Absence Of Arterial Hypertension Research Articles

Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis

This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF). sCR was defined as clinical-Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)= 0 and estimated glomerular filtration rate (eGFR) >60 ml/min per 1.73 m2 lasting≥1 year; IKF: eGFR<60 ml/min per 1.73 m2 for >3 months. We analyzed the probability of achieving and maintaining sCR, and the yearly risk of flare. Cox models were used to identify predictors of sCR and IKF with variables analyzed as time-dependent covariates when appropriate. Of 303 patients followed-up with for 14.8 (interquartile range: 9.8-22) years, 257 (84.8%) achieved sCR. The probability of achieving sCR progressively increased over time reaching 90% at 15 years. Baseline age (hazard ratio [HR]: 1.017; 95% confidence interval [CI]: 0.005-1.029; P= 0.004), hydroxychloroquine intake (HR: 1.385; 95% CI: 1.051-1.825; P= 0.021), and absence of arterial hypertension (HR: 0.699; 95% CI: 0.532-0.921; P= 0.011) were independent predictors of sCR. Among patients who achieved sCR, 142 (55.3%) developed a lupus flare after a median time of 3.6 (2.3-5.9) years. In the remaining 115 patients, sCR persisted for 9.5 (5.8-14.5) years. The probability of sCR to persist at 15 years was 38%. SLE flare risk decreased to 10%, 5%, and 2% in patients with sCR lasting<5, 5 to 10, and >10 years, respectively. At the last observation, 57 patients (18.81%) had IKF. sCR achievement (HR: 0.18, P< 0.001) and its duration (HR: 0.83, P< 0.001) were protective against IKF. sCR is an achievable target in LN management and protects against IKF. The longer the sCR, the higher the chance of its persistence and the lower the risk of SLE flares.

Показатели нового полуколичественного экспресс-теста на прокальцитонин у пациентов с внебольничной пневмонией при наличии и отсутствии артериальной гипертензии

The presence of cardiovascular diseases can be an independent risk factor for an unfavorable prognosis of community-acquired pneumonia (CAP) and cause its erased course, which significantly complicates the timely diagnosis. It has been reported that assessment of plasma procalcitonin (PCT) levels may be useful in the differential diagnosis of lung diseases. Aim. To study the levels of a new semi-quantitative rapid PCT test (PCT RT) of plasma in therapeutic patients with CAP depending on the presence or absence of arterial hypertension (AH). Design. The simultaneous comparative study. Materials and methods. The study included 123 patients hospitalized with a diagnosis of CAP: 41 patients (mean age 69.8 ± 11.9 years) with hypertension and 82 patients (mean age 39.3 ± 16.7 years) without hypertension, who made up the comparison group. Using a new semi-quantitative RT and the method of enzyme-linked immunosorbent assay, the plasma PCT level was determined before the start of antibiotic therapy. Results. In patients with CAP and hypertension, positive PCT RT results were registered 1.8 times more often than in the comparison group — 19 (46.3%) people and 21 (25.6 %) people, respectively (p = 0.018), borderline values of PCT RT — 2.2 times more often: in 13 (31.7%) people and 12 (14.6%) people (p = 0.001) patients, respectively. The comparison group was characterized by negative PCT RT values, which were recorded in 61 (74.4%) of cases (p = 0.001). Quantitative PCT scores did not have statistically significant differences in the groups studied. In the group of patients with CAP and hypertension, positive correlations of PCT RT with body temperature (r = 0.329; p = 0.038), quantitative PCT (r = 0.505; p = 0.001), plasma glucose levels (r = 0.325; p = 0.041) and potassium (0.325; p = 0.041) were established. Conclusion. Patients with CAP and hypertension in comparison with those without hypertension are characterized by positive values of the new PCT RT, which have positive correlations with body temperature, quantitative PCT values, and plasma glucose and potassium levels. Keywords: community-acquired pneumonia, arterial hypertension, diagnostics, procalcitonin, procalcitonin rapid test.

Effect of Cardiovascular Risk Factors on 30-Day All-Cause Mortality in Cardiogenic Shock.

Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from 2019 to 2021. The prognosis of patients with "low CVR" (i.e., 0-1 CVR factors) was compared to patients with "high CVR" (i.e., 2-4 CVR factors) according to presence or absence of arterial hypertension, diabetes mellitus, hyperlipidaemia or smoking. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier and Cox proportional regression analyses. 273 consecutive patients with CS were included. 28% presented with low CVR and 72% with high CVR. Within the entire study cohort, the risk of 30-day all-cause mortality did not differ between patients with high and low CVR (55% vs. 57%; log rank p = 0.727; HR = 0.942; 95% CI 0.663-1.338; p = 0.738). Even after multivariable adjustment, high CVR was not associated with an elevated risk of 30-day all-cause mortality (HR = 1.039; 95% CI 0.648-1.667; p = 0.873). The presence of arterial hypertension (55% vs. 58%; log rank p = 0.564; HR = 0.906; 95% CI 0.638-1.287; p = 0.582), diabetes mellitus (60% vs. 52%; log rank p = 0.215; HR = 1.213; 95% CI 0.881-1.671; p = 0.237) and a history of smoking (56% vs. 56%; log rank p = 0.725; HR = 0.945; 95% CI 0.679-1.315; p = 0.737) did not significantly influence short-term prognosis.. Only the absence of hyperlipidaemia significantly decreased the risk of all-cause mortality (65% vs. 51%; log rank p = 0.038; HR = 0.718; 95% CI 0.516-0.998; p = 0.049), which was no longer observed after multivariable adjustment (HR = 0.801; 95% CI 0.536-1.195; p = 0.277). In conclusion, neither the overall CVR nor individual CVR factors were associated with the risk of 30-day all-cause mortality in patients with CS.

#3191 RISK OF CKD IN LUPUS NEPHRITIS: CORRELATION WITH DURATION OF REMISSION AND DEVELOPMENT OF RENAL AND EXTRARENAL FLARES

Abstract Background and Aims Achievement of remission and prevention of SLE flares are important therapy targets in patients with SLE in order to avoid the development of systemic chronic damage. In patients with lupus nephritis, the correlation between the duration of remission, the occurrence of SLE flares and the development of CKD is unclear. The aims of this study are to investigate a) the risk of CKD in patients with lupus nephritis b) the correlation between the risk of CKD and the development of renal and extrarenal SLE flares c) the correlation between the risk of CKD and the achievement and duration of remission d) the probability and predictors of renal and extrarenal remission. Method This is a retrospective multicentric study of prospectively collected data. Patients were included if they were &amp;gt;18 years old, they had a histological diagnosis of lupus nephritis and they had at least 5 years of follow up after the diagnosis. CKD was defined as eGFR &amp;lt;60 ml/min/1.73m2 without active urinary sediment for at least 3 months. Remission was defined as normal renal function (serum creatinine &amp;lt;1.0 mg/dl, eGFR &amp;gt;60 ml/min/1.73m2), proteinuria &amp;lt;0.5 g/24h and cSLEDAI = 0 for at least 1 year. The probability of developing flares and achieving remission was estimated using Cox regression analysis. Results CKD developed in 57 patients out of the 303 included in the study (18.8%) during a median follow-up of 14.8 years. During the observation 257 patients achieved remission in a median time of 1.4 (0.7-3.6) years, while 46 patients never achieved it. 115 patients maintained remission until the end of follow-up (9.5 (5.8-14.5) years), while 142 developed a flare after a median time of 3.6 (2.3-5.9) years from the beginning of remission. Altogether, in these 142 patients, 174 SLE flares developed during a median follow-up of 17.8 (13.3-24.2) years: 132 renal flares (20 with serum creatinine increase, 112 with proteinuria) and 42 extra-renal flares. CKD developed in 11 patients with creatinine flares (55%), 19 patients with proteinuric flares (16.9%) and 1 patient with extra-renal flares (2.4%) (p&amp;lt;0.0001). The longer was the duration of remission, the lower the probability that remission was interrupted (Figure 1A) by the development of a SLE flare: the risk of flare reduced from 10% when the remission lasted less than 5 years, to 5% if the remission lasted 5-10 years and to 2% if the remission lasted more than 10 years (Figure 1B). CKD developed in 26 out of the 46 patients who never achieved remission (56%), in 31 patients among those who achieved remission but developed SLE flares (21.8%) and in none among those who maintained remission until the end of the observation (p&amp;lt;0.0001). We found that 3 years of persistent remission significantly reduced the risk of CKD development (Figure 2). At multivariate Cox regression analysis, age &amp;gt;40 years (OR: 1.017; 95% CI: 1.005-1.028; p = 0.004), therapy with hydroxychloroquine (OR: 1.384; 95% CI: 1.109-1.661; p = 0.021) and absence of arterial hypertension (OR: 0.699; 95% CI: 0.425-0.975; p = 0.011) were independent predictors of remission. Conclusion in patients with lupus nephritis, the risk of CKD is significantly higher if renal-extrarenal remission is not achieved or if it is interrupted by SLE flares. In particular, the risk of CKD is very high in patients who develop renal flares with creatinine increase. A longer duration of remission is related to a lower risk of SLE flares and of CKD: in particular, 3 years of remission protect from the development of CKD. Age older than 40 years, therapy with hydroxychloroquine and absence of arterial hypertension are associated with the achievement of remission.

