Cardiovascular risk factors in patients with lichen planus

Background

Chronic inflammation was found to play an important role in the development of cardiovascular risk factors. Recently a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values, glucose levels, or blood pressure.

Objective

The objective of this case-control study was to evaluate cardiovascular risk factors included in Adult Treatment Panel III criteria for metabolic syndrome in men and women with lichen planus and in healthy controls.

Patients and Methods

This case-control study included 200 patients, 100 with lichen planus (50 men and 50 women) and 100 controls consecutively admitted to the outpatient clinic in Dermatology departments in Granada, Spain.

Results

Analysis of metabolic syndrome parameters revealed a higher significant prevalence of dyslipidemia in patients with lichen planus. No significant differences were observed in glucose levels, abdominal obesity, or blood pressure. Elevated levels of C-reactive protein, erythrocyte sedimentation rate, and fibrinogen were noted in patients with lichen planus. Adjusted odds ratio for dyslipidemia in patients with lichen planus was 2.85 (95% confidence interval, 1.33-5.09; P = .001).

Conclusion

Chronic inflammation in patients with lichen planus may explain the association with dyslipidemia. Lipid levels screening in men or women with lichen planus may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.     

8例百岁老人尸检资料分析和探讨

从８例百岁老人尸检，分析各脏器生理和病理变化，肝、肾发生老年性萎缩极为明显，重量可减轻１／２左右，但生前肝肾功能可在正常范围，脑组织及心脏萎缩并不明显。动脉粥样硬化程度存在个体差异。百岁老人发生慢性疾患病理变化较多，平均在５．３种慢性疾病，致死病因以支气管肺炎居多，其次是肿瘤等，并非通常认为的百岁老人是无疾而终。     

Cardiovascular risk factors and recommended lipid goals attainment among patients referred in a tertiary care lipid clinic

Background

Many adults are not at recommended lipid levels and the extent of treatment of dyslipidemia remains poor. We investigated the burden of cardiovascular risk and the distance of lipid fractions from the recommended targets by statin therapy and risk status in patients referred to a tertiary care lipid clinic.

Methods

Assessment of cardiovascular risk factors was performed in 1657 patients, mostly dyslipidemics, referred by family physicians to our Lipid Clinic, 393 patients being under statin therapy. The shortfall of lipid fractions from the National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) recommended goals was evaluated.

Results

A high prevalence of cardiovascular risk factors was found. LDL cholesterol target was reached by 20% and 45% of untreated and statin treated patients, whereas non-HDL cholesterol target by 13% and 45% of untreated and statin treated patients, respectively. LDL cholesterol was over the goal by 27% in untreated patients and by 25% in statin treated patients. More than 40% and 65% statin treated patients were taking either a low statin dose or statins with low-to-moderate LDL cholesterol lowering efficacy (< 30%). A decrease in the proportion of patients at target and greater shortfalls from recommended goals were found from low to high risk categories.

Conclusion

The shortfall in reaching lipid targets, particularly among high risk statin untreated patients, may be partly explained by delayed or even inadequate lipid lowering therapy. Shortfalls in reaching the targets are not necessarily high and might be possibly managed at a primary care level.     

Cardiovascular implications of HIV-induced dyslipidemia

Cardiovascular disease (CVD) is currently the second most frequent cause of death (after cancer) among HIV-positive subjects. The clinical use of highly active antiretroviral therapy (HAART) has dramatically reduced mortality and morbidity in HIV-positive population, leading to prolonged and improved quality of life. However, as mortality and morbidity from AIDS-related conditions improve, CVD assumes increasing magnitude. It is estimated that by 2015 more than 50% of HIV-positive patients will be older than 50 years. Since age is a major unmodifiable cardiovascular risk factor, the risk for CVD in this population will significantly and progressively increase in the near future. A large part of the risk for cardiovascular events appears to be a result of lipid abnormalities characterizing HIV-positive persons. This review focuses on HIV-associated lipid abnormalities and CVD. Lipid abnormalities may be related to either viral infection, HAART or both. Dyslipidemia characterizing HIV-infected patients has become a therapeutic target to reduce cardiovascular risk of HIV-treated patients. HAART-treated patients show an atherogenic lipid profile comprised of low HDL-cholesterol levels, hypertrigliceridemia and increased levels of small-LDL particles. Current guidelines for the treatment of dyslipidemia and reducing cardiovascular risk in HIV-positive patients suggest that when lifestyle modifications (i.e., diet and exercise) and switching antiretroviral therapy are not enough, statins should be the first-line therapy for dyslipidemia. HDL raising interventions (niacin and fibrates) should be considered to raise HDL levels and lower triglyceride in HIV-infected patients. Implications of lipid-related interventions in HIV-treated patients to avoid drug interactions and their adverse effects are also discussed.     

