Atherosclerotic Markers Research Articles

Low testosterone levels are related to oxidative stress, mitochondrial dysfunction and altered subclinical atherosclerotic markers in type 2 diabetic male patients

IntroductionLow testosterone levels in men are associated with type 2 diabetes and cardiovascular risk. However, the role of testosterone in mitochondrial function and leukocyte-endothelium interactions is unknown. Our aim was to evaluate the relationship between testosterone levels, metabolic parameters, oxidative stress, mitochondrial function, inflammation and leukocyte-endothelium interactions in type 2 diabetic patients. Materials and methodsThe study was performed in 280 male type 2 diabetic patients and 50 control subjects. Anthropometric and metabolic parameters, testosterone levels, reactive oxygen species (ROS) production, mitochondrial membrane potential, TNFα, adhesion molecules and leukocyte-endothelium cell interactions were evaluated. ResultsTestosterone levels were lower in diabetic patients. Total and mitochondrial ROS were increased and mitochondrial membrane potential, SOD and GSR expression levels were reduced in diabetic patients. TNFα, ICAM-1 and VCAM-1 levels, leukocyte rolling flux and adhesion were all enhanced in diabetic patients, while rolling velocity was reduced. Testosterone levels correlated negatively with glucose, HOMA-IR, HbA1c, triglycerides, nonHDL-c, ApoB, hs-CRP and AIP, and positively with HDL-c and ApoA1. The multivariable regression model showed that HDL-c, HOMA-IR and age were independently associated with testosterone. Furthermore, testosterone levels correlated positively with membrane potential and rolling velocity and negatively with ROS production, VCAM-1, rolling flux and adhesion. ConclusionsOur data highlight that low testosterone levels in diabetic men are related to impaired metabolic profile and mitochondrial function and enhanced inflammation and leukocyte-endothelium cell interaction, which leaves said patients at risk of cardiovascular events.

Increased interarm blood pressure difference is associated with autonomic dysfunction and atherosclerosis in patients with chest pain and no history of coronary artery disease

ObjectivesInterarm blood pressure (BP) difference has been reported to be associated with atherosclerosis and increased cardiovascular death. We were to investigate associations of interarm systolic blood pressure (SBP) difference with heart rate recovery (HRR) after exercise, an index of autonomic function, and carotid atherosclerotic markers, and to evaluate the association of interarm SBP difference with concurrent coronary artery disease (CAD). MethodsA total of 995 consecutive patients who underwent treadmill stress echocardiography with chest pain but no history of CAD were enrolled. Interarm SBP difference, carotid intima-media thickness (IMT) and plaque were measured before exercise, and HRR 2min following exercise was assessed. Suspected CAD was defined as newly developed wall motion abnormalities after treadmill exercise. ResultsPatients with an interarm SBP difference≥10mmHg had higher prevalence of hypertension, increased right and left SBP, right diastolic BP, mean arterial pressure, body mass index and carotid IMT, existent carotid plaque, lower metabolic equivalents and slower HRR. Interarm SBP difference≥10mmHg was independently associated with slower HRR and existent carotid plaque. Suspected CAD was associated with existent carotid plaque or slower HRR, but not with an interarm SBP difference≥10mmHg. ConclusionsIncreased interarm SBP difference was associated with lower autonomic modulation and carotid atherosclerosis in patients with chest pain and no history of CAD, but not with suspected CAD. Observed adverse prognosis in patients with increased interarm BP difference might result from long-term persistent autonomic dysfunction and atherosclerosis.

Роль неалкогольной жировой болезни печени в формировании атеросклеротического поражения сосудистой стенки у пациентов с абдоминальным ожирением