ОЦЕНКА ЗНАЧИМОСТИ ВЗАИМОСВЯЗИ МЕЖДУ ПОКАЗАТЕЛЯМИ РЕМОДЕЛИРОВАНИЯ СОСУДОВ, ВОСПАЛИТЕЛЬНОГО ОТВЕТА И ПОЛИМОРФИЗМА ГЕНОВ ДИСФУНКЦИИ ЭНДОТЕЛИЯ У ПАЦИЕНТОВ МУЖСКОГО ПОЛА С ИНФАРКТОМ МИОКАРДА В ЗАВИСИМОСТИ ОТ НАЛИЧИЯ ИЛИ ОТСУТСТВИЯ ГИПЕРТОНИЧЕСКОГО АНАМНЕЗА

Introduction. Endothelial dysfunction, arterial hypertension and surrogate events of myocardial infarction are interrelated phenomena, while the genetic predisposition in these patients is an independent risk factor for the development of cardiovascular pathology. Aim. The aim of the study was to evaluate the significance of the interaction of associations of polymorphic loci of adhesion molecule genes (immunoglobulin VCAM1), MCP-1 chemokine, vascular endothelial growth factor (VEGFA), nitric oxide control enzyme (DDAH1), markers of the inflammatory response, vascular remodeling and endothelial dysfunction in patients with male myocardial infarction, depending on the presence or absence of arterial hypertension in history in the development of myocardial infarction. Material and methods. 667 male patients and 621 practically healthy individuals in the comparison group were examined. Patients underwent determination of general clinical parameters, serum concentrations of monocyte-chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGFA), cytokines (IL-1,6; TNF-α), molecular genetic study, measurement of media intima thickness of the common carotid artery. Selected in the group of patients with myocardial infarction, individuals with or without a history of arterial hypertension. Results and discussion. As a result of a comparative analysis of groups of patients with and without a history of arterial hypertension with a group of healthy individuals, significant differences in the frequencies of genotypes and alleles for the following polymorphic gene loci were revealed: MCP-1, VEGFA, DDAH1, VCAM1. The serum concentration of cytokines (IL-1,6; TNF-α) in patients, regardless of the presence or absence of a history of hypertension, significantly exceeded the level in the comparison group. The VEGFA index in patients with myocardial infarction with arterial hypertension was significantly increased compared to the serum level in patients with myocardial infarction without arterial hypertension. Conclusion. A higher significance of the interaction between indicators of vascular remodeling, inflammation, endothelial dysfunction gene polymorphism in the development of myocardial infarction in patients with a history of hypertension, in contrast to non-hypertensive patients with myocardial infarction, was revealed, which indicates a powerful contribution of arterial hypertension to the etiology and implementation of myocardial infarction.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ КЛИНИКО-ЛАБОРАТОРНЫХ МАРКЕРОВ ПОРАЖЕНИЯ НЕРВНОЙ СИСТЕМЫ, АССОЦИИРОВАННЫХ С БЕРЕМЕННОСТЬЮ

Abstract. Objective: To study, to systematize and to evaluate the prognostic significance of clinical and laboratory markers of nervous system damage associated with pregnancy with and without arterial hypertension (AH) in order to determine the main risk factors for the development of stroke. Materials and methods. Assessment of autonomic dysfunction, neuro-ophthalmological examination, additional research methods: laboratory and instrumental methods, including the study of gene polymorphism, CT, MRI Results. Based on the results of constructing a set of logistic regression models that generalize their results of a high probability detection algorithm, it is shown that in order to identify the final group of high risk of developing ischemic stroke in pregnant women, it is necessary to exclude patients without autonomic dysfunction before pregnancy, and also take into account the risks if they are detected in at least two stages. Factors such as the presence of cephalgic syndrome, autonomic dysfunction before pregnancy, contraception, concomitant pathology of more than 3 nosological units, hypoplasia of cerebral vessels, retinal angiopathy according to neuro-ophthalmological examination, elevated levels of fibrinogen and high activity of von Willebrand factor are common risk factors for the development of cerebrovascular accident ischemic type, regardless of the presence or absence of arterial hypertension.