客观认识心血管疾病危险因素的强化干预策略

<正>基于大量研究证据,积极控制各种危险因素可以显著降低心血管疾病的致死致残率已成为共识。为进一步降低心血管风险,更大程度地改善患者预后,许多学者试图通过更为严格的控制血压、血糖、血脂等危险因素取得更大的临床获益。在此背景     

Monocyte cyclooxygenase-2 overactivity: a new marker of subclinical atherosclerosis in asymptomatic subjects with cardiovascular risk factors?

AIMS: Cyclooxygenase-2 (COX-2)-mediated prostaglandin production by activated macrophages is associated with inflammation and atherosclerosis. We investigated the relationship between COX-2-mediated prostaglandin-E2 (PGE2) release, cardiovascular risk factors, and carotid atherosclerosis in apparently healthy subjects. METHODS AND RESULTS: PGE2 release by lipopolysaccharide-stimulated blood monocytes was measured by ELISA in 291 subjects (76.5% men, mean age 58) who underwent global vascular risk assessment and carotid ultrasonography. COX-2 expression (real-time RT-PCR) was analysed in a subgroup of 100 subjects (76% men, mean age 59). Inducible PGE2 production was associated with smoking and diabetes (P<0.05), but not with arterial hypertension, dyslipidaemia, or obesity. Subjects in the highest tertile of PGE2 (>8.1 ng/mL) had significantly higher mean carotid intima-media thickness (IMT) than those in the lowest tertile (P<0.01). No significant differences among tertiles were observed in the levels of inflammatory markers (C-reactive protein, fibrinogen, and von Willebrand factor). The association between PGE2 and carotid IMT remained statistically significant (P=0.012) after adjustment for a number of cardiovascular and inflammatory risk factors. A correlation between COX-2 expression and PGE2 production was observed (P<0.005). CONCLUSIONS: COX-2-mediated PGE2 overproduction by stimulated monocytes might provide a new marker of subclinical atherosclerosis in asymptomatic subjects exposed to cardiovascular risk factors.     

Cardiovascular risk factors in the normoglycaemic Asian-Indian population—influence of urbanisation

Aims/hypothesis  The aim of this study was to investigate the prevalence of cardiovascular risk factors in normoglycaemic Asian-Indians and its association with urbanisation and plasma glucose. Methods  Data on 5,517 normoglycaemic individuals aged ≥20 years (1,521, 1,851 and 2,145 inhabitants of a city, a town and villages, respectively), from a 2006 diabetes survey, were used. The presence of single and multiple abnormalities, including obesity, abdominal obesity, hypertension and dyslipidaemia, was analysed. Risk associations for hypertension and dyslipidaemia were analysed using multivariate analysis after adjusting for confounding variables. Results  Both the prevalence and clustering of cardiovascular risk variables were higher in urban areas than in villages, and were higher in the city than in the town. Nearly half (47%) of the normoglycaemic individuals from villages had at least one risk factor. Age, male sex, BMI, waist circumference, lack of physical activity and living in an urban environment were associated with hypertension and dyslipidaemia; postprandial glucose level showed no association with hypertension or dyslipidaemia after adjusting for these risk factors. Fasting plasma glucose level showed an independent association with dyslipidaemia. Conclusions/interpretation  There is a high prevalence of cardiovascular risk factors even among normoglycaemic individuals, and this is highest in urban areas. Fasting plasma glucose level showed an association with dyslipidaemia but not hypertension.     

