Results of nonmedical interventions in multicenter randomized open study of efficacy of lifestyle modification and therapy with quinapril in patients with obesity and hypertension

There is a pathogenetic interrelationship between obesity and hypertension. Moreover it has become evident that the use of most modern and active antihypertensive drugs can not be effective without concomitant treatment of obesity. This study was conducted in 18 cities of Russian Federation in order to demonstrate influences of lifestyle changes on hypertension and levels of cardiovascular risk factors. The objective was to attract attention of physicians and patients to the problem of obesity and hypertension and to their inherent dangers.     

Diagnosis and treatment of pulmonary heart before and after hospitalization

Prevalence of pulmonary heart among patients with cardiovascular pathology is 5%. Clinical picture of pulmonary heart comprises symptoms of underlying disease and signs of pulmonary and cardiac failure. The following instrumental methods of investigation are very helpful for diagnosis of pulmonary heart: chest roentgenography, electrocardiography, echocardiography, pulmonary function testing, computer tomography. Pulmonary heart should be diagnosed during ambulatory examination. Hospitalization of patients with pulmonary heart is dictated by severity of clinical condition or presence of diagnostic problems. Radionuclide pulmonary scintigraphy, pulmonary angiography, right heart catheterization, lung biopsy can be carried out in hospital. Treatment should be directed at underlying disease, lowering of pulmonary artery pressure, alleviation of respiratory and cardiac failure.     

The use of insulin-modified intravenous glucose tolerance test in the diagnosis of insulin resistance in patients with metabolic syndrome

Fifty-five patients (mean age 42.3) with clinical signs of metabolic syndrome were investigated. The peroral glucose-tolerance and insulin-modified intravenous glucose-tolerance tests were used in the diagnosis of insulin-resistance. According to the SI index, a lower tissue sensitivity to insulin was detected in 48 (87%) of patients; it is noteworthy, that a low SI index was registered in some of them, when indirect signs of insulin-resistance, like hyperglycemia, hyperinsulinemia, were absent.     

Soluble P-selectin - a marker of platelet activation and vessel wall injury: increase of soluble P-selectin in plasma of patients with myocardial infarction, massive atherosclerosis and primary pulmonary hypertension

AIM: A comparative analysis of the content of the soluble form of cell adhesion protein P-selectin in the blood plasma of patients with acute myocardial infarction (AMI), massive atherosclerosis (MA) and primary pulmonary hypertension (PPH), investigation of the relationship between plasma content of P-selectin and known markers of platelets and endothelial cells activation, preliminary assessment of the prognostic value of P-selectin determination. MATERIALS AND METHODS: This study included 16 patients with AMI, 20 patients with MA, 21 patients with PPH and 18 healthy donors. The follow-up was 1-5 years. End-points in the group of patients with AMI were recurrent acute coronary syndrome and coronary artery by-pass operation, in the group with MA--thrombotic complications (acute coronary syndrome, ischemic stroke) and in the group with PPH--death. P-selectin was measured by ELISA and platelet factor 4 (PF4), thromboxane B2 (TXB2), endothelin-I and stable prostacyclin metabolite 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) by means of commercial ELISA kits. RESULTS: Mean level of P-selectin in blood plasma of patients with AMI (1 day) (361 +/- 18 ng/ml), MA (410 +/- 31 ng/ml) and PPH (627 +/- 83 ng/ml) was increased in comparison with the group of healthy donors (269 +/- 12 ng/ml) (everywhere p < 0.001). In AMI, P-selectin was increased on day 1 only, on days 2, 3 and 10-14 of the disease the level of P-selectin was significantly lower than on day 1 and did not differ from the control level in the group of donors. In patients with MA a significant correlation was detected between plasma content of P-selectin and platelet activation marker PF4 (r = 0.606, P = 0.007) and in patients with PPH between the content of P-selectin and another platelet activation marker TXB2 (r = 0.622, p = 0.013). However, no correlation was found in PPH patients between the content of P-selectin and markers of endothelial activation and/or damage (endothelin-1 and 6-keto-PGF1 alpha). Difference in the concentration of P-selectin in patients with or without end-points during the follow-up period was detected in patients with AMI (353 +/- 14 ng/ml and 451 +/- 24 ng/ml, p = 0.009) and PPH (477 +/- 58 ng/ml and 927 +/- 184 ng/ml, p = 0.017) but not with MA (426 +/- 37 ng/ml and 361 +/- 24 ng/ml, p = 0.295). CONCLUSION: The level of P-selectin in plasma was increased in patients with acute thrombosis (AMI, 1 day) as well as in patients without clinical signs of thrombosis but with a massive injury of the vasculature (MA and PPH). The increase of P-selectin was, presumably, caused by its secretion from activated platelets since its concentration in plasma correlated with platelet concentration but not endothelial activation markers. Preliminary data indicate that blood plasma soluble P-selectin may be considered as a potential prognostic marker in AMI and PPH.     