Aim of investigation. To study the vascular wall changes of common carotid artery and internal carotid arteries in patients with abdominal obesity (AO) and different forms of nonalcoholic fatty liver disease (NAFLD). Material and methods. The study involved 60 patients with AO (waist circumference ≥80 cm in women and ≥94 cm in men) and NAFLD who provided written informed consent to participate in the study. The age of the patient ranged from 18 to 59 years. Patients’ symptoms, past history, were evaluated to exclude alcoholic or drug-induced liver disease, anthropometric parameters were studied. All patients underwent a complex of laboratory and instrumental tests required by the Russian guidelines for diagnosis and treatment of NAFLD (2015). Severity of pathological changes in the liver tissue (fibrosis and steatosis) was assessed by noninvasive Steatoskrin diagnostic method (Biopredictive laboratory, France). Measurement of the intima-media complex thickness of the common carotid artery (IMT CCA) was performed by standard procedures at Voluson 730 Expert device, equipped with 7,5 MHz linear phased array transducer. The presence of early atherosclerotic markers was evaluated by local thickening of the IMT CCA over 0.86 mm in any point of the carotid artery (IMT CCA max). The data were processed by comparative and correlation analysis. Results. The relationship between the presence of NAFLD, initial manifestations of atherosclerosis and insulin resistance was established. This resulted in the rank of prognostic factors based on severity of carotid artery changes, making it possible to conclude individual atherosclerotic risk score for AD and different forms of NAFLD. Conclusion. The results of the study require more profound examination of patients with NAFLD to evaluate both liver and cardiovascular diseases risk.

White-coat hypertension during coronary computed tomography angiography is associated with higher coronary atherosclerotic burden.

White-coat hypertension (WCH) is a prevalent entity, which has been associated with an increased cardiovascular risk. Assess whether WCH is associated with a higher coronary atherosclerotic burden, evaluated by coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scoring. A total of 1362 patients who performed CCTA and simultaneous CAC for the assessment of coronary artery disease (CAD) were prospectively enrolled in a single-center registry and divided into three groups: (A) patients with normal blood pressure (BP) (n=386); (B) patients with WCH (n=174; without a history of hypertension or antihypertensive medication, but with systolic BP ≥140 and/or diastolic BP ≥90 mmHg before examination acquisition); and (C) patients with hypertension (n=802). The following coronary atherosclerotic markers were evaluated: CAC above the 50th percentile (CAC>p50), prevalence of CAD (any plaque), and obstructive CAD (plaque with>50% stenosis). Patients with WCH had a higher coronary atherosclerotic burden compared with patients with normal BP for all markers (30.5 vs. 19.4%, P=0.004 for CAC>p50; 50.6 vs. 36.8%, P=0.002 for CAD, any plaque; and 13.8 vs. 8.3%, P=0.045 for obstructive CAD). On multivariate analysis, WCH was an independent predictor of a CAC>p50 [odds ratio (OR) 1.563, 95% confidence interval 1.018-2.400, P=0.041], but not of the presence of CAD (any plaque) (OR 1.335, P=0.169) or obstructive CAD (OR 1.376, P=0.301). In this registry of patients, WCH was an independent predictor of a CAC above the p50. It was also associated with higher other markers of coronary atherosclerotic burden, such as the presence of CAD on CCTA, compared with patients with normal BP.

Influence of Homocysteine and Vertebral Fractures on prevalent Abdominal Aortic Calcification in Postmenopausal Women - A multicentric cross-sectional study

The main of this study was to examine the relationship between plasma homocysteine (Hcy), asymptomatic osteoporotic vertebral fractures (VFs) using vertebral fracture assessment (VFA) and prevalent abdominal aortic calcification (AAC) in Moroccan postmenopausal women. The study cohort consisted of 188 consecutive postmenopausal women with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism. Mean age, weight, height, body mass index and plasma homocysteine were determined. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy Vision densitometer (GE Healthcare Inc., Waukesha, WI). VFs were defined using a combination of Genant’s semiquantitative approach and morphometry. VFA images were also scored for prevalent AAC using a validated 24 point scale. Fifty-eight (30.9%) patients had densitometric osteoporosis. VFs were identified using VFA in 76 (40.4%) patients: 61 women had grade 1 VFs and 15 had grade 2 or 3 VFs. One hundred twenty nine women (68.6%) did not have any detectable AAC, whereas the prevalence of significant atherosclerotic burden defined as AAC score of 5 or higher, was 13.8%. A significant positive correlation between AAC score and homocysteine was observed. Women with extended AAC, were older, had a lower weight, BMI and BMD, higher homocysteine levels and more prevalent VFs than women without extended AAC. Multiple regression analysis showed that the presence of extended AAC was significantly associated with Age and grade 2/3 VFs and not independently associated with homocysteine levels. This study did not confirm that homocysteine is important determinant of extended AAC in postmenopausal women. However, this significant atherosclerotic marker is independently associated with VFs regardless of age.

Evaluation of 2D:4D digit ratio and diagonal earlobe crease as markers of coronary artery disease

IntroductionCoronary artery disease (CAD) is increasing in prevalence worldwide. In this regard, the extravascular markers in evaluating atherosclerosis is of importance in clinical evaluation. MethodologyAfter informed consent from fifty CAD patients (confirmed from coronary angiographic studies) were recruited into the study. Similar number of age and sex matched controls without CAD were selected. We evaluated digit ratio (2D:4D) and diagonal ear lobe crease (DELC) in patients and compared with healthy individuals. Measurement of digit ratio was by photographic method. Ear lobe of all patients were photographed and evaluated for presence of diagonal ear lobe crease. ResultsWe found that 2D:4D ratios in males with CAD are higher than the control group. There were no such differences in females. 2D:4D ratios as usual sexually dimorphic. Coden’s d calculation revealed that 84% of the males with CAD will be having digit ratios above mean of the control group, and there is a 76% chance that a person picked at random from the CAD group will have a digit ratio more than the mean of control group. Diagonal ear lobe crease was found in 74% of CAD patients out of which 40% creases were unilateral and 34% were bilateral. DiscussionIt is concluded that 2D:4D ration and Diagonal ear lobe crease are the two extravascular atherosclerotic markers are invaluable in clinical evaluation of CAD patients.

Injection of hTERT-Transduced Endothelial Progenitor Cells Promotes Beneficial Aortic Changes in a High-Fat Dietary Model of Early Atherosclerosis

Objectives: Cultured endothelial progenitor cells (EPCs) display troubling issues that adversely affect their applicability to endothelial regeneration. We hypothesized that transduction of the human telomerase catalytic subunit (hTERT) gene would enhance EPC function in treating dietary-induced early atherosclerosis (AS). Methods: A dietary-induced early AS model was successfully constructed in 90 healthy male rats, while 30 healthy control (HC) rats were normally fed. Four experimental groups were constructed: an untreated HC group; an untreated AS group injected with PBS; a null EPC AS group injected with null vector-transduced EPCs, and an hTERT EPC AS group injected with hTERT-transduced EPCs. Two months postinjection, abdominal aortas were extracted to validate EPC integration and comparatively assess mRNA and protein expression of the early atherosclerotic markers VCAM-1, ICAM-1, LFA-1, Mac-1, CD44, MCP-1, endothelial nitric oxide synthase (eNOS), and apolipoprotein E. Results: In vitro, hTERT transduction of EPCs resulted in a significantly superior proliferative capacity as well as significantly higher NO, iNOS, and LDH secretory capacity. In vivo injection of hTERT-transduced EPCs produced significant reductions in CD44 and MCP-1 expression as well as a significant increase in eNOS expression relative to injection with null vector-transduced EPCs (all p < 0.05). Conclusion: hTERT-transduced human EPCs may be useful in treating dietary-induced early AS.

Cryptogenic mechanism in ischaemic stroke patients is a predictor of 5-year survival: A population-based study.

The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism. A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At "home without help" was used as a surrogate marker for low Rankin (0-1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan-Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis. About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66-2.02]), coronary artery disease (HR = 1.28; [1.05-1.56]), cardiac arrhythmia (HR = 1.36; [1.11-1.67]), peripheral artery disease (HR = 1.66 [1.29-2.13]) and incomplete assessment (HR = 1.39; [1.12-1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68-0.94]), high Glasgow Coma Scale score (GCS > 12) (HR = 0.58; [0.45-0.76]), lacunar syndrome (HR = 0.82; [0.68-0.99], being 'at home without help' (HR = 0.50; [0.41-0.59]) and negative assessment (HR = 0.75; [0.58-0.97], compared to cardioembolism) were associated with better survival probability. Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality. Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers.

Epicardial fat and BMI relationships with coronary atherosclerotic markers in patients with coronary calcium score >0: The effect of age and gender

Objectives: To study the effect of age and gender on the relationship of obesity measures(EFV and BMI) with coronary atherosclerotic markers (croaonry calcificed plaque(CCP) and coronary artery obstructive disease (CAD)) in patients with coronary calcium score >0(CAC).

Assessment of Multiple Cardiac Biomarkers in Acute STEMI Patients without Clinical Manifestation of Heart Failure in NICVD

Background: In patients with acute coronary syndrome (ACS), Cardiac Troponin I (cTnI) elevation is indicative of myocardial damage. After acute myocardial infarction (AMI), level of Pro-BNP rises rapidly during the first 24 hours and tends to stabilize thereafter.Objective: The present study tried to explore the pattern of multiple cardiac biomarkers (cTnI, CK-MB, Pro-BNP, SGOT and LDH) in newly diagnosed acute ST-elevation myocardial infarction (STEMI) patients without clinical symptoms of heart failure.Materials and method: This was a prospective study. Total 82 acute STEMI patients were recruited purposively from National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh, within 24 hours of symptoms having normal serum creatinine level. cTnI and pro-BNP elevation were defined &gt;1mg/mL and &gt;125 pg/mL respectively. The study population was sub grouped according to age: group A (&lt;40 years), group B (40-50 years), group C (&gt;51-60 years) and group D (&gt;60 years).Results: The mean±SD age of patients was 53.3±11.6 years and 42.70% population belonged to relatively younger age group (group B). Smoking was found on the top of the list (73.20%) as a risk factor. There was no difference among the groups regarding atherosclerotic marker and no other cardiac markers except pro-BNP. Only Pro-BNP (pg/mL) showed gradual and progressive increment with increasing age. No significant difference was observed between CRP positive and negative groups in different age groups (cut off value &lt;6mg/dL). Group B (40-50 years) seems to be the most vulnerable as the anterior and the extensive anterior myocardial infarctions (worst prognosis) were highest in this group.Conclusion: Worst prognosis is associated with increased age and raised pro-BNP level.Delta Med Col J. Jul 2016 4(2): 55-60

Brachial artery flow-mediated dilatation and carotid intima-media thickness in young ED patients with insulin resistance.

The evidence of a close relationship between cardiovascular disease and erectile dysfunction (ED) is well documented. The aim of this study is to investigate whether there is an early asymptomatic impairment of the peripheral vasculature in young ED patients without obvious cardiovascular disease. We studied a total of 261 ED patients (19-40 years old) and 40 age-matched healthy controls. All participants received questionnaires of cardiovascular risk factors and erectile function assessment, were subjected to lab tests of fasting blood sample, and underwent the ultrasonographic examination of brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (c-IMT). Insulin resistance (IR) was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Compared with normal human controls, FMD was significantly lower, whereas the average c-IMT was significantly greater in ED patients. An inverse correlation was found between FMD and mean c-IMT. The ED patients had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index, but showed relatively lower total testosterone and prolactin levels than the controls. Both FMD and c-IMT showed a significant correlation with International Index of Erectile Function-5 questionnaire (IIEF-5) score, age and HOMA-IR. Multivariate stepwise regression analysis demonstrated that age, HOMA-IR and IIEF-5 score were the risk factors associated with FMD and c-IMT. In conclusion, young ED patients in association with IR display diminished FMD and increased c-IMT. Furthermore, ED, HOMA-IR and age are independent predictors of the two subclinical atherosclerotic markers.

PECAM-1 gene polymorphism (rs668) and subclinical markers of carotid atherosclerosis in patients with type 2 diabetes mellitus.

ABSTRACTThe platelet endothelial cell adhesion molecule 1 (PECAM-1) plays an important role in many inflammatory processes, including the development of atherosclerosis. Polymorphism rs668 of the PECAM-1 gene (373C/G) is functional, and it was reported to be associated with increased serum levels of PECAM-1. We investigated the association between the rs668 polymorphism of PECAM-1 and subclinical markers of carotid atherosclerosis in subjects with type 2 diabetes mellitus (T2DM). Five hundred and ninety-five T2DM subjects and 200 control subjects were enrolled. The carotid intima-media thickness (CIMT) and plaque characteristics (presence and structure) were assessed ultrasonographically. Biochemical analyses were performed using standard biochemical methods. Geno-typing of the PECAM-1 gene polymorphism (rs668) was performed using KASPar assays. The control examinations were performed 3.8 ± 0.5 years after the initial examination. Higher CIMT was found in patients with T2DM in comparison with subjects without T2DM. Statistically sig-nificantly faster progression of the atherosclerotic markers was shown in subjects with T2DM in comparison with the control group. When adjusted to other risk factors, the rs668 GG genotype was associated with an increased risk of carotid plaques in subjects with T2DM. We concluded that our study demonstrated a minor effect of the rs668 PECAM-1 on markers of carotid atherosclerosis in subjects with T2DM.

ABO blood group differences relationship with coronary atherosclerotic markers

BackgroundThe mechanisms linking ABO blood group to coronary atherosclerosis is inconsistent and not fully understood. ObjectivesTo investigate the relationship between ABO blood groups with coronary atherosclerotic markers (coronary artery calcification (CAC), coronary plaque presence and coronary luminal stenosis (CAD)) and pericardial fat volume (PFV) in patients with suspected coronary artery disease assessed by Multidetector CT angiography (MDCT). Patients and methodsTwo hundred twenty consecutive patients who underwent 64-slice MDCT angiography for assessment of coronary artery disease were recruited. Of these, 180 patients (97 females (54%) and 83 males (46%) with a mean age of 51.7 ± 12 years) were found to be eligible and were enrolled in the study. ResultsWe classified the blood groups into O blood group (51.6%) and non O blood group (38%). There were no significant differences in the distribution of CAC, CAD, PFV and coronary plaque presence between different blood groups (P > 0.05). The distribution of major cardiovascular risk factors did not differ significantly among the ABO blood groups, except for a significant association between O blood group and smoking (P = 0.04).Adjustment for age and sex showed no significant associations between blood groups with coronary atherosclerotic markers or PFV (P > 0.05). Non O blood group were significantly correlated with CAC (P = 0.01), coronary plaque (P = 0.04) and PFV (P = 0.03) after adjustment for CAD and CAC. ConclusionNo significant relationship were observed between ABO blood groups with coronary atherosclerotic markers and PFV. Non O blood group showed a significant correlation with CAC and PFV after adjustment for CAC and CAD.

Carotid and femoral intima-media thickness as an early atherosclerotic marker. Advantages and limits

The intima-media thickness (IMT) is defined as the distance between the hyperechogenic inner (blood-intima interface) and outer line (media-adventitia interface) of the arterial wall. It is a surrogate marker of atherosclerotic damage. No consensus guidelines are available on which site and how carotid IMT sampling should be performed, and comparison among data from different studies is difficult. IMT is the "phenotype" of the early phases of atherosclerotic disease and is related to the main traditional risk factors. Moreover, IMT is a marker of organ damage either in the heart or in other vascular districts. Although threshold IMT values for the prediction of cardiovascular events have not been identified, high IMT values are associated with an increased occurrence of cardiovascular events. Indeed, an IMT > or = 0.9 mm was demonstrated to be associated with an increased cardiovascular risk even after age adjustment. The value of IMT as an independent risk factor is still under debate, especially in young patients at intermediate risk. Moreover, the IMT regression reported in therapeutic trials with statins and antihypertensive drugs was only weakly or not at all associated with a decrease in cardiovascular events. In comparison to carotid IMT, femoral IMT is more strictly correlated with the severity of coronary artery disease and the need for revascularization in effort angina. The simultaneous measurement of carotid and femoral IMT may improve risk stratification in patients with coronary heart disease. The challenge for the future is to establish an IMT cut-off value for a better definition of the individual cardiovascular risk. Such cut-off value may be derived from the combined measurement of carotid and femoral IMT.

Nitroglycerin mediated dilation evaluated by ultrasound is associated with sTWEAK in hemodialysis patients.

The main cause of death in hemodialysis (HD) patients is cardiovascular disease. Ultrasound assessment of the brachial artery dysfunction is easily achievable and can non-invasively detect atherosclerosis in various stages. In HD patients the cardiovascular risk profile is different and the determinants of brachial arterial function can be distinct comparing with general population. The aim of the study is to assess the determinants of arterial brachial function (flow-mediated and nitroglycerin-mediated dilation) evaluated by ultrasound in HD patients and their relation with tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) described as atherosclerotic marker in chronic kidney disease patients. We conducted a cross-sectional observational study on 54 hemodialysis patients. We recorded clinical and biological data and we measured sTWEAK serum levels by ELISA. We evaluated the arterial brachial function by measurement of flow-mediated and nitroglycerin-mediated dilation, using B mode ultrasound. The determinants of flow-mediated dilation were: Kt/V (r=0.47, p<0.001), LDL-cholesterol (r=0.29, p=0.04), and total cholesterol (r=0.31, p=0.02). Flow-mediated dilation correlated with nitroglycerin-mediated dilation (r=0.70, p<0.001). In multivariate analysis kt/V was the only significant predictor for flow-mediated dilation (p=0.04). Nitroglycerin-mediated dilation correlates with sTWEAK (r=-0.30, p=0.03), systolic blood pressure (r=-0.28, p=0.04) and pulse pressure (r=-0.31, p=0.02). In multivariate analysis sTWEAK was the only significant predictor for nitroglycerin-mediated dilation (p=0.04). The main determinant of nitroglycerin-mediated dilation was sTWEAK. In addition, decreased nitroglycerin-mediated dilation was associated with higher systolic blood pressure and pulse pressure. The main determinant of FMD was Kt/V. Increased flow-mediated dilation was associated with better dialysis efficiency and high total cholesterol and LDL-cholesterol.

Nitroglycerin mediated dilation evaluated by ultrasound is associated with sTWEAK in hemodialysis patients.

Aims: The main cause of death in hemodialysis (HD) patients is cardiovascular disease. Ultrasound assessment of the brachial artery dysfunction is easily achievable and can non-invasively detect atherosclerosis in various stages. In HD patients the cardiovascular risk profile is different and the determinants of brachial arterial function can be distinct comparing with general population. The aim of the study is to assess the determinants of arterial brachial function (flow-mediated and nitroglycerin-mediated dilation) evaluated by ultrasound in HD patients and their relation with tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) described as atherosclerotic marker in chronic kidney disease patients. Material and methods: We conducted a cross-sectional observational study on 54 hemodialysis patients. We recorded clinical and biological data and we measured sTWEAK serum levels by ELISA. We evaluated the arterial brachial function by measurement of flow-mediated and nitroglycerin-mediated dilation, using B mode ultrasound. Results: The determinants of flow-mediated dilation were: Kt/V (r=0.47, p&lt;0.001), LDL-cholesterol (r=0.29, p=0.04), and total cholesterol (r=0.31, p=0.02). Flow-mediated dilation correlated with nitroglycerin-mediated dilation (r=0.70, p&lt;0.001). In multivariate analysis kt/V was the only significant predictor for flow-mediated dilation (p=0.04). Nitroglycerin-mediated dilation correlates with sTWEAK (r=-0.30, p=0.03), systolic blood pressure (r=-0.28, p=0.04) and pulse pressure (r=-0.31, p=0.02). In multivariate analysis sTWEAK was the only significant predictor for nitroglycerin-mediated dilation (p=0.04). Conclusions: The main determinant of nitroglycerin-mediated dilation was sTWEAK. In addition, decreased nitroglycerin-mediated dilation was associated with higher systolic blood pressure and pulse pressure. The main determinant of FMD was Kt/V. Increased flow-mediated dilation was associated with better dialysis efficiency and high total cholesterol and LDL-cholesterol.

Increased Type 2 Diabetes Mellitus Risk (Assessed by Findrisc Score) is Associated with Subclinical Atherosclerotic Markers in Asymptomatic Adult Population

Abstract Background and Aims. Risk score questionnaires for the screening of type 2 diabetes mellitus (DM) present high accuracy, especially the Finnish Diabetes Risk Score (FINDRISC). The aim of the study was to assess the FINDRISC score and its correlations with multiple markers of subclinical atherosclerosis in an asymptomatic urban population. Material and Methods. In the current prospective study, 111 randomized asymptomatic subjects, aged 35-75, were evaluated. FINDRISC score, the cardiovascular and metabolic risk profile were evaluated. Multiple markers of subclinical atherosclerosis were assessed including carotid intima-media thickness (IMT), ankle-brachial index (ABI), pulse wave velocity (PWV) and left ventricular mass index (LVMI). Results. Mean age was 51.87 ± 10.64 years while FINDRISC score was 10.53 ± 4.53. 77% of the subjects were overweight and all parameters of obesity were well associated with FINDRISC score (p&lt;0.001). This asymptomatic population was dyslipidemic (total cholesterol 212.79±44.99 mg/dl). DM risk correlated with age, blood pressure, fasting plasma glucose and glomerular filtration rate. Increased FINDRISC was associated with IMT (r=0.24, p=0.01), PWV (r=0.26, p=0.008) or LVMI (r=0.23, p=0.01). Conclusions. This asymptomatic population was metabolically uncontrolled. Easily administered type 2 DM screening questionnaires should be routinely performed as increased risk score values are associated with subclinical atherosclerosis.