Smoking, aging and the centenarians

The smoke of cigarettes represents an important accelerator of the aging process, both directly through complex mechanisms mediated prevalently by excessive formation of free radicals, and indirectly by favoring the appearance of various pathologies in which smoke is a recognized risk factor. This means that smoke compromises not only life expectancy, but also the quality of the life, favoring the occurrence of non-autosufficiency. Smoking is an important risk factor for many diseases, such as cancer, cardiovascular and respiratory diseases. These are also the main causes of death in the industrialized Countries, where the habit of smoking is also largely diffused. Non-smokers have a much higher life expectancy than smokers, and the suspension of smoking is accompanied, even in the elderly, by an increase in the survival time due to the reduction of smoke-induced biological damage. Therefore, cigarette smoking is opposing the longevity, particularly the extreme one, as it is confirmed by the observations obtained on centenarians. Among them, smoking is extremely rare, and even when it occurs among them, it is correlated almost exclusively to bad health conditions and non-autosufficiency, indicating that it compromises health status and the quality of life even in extremely long living subjects. Considering the demonstrated beneficial effects of suspension of smoking, all practitioners and geriatricians in particular, should promote the abstinence from smoking as a behavioral norm for a correct life style. Non-smokers can delay the appearance of diseases and of the aging process, thus attaining longevity; further, non-smoking habit allows genetically predisposed subjects to reach the extreme longevity and maintain an acceptable health status and autosufficiency.     

Cardiovascular Risk and Psoriasis: Beyond the Traditional Risk Factors

Psoriasis is an autoimmune disease resulting in plaques of the skin. Similar to atherosclerosis, inflammation is integral to the initiation and propagation of plaque development. Mounting evidence has emerged demonstrating that psoriasis not only is associated with increased prevalence of cardiovascular risk factors, but also is an independent risk factor for the development of cardiovascular disease. Systemic therapies for moderate to severe psoriasis can increase the cardiovascular risk. Despite the evidence that psoriasis is an independent risk factor for cardiovascular disease, current guidelines only address managing traditional risk factors. An interdisciplinary approach is needed to find the necessary steps beyond classic risk reduction and detection of early cardiovascular disease in patients with psoriasis, as well as to develop a cardiovascular disease preventive regimen.     

Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors

Background: Alcohol drinking affects atherosclerotic progression mainly through blood pressure and lipid metabolism. The purpose of the present study was to clarify whether effects of alcohol drinking on atherosclerotic risk factors differ by gender and age. Methods: The database of periodic health check-ups for local district workers was used. The subjects were divided into 3 groups according to mean ethanol consumption per day (nondrinkers; light drinkers, less than 30 g per day; moderate-to-heavy drinkers, 30 g or more per day). The mean levels of each atherosclerosis-related variable in the 3 groups were compared. Results: The mean level of body mass index (BMI) was slightly but significantly lower in drinkers than in nondrinkers in the thirties, forties, and fifties age groups in men and in the twenties, thirties, forties, and fifties age groups in women, while this tendency was not found in the sixties age groups of men and women. In men, mean blood pressure was higher in moderate-to-heavy drinkers than in nondrinkers in all age groups and was higher in light drinkers than in nondrinkers only in the age groups after 40 years. Mean blood pressure of women was higher in the moderate-to-heavy drinker group than in the nondrinker group and this difference became higher with advance of age. In women, mean blood pressure was not affected by light drinking in any of the age groups except for the fifties age group. In men, serum total cholesterol was higher in drinkers than in nondrinkers in the twenties age group but was lower in drinkers than in nondrinkers at thirties or older. Serum total cholesterol in women was lower in drinkers than in nondrinkers in the age groups from twenties to forties but tended to be higher in drinkers than in nondrinkers in the sixties age group. Serum HDL cholesterol increased with advance of age from thirties to sixties in men, while it decreased with advance of age from twenties to sixties in women. Serum HDL cholesterol was higher in drinkers than in nondrinkers in all age groups of men and women, and atherogenic index, calculated by using serum total cholesterol and HDL cholesterol concentrations, was lower in drinkers than in nondrinkers in all age groups of men and women. Conclusion: Both in men and women, blood pressure and HDL cholesterol were strongly affected by alcohol drinking: the elevating effect of alcohol drinking on blood pressure was more prominent in the elderly than in the young, while the elevating effect of alcohol drinking on serum HDL cholesterol was not influenced by age. Relationships of drinking with total cholesterol and BMI vary by age and gender.     