A clinically applicable method for determining the three major alleles at the Duffy (FY) blood group locus using polymerase chain reaction with allele-specific primers

BACKGROUND: The clinically significant antigens of the Duffy (Fy [FY]) blood group system are expressed on the red cell form of the FY glycoprotein, a promiscuous chemokine receptor and also a receptor for malarial parasites. After the cloning of cDNA coding for FY glycoprotein, the molecular basis of the three major alleles (Fya/Fyb/Fy) has been established. Because of the mistyping of the silent Fy allele as Fyb, the error rate of current genotyping methods is high in black populations. STUDY DESIGN AND METHODS: Two hundred blood donors (European whites and African Blacks) and some amniotic DNA samples were investigated by a new allele-specific primer polymerase chain reaction technique. Sense primers corresponding to normal and GATA-1-mutated FY gene promoter region sequences were combined with antisense primers discriminating the Fya/Fyb polymorphism. RESULTS: Complete correlation between FY phenotypes and genotypes was obtained in all samples studied, although, in two whites and one black, serology showed weak Fyb expression while polymerase chain reaction indicated a Fyb allele. Gene frequencies were calculated. CONCLUSION: This simple and rapid polymerase chain reaction method was shown to detect the three common alleles at the FY locus in two representative ethnic populations. Its future use as an independent technique in red cell FY investigations and for fetal genotyping in hemolytic disease of the newborn is predicted.     

Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes

When designing a study to develop a new prediction model with binary or time-to-event outcomes, researchers should ensure their sample size is adequate in terms of the number of participants (n) and outcome events (E) relative to the number of predictor parameters (p) considered for inclusion. We propose that the minimum values of n and E (and subsequently the minimum number of events per predictor parameter, EPP) should be calculated to meet the following three criteria: (i) small optimism in predictor effect estimates as defined by a global shrinkage factor of ≥ 0.9, (ii) small absolute difference of ≤ 0.05 in the model's apparent and adjusted Nagelkerke's R² , and (iii) precise estimation of the overall risk in the population. Criteria (i) and (ii) aim to reduce overfitting conditional on a chosen p, and require prespecification of the model's anticipated Cox-Snell R² , which we show can be obtained from previous studies. The values of n and E that meet all three criteria provides the minimum sample size required for model development. Upon application of our approach, a new diagnostic model for Chagas disease requires an EPP of at least 4.8 and a new prognostic model for recurrent venous thromboembolism requires an EPP of at least 23. This reinforces why rules of thumb (eg, 10 EPP) should be avoided. Researchers might additionally ensure the sample size gives precise estimates of key predictor effects; this is especially important when key categorical predictors have few events in some categories, as this may substantially increase the numbers required.     

Body mass loss due to orlistat therapy and multiple factors of cardiovascular risk

AIM: To study effects of body mass loss due to orlistat on carbohydrate and lipid metabolism, insulin resistance, 24-h profile of arterial pressure (AP), left ventricular myocardial hypertrophy, brain perfusion in patients with metabolic syndrome (MS). MATERIAL AND METHODS: Thirty middle-aged patients with MS entered the trial. They received orlistat in a dose 120 mg twice a day for 24 weeks. Before and after the treatment the patients' carbohydrate and lipid metabolism, insulin resistance were studied, 24-h monitoring of arterial pressure, echo-cardiography were made. Brain perfusion was studied with single-photon emission computed tomography in 18 patients. Results. All the patients lost much weight. This was accompanied with improved indices of AP profile, metabolism of carbohydrates and lipids, insulin resistance, left ventricular hypertrophy, brain perfusion. Conclusion. Orlistat treatment weakens basic factors of cardiovascular risk.     

Carvedilol in treating primary pulmonary hypertension patients: effect on severity of cardiac failure,degree of pulmonary hypertension,concentration of catecholamines in blood plasma and dependence of cyclic AMP synthesis in lymphocytes on beta-adrenergic receptors

AIM: To evaluate carvedilol effect on clinical state, norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta 2-adrenoreceptor dependent cAMP synthesis in patients with primary pulmonary hypertension (PPH). MATERIAL AND METHODS: 14 patients with PPH were included in the study; 9 patients were treated by carvedilol; 5 patients were in the control group. The primary efficiency parameters were submaximal exercise measured by 60 min walk test, systolic pulmonary artery pressure (SPAP) measured by Doppler echocardiography, heart rate (HR) measured by 24-hour ECG-monitoring. RESULTS: One month carvedilol treatment of PPH patients resulted in a significant HR reduction. There was a tendency to SPAP decrease, the 6-minute walk test results improved in IIINYHA patients. CONCLUSION: Carvedilol therapy improves clinical state and evoked lymphocyte beta 2-adrenoceptor resensitization in PPH patients.     

Anxiety-depressive disorders in patients with type 2 diabetes mellitus complicated with acute coronary syndrome

Psychological status of 140 patients with type 2 diabetes mellitus (DM) and acute coronary syndrome (ACS) was studied on the 12-th day after the moment of admission to the cardioreanimation department and in 6 months after discharge from hospital. Spielberger questionnaire was used for assessment of level of personal and reactive anxiety, Beck scale -- for estimation of level of depression, and Holmes - Ray scale -- for calculation of total number of stressful events. Average level of anxiety in acute period of ACS corresponded to high level of anxiety disorders (reactive anxiety score 47.64 +/- 10.49, personal anxiety score 48.7 +/- 8.77). Level of depressive disorders was in the limits of 3-49 points (median score 15.1 [5.1; 32.9]). Clinically evident depression corresponded to moderate and severe degree in 48.6% (68 of 140) patients. Mean total number of stressful events was 154 +/- 9.8 (median 129 [68.8; 317.8] points). After 6 months of follow up levels of personal and reactive anxiety remained high and were approximately equal to initial (45.63 +/- 11.3 and 40.79 +/- 11.6 points, respectively). Depressive disorders persisted in 57.4% of patients and level of depression corresponded to moderate and severe depressive disorders in 37.7% of cases. High prevalence of anxiety-depressive disorders was revealed in patients with type 2 DM complicated with development of ACS. Anxiety-depressive disorders persist minimally for 6 months after ACS.