Influence of the age on the correlation of obesity measures with coronary atherosclerotic markers

Abstract Objectives To assess the influence of age on the association of pericardial fat volume (PFV), weight and body mass index (BMI) with coronary stenosis, plaque and coronary artery calcification (CAC). Materials and methods A total of 127 consecutive patients with intermediate pretest probability of ischemic heart disease who underwent CT angiography examination were enrolled in this study. Of these, only 86 patients were found to be eligible to enroll in this study. Results Statistical analysis was performed in two steps. First we studied the relationship of anthropometric measures and coronary atherosclerotic markers in the whole sample. Second, we classified the patients into two groups according to age: age ⩽50 group [30 patients, 18 (60%) male, 12 (40%) female with age 50 group [56 patients, 38 male (68%), 18 female (32%) with age above 50 years]. PFV was significantly associated with coronary artery stenosis (r = 0.381, P = 0.00) and this association persisted even after dividing the patients into young and older age group while there was inconsistent relationship between PFV and coronary plaque. There was a significant association between PFV and CAC in older age group only (P = 0.03). Weight and body mass index failed to demonstrate a significant association with coronary atherosclerotic markers in both young and older age groups. Conclusion Weight and BMI showed no significant correlation with coronary atherosclerotic markers while PFV as a new imaging marker for obesity showed a significant correlation with coronary atherosclerotic markers particularly stenosis severity.

Study of atherosclerotic risk markers in patients with nonalcoholic fatty liver disease

Introduction: Nonalcoholic fatty liver disease (NAFLD) is described as hepatic component of metabolic syndrome as close association exists between the two. It has gained lots of importance in midst of rising epidemic of obesity worldwide in recent times as one of the predisposing risk factors of cardiovascular events. Study Design: The study design was a cross-sectional hospital-based study. Materials and Methods: Forty-eight patients diagnosed to have NAFLD were assessed for insulin resistance (IR) and noninvasive markers of subclinical atherosclerosis and compared with age, gender, and body mass index-matched controls. Results: The patients with NAFLD had significantly higher waist circumference, diastolic blood pressure, fasting insulin, homeostasis model assessment-IR, and significantly lower levels of high-density lipoprotein-cholesterol. They also had significantly higher carotid intima media thickness (CIMT) than controls. Mean CIMT was 0.76 ± 0.12 mm in patients with NAFLD and 0.54 ± 0.18 mm in controls. This difference was statistically significant (P = 0.001). The mean increase in brachial artery diameter was 0.26 ± 0.13 mm in patients and 0.48 ± 0.09 mm in controls. Conclusion: Patients with NAFLD have greater propensity to develop cardiovascular disease in view of the presence of subclinical atherosclerotic markers compared to controls.

Seasonal vitamin D status and endothelial function in healthcare workers.

Healthcare workers have long working hours indoors and are at risk of vitamin D deficiency. The aim of this study was to determine seasonal vitamin D status and its relationship with early atherosclerotic markers, endothelial function, and carotid intima-media thickness (CIMT) in healthcare workers of Marmara University Hospital, İstanbul. One hundred and ninety healthy volunteer healthcare workers and 66 nonmedical volunteers of Marmara University Hospital were included in the study and 25-hydroxyvitamin D (25(OH)D), calcium, intact parathyroid hormone (PTH), endothelial function, and CIMT were measured twice during winter and summer seasons. Mean vitamin D levels were 20 ng/mL in summer and 16.4 ng/mL in winter. Out of the healthcare workers, 48.9% were vitamin D deficient at the end of summer and 71.5% in winter. Flow-mediated dilation (FMD) values were similar in both groups in both seasons; however, FMD values of 64 healthcare workers in summer were significantly higher than in winter. Serum 25(OH)D was positively associated with FMD (r = 0.1797, P = 0.0441) and negatively correlated with serum PTH (r = -0.2459, P < 0.0001). A negative correlation between FMD and serum PTH (r = -0.1757, P = 0.0473) was observed. Vitamin D levels of healthcare workers are very low, even in summer time. Healthcare workers must be considered a group at major risk for vitamin D deficiency.