Assessment of adiponectin and its isoforms in Polish centenarians

Background

The physiological mechanisms that promote longevity remain unclear. It has been suggested that insulin sensitivity is preserved in centenarians, whereas typical aging is accompanied by increasing insulin resistance. The oldest-old individuals display raised total adiponectin levels, despite the potential correlation between enhanced adiponectin and all-cause and cardiovascular mortality.

Aim

To evaluate the level of adiponectin and its isoforms in sera of centenarians and to assess associations between adiponectin and metabolic parameters.

Participants

A group of 58 Polish centenarians (50 women and 8 men, mean age 101 ± 1.34 years) and 68 elderly persons (55 women and 13 men, mean age 70 ± 5.69 years) as controls.

Measurements

Serum samples were analyzed to evaluate the following parameters: adiponectin array (total adiponectin, HWM-, MMW- and LMW-adiponectin; all by ELISA methods), insulin (by IRMA methods), glucose and lipid profiles. HOMA-IR was calculated. Clinical data were collected. Statistical analyses were performed.

Results

The concentrations of all adiponectin isoforms were significantly higher in the oldest-old participants. In the centenarian group, total adiponectin positively correlated with age and HDL-cholesterol, and HMW-adiponectin was negatively associated with insulin and triglycerides. The long-lived participants had a lower incidence of hypertension, type 2 diabetes, overweight and obesity, with lower concentrations of serum glucose and insulin, and reduced HOMA-IR.

Conclusion

Our findings support the thesis that centenarians possess a different adiponectin isoform pattern and have a favorable metabolic phenotype in comparison with elderly individuals. However, additional work is necessary to understand the relevance of these findings to longevity.     

Cardiovascular risk factors and blood pressure in a primary care unit: Yugoslav Study of the Precursors of Atherosclerosis in School Children (YUSAD)

OBJECTIVES: The presence of cardiovascular risk factors in children may be important in the development of atherosclerosis in adulthood. Adequate control of blood pressure is a cornerstone in atherosclerosis prevention. The aim of the Yugoslav Study of the Precursors of Atherosclerosis in School Children (YUSAD) was to identify risk factors for elevated blood pressure in school children. METHODS: The YUSAD study is a multicentre follow-up study comprised of two cross-sectional surveys conducted five years apart. At baseline, 10-year-old children (3226 boys and 3074 girls [n=6300]) were randomly selected during periodical visits to primary health care centres. The risk factors measured were heart rate, weight, body mass index (BMI), waist-to-hip ratio, grade point average and current smoking status. RESULTS: Significant age and sex differences were identified in systolic blood pressure, diastolic blood pressure and all investigated independent variables. In a multivariate analysis, diastolic blood pressure in 10-year-old boys was directly and significantly related to total cholesterol and height, whereas it was inversely related to weight. At follow-up, in the multivariate model, only BMI was a significant predictor of diastolic blood pressure in boys. In girls at baseline in the multivariate regression analysis, the only significant predictor of diastolic blood pressure was total cholesterol. In 15-year-old girls, diastolic blood pressure was significantly and directly related to BMI and heart rate, whereas it was inversely related to weight. For both 10- and 15-year-old male and female participants, none of the variables by multivariate analysis were a significant predictor of systolic blood pressure. CONCLUSIONS: Age, sex, heart rate, cholesterol and weight are the most important predictors of blood pressure in school children.     

