the GRACE score in patients with STEMI.     

Comparing hepatic steatosis distribution patterns between non-alcoholic fatty liver disease and fatty liver disease with chronic hepatitis B by second-harmonic generation/two-photon excited fluorescence method

Introduction and objectivesHepatitis B virus (HBV) might be an etiological factor modulating fat distribution in steatotic livers. We aim to compare hepatic steatosis distribution patterns between NAFLD and FL&CHB patients with second-harmonic generation (SHG)/two-photon excited fluorescence (TPEF) method.Patients and methods42 patients with NAFLD, 46 with FL&CHB and 55 without steatosis were enrolled in the study. Overall and regional steatosis in liver sections were quantified by SHG/TPEF method. The accuracy of which was validated by pathologist evaluation and magnetic resonance spectroscopy (MRS). Difference in degree of overall and regional steatosis between NAFLD and FL&CHB groups was analyzed by Mann–Whitney U test. Multivariable linear regression analysis was used to model factors contributing to steatosis distribution.ResultsThe hepatic steatosis measured by SHG/TPEF method was highly correlated with pathologist grading (r = 0.83, p < 0.001) and MRS measurement (r = 0.82, p < 0.001). The level of overall steatosis in FL&CHB group is significantly lower than that in NAFLD group (p < 0.001). In NAFLD group, periportal region has significantly lower steatosis percentage than lobule region and overall region (p < 0.001); while in FL&CHB group there is no difference among regions. The ratio of steatosis at periportal region to lobule region is significantly higher in FL&CHB group than that in NAFLD group (p < 0.05). Multivariable linear regression analysis shows that HBV infection is the major contributing factor (β = 0.322, p < 0.01).ConclusionsSHG/TPEF method is an accurate and objective method in hepatic steatosis quantification. By quantifying steatosis in different histological regions, we found steatosis distribution patterns are different between FL&CHB and NAFLD patients.     

The impact of intra-aortic balloon counter-pulsation on in-hospital mortality in patients presenting with anterior ST-elevation myocardial infarction without cardiogenic shock

ObjectivesThis study aimed to determine whether the elective insertion of an intra-aortic balloon counter pulsation (IABP) device at the time of myocardial revascularization in patients presenting with an acute anterior ST-elevation myocardial infarction (STEMI) without cardiogenic shock has any impact on the in-hospital rate of cardiac mortality.BackgroundThe role of IABP in patients presenting with an acute MI without cardiogenic shock remains ill defined.MethodsThe present study comprised 605 consecutive patients who underwent primary percutaneous coronary intervention for an anterior STEMI without cardiogenic shock. Patients who received IABP at the time of their coronary revascularization (n = 105) were compared to those who had not (n = 500). Patients with stable angina, unstable angina, non-STEMI, non-anterior STEMI, and cardiogenic shock were excluded.ResultsThe two cohorts were well matched for the conventional risk factors for coronary artery disease. Although the left ventricular ejection fraction was significantly lower in the patients who received IABP (0.32 ± 0.11 vs. 0.39 ± 0.12; P < 0.001), the two cohorts were well matched for history of MI, coronary revascularization, and chronic renal impairment. Following propensity scoring, the in-hospital rate of cardiac death was similar between the two cohorts (5.6% vs. 0%; P = .12) as was the rate of vascular complications. Major bleeding was significantly greater in the IABP cohort (10.0% vs. 0%; P = .01) leading to a greater transfusion requirement (14.9% vs. 2.9%; P = .01).ConclusionThe adjunctive use of an IABP in patients presenting with an acute anterior STEMI without cardiogenic shock may not be associated with an in-hospital mortality benefit.     

Liver transplantation for NASH cirrhosis is not performed at the expense of major post-operative morbidity

BackgroundNon-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation (LT) and coexists with multiple comorbidities. Obese and cirrhotic patients experience more perioperative complications. Limited data exist about short-term complications after LT for NASH cirrhosis.AimInvestigate short-term complications in patients transplanted for NASH cirrhosis.MethodsSingle center retrospective cohort study including patients >18 years who underwent LT between 2009–2015. Exclusion criteria were LT for acute liver failure and non-cirrhotic disease. Post-operative complications and severity within 90-days were classified using the Clavien–Dindo classification of surgical complications and comprehensive complication index (CCI). P < 0.05 was significant.ResultsOut of 169 eligible patients, 34 patients (20.1%) were transplanted for NASH cirrhosis. These patients were significantly older (59.2 vs. 54.8 years, P = 0.01), more obese (61.8% vs. 8.1%, P < 0.01), had more diabetes mellitus (73.5% vs. 20%, P < 0.01), metabolic syndrome (83.3% vs. 37.8%, P < 0.01) and cardiovascular disease (29.4% vs. 11.1%, P < 0.01). More grade 1 complications (OR 1.64, 95%CI 1.03–2.63, P = 0.04) and more grade 2 urogenital infections (OR 3.4, 95%CI 1.1–10.6, P = 0.03) were found. Major complications, CCI, 90-day mortality and graft survival were similar.ConclusionDespite significantly increased comorbidities in patients transplanted for NASH cirrhosis, major morbidity, mortality and graft survival after 90 days were comparable to patients transplanted for other indications.     

Association entre tissu adipeux epicardique et dysfonction systolique infraclinique détectée par strain longitudinal chez les diabétiques mal équilibrés

ObjectiveThe aim of this study is to assess the association between epicardial adipose tissue (EAT) and infraclinical myocardial dysfunction detected by strain imaging in diabetic patients (T2DM) with poor glycemic control.Methods22 patients with T2DM and 22 healthy control subjects of similar age and sex were prospectively recruited. Echocardiographic parameters were investigated.ResultsIn comparison to controls, diabetic patients had significantly higher body mass index (27.7 vs. 24.6; P < 0.01), waist perimeter (103 vs. 84; P < 0.001) and usCRP level (5.4 vs. 1.5; P < 0.01). On echocardiography; no differences were found in terms of ejection fraction or ventricular mass; however, patients with T2DM had significantly thicker EAT (8.7 ± 0.7 vs. 3.0 ± 1.0; P < 0.001) and altered systolic longitudinal strain (−18.8 ± 3.2 vs. 22.3 ± 1.6; P < 0.001). On multivariate analysis, EAT was identified as an independent contributor (β=0,46, P = 0.001) to systolic longitudinal strain.ConclusionIn patients with T2DM and poor glycemic control; EAT was associated with infraclinical systolic dysfunction evaluated by global longitudinal strain despite normal at rest ejection fraction and no coronary artery disease.     

Electrocardiography as a predictor of left main or three-vessel disease in patients with non-ST segment elevation acute coronary syndrome

IntroductionAcute coronary syndrome remains the leading cause of morbidity and mortality worldwide. It will continue to rise as the prevalence of patients with obesity and diabetes increases. Patients with non-ST segment elevation acute coronary syndrome had a bad prognosis in patients with left main ± three vessel diseases, so early identification of these patients by electrocardiography if ST segment elevation in lead aVR ?0.5 m and maximal QRS duration of ?90 ms is important for the selection of optimal treatment.Materials and methodsThe study was designed as a multicenter cross-sectional study that was conducted on 150 patients presenting with non-ST segment elevation acute coronary syndromes, 80 patients had non-ST segment elevation myocardial infarction and 70 patients had unstable angina in the period between January 2009 till January 2010. All patients had full history, clinical examination, laboratory investigations including lipid profile, blood glucose, cardiac Troponin T and renal function, also electrocardiography and coronary angiography was done to prove the diagnosis. ECG was analyzed to assess the degree of ST segment elevation in aVR, ST segment depression in other leads and the maximal QRS was analyzed. Coronary angiography was done to all patients with detection of the presence of left main 50% stenosis at least with or without other three significant coronary vessels showing 70% stenosis or more to be included in 67 patients in group I. Group II include 83 patients with normal coronaries or significant stenosis in one or two vessels.ResultsLeft main coronary stenosis with or without three significant coronary vessel stenosis occurs in 67 patients (44.7%) in group I vs. 83 patients (55.3%) in group II (i.e. without left main disease or three vessel disease). The mean age of the patients 59 ± 9 years which was not significant in both the groups (P > 0.05). The following also were not significant gender, smoking, dyslipidemia, renal impairment, hypertension and positive family history. Diabetes was considered significant in 44 patients (65.7%) in group I in comparison to 34 patients (41%) in group II (P < 0.003). Positive Troponin T was also significant in group I in 47 patients (70.1%) vs. 33 patients (39.8%) in group II. ST segment elevation ?0.5 mm in lead AVR is significant in group I in 52 patients (77.6%) vs. 29 patients (34.9%) in group II (P < 0.001). ST segment depression ?0.5 mm in leads other than aVR is significant in group I in 56 patients (83.6%) vs. 41 patients (49.4%) in group II (P < 0.001). The presence of QRS duration > 90 ms in the admission ECG was significant in group I in 45 patients (67.2%) vs. 16 patients (19.3%) in group II (P < 0.001).ConclusionST-segment elevation in lead aVR ?0.5 mm and QRS duration ?90 ms are good electrocardiographic predictors of left main or three vessel disease in patients with non-ST segment elevation acute coronary syndrome.     

Comparative Effects of Benidipine and Amlodipine on Proteinuria,Urinary 8-OHdG,Urinary L-FABP,and Inflammatory and Atherosclerosis Markers in Early-Stage Chronic Kidney Disease

IntroductionWe examined the effects of 2 calcium channel blockers, benidipine (T-, L-, and N-type) and amlodipine (L- and N-type), on renal, inflammatory, oxidative, and atherosclerosis markers in hypertensive patients with mild chronic kidney disease (CKD).MethodsForty hypertensive patients with CKD were assigned randomly to either of the 2 treatments: 8 mg benidipine once daily (n = 20, group A) or 5 mg amlodipine once daily (n = 20, group B). Treatment was continued for 12 months. Blood pressure, serum creatinine, estimated glomerular filtration rate, urinary protein excretion, urinary liver-type fatty acid-binding protein, interleukin-6, high mobility group box-1 protein, urinary 8-hydroxy-2′- deoxyguanosine, pulse wave velocity, intima-media thickness, and blood asymmetric dimethylarginine were monitored.ResultsBlood pressure decreased equally in both groups (P < 0.001, at 6 and 12 months versus before treatment). Serum creatinine and estimated glomerular filtration rate changed little during the experimental period in each group. However, urinary protein excretion (P < 0.001), urinary liver-type fatty acid-binding protein (P < 0.001), urinary 8-hydroxy-2'-deoxyguanosine (P < 0.001), blood interleukin-6 (P < 0.001), blood high mobility group box-1 (P < 0.5), and pulse wave velocity (P < 0.01) decreased more in group A than in group B with 12 months of treatment. The percent reductions in intima-media thickness and blood asymmetric dimethylarginine were significantly greater in group A than in group B (P < 0.001).ConclusionsBenidipine is more effective than amlodipine for protecting renal function and potentially for ameliorating atherosclerosis in hypertensive patients with mild CKD. T-type calcium channel blockers may be effective in patients with CKD.     

Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study

AimsPropolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated.MaterialsSerial consenting subjects (n = 24) with DFU ≥ 4 week's duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data were compared with a matched control cohort of n = 84 with comparable DFU treated recently at the same center.ResultsUlcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P < 0.001), and by 63 vs. 44% at week 3, respectively (P < 0.05). In addition, 10 vs. 2% (P < 0.001), then 19 vs. 12% (P < 0.05) of propolis treated vs. control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1 vs. 2.8% week 3 from baseline in propolis treated ulcers vs. controls (P < 0.001), as were bacterial counts (P < 0.001). No adverse effects from propolis were reported.ConclusionsTopical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers.     

Associations of symptomatic or asymptomatic peripheral arterial disease with all-cause mortality and cardiovascular mortality

BackgroundTo investigate the rate of all cause and cardiovascular mortality in patients with symptomatic or asymptomatic peripheral arterial disease (PAD) compared to those without PAD.Methods and resultsAll the subjects were inpatients at high risk of atherosclerosis and enrolled from February to November, 2006. A total of 320 were followed up until an end-point (death) was reached or until February 2010. The mean follow-up time was 37.7 ± 1.5 months. Compared with non-PAD, PAD patients had significantly higher rates of hypertension, diabetes mellitus, and smoking (P < 0.01). Those with symptomatic and asymptomatic PAD had a much higher all cause (37.5% and 23.0% vs. 12.1%) and cardiovascular mortality (18.8% and 13.8% vs. 6.7%) compared to those without PAD (P < 0.001). The symptomatic PAD patients were 1.831 times (95% CI: 1.222–2.741) as likely to die as those without PAD, and 1.646 times (95% CI: 1.301–2.083) in asymptomatic PAD patients after adjusting for other factors. Those with symptomatic or asymptomatic PAD were more than twice as likely to die of CVD as those without PAD (RR: 2.248, 95% CI: 1.366–3.698 and RR: 2.105, 95% CI: 1.566–2.831, respectively).ConclusionsPAD was associated with a higher all cause and cardiovascular mortality whether or not PAD is symptomatic.     

Does the preoperative mild renal dysfunction effect mortality and morbidity following valve cardiac surgery?

AimsThe objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD), not requiring dialysis, on mortality and morbidity after valve cardiac surgery (VCS).PopulationWe studied 340 consecutive patients (2008–2012), who underwent VCS with or without coronary artery bypass graft (CABG).MethodsPreoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60 ml/min/1.73 m². Logistic regression analysis was used to assess the effect of preoperative renal dysfunction (RD) on operative and adverse outcomes.Results80 patients (30%) had preoperative mild RD. Patients with preoperative RD were older, had a higher rate of preoperative anemia (43% vs. 25%, p < 0.001), and more comorbidities. Patients with preoperative RD had worse outcomes with more reoperation (6.8% vs. 2.3%, p < 0.001).ConclusionPreoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, p < 0.001). Mortality was similar in both groups (3.4% vs. 2.3%, p = 0.43). Preoperative mild RD in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.     

Clinical profile and impact of family history of premature coronary artery disease on clinical outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial

Background/PurposeFamily history of coronary artery disease (CAD) is a well-established risk factor of future cardiovascular events. The authors sought to examine the relationship between family history of CAD and clinical profile and prognosis of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Materials/MethodsBaseline features and clinical outcomes at 30 days and at 3 years from 3601 patients with STEMI enrolled in the HORIZONS-AMI trial were compared in patients with and without family history of premature CAD, which was present in 1059 patients (29.4%).ResultsThese patients were younger (median 56.7 vs. 62.1 years, P < 0.0001) and more often current smokers (52.4% vs. 43.5%, P < 0.0001), had more dyslipidemia (47.7% vs. 41.1%, P = 0.0003), less diabetes mellitus (14.1% vs. 17.5%, P = 0.01) and had shorter symptom onset to balloon times (median 213 vs. 225 min, P = 0.02). Patients with a family history of premature CAD had higher rates of final TIMI 3 flow (93.8% vs. 90.6%, P = 0.002), and myocardial blush grade 2 or 3 (83.2% vs. 78.0% P = 0.0008), and fewer procedural complications. Although the unadjusted 30-day and 3-year mortality rates were lower in patients with a family history of premature CAD (1.8% vs. 3.0%, P = 0.046 and 4.8% vs. 7.7%, P = 0.002, respectively), by multivariable analysis the presence of a family history of premature CAD was not an independent predictor of death at 3 years (HR [95%CI] = 1.00 [0.70, 1.44], P = 0.98).ConclusionsA family history of premature CAD is not an independent predictor of higher mortality.     

The metabolic syndrome: Prevalence,main characteristics and association with socio-economic status in adults living in Great Tunis

AimsThis study aimed to determine the prevalence of the metabolic syndrome (MetS) and its association with socio-economic status in the population of Great Tunis.MethodsThe study included 2712 subjects (1228 men and 1484 women), aged 35–70 years and living in the Great Tunis region, all of whom were recruited between March 2004 and June 2005. The sample was weighted by using the inverse of the response rate according to governorate, district and gender. The MetS was defined according to the National Cholesterol Education Program–Adult Treatment Panel III.ResultsIn the studied population, the overall prevalence of the MetS was 31.2%, and it was significantly more frequently seen in women than in men (37.3% vs 23.9%, respectively; P < 0.001), as were abdominal obesity (69% vs 21.6%, respectively; P < 0.001), high blood pressure (50.3% vs 43.1%, respectively; P < 0.001) and low HDL cholesterol (40.6% vs 33.6%, respectively; P < 0.001), the most common characteristics of the MetS. Also, the prevalence of the MetS increased with age in both genders, but more so in women. In those aged greater than 55 years, the prevalence of MetS was 56.7% in women and 30.7% in men. An inverse relationship was observed between level of education and prevalence of the MetS in women, with the highest prevalence being in illiterate women and the lowest in those who were university graduates.ConclusionThe prevalence of the MetS is markedly high within the population of Great Tunis and especially in women. As these findings predict future increases in cardiovascular disease in these populations, substantial efforts need to be made to fight against obesity and sedentary lifestyles to ameliorate the expected poor health outcomes.     

Anemia in diabetic patients at an internal medicine ward: Clinical correlates and prognostic significance

BackgroundCharacteristics and prognostic significance of anemia in hospitalized diabetic patients are unknown.MethodsWe studied 3145 unselected patients admitted to two Internal Medicine Departments, 872 (27.7%) of whom were diabetic. Forty diabetic patients died during the first hospitalization period. Out of the remaining 832 patients, 334 (40.2%) were anemic and evaluated for survival. In 87 diabetic patients, the cause of anemia was evident on admission, whereas the other 247 had to be further investigated for etiology of anemia.ResultsCompared to non-anemic diabetic patients, the diabetic anemic patients were older (mean age 71.4 vs. 64.4 years, P < .001) and predominantly females (52.4% vs. 44.4%, P < .02). Of the 247 evaluated patients, 38% were deficient in iron, 12% in vitamin B₁₂ and/or folate, 54% had anemia of chronic disease, 47% suffered from heart failure, 39% had renal dysfunction and 22% were complex nursing care patients and/or had diabetic foot. On median follow-up of 19.2 months, mortality rate was higher in anemic compared to non-anemic diabetic patients (17.3% vs. 4%, P < .001), the main cause of death being infection. Male sex (P = .03), albuminuria (P = .01) and heart failure (P = .06) were associated with shorter survival, male sex being the most significant (OR 2.02, 95% CI 1.04 ? 4.00).ConclusionFrequency of anemia was increased in diabetic patients admitted to the Internal Medicine Departments, compared to the studies performed on ambulatory patient populations. Anemia was multifactorial and associated with higher mortality, predominantly from infections. Males with albuminuria and heart failure were at higher risk of death.     

Influencia del tratamiento biológico en los factores de riesgo cardiovascular de los pacientes con enfermedad inflamatoria intestinal

IntroductionChronic immune-mediated diseases, including inflammatory bowel disease (IBD), present an increased risk of developing early atherosclerosis and cardiovascular events (CVE) at early age.ObjectiveTo describe the baseline and 1-year cardiovascular profile of patients with IBD according to the biologic treatment received, taking into account the inflammatory activity.Patients and methodsIt is a retrospective, observational study that included 374 patients. Cardiovascular risk factors (CVRF) and CVE were collected at the baseline visit and at one-year follow-up to describe the cardiovascular risk according to the biological treatment received, also assessing clinical and biological remission.ResultsA total of 374 patients were included: 146 (38.73%) were treated with Infliximab, 128 (33.95%) with adalimumab, 61 (16.18%) with ustekinumab and 42 (11.14%) with vedolizumab.The changes in blood glucose levels are [86.31 mg/dL (84.57–88.06) vs. 89.25 mg/dL (87.54–90.96), P=.001] for those treated with antiTNFα and [86.52 mg/dL (83.48–89.55) vs. 89.44 mg/dL (85.77–93.11), P=.11] in the other group.In the group treated with antiTNFα total cholesterol values at baseline visit are [169.40 mg/dL (164.97–173.83) vs. 177.40 mg/dL (172.75–182.05) at one year of treatment, P=<.001], those of HDL [50.22 mg/dL (48.39–52.04) vs. 54.26 mg/dL (52.46–56.07), P=<.001] and those of triglycerides [114.77 mg/dL (106.36–123.18) vs. 121.83 mg/dL (112.11–131.54), P=.054].Regarding weight, an increase was observed, both in those patients treated with antiTNFα [71.39 kg (69.53–73.25) vs. 72.87 kg (71.05–74.70), P<.001], and in the group treated with ustekinumab and vedolizumab [67.59 kg (64.10–71.08) vs. 69.43 kg (65.65–73.04), P=.003].Concerning CVE, no significant differences were observed neither according to the drug used (p = 0.36), nor according to personal history of CVE (P=.23) nor according to inflammatory activity (P=.46).ConclusionsOur results on a real cohort of patients with IBD treated with biologic drugs show a better control of certain cardiovascular parameters such as CRP or HDL, but a worsening of others such as total cholesterol or triglycerides, regardless of the treatment. Therefore, it is possibly the disease control and not the therapeutic target used, the one that affect the cardiovascular risk of these patients.