Metabolic changes in elderly people with sarcopenia

Sarcopenia is a special condition that develops in older people. Sarcopenia represents a loss of muscle strength and mass in the elderly and is a common disease and is also associated with several adverse health effects. Due to the impact of sarcopenia on quality of life, disability and mortality, greater awareness is needed to correctly identify this condition and in particular its biological immunoendocrine markers. The purpose of the study was to study the characteristics of metabolism in sarcopenia in elderly people at the molecular, cellular and organizational levels. Material and methods. The study included 402 elderly people (199 men and 203 women, average age 68.9 ± 1.2 years), who are divided into three groups depending on the presence or absence of arterial hypertension and sarcopenia. The state of adipose and muscle tissue was studied using anthropometric measurements, bioimpedansometry and dynamometry. Results and discussion. The present study revealed a significant increase in energy exchange tension in patients with arterial hypertension, expressed in the increase in ADP content, but it was not enough to maintain the ATP/ADP ratio at the proper level. In patients with arterial hypertension and sarcopenia, a pronounced deficiency in ATP and ADP content, as well as ATP/ADP ratio was observed. The energy deficiency can also be explained by increase in lactate dehydrogenase activity in patients with arterial hypertension to compensate for energy deficiency by enhancing glycolysis processes. However, when sarcopenia was attached, this sanogenetic compensatory mechanism no longer worked. Conclusions. Dysfunction of adipose tissue in patients with arterial hypertension precedes the development of sarcopenia, while there is an increase in tension in energy exchange, expressed in elevation of ADP content, but when sarcopenia joins, there is a pronounced deficiency in both ATP and ADP content, as well as ATP/ADP ratio.

Risk Factors Predisposing to Angina in Patients with Non-Obstructive Coronary Arteries: A Retrospective Analysis.

No hemodynamically significant atherosclerotic plaques are observed in up to 30% of patients reporting angina and undergoing coronary angiography. To investigate risk factors associated with non-obstructive coronary artery disease (NOCAD), we analyzed the medical records of, consecutively, 136 NOCAD subjects and 128 patients with significant stenosis in at least one coronary artery (the OCAD group). The blood concentrations of the TC (4.40 [3.78–5.63] mmol/L vs. 4.12 [3.42–5.01] mmol/L; p = 0.026), LDL-C (2.32 [1.80–3.50] mmol/L vs. 2.10 [1.50–2.70] mmol/L; p = 0.003), non-HDL-C (2.89 [2.29–4.19] mmol/L vs. 2.66 [2.06–3.39] mmol/L; p = 0.045), as well as the LDL-C/HDL-C ratio (1.75 [1.22–2.60] vs. 1.50 [1.10–1.95]; p = 0.018) were significantly increased in the NOCAD patients compared to the OCAD group due to the lower prevalence and intensity of the statin therapy in the NOCAD individuals (p < 0.001). Moreover, the abovementioned lipid parameters appeared to be valuable predictors of NOCAD, with the LDL-C (OR = 1.44; 95%CI = 1.14–1.82) and LDL-C/HDL-C (OR = 1.51; 95%CI = 1.13–2.02) showing the highest odds ratios. Furthermore, multivariable logistic regression models determined female sex as the independent risk factor for NOCAD (OR = 2.37; 95%CI = 1.33–4.20). Simultaneously, arterial hypertension substantially lowered the probability of NOCAD (OR = 0.21; 95%CI = 0.10–0.43). To conclude, female sex, the absence of arterial hypertension, as well as increased TC, LDL-C, non-HDL, and LDL-C/HDL-C ratio are risk factors for NOCAD in patients reporting angina, potentially as a result of poor hypercholesterolemia management.

Normotensive primary hyperaldosteronism due to an adrenocortical adenoma in a dog

AbstractWe present an 8‐year‐old poodle with polyuria, polydipsia and muscle weakness. Physical examination revealed no abnormalities. Laboratory alterations were hypokalemia and hypernatraemia with a low urine specific gravity. Abdominal ultrasound revealed a nodule in the right adrenal gland (diameter 0.95 cm). Systolic blood pressure was normal for several consecutive days (on average 120 mmHg). Elevated plasma aldosterone and undetectable plasma renin concentrations were diagnostic of primary hyperaldosteronism. An uncomplicated adrenalectomy was performed. Histopathological examination revealed an adrenocortical adenoma with positive expression for neuron‐specific enolase but not for synaptophysin and chromogranin on immunohistochemistry. In addition, immunostaining for neuron‐specific enolase was also found in cells from the normal glomerular zone of the same adrenal gland. Therefore, zona glomerulosa origin of the neoplasm was inferred. Adrenalectomy normalised laboratory abnormalities with remission of clinical signs. This report highlights the importance of not excluding the diagnosis of primary hyperaldosteronism in the absence of arterial hypertension.

Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients.

Simple SummaryTo evaluate the best possible treatment of malignant pleural mesothelioma—a cancer whose development is associated with asbestos exposure—an analysis of 112 consecutive patients treated at a high-volume center in Vienna (Austria) was conducted. The average survival of all patients was 16.9 months after diagnosis. Of the patients who underwent combined chemotherapy and lung-preserving surgery, 29% were still alive 5 years after diagnosis. In statistical analysis, combined chemotherapy and surgery, epithelioid tumor subtype, early tumor stage and the absence of relevant comorbidities were found to be favorable factors for survival. Therefore, the best possible treatment for malignant pleural mesothelioma should incorporate multiple therapeutic approaches.Malignant pleural mesothelioma (MPM) is a rare pleural cancer associated with asbestos exposure. According to current evidence, the combination of chemotherapy, surgery and radiotherapy improves patients’ survival. However, the optimal sequence and weighting of the respective treatment modalities is unclear. In anticipation of the upcoming results of the MARS-2 trial, we sought to determine the relative impact of the respective treatment modalities on complications and overall survival in our own consecutive institutional series of 112 patients. Fifty-seven patients (51%) underwent multimodality therapy with curative intent, while 55 patients (49%) were treated with palliative intent. The median overall survival (OS) of the entire cohort was 16.9 months (95% CI: 13.4–20.4) after diagnosis; 5-year survival was 29% for patients who underwent lung-preserving surgery. In univariate analysis, surgical treatment (p < 0.001), multimodality therapy (p < 0.001), epithelioid subtype (p < 0.001), early tumor stage (p = 0.02) and the absence of arterial hypertension (p = 0.034) were found to be prognostic factors for OS. In multivariate analysis, epithelioid subtype was associated with a survival benefit, whereas the occurrence of complications was associated with worse OS. Multimodality therapy including surgery significantly prolonged the OS of MPM patients compared with multimodal therapy without surgery.

Гормональные и гемодинамические изменения у городских жителей среднего возраста с ожирением в зависимости от уровня артериального давления

Актуальность. Актуальность исследования обу­словлена значительным распространением избыточной массы тела разной степени выраженности среди населения и высоким риском развития коморбидных патологических состояний, в том числе артериальной гипертензии (АГ). Сегодня не до конца выясненным остается вопрос гормонально-метаболически-гемодинамических отличий у представителей украинской популяции с ожирением (ОЖ) и АГ и с ОЖ без АГ. Решение этого вопроса может помочь оптимизировать алгоритм профилактических мероприятий развития АГ среди населения Украины. Цель: детализировать особенности гемодинамики, водных секторов тела, функционирования ренин-альдостероновой системы, секреции лептина, инсулина у лиц среднего возраста с разной массой тела и артериальным давлением (АД) с учетом выраженности хронического неспецифического воспаления. Материалы и методы. Обследованы 273 жителя г. Харькова (мужчины/женщины = 56/217) среднего возраста (56,41 ± 6,93 года), которые не лечились в прошлом по поводу ОЖ и АГ. Определяли индекс массы тела, охват талии, измеряли АД. Методом биоимпедансного анализа исследовали состав тела (жировую, относительную жировую, безжировую, активную клеточную массу), иммуноферментным методом — уровни инсулина, лептина, ренина, альдостерона и кластерина в сыворотке крови. Рассчитывали индекс инсулинорезистентности НОМА. Результаты. Пациенты с ожирением независимо от наличия или отсутствия у них АГ имеют достоверное увеличение абсолютной гидратации организма с одновременным увеличением сердечного выброса и ударного объема в сравнении как со здоровыми лицами, так и с пациентами без ожирения с АГ. Доказано, что при этих изменениях имеет место достоверное увеличение уровней ренина и альдостерона крови у лиц с ожирением. Развитие ожирения у пациентов с АГ сопровождается увеличением у них объема циркулирующей крови, общего периферического сопротивления сосудов и среднего артериального давления, выраженности инсулинорезистентности и хронического неспецифического воспаления, повышением уровней инсулин-, лептин-, ренин- и альдостеронемии. Уровни циркулирующего ренина и альдостерона в сыворотке крови лиц среднего возраста прямо связаны со степенью инсулин-, лептин-, кластеринемии и индексом НОМА. Выводы. Приблизительную оценку уровней ренинемии и альдостеронемии у городских жителей Украины среднего возраста при массовых исследованиях можно проводить путем измерения интегральной реографии тела с определением параметров ударного индекса и ударного объема. Соответствующие уравнения регрессии касаемо их оценки определены в данном исследовании.

Risk factors for progression of diabetic retinopathy

Gabija Stankevičiūtė1, Konstancija Ambrazaitė1 1Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania Abstract Diabetic retinopathy (DR) is the most common complication of type 1 and 2 diabetes mellitus (DM) and is diagnosed in 77%-82.6% of people with the diagnosis of DM of 15 years or more [1]. About 60% of patients diagnosed with DR are in the working-age population. It is thought that the progression of DR is due to a combination of risk factors rather than a single cause [2]. Some research suggests that the main risk factors for DR progression are uncontrolled glycaemic control and arterial hypertension; other factors, such as adolescence, pregnancy, cataract surgery, dyslipidaemia and inflammation, only further exacerbate the already existing interaction between the previously mentioned risk factors [3]. On the other hand, the already existing dyslipidaemia and inflammation in DM can be associated with further comorbidities, although subjected to longer periods of time [2,3,4]. Moreover, the delayed statin treatment is associated with the complications of DR, such as blindness, glaucoma, bleeding into the vitreous body, oedema of the macula, retinal detachment – conditioned to the presence of dyslipidaemia and the absence of arterial hypertension [3,5,6,7]. Thereby, the controversy in the literature highlights the need to explore the factors which influence the progression of diabetic retinopathy. Aim: to analyze scientific literature and provide a review of literature related to the risk factors of diabetic retinopathy. Methods: literature review and data collection sources were selected from PubMed and Cochrane Library scientific databases, following dates from 2016 to 2021, using original language keywords: “diabetic retinopathy”, “risk factors”, “diabetes mellitus”, “dyslipidaemia”, “glycaemic control”. Conclusions: the main risk factors for DR progression are glycaemic control, pregnancy, cataract surgery, and arterial hypertension. Other factors such as dyslipidaemia, systemic inflammation and diabetic retinopathy have synergistic effect within the progression of DR. Keywords: diabetic retinopathy, risk factors, diabetes mellitus, dyslipidaemia, glycaemic control. https://doi.org/10.53453/ms.2021.06.10

Promotion of Arterial Stiffness by Childhood Cancer and Its Characteristics in Adult Long-Term Survivors.

BackgroundVascular alterations induced by antineoplastic treatment might be considered as a possible underlying mechanism of increased cardiovascular sequelae in childhood cancer survivors (CCSs). We aimed to evaluate arterial stiffness among long‐term CCSs and to compare the data against a population‐based sample.Methods and ResultsArterial stiffness was assessed by digital photoplethysmography (stiffness index; m/s) among 1002 participants of the CVSS (Cardiac and Vascular Late Sequelae in Long‐Term Survivors of Childhood Cancer) study, diagnosed with neoplasia (1980–1990) before an age of 15 years. A population‐based sample from the GHS (Gutenberg Health Study) (n=5252) was investigated for comparison. All subjects underwent a comprehensive, standardized clinical examination in the same study center. CCSs had higher stiffness index (β=0.66 m/s; 95% CI, 0.51–0.80 m/s) in multivariable linear regression analysis after adjustment for cardiovascular risk factors compared with the population sample of comparable age range. Stiffer vessels were found among CCSs also in absence of arterial hypertension (β=0.66; 95% CI, 0.50–0.81) or history of chemotherapy/radiotherapy (β=0.56; 95% CI, 0.16–0.96) in fully adjusted models. Moreover, stiffness index differed by tumor entity, with highest values in bone and renal tumors. Almost 5.2‐fold higher prevalence of stiffness index values exceeding age‐specific, population‐based reference limits was observed among CCSs compared with GHS participants.ConclusionsThis is the first study demonstrating increased arterial stiffness among long‐term CCSs. The data suggest that vascular compliance might differ in survivors of childhood cancer from the established development concept for arterial stiffness in the population; cancer growth and antineoplastic treatment might be relevant determinants of the pathobiological features.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02181049.

TO THE QUESTION OF CHOOSING OPTIMAL APPROACHES TO THE PREVENTION OF ARTERIAL HYPERTENSION IN THE WORK PLACES IN THE ORGANIZED POPULATION OF BAKU CITY

Introduction. Due to the growing prevalence of arterial hypertension (AH) among the adult population of industrialized countries, the issues of prevention and treatment of this disease are under the close attention of researchers and are among the most pressing problems of modern cardiology.Material and methods. The survey of 110 employees (84 women and 26 men) of one of the scientific libraries of Baku city was conducted with the help of a set of standard methods of epidemiological research in cardiology.Results of the research. The presence of AH was found in 26.4% of persons in the institution under study. Moreover, 15.5% of them were patients with AH, the remaining 10.9% were patients who did not know about their disease. In order to determine the possible risk of new cases of AH in this institution, a comparative analysis of the frequency of occurrence of the main risk factors (RF) of cardiovascular disease (CVD) among the surveyed staff with the presence and absence of AH was conducted. Although all patients without AH were younger than 40 years of age, the incidence of major RF of CVD was noted, in some cases close to that of patients with AH.Conclusion. The received data testify to the fact that the introduction of preventive measures aimed at the correction of the RF of CVD taking into account the specific conditions and specifics of work in the institution under study will significantly reduce the possibility of new cases of AH among the investigated category of patients.

The choice of treatment for myocardial infarction based on individual cardiovascular risk and symptoms of coronary heart disease

According to the data of hospital mortality of patients of the Shymkent cardiological center, the most frequent case of the indicator at the stationary stage in patients with myocardial infarction occurs when the class of acute heart failure according to Killip II-IV is determined in patients, the level of blood glucose is more than 8.0 mmol/l, the level of blood creatinine is more than 123.8 mmol/l and the absence of arterial hypertension when entering the clinic. The main causes of mortality among such elderly and senile patients were Killip class II-IV, blood glucose level of more than 7.30 mmol/l, blood creatinine level of more than 141.4 mmol/l, belonging to the female sex and the absence of hypertension on admission. Implementation of coronary artery stenting taking into account risk factors affecting mortality in hospital in patients with acute myocardial infarction leads to a decrease in hospital mortality and long-term mortality, compared with conservative treatment. Implantation of drug-coated stents and uncoated metal stents equally reduced the mortality rate of myocardial infarction in patients. In elderly and senile patients with myocardial infarction in combination with diabetes mellitus after coronary artery stenting there is a deterioration in long-term survival. Long-term survival at the end of 2010-2018 was 83.67%, while in patients with concomitant diabetes mellitus - only 40.03%, p=0.045 (Log-rank test). Thrombolytic therapy did not improve survival in hospital and long-term patients in the elderly and senile age group. Implementation of thrombolysis in elderly and senile patients hospitalized up to 1.5 hours from the onset of symptoms of myocardial infarct, leads to an unreliable reduction in mortality (p=0.085), hospitalized later than 1.5 hours - there is an increase in mortality compared with patients without thrombolysis(p=0.848). Coronary stenting in acute myocardial infarction reduced mortality in elderly and senile patients regardless of the time between the onset of symptoms of myocardial infarction and hospitalization (p=0.486 and p=0.004).

Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up

BackgroundPredictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). MethodsForty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. ResultsBAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). ConclusionsClassic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

Тhe prevalence of metabolically healthy obesity: data from the epidemiological survey in of Novosibirsk

Background: Obesity is associated with numerous metabolic complications, such as type 2 diabetes mellitus (DM2), dyslipidemia, arterial hypertension (AH), cardiovascular diseases and some forms of cancer. Nevertheless, the literature describes a group of obese individuals who are more resistant to the development of metabolic disorders. At present, this phenomenon is known as "Metabolically healthy obesity", "metabolically healthy obesity" (MZO). Despite the presence of excess weight or obesity, a favorable metabolic profile can be observed in this cohort of patients, characterized by preserved insulin sensitivity, absence of arterial hypertension, normal lipid, hormonal profile, absence of inflammation and unchanged hepatic transaminases.&#x0D; Aims: To study the prevalence of metabolically healthy obesity (MHO) and its characteristics in men and women at the age of 4569 years in Novosibirsk.&#x0D; Materials and methods: To study covered 3197 persons from the base of the international project HAPPIE. They had a body mass index (BMI 30 kg/m). Metabolically healthy obesity was determined as obesity (BMI 30 kg/m, with 2 and fewer components of metabolic syndrome (MS) by criteria NCEP ATP III, 2001. Statistical analisys SPSS-13.&#x0D; Results: The prevalence of metabolic healthy obesity (MHO) was 42% (38% for men and 43% for women). The examined people with MHO have reliably more favorable average level of TG, HDL-cholesterol, indicators of blood glucose, systolic arterial pressure and diastolic arterial pressure and less waist circumference. In the groups withMHO and MS abdominal obesity is common in men at 95 and 71%, in women at 99 and 90%; hyperTG in men at 74 and 9%, in women at 72 and 5,5%; lower level HDL-cholesterol in 16 and 1% for men, and in 44,5% and 3% for women; AP in 96 and 77% and 94 and 71% in men and women respectively, the frequency fasting of hyperglycaemia 77 and 21% in men and 60 and 5% in women was markedly different. According to the data obtained by us, the frequency in the sample is high and amounted to 42%. In the subgroup the most commonly found is the MHO phenotype 53%, than in the men -38%, р 0,001&#x0D; Conclusions: According to our data, the frequency of metabolic healthy obesity in the sample is high and amounted to 42%. In the female subgroup, a metabolically healthy phenotype is more common 43% than in the male 38%, p 0.001. Metabolically healthy obese individuals are characterized by a significantly lower incidence of fasting hyperglycaemia and dyslipidemia.

ARTERIAL HYPERTENSION AS A RISK FACTOR OF ISCHEMIC HEART DISEASE DESTABILIZATION (FRAGMENT OF RACSMI‑UZ STUDY)

Background. Registries are the most accurate tool for assessing the status of real clinical practice. The registries help to identify deficiencies in the management of patients, to determine the most optimal ways to improve the quality of treatment. In 2015, the Republican Specialized Center of Cardiology organized and initiated the Registry of acute coronary syndrome (ACS) and acute myocardial infarction (AMI) in one of the districts of Tashkent city (RACSMI-Uz Registry). In the present work, which is a fragment of the RACSMI-Uz study, the main clinical and laboratory characteristics of patients with ACS/AMI were collected and analyzed, depending on the presence or absence of arterial hypertension (HTN). Design and methods . We analyzed the registry database of 432 patients who survived ACS/AMI. Results . In HTN patients survived after ACS/AMI, such accompanying pathologies as 1–2 stage obesity, myocardial infarction in past, type 2 diabetes mellitus, etc. were registered more often and the rate of stenotic (> 50 %) narrowing of the coronary arteries was greater. The heart rate > 80 beats/min was 1,5-times greater among HTN patients than among non-HTN subjects. Lipid metabolism in patients after ACS/AMI with concomitant HTN was characterized by hypertriglyceridemia and relatively safe low values of total cholesterol level. Compliance with medications was 2 times higher in HTN patients with ACS/AMI than among those without HTN.

IMPACT OF POLYMORPHISM OF CARDIOVASCULAR RISK GENES ON ARTERIAL REMODELLING DEVELOPMENT DEPENDING ON PRESENCE OF SYSTEMIC HYPERTENSION

Aim. To investigate on clinical and genetic characteristics of patients with multiple cardiovascular risk factors depending on the presence or absence of arterial hypertension (AH) and severity of pure arterial stiffness. Material and methods. To the study, 330 patients of economically active age were included, with multiple cardiovascular risk factors at one of Perm city factories. Mean number of the risk factors 5,25±1,04. Mean age 46,67±8,46 y. o. Among the participants 205 (62,12%) males and 125 (37,88%) females. In 177 (53,6) there was AH of grade 1-3 diagnosed. All participants underwent genotype assessment by the markers AGT Thr174Met rs4762, GNB3 C825T rs5443, MTHFR C677T rs1801133, MTRR Ile22Met rs1801394, ApoE Cys130Arg rs 429358, PPARα G/C rs4253778; volume sphygmopletysmography with the CAVI1 measurement. In the first part of the study, patients were selected to 2 groups according to AH presence. In the second part — by CAVI1 level, selected to 3 subgroups: 1st subgroup — no lesion of arteries and CAVI1 9. Results. Among the patients with borderline arteries lesion with AH or with none, the most significant are genotypes С/Т and ТТ of polymorphism Thr174Met rs4762 gene AGT, genotypes С/Т and Т/Т of polymorphism C825T rs5443 gene GNB3, genotypes С/Т and Т/Т of polymorphism C677T rs1801133 gene MTHFR, and genotypes С/С of polymorphism G/C rs4253778 gene PPARα. In patients with the CAVI1 >9 also, regardless of AH presence, were significant the С/Т and ТТ polymorphism Thr174Met rs4762 of gene AGT, genotypes С/Т and Т/Т polymorphism C677T rs1801133 gene MTHFR, genotypes A/G and G/G of polymorphism Ile22Met rs1801394 gene MTRR, and genotype G/С and С/С polymorphism G/C rs4253778 gene PPARα. Presence of AH with no target organ lesion is associated with С/Т polymorphism of the gene GNB3, genotype Т/Т polymorphism of gene MTHFR, and genotypes G/С and С/С of gene polymorphism PPARα. Correlational analysis showed moderate direct correlation of CAVI1 and polymorphism of the genes AGT (r=0,35; p=0,022), GNB3 (r=0,43; p=0,029), MTHFR (r=0,42; p=0,002), MTRR (r=0,43; p=0,025), PPARα (r=0,39; p=0,036). Relation with САVI1 and gene polymorphism АроЕ was not significant. Conclusion. The study witness on the fact that cardiovascular risk shaping and the development of arterial stiffness depend not only on blood pressure level, but patient’s genotype. The data showed that some definite genotypes can be regarded as early markers of cardiovascular risk and arteries lesion in AH patients, and in no AH as well.

Reverse epidemiology of elevated blood pressure among chronic hemodialysis black patients with stroke: a historical cohort study

BackgroundStroke is the third leading cause of cardiovascular mortality in dialysis patients. The objective of this study was to assess the extent of stroke in chronic hemodialysis patients.MethodsHistorical cohort of patients enrolled in two hemodialysis (HD) centers from January 1, 2010 to December 31, 2011, including 191 patients (mean age 52 years, 68% men). Incidence curves and survival time analysis between the first day of HD and the end of the study were described by the Kaplan-Meier method. Independent stroke predictors were identified by multiple logistic regression analysis. P < 0.05 defined the level of statistical significance.Results12 incident stroke were recorded during the study period, with 1622.1 person-months (PM), a stroke incidence rate of 7.4 cases per 1000 PM (95% CI = 7.35–7.44) at the point date. The incidence of stroke at 6 months, 12 months and 24 months was 9.8%, 11.9% and 13%, respectively. Only the absence of arterial hypertension (RR = 5.7, 95% CI: 1.52–21.42) emerged as an independent determinant of stroke.ConclusionThe high incidence of stroke in Kinshasa HD centers is partially explained by reverse epidemiology. Efforts must be made to understand this phenomenon in order to reduce its impact.