Atherosclerotic Vascular Changes Research Articles

Abstract P451: Clinical, Demographic, and Geographic Trends in Cardiovascular Causes of Deaths Associated With Homelessness

Background: Cardiovascular disease (CVD) remains the leading cause of death in the United States, accounting for a staggering 928,741 fatalities in 2020. Persons experiencing homelessness (PEH) have a 3- to 5-fold excess risk of mortality from CVD, which ranks as a predominant cause of mortality in this setting, second only to overdose deaths. The elevated incidence of CVD mortality for PEH may be attributable to complex interactions between social determinants and risk factors that include delayed diagnosis, limited healthcare access, heightened smoking rates, and the increased incidence of diabetes and hypertension among other factors. Methods: This study utilized records from the county medical examiner in the third most populous county in the US from 2021-2022, focusing exclusively on CVD mortality in medicolegal cases to analyze the impact of specific risk factors for PEH. All medicolegal deaths involving CVD were analyzed to determine relative frequencies of associated or secondary causes between housed and PEH deaths along with insights into the influence of age, race, and gender. Results: The examination of the CVD mortality in PEH cases in 2021 (n=52) and 2022 (n=71) revealed important trends, yielding an estimated, unadjusted mortality rate of 23 deaths per 1,000 person-years-exposed-to-homelessness (compared to around 2 per 1,000 person-years in population). The mean age for CVD deaths in PEH was 58.6 and 60.6 years in 2021 and 2022 respectively (males increased 57.8 to 61.3 years; females increased 58.8 to 60.6 years), while the proportion of CVD deaths increased among males (30-32%) but decreased for females (29-22%). This widening gap in the percent of CVD deaths occurring among male PEH and female PEH is evident where the gap stood at 1% in 2021 but expanded to 10% in 2022 (p=n.s.). Racial disparities show a rapid increase in CVD deaths for Black/African American PEH (26.1-33.7%). Top conditions associated with CVD deaths were hypertension and atherosclerosis, regardless of housing status at death. Diabetes mellitus (25%), obesity (22%), and chronic ethanolism (16%) round out the top 5 conditions for housed decedents, while among the unhoused COPD (19.7%), CHF (12.7%), and diabetes mellitus (11.3%) were the most common. Conclusion: Exposure to homelessness and housing instability is a major driver of cardiovascular mortality. These findings suggest that PEH face ongoing challenges in the management and prevention of CVD. Additionally, CVD deaths associated with homelessness often point foremost to hypertensive and atherosclerotic vascular changes, contributing to natural deaths. These conditions point to persistent risk factors such as limited healthcare access, high smoking rates (contributing to COPD), and higher incidences of diabetes and hypertension. Additional research is needed on underlying causes of the identified gender disparities.

Interrelation of growth/differentiation factor-15 level with laboratory and clinical and functional parameters of patients with coronary artery disease

Growth differentiation factor 15 (GDF-15) is a circulating protein that is associated with various pathological conditions.Aim. To study the relationship between the level of GDF-15 and labo­ratory, clinical and functional parameters of patients with coronary artery disease (CAD).Material and methods. All patients with coronary artery disease under­went a general clinical examination, coronary angiography, extrac­ranial artery ultrasound examination, echocardiography, deter­mi­nation of the serum level of GDF-15 (ng/ml) and matrix metal­lopro­teinase 9 (ng/ml). Statistical processing of the obtained results was carried out using the Statistica 10.0 software.Results. The study included 88 people (55 men and 33 women), 78 of whom were patients with an established diagnosis of CAD and 10 were healthy volunteers (control group). In the group of CAD patients, the median level of GDF-15 was 4,98 ng/ml [3,15; 8,24], while in the cont­rol group — 1,95 ng/ml [0,01; 2,45]. An association of GDF-15 con­centration with the age of patients was found (r=0,44; p<0,001). There was a direct correlation between the level of GDF-15 and interventricular septal thickness (r=0,33; p<0,05), heart failure stage (Strazhesko-Vasilenko classification) (r=0,23; p<0,05), the concentration of matrix metal­loproteinase 9 (r=0,24; p<0,05), carotid intima-media thickness (r=0,28; p<0,05), the number of coronary arteries that required revas­cularization during coronary artery bypass grafting (r=0,52; p<0,05), and multifocal atherosclerosis (r=0,23; p<0,05). In patients with athero­sclerotic lesions in 2 or 3 vascular beds, the level of GDF-15 was signifi­cantly higher than in patients with CAD (p<0,05).Conclusion. The results obtained demonstrate the value of GDF-15 as a potential marker of atherosclerotic vascular changes, the severity of myocardial hypertrophy, and the severity of heart failure.

Evaluation of Arterial Stiffness and Carotid Intima-Media Thickness in Children with Primary and Renal Hypertension.

Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children.

Efficacy of Biologically Active Food Supplements for People with Atherosclerotic Vascular Changes.

The current paper deals with the development of a new biologically active food supplement (BAFS) aimed at treating atherosclerosis. Since atherosclerosis is considered to be a disease of aging, the composition of the supplement includes such essential minerals as magnesium and potassium, which are commonly used to prevent atherosclerosis, as well as vitamins C, E and the B-group vitamins in order to address the needs of the elderly. The authors outline the supplement-manufacturing technology and discuss the clinical trial undertaken by patients, aged about 60 years, with peripheral atherosclerosis. The research methodology focuses on studying the effectiveness of the developed supplement by assessing the influence of the active ingredients on treating metabolic disorders. To establish the efficacy of the supplement, blood tests, ultrasound and physical examinations were applied. The combination therapy resulted in improved metabolism and an overall better performance of the cardiovascular system; therefore, the BASF can be recommended as part of combination therapy to prevent and treat atherosclerotic and age-related changes in blood vessels.

Peculiar features of arterial hypertension state on the background of atherosclerosis (clinical and instrumental comparisons)

A comparative analysis of the clinical and functional state of patients with arterial hypertension (AH), depending on the presence or absence of arterial sclerotic disease of the arterial bed is represented. 2 groups of 110 and 60 patients respectively were formed. The 1st group included persons with arterial hypertension (AH) and atherosclerotic changes in the arterial bed, the 2nd — with hypertension and without any atherosclerotic changes. It is shown that patients with hypertension and stenotic changes of the vascular bed are characterized by an increase in the levels of diastolic blood pressure and indicators of systolic and diastolic pressure load during the day. They have signs of structural changes in the cardiovascular system, as proved by indicators of arterial stiff ness, myocardium remodeling, circadian rhythms of blood pressure abnormalities, and, in addition, kidney damage in a chronic form of disease, stage 2–3.On the contrary, hypertension without atherosclerotic changes of the vascular bed is characterized by higher values of systolic blood pressure, increased variability of systolic and diastolic blood pressure during the day, and, in addition, atherogenic dislipoproteinemia and hyperuricemy within the metabolic syndrome are present. As a clinical sign of atherosclerotic vascular changes in patients with hypertension, more “severe” blood pressure is observed. It requires combined antihypertensive therapy, consisting of 3 or more groups of medications.

EVALUATION OF HORMONAL AND METABOLIC PARAMETERS, ALONG WITH CARDIOVASCULAR RISK FACTORS IN WOMEN WITH NON-ALCOHOLIC FATTY LIVER DISEASE COMBINED WITH SUBCLINICAL HYPOTHYROIDISM DEPENDING ON AGE

Patients with NAFLD (non-alcoholic fatty liver disease) and subclinical hypothyroidism are at risk of cardiovascular complications that cause cardiometabolic changes, thus enabling to broaden our understanding of the cardiovascular events risk in a comorbid patient.&#x0D; The aim: The study of hormonal and metabolic indicators and cardiovascular risk factors in women from NAFLD combined with SH (subclinical hypothyroidism) depending on the age.&#x0D; Materials and methods: 128 patients with NAFLD were studied, which were divided into 2 groups: І group – patients with NAFLD and level of thyroid-stimulating hormone (TSH) – 4 to 10 mIU/mL (n=45), ІІ group - patients with NAFLD and level of TSH &gt;10 mIU/mL (n=49). The control group consisted of 34 NAFLD patients without SH. Depending on the level of TSH and age, degree of cardiovascular risk, indicators of carbohydrate and lipid metabolism, as well as the indicators that reflect ED were evaluated.&#x0D; Results: Comparison of metabolic parameters in two groups showed a significant difference (p&lt;0.01 between indicators depending on the TSH level, where patients were below 50 years of age: HbA1c, LDL cholesterol, HDL cholesterol, gamma-glutamyltranspeptidase (GGTP). The levels of CDEC (circulating desquamated endothelial cells), VEGF (vascular endothelial growth factor), CRP (C-reactive protein) and TNF-α (tumor necrosis factor-α) were dependent not only on TSH, but also on age. Significant differences (p=0.001) were obtained in patients aged ≤ 50 years: CDEC; VEGF, CRP; TNF-α.&#x0D; Conclusions: Patients from NAFLD combined with SH have hormonal-metabolic disorders, and their degree depends on the TSH level. Early cardiometabolic changes in women are formed already at the age under 50 years, which indicates the formation of early atherosclerotic vascular changes

SELECTION OF A RADIOPHARMACEUTICAL DRUG FOR POSITRON EMISSION TOMOGRAPHY OF THE MYOCARDIAL FOR PLANNING CORONARY INTERVENTIONS

A study comparing the effectiveness of 18-fluorodeoxyglucose and rubidium-82 in positron emission tomography for planning coronary interventions was carried out. 37 PET studies with 18-FDG were performed in patients with complaints of angina pectoris, previously identified atherosclerotic vascular changes, coronary intervention for a history of ischemic heart disease or myocardial infarction. As a result, 3 patients were found to have defects in FDG metabolism corresponding to cicatricial changes in the background of a previous myocardial infarction. After examination, a representative group of 11 patients was selected for PET with rubidium-82. According to the results of the study, one patient had a myocardial perfusion defect corresponding to the FDG ametabolism zone. In two patients, the study in exercise revealed a defect in myocardial perfusion, which was not previously determined. Subsequent coronary angiography confirmed the presence of hemodynamically significant stenosis of the anterior interventricular branch of the left coronary artery, in the basin of which a perfusion defect was detected. The results obtained make it possible to diagnose the presence of incoming myocardial ischemia in a patient. The study revealed the advantages of PET with rubidium-82 over PET with 18-FDG when planning coronary interventions. Keywords. positron emission tomography, PET, radiology, 18-fluorodeoxyglucose, rubidium chloride-82.

Cardiovascular Involvement in Psoriasis, Diagnosing Subclinical Atherosclerosis, Effects of Biological and Non-Biological Therapy: A Literature Review.

Psoriasis is a long-lasting, noncontagious chronic inflammatory disease of skin and joints. Previous epidemiological studies have demonstrated that psoriatic patients have a shorter life expectancy, mainly due to cardiovascular (CV) events with a higher prevalence of cardiovascular risk factors like dyslipidemia, diabetes mellitus, insulin resistance, obesity, and hypertension. Besides these risk factors, psoriasis likely plays an independent role in increasing CV events probably due to the chronic inflammatory state. This literature review aims to summarize the mechanism of atherosclerosis formation, CV risk factors, tools to diagnose subclinical atherosclerosis, and the effects of various therapies in psoriatic patients to prevent cardiovascular-related deaths in psoriasis. This review was performed by searching the relevant articles in PubMed and Google Scholar databases without including any exclusion criteria and time limitations. Our review documented that psoriatic patients are at increased risk of CV events due to chronic inflammatory profile and the associated CV risk factors. Also, anti-inflammatory therapies may prevent early subclinical atherosclerotic vascular changes reducing cardiovascular events. However, the available studies lack to establish the exact targets for CV risk factors, to assess the clinical importance of screening for subclinical vascular changes and the impact of anti-inflammatory therapies on CV risk profile in psoriatic patients. This heightened awareness about the CV involvement in psoriasis should encourage conducting large, well planned comprehensive studies to address these issues that can reduce cardiovascular morbidity and mortality.

Recent Advances in Vascular Imaging.

Recent advances in vascular imaging have enabled us to uncover the underlying mechanisms of vascular diseases both ex vivo and in vivo. In the past decade, efforts have been made to establish various methodologies for evaluation of atherosclerotic plaque progression and vascular inflammatory changes in addition to biomarkers and clinical manifestations. Several recent publications in Arteriosclerosis, Thrombosis, and Vascular Biology highlighted the essential roles of in vivo and ex vivo vascular imaging, including magnetic resonance image, computed tomography, positron emission tomography/scintigraphy, ultrasonography, intravascular ultrasound, and most recently, optical coherence tomography, all of which can be used in bench and clinical studies at relative ease. With new methods proposed in several landmark studies, these clinically available imaging modalities will be used in the near future. Moreover, future development of intravascular imaging modalities, such as optical coherence tomography-intravascular ultrasound, optical coherence tomography-near-infrared autofluorescence, polarized-sensitive optical coherence tomography, and micro-optical coherence tomography, are anticipated for better management of patients with cardiovascular disease. In this review article, we will overview recent advances in vascular imaging and ongoing works for future developments.

Assessment of arterial stiffness and epicardial adipose tissue thickness in predicting the subclinical atherosclerosis in patients with ankylosing spondylitis

ABSTRACT Objective Atherosclerosis is a chronic, progressive, inflammatory disease. Recognition of subclinical atherosclerotic vascular changes before clinical manifestation in an asymptomatic population is important for risk stratification and optimal management, which finally leads to the prevention of cardiovascular disease. We aimed to determine the risk of premature subclinical atherosclerosis by evaluating epicardial adipose tissue thickness (EATT) and arterial stiffness parameters in patients with ankylosing spondylitis (AS). Methods We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS compared to 60 controls matched for age and sex. Patients with traditional cardiovascular risk factors were excluded. Arterial stiffness parameters and EATT (examined via echocardiography) values of all patients and control groups were measured. Results There was no difference between basal characteristic and echocardiographic parameters in patients with AS and in the control group. EATT and pulse wave velocity (PWV) were higher in the AS patients compared to the control group. EATT was 5.74 ± 1.22 mm and 4.91 ± 1.21 mm (p < .001) and PWV was 9.90 ± 0.98 m/s and 6.46 ± 0.83 m/s (p = .009) in the AS and control groups, respectively. Also, PWV was significantly correlated with EATT, age, and central blood pressure in patients with AS. Conclusions EATT and PWV, markers of atherosclerosis and cardiovascular disease, were significantly higher in patients with AS than the control group. In addition, in this study, it has been shown that there is a significant relationship between PWV and EATT in patients with AS.

FEATURES OF MICROCIRCULATORY DYSFUNCTION ACCORDING TO WAVLET ANALYSIS LASER DOPPLER FLOWMETRY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE AND CONCOMITANT DIFFUSE LIVER DISEASES

Aim. To determine the features of microcirculatory dysfunction and in patients with chronic ischemic heart disease, depending on the presence of concomitant diffuse liver disease. Materials and methods. We performed a prospective study on the basis of MC «Doctor Vera», as well as in the diagnostic department of Medbud Clinic between 2009 and 2019. A total of 187 patients were examined. Patients' blood flow was assessed by transthoracic echocardiography, wavelet analysis laser Doppler flowmetry (LDF). Results. In the analysis of indicators of microcirculatory dysfunction in patients with ischemic heart disease, statistically significant deterioration of wavelet analysis laser Doppler flowmetry was determined. In patients with ischemic heart disease and left ventricular ejection fraction &lt; 40 %, indicators of wavelet analysis LDF were significantly lower. We also found that the severity of diffuse liver disease significantly disrupts peripheral blood flow (Р &lt; 0.05). Conclusions. The results of intracardiac hemodynamics, microcirculatory dysfunction were first presented. In patients with isolated ischemic heart disease as the left ventricular EF decreased, a significant decrease in capillary blood flow was observed as a result of deterioration of central hemodynamics, development of atherosclerotic vascular changes, as well as an increase in their vascular tone. We have proved that in the presence of DLD in patients with ischemic heart disease and EF &lt; 40 %, the degree of increase in peripheral resistance and impaired venous outflow were more pronounced due to the depletion of vasoactive substances production, impaired their excretion by hepatocytes due to irreversible morpho-functional changes in liver at the stage of decompensation of HF, severe fibrosis, the formation of regeneration nodes. In patients with LC, the most severe disorders of peripheral blood flow were determined according to the data of the digital capillaroscopy, which testifies to the influence of the degree of liver damage on the state of microcirculation.

The Impact of Gestational Weight Gain on Subclinical Atherosclerosis, Placental Circulation and Neonatal Complications

Objective: Vascular atherosclerotic changes, mediated by environmental and genetic factors, develop years before an event. Detection of vascular damage, using ultrasonographic measurement of carotid IMT, is predictive of future cardiovascular events. The present study was designed to investigate the impact of gestational weight gain (GWG) on early atherosclerotic changes during late pregnancy, using intima media thickness (IMT), as well as placental vascular circulation and inflammatory lesions and pregnancy outcome. Design and methods: 59 women who gave birth at Wolfson Medical Center during 2018 were divided into two groups according weight gain during pregnancy: Group 1 included 32 women with pregnancy weight gain within recommended range, Group 2 included 27 wonen with exessive weight gain during pregnancy. IMT was measured by High-resolution B-mode ultrasound (Sonosite Titan/Sonosite, Inc., Bothell, Washington, USA). Placental histology was performed for vascular circulation, as well as inflammatory lesions of maternal and fetal origin. Metabolic measures such as fasting glucoe, lipids, hs-CRP, HOMA-IR were determined. Maternal and neonatal outcome parameters were collected. Results: Weight gain during the pregnancy was significantly higher in Group 1, compared to Group 2 (17.5+/-6.2 vs 6.8+/-5.7, p<0.0001), whereas pre-gestational BMI did not differ significantly between groups (p=0.059). IMT levels differed between groups and was significantly higher in group 1 compared to Group 2 (0.7+/-0.1 vs 0.6+/-0/1, p=0.028). In regression analisys, pregnancy weight gain remained a significant independent predictor of IMT. Rate of macrosomia was significantly higher in Group 1 than in Group 2 (p=0.014). Maternal vascular supply (MVS) abnormalities of the placental bed did not differ significantly between groups (p=0.297). Among placental lesions related to fetal vascular malperfusion, villous changes consistent with fetal thrombo-occlusive disease (FTOD) were significantly higher in Group 1 than in group 2 (p=0.034). Conclusion: In the present study, excessive weight gain during pregnancy was significantly and independently associated with an increased IMT. Among placental vascular lesions, villous changes consistent with fetal thrombo-occlusive disease (FTOD) were significantly higher women with excessive weight gain during pregnancy.

Development and validation of a new prediction model for graft function using preoperative marginal factors in living-donor kidney transplantation

Recently, living-donor kidney transplantation from marginal donors has been increasing. However, a simple prediction model for graft function including preoperative marginal factors is limited. Here, we developed and validated a new prediction model for graft function using preoperative marginal factors in living-donor kidney transplantation. We retrospectively investigated 343 patients who underwent living-donor kidney transplantation at Kyushu University Hospital (derivation cohort). Low graft function was defined as an estimated glomerular filtration rate of < 45mL/min/1.73m2 at 1year. A prediction model was developed using a multivariable logistic regression model, and verified using data from 232 patients who underwent living-donor kidney transplantation at Tokyo Women's Medical University Hospital (validation cohort). In the derivation cohort, 89 patients (25.9%) had low graft function at 1year. Donor age, donor-estimated glomerular filtration rate, donor hypertension, and donor/recipient body weight ratio were selected as predictive factors. This model demonstrated modest discrimination (c-statistic = 0.77) and calibration (Hosmer-Lemeshow test, P = 0.83). Furthermore, this model demonstrated good discrimination (c-statistic = 0.76) and calibration (Hosmer-Lemeshow test, P = 0.54) in the validation cohort. Furthermore, donor age, donor-estimated glomerular filtration rate, and donor hypertension were strongly associated with glomerulosclerosis and atherosclerotic vascular changes in the "zero-time" biopsy. This model using four pre-operative variables will be a simple, but useful guide to estimate graft function at 1year after kidney transplantation, especially in marginal donors, in the clinical setting.

MORTALITY ANALYSIS OF THE PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS

Background. Alcohol is considered to be the main risk factor for adverse event deaths around the world. In Ukraine, mortality due to alcoholic liver disease (ALD) has taken the second place in the structure of death causes from diseases of the digestive system.&#x0D; Objective. The aim of the research was to study the peculiarities of the causes of death in the patients with alcoholic liver disease at the stage of liver cirrhosis (LC) based on the analysis of protocols of pathoanatomical research.&#x0D; Methods. The analysis of 149 protocols of the pathoanatomical study of the patients, who died from alcoholic LC, has been carried out at the premises of the Pathoanatomical Department of the Ivano-Frankivsk Regional Clinical Hospital in 2006-2018.&#x0D; Results. Most people were young and middle aged. Fatal cases were caused by decompensation of the LC with the development of hepatic, hepatic-renal, cardio-pulmonary insufficiency, pancreatic necrosis, gastrointestinal bleeding (GIB), sepsis, hepatocellular carcinoma (HCC). In 37.6 % of the patients the concomitant illness was coronary heart disease (CHD), 10.7 % of the people had hypertension. In 6 % of the patients, ischemic stroke of the brain was diagnosed. In most people atherosclerotic vascular changes were revealed.&#x0D; Conclusions. Excessive consumption of alcohol and, consequently, the development of LC, can be considered as an adverse factor in the reducing social standard of living. In the majority of people, who died from the decompensation of alcoholic LC, atherosclerotic vascular lesions have been detected. This indicates a significant prevalence of lipid metabolism disturbance in the people with alcoholic LC.

Association of fasting glucagon-like peptide-1 with oxidative stress and subclinical atherosclerosis in type 2 diabetes

AimGlucagon-like peptide-1(GLP-1) is a gut hormone that beside its main function in glucose homeostasis may play a role as an anti-oxidant and anti-atherosclerotic factor. The aim of this study was to estimate fasting total GLP-1 level in type 2 diabetes (T2DM) patients and to determine its relation with oxidative stress and atherosclerotic vascular changes. MethodsThe study included 60 T2DM male patients with age ≥40 and 30 healthy male subjects matched for age. All of them were subjected to measuring of fasting total GLP-1, 8-iso prostaglandin F2α (8-iso PGF2α) as a marker of oxidative stress and carotid intima media thickness (CIMT) as a marker of subclinical atherosclerosis. ResultsFasting total GLP-1 was not significantly different in diabetics in comparison with healthy subjects (p = 0.52). Fasting total GLP-1 was found to have significant negative correlations with both 8-iso PGF2α (p < 0.05) and CIMT (p < 0.001). ConclusionEndogenous fasting GLP-1 appears to have anti-oxidant and anti-atherosclerotic effects in T2DM.

The association of the fasting serum level of glucagon like peptide-1 (GLP-1) with oxidative stress, atherosclerotic vascular changes and cardiometabolic risk factors in type 2 diabetic patients

The association of the fasting serum level of glucagon like peptide-1 (GLP-1) with oxidative stress, atherosclerotic vascular changes and cardiometabolic risk factors in type 2 diabetic patients

Elevated C5a Plasma Concentrations in Mongolian Patients with Atherosclerotic Vascular Diseases

Objectives: Complement activation product C5a is increased in acute cardiovascular events and infl ammation. However, investigation of C5a in patients with atherosclerotic vascular changes among Mongolian populations is still lacking. Methods: A total of 43 patients were selected using special criteria for this study. Plasma C5a and lipid levels were measured by high-sensitive enzyme-linked immune sorbent assay and colorimetric enzyme assay at the Mongolian National University of Medical Sciences, Core Laboratory and Second General Hospital. All data were analyzed for normality and then parametric or nonparametric tests using GraphPad Prism 6.0 software. The Pearson r correlation analysis was performed using Microsoft Excel. Results: Patients were divided into a healthy group ((n=23, carotid intima-media thickness (cIMT) &lt;0.7 mm)) and a group with atherosclerosis (n=20 with cIMT &gt;1.0 mm by Doppler-ultrasound imaging). The suffi cient number of patients within groups was approved by using column statistical analysis. A signifi cantly elevated plasma C5a protein concentration was found in patients with atherosclerosis compared to healthy controls (276.28±24.82 vs. 61.56±4.35 pg/mL, P&lt;0.0001), which was directly correlated with increased total plasma cholesterol levels (r=0.68, P&lt;0.01). Conclusion: Our study supported the notion that complement anaphylatoxin C5a may be involved in the pathogenesis of atherosclerotic vascular diseases.

Increased adiponectin is associated with cerebral white matter lesions in the elderly with cognitive impairment.

Adiponectin is an adipocyte-derived peptide that increases with age and is thought to protect against atherosclerotic vascular changes and organ damage. However, paradoxically, higher adiponectin levels are associated with increased risk for cardiovascular events and mortality. We investigated whether this adiponectin paradox occurs in elderly people with cognitive impairment. Fifty-two elderly participants with mild cognitive impairment or dementia (20 male and 32 female, aged 60-93years, mean 80.0) were recruited. We evaluated serum adiponectin levels and cerebral white matter lesions (WML), which are involved in cognitive decline and dementia, by computed tomography. Body mass index (BMI), Mini-Mental State Examination score, history of hypertension (HT), chronic kidney disease, and diabetes mellitus were also assessed. Stepwise multiple regression analysis was used to reveal the relationships between serum adiponectin and age, sex, BMI, HT, diabetes mellitus, chronic kidney disease, Mini-Mental State Examination, and WML scores. High serum adiponectin levels correlated with more severe WML (P = 0.013). Low BMI (P < 0.001), female sex (P = 0.025), and high WML scores (P = 0.039) were significant determinants of high serum adiponectin. HT (P = 0.032) and high adiponectin levels (P = 0.021) were independent risk factors for WML. Overall, we observed an association between serum adiponectin levels and WML severity in elderly people with cognitive decline. Our findings reveal that the adiponectin paradox occurs in this population, and this study may help guide future treatments for elderly people with mild cognitive impairment or dementia.

Contribution of Type 2 Diabetes Mellitus to Subclinical Atherosclerosis in Subjects with Morbid Obesity

IntroductionType 2 diabetes mellitus (T2DM) and obesity are both related to increased risk of cardiovascular disease and mortality. Early atherosclerotic vascular changes can be detected by non-invasive tests like carotid artery intima-media thickness (cIMT) and pulse wave velocity (PWV). Both cIMT and PWV are significantly impaired in T2DM patients and in obese patients, but the additional effect of T2DM on these vascular measurements in obese subjects has not been evaluated.MethodsTwo hundred morbidly obese patients with or without T2DM were enrolled in a prospective cohort study and underwent extensive laboratory testing, including cIMT and PWV measurements. The cohort was divided into a group with and a group without T2DM.ResultsWithin this cohort, 43 patients (21.5%) were diagnosed with T2DM. These patients were older and had more often (a history of) hypertension as compared to patients without T2DM. HbA1c levels were significantly increased, while LDL cholesterol was significantly lower and the use of statins higher than in non-diabetic participants. cIMT and PWV were significantly increased in subjects suffering from T2DM. The variability in cIMT and PWV was related to differences in age and systolic blood pressure, but not to the presence of T2DM.ConclusionWhile T2DM negatively affects the vasculature in morbid obesity, hypertension and age seem to be the major risk factors, independent from the presence of T2DM.Clinical Trial RegistrationDutch Trial Register NTR5172.

MORPHOLOGICAL AND FUNCTIONAL STATE OF ENDOTHELIUM AT PATIENTS WITH CORONARY ARTERY DISEASE AND CHRONIC GLOMERULONEFRITIS

All over the world the increase in quantity of patients with vascular complications of chronic inflammatory diseases of kidneys is marked. The interrelation of morphological and biochemical markers of atherosclerotic lesions were studied in 41 patients with coronary artery disease (CAD) (group 1) and 62 - with CAD and chronic glomerulonephritis (CGN) (group 2). An extracranial carotid artery (CA) status was investigated by duplex ultrasonography. VE-cadherin content determined by ELISA. States of the antioxidant system was evaluated by the concentration of malondialdehyde (MDA) and sulfhydryl groups (SH-groups) in the blood plasma by the photometric method. The levels of nitric oxide stable metabolites – NO2 and total (NO2+NO3) in plasma was determined by the photometric method. There was found that the frequency of CA plaques detection in groups 1 and 2 did not differ (27,6% and 31,0%, respectively), but patients of group 2 were reliably younger. Pronounced VE-cadherin increase (3,6-fold, p &lt;0,01) at the background of the deterioration of renal function (2,24 -fold GFR decrease, and urinary protein excretion reaches (0,200,98) g / day) was observed in group 2. The content of NO2 in group 2 was significantly lower than in controls, and total (NO2+NO3) was increased as compared with control (2,40-fold, P &lt;0,01), and with patients of group 1 (in 1,86-fold, p &lt;0.05). Increase of MDA level in patients of group 2 (2,61-fold, P&lt;0,01) accompanied by reduction of SH groups content – by 25,2% (P &lt;0.05) compared with control. Thus, in patients with combined pathology revealed the most pronounced disorders of endothelial integrity and function, which was worsening by imbalance in the pro-antioxidant system. Accelerated atherosclerotic vascular changes in these patients are probably related to the chronic inflammatory process.