炎症、动脉粥样硬化和心脑血管疾病

心脑血管疾病的病理基础是动脉粥样硬化,动脉粥样硬化被证实是细胞和分子的炎症反应。临床研究论证了炎症标记C 反应蛋白的增高预测心脑血管病发生的危险。C 反应蛋白已被美国心脏协会和疾病控制中心推荐为目前可信性最高的预测冠心病危险的临床检测指标,使极早期预测心脑血管疾病成为可能。至今发现的抗动脉炎症药物包括:阿司匹林、克皮格尔、他汀类降脂药和血管紧张素转换酶抑制剂。     

血脂相关性心血管剩留风险控制中国专家共识

近60年来,对心血管疾病危险因素的综合控制取得了显著成效。然而,经目前标准治疗,低密度脂蛋白胆固醇（LDL—C）、血压、血糖等传统危险因素得到控制后,血脂异常患者仍存在较高的心血管事件的剩留风险。     

Cardiovascular risk factor profile on a population basis: Results from the Lipid Study Leipzig (LSL)

Population-based lipid screening studies were initiated in the city of Leipzig, Germany, and included more than 30,000 subjects. The objectives of the Lipid Study Leipzig (LSL) were to evaluate the cardiovascular risk factor profile and its dependence on age, nutrition and social factors. In addition, the study results were compared with those of other population-based studies, and the development of cardiovascular risk factors over a 10-year period was evaluated. LSL data were obtained from subjects recruited at community centres, work sites, schools and the University of Leipzig, Germany. Capillary blood cholesterol and high-density lipoprotein-cholesterol levels were measured using the Reflotron dry-chemistry system (Roche Diagnostics, Germany). Study data also included blood pressure, body mass index, waist-to-hip ratio, and the evaluation of dietary and lifestyle factors. The results of LSL show an age-dependent increase in cardiovascular risk, which may have been partly preventable. Furthermore, LSL showed an improvement in cardiovascular risk, with respect to plasma cholesterol, over the past 10 years in men and women older than 30 and 50 years, respectively. The known age dependence of total cholesterol and non-high-density lipoprotein-cholesterol is less pronounced for those following a healthy lifestyle and for vegetarians. This suggests that the age-dependent rise of these parameters is partly preventable.     

Cardiovascular disease risk in youth with diabetes mellitus

In the United States, cardiovascular disease is the leading cause of mortality in adults with diabetes over age 30 years. Studies in persons without diabetes have shown that atherosclerosis, a central factor in cardiovascular disease, begins in childhood and the presence of cardiovascular disease risk factors in youth lead to increased cardiovascular disease risk in adults. Therefore, youth with diabetes are at increased risk for developing cardiovascular disease as adults and there is a role for risk factor screening and addressing modifiable factors to lower cardiovascular disease risk starting in childhood. This paper reviews the literature on traditional cardiovascular disease risk factors in youth with diabetes including hyperglycemia, hypertension, dyslipidemia, smoking, obesity and family history of cardiovascular disease with an emphasis on type 1 diabetes as well as current American Diabetes Association guidelines for screening and treatment of modifiable risk factors. Current roles of inflammatory markers and measures of subclinical vascular changes such as arterial stiffness are also discussed.     

Analysis of HLA-DRB1, DQA1, DQB1 haplotypes in Sardinian centenarians

Some genetic determinants of longevity might reside in those polymorphisms for the immune system genes that regulate immune responses. Many longevity association studies focused their attention on HLA (the human MHC) polymorphisms, but discordant results have been obtained. Sardinians are a relatively isolate population and represent a suitable population for association studies. Some HLA-DR and DQ alleles form very stable haplotypes with a strong linkage disequilibrium. In a previous study on Sardinian centenarians we have suggested that HLA-DRB1 *15 allele might be marginally associated to longevity. HLA-DR,DQ haplotypes are in strong linkage disequilibrium and well conserved playing a role in the association to diseases. Hence, we have evaluated, by amplification refractory mutation system/polymerase chain reaction (ARMS-PCR) the HLADQA1 and HLA-DQB1 allele frequencies in 123 centenarians and 92 controls from Sardinia to assess whether the association to HLA-DRB1 *15 allele may be due to the other genes involved in the HLA-DR,DQ haplotypes. The frequencies of HLA-DQA1, DQB1 haplotypes were not significantly modified in centenarians. Nevertheless by evaluating the frequency of DRB1 *15 linked haplotypes, we observed a not significant increase in centenarians of HLA-DQA1 *01, DQB1 *05 and HLA-DQA1 *01,DQB1 *06 haplotypes. These data suggest that these haplotypes might have a role in determining life span expectancy and longevity.