Cardiovascular Complications In Patients Research Articles

Uric acid as a predictor of the development of non-alcoholic fatty liver disease in patients with arterial hypertension

Introduction. Currently, increased uric acid (UA) levels are considered an independent risk factor for the development of non-alcoholic fatty liver disease. Oxidative stress, chronic systemic inflammation, and insulin resistance characteristic of non-alcoholic fatty liver disease (NAFLD) may represent possible mechanisms for the association between the development of hyperuricemia and NAFLD.Aim. To clarify the meaning and nature of the relationship between an increase in the level of UA concentration and the development of NAFLD, as well as to evaluate the relationship between uric acid and the risk of cardiovascular complications in patients with hypertension and NAFLD.Materials and methods. A cross-sectional comparative study was conducted, which involved 120 patients aged from 45 to 65 with hypertension of 1–2 degrees, 1–2 stages (with and without NAFLD (FLI > 60). During the examination, a clinical examination was carried out: analysis of anamnesis data, anthropometry. Lipids and uric acid in blood plasma were also analyzed.Results. In the group of comorbid patients, there were significantly more patients with excess of the reference values of UA levels in the blood plasma (OR = 2.25: 95% CI 1.08–4.71). ROC analysis showed that with an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD is predicted. The UA/Cr index in patients with hypertension and NAFLD was statistically significantly higher than in patients in the control group. Increase in the MK/Kr index by 1 USD increases the chances of developing NAFLD by 1.54 times (95% CI: 1.11–2.13). Also, an increase in the concentration of sUA level by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6%.Conclusions. With an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD in the study group is predicted. Increase in UA/creatinine index by 1 USD increases the chances of developing NAFLD by 1.54 times. In addition, an increase in the concentration of sUA in the blood plasma by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6% in patients with hypertension and NAFLD.

Changing perceptions about the role of combination therapy with statin and fibrate in patients with hypertriglyceridemia

The article discusses the modern therapeutic approach to lowering blood triglyceride levels. The need to consider indications for the use of lipid-lowering therapy in patients with hypertriglyceridemia is caused by the emergence of new evidence-based information. The article describes how elevated blood TG levels are associated with the risk of developing cardiovascular (CV) complications, as well as pancreatitis. The mechanisms of TG metabolism that may regulate the relationship between elevated blood TG levels and the risk of developing CV complications are considered. The findings of large randomized clinical trials, including recent ones, which laid the foundation for the current clinical guidelines for the use of drugs to lower triglycerides levels, are discussed. Indications for fibrate therapy in patients with elevated blood TG levels in various clinical situations are considered. The article emphