A combination of increased Rho kinase activity and N-terminal pro-B-type natriuretic peptide predicts worse cardiovascular outcome in patients with acute coronary syndrome

Background

Recent experimental evidence suggests that the Rho/Rho-kinase (ROCK) system may play an important role in the pathogenesis of acute coronary syndrome (ACS) but there are little clinical data. This study examined if ROCK activity is increased in patients with acute coronary syndrome and if ROCK activity predicts long‐term cardiovascular event.

Method

Blood samples were collected from 188 patients within 12 h after admission for ACS (53% men; aged 70 ± 13) and from 61 control subject. The main outcome measures were all cause mortality, readmission with ACS or congestive heart failure (CHF) from presentation within around 2 years (mean:14.4 ± 7.2 months; range: 0.5 to 26 months).

Results

ROCK activity increased in ST elevation myocardial infarction (STEMI, n = 90) (3.33 ± 0.93), non-STEMI (NSTEMI, n = 68) (3.37 ± 1.04) and unstable angina (UA, n = 30) (2.53 ± 0.59) groups when compared with disease controls (n = 31) (2.06 ± 0.38, all p < 0.001) and healthy controls (n = 30) (1.54 ± 0.43, all p < 0.001). There were 24 deaths, 34 readmissions with ACS and 15 admissions with CHF within 2 years. Patients with a high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high ROCK activity on admission had a five-fold risk of a cardiovascular event (RR: 5.156; 95% CI: 2.180–12.191) when compared to those with low NT-proBNP and low ROCK activity.

Conclusion

ROCK activity was increased in patients with ACS, particularly in those with myocardial infarction. The combined usage of both ROCK activity and NT-proBNP might identify a subset of ACS patients at particularly high risk.     

Increased arterial stiffness is closely associated with hyperglycemia and improved by glycemic control in diabetic patients

Aims/Introduction

Although arteriosclerotic diseases have been reported to be frequently complicated by diabetes mellitus (DM), a detailed relationship between hyperglycemia and arterial stiffness has not been fully clarified. We investigated the influence of hyperglycemia on arterial stiffness using the cardio‐ankle vascular index (CAVI), which is a new method for estimating arterial stiffness.

Materials and Methods

CAVI values of 52 early‐staged DM patients (duration <5 years, no microangiopathies) were compared with those of 43 age‐matched non‐diabetic (NDM) subjects. The association between CAVI and clinical background factors was evaluated. The effect of glycemic improvement on CAVI was examined in 36 DM patients who were hospitalized for 2 weeks to treat hyperglycemia. CAVI and clinical parameters were measured twice during hospitalization and again after 8 weeks. Additionally, we measured CAVI before and 2 h after breakfast in five DM and five NDM subjects.

Results

The CAVI of DM patients was significantly higher than that of NDM subjects. Multiple regression analysis showed that neither hypertension, obesity nor dyslipidemia, but aging and hemoglobin A1c (HbA_1c) were significantly related to CAVI elevation. The CAVI, HbA_1c and total cholesterol (TC) had significantly improved. Improvement of CAVI was significantly associated with HbA_1c improvement. In contrast, no significant association was observed between the improvements of TC and CAVI. CAVI values before and after breakfast did not change significantly.

Conclusions

CAVI elevation seems to be a sensitive arteriosclerotic marker, which is closely associated with hyperglycemia and improved by glycemic control.     

Are cardiovascular risk parameters and glycemic levels associated with periodontitis in type 2 diabetes patients? A clinical study

This study investigated the associations between cardiovascular risk parameters, glycemic level and periodontitis in the diabetic adult population. BMI (body mass index), total cholesterol and triglyceride was used as cardiovascular risk measure and glycosylated hemoglobin (HbA1c) was recorded for glycemic levels. Study results provide evidence of significant association between periodontal disease, cardiovascular risk and glycemic levels.     

Discontinued drugs in 2007: cardiovascular drugs

This perspective is part of an annual series of papers discussing drugs dropped from clinical development in the previous year. Specifically, this paper focuses on the 16 cardiovascular drugs discontinued in 2007. Information for this perspective was derived from a search of the Pharmaprojects database for drugs discontinued after reaching Phase I – III clinical trials.     

Cardiovascular Risk Behavior among Students of a Medical College in Delhi

Background:

Life style related behavioural risk factors are mainly implicated for increased burden of cardio- vascular diseases. Research related to these risk behaviours especially among medical students is essential, considering their role as future physicians and role models in public health intervention programmes.

Objective:

To evaluate the burden of cardiovascular risk behaviours among students of a medical college of Delhi, India.

Materials and Methods:

A cross sectional study was carried out among undergraduate medical students of a medical college in Delhi. Self administered questionnaire was used to collect information on identification data and risk behaviours in relation to cardiovascular diseases. Binary logistic regression analysis was done to calculate adjusted odds ratio to assess association between risk behaviours and covariates.

Results:

The minimum recommendation of taking at least five servings per day of fruits and vegetables was complied only by 12% of students. Consumption of carbonated soft drinks either once or more on daily basis was present in 23.7% students and 32.0% reported frequent consumption of fast foods in past week. Consumption of alcohol was present in 28.8% students but only small proportion of students (7%) was current tobacco users. Large proportions of students (42.6%) were either not carrying out or were involved in only occasional physical activity in past week.

Conclusions:

Unhealthy behavioural practises are present and may progress as student advance through medical college. Developing strategies targeting at these risk behaviours and determining factors is necessary to promote healthy life style among medical students.     

15例法乐四联症手术的体外循环管理

目的对15例法乐氏四联症(TOF)根治术患者的体外循环(CPB)术中管理进行回顾性总结。方法15例中男10例,女5例,年龄5～28岁,体重16～57kg,11例采用中低温中高流量,4例采用深低温低流量,10例用冷晶体停跳液灌注,5例用4∶1冷氧合血停跳液灌注。转流前静脉放血4例,转流中超滤4例。结果除1例因术后重度低心排综合征加上肺部感染死亡外,其余患者均治愈出院。结论针对TOF的特点,选用合适的体外循环方法,对手术成功具有重要作用。     

中风心脑血管病与微观证治学

高血压是各种类型卒中最重要而且可以干预的危险因素。应用微观证治学方法，从中风“风中五脏”，按肝风证治降压熄风，调脂祛痰和活血化瘀“治风三法”，为防治高血压伴有动脉粥样硬化心脑血管病的首选方药。     

缺氧复氧对大鼠离体中性粒细胞与心肌细胞粘附的影响

目的　研究粘附分子在中性粒细胞介导的缺氧复氧大鼠心肌细胞损伤中的作用。方法　体外培养的大鼠心肌细胞缺氧６ 小时后复氧２ 小时。采用粘附试验和抗细胞间粘附分子－１（ｉｎｔｅｒｃｅｌｌｕｌａｒｃｅｌｌａｄｈｅｓｉｏｎ ｍ ｏｌｅｃｕｌｅ－１,ＩＣＡＭ－１）单克隆抗体阻断试验观察中性粒细胞与心肌细胞间的粘附作用和心肌细胞乳酸脱氢酶的释放。结果　缺氧６小时后复氧２小时可使心肌细胞与中性粒细胞粘附数显著增加（Ｐ＜ ０．０１）,为正常培养组的１．７８ 倍;同时心肌细胞释放ＬＤＨ也明显增高（Ｐ＜ ０．０１）。５ μｇ／ｍ ｌ抗Ｉ－ＣＡＭ－１和抗淋巴细胞功能相关抗原－１（ＬＦＡ－１）单克隆抗体均可显著阻断中性粒细胞与心肌细胞间的粘附,阻断率为３６．７２％ 和３１．４１％ ,且心肌细胞释放ＬＤＨ明显下降（Ｐ＜ ０．０１）。结论　缺氧复氧后心肌细胞与中性粒细胞粘附增加,这种粘附作用伴随着中性粒细胞的激活和其细胞毒作用;抗ＩＣＡＭ－１ 和抗ＬＦＡ－１ 单抗能部分阻断这一粘附过程,提示粘附分子ＩＣＡＭ－１和ＬＦＡ－１ 参与介导中性粒细胞对缺氧复氧心肌细胞的损伤机制。抗ＩＣＡＭ－１ 和抗ＬＦＡ－１ 单抗可减轻中性粒细胞对缺氧复氧心肌细胞的损害     

依达拉奉对心肺复苏后脑水通道蛋白-4表达的影响

目的 探讨大鼠心肺复苏后脑水通道蛋白-4(AQP4)表达与脑水肿动态变化的关系,评价依达拉奉的干预作用.方法 72只雄性SD大鼠随机分为4组:正常对照组(A组,6只),假手术组(B组,6只),复苏组(C组,按ROSC后1 h,6 h、12 h、24 h、72 h各时点分5亚组,各6只),依达拉奉处理组(D组,亚组同C组),复苏即刻予以依达拉奉干预.分别测定脑组织含水量,免疫组化法检测其AQP4蛋白表达,行神经功能缺损评分(neurodeficit score,NDS)及脑组织病理形态学观察.结果 C组大鼠ROSC后脑组织含水量呈上升趋势,24 h达高峰,各时点均高于B组(P<0.01).AQP4表达呈现与脑含水量同样趋势改变,积分光密度(iOD)、显色面积比(△S)增加(P<0.01),相关性分析表明iOD(r=0.858,P<0.01)、AS(r=0.870,P<0.01)与脑组织含水量呈正相关.与C组相比,依达拉奉干预处理后脑组织含水量明显下降(P<0.05);AQP4蛋白iOD、△S显著下调(P<0.01);病理学损伤程度减轻,NDS评分显著提高(P<0.05).结论 大鼠心肺复苏后脑AQP4表达上调,与脑水肿变化正相关,AQP4可能参与心肺复苏后脑水肿形成.依达拉奉可抑制AQP4表达,减轻大鼠心肺复苏后脑水肿,具有脑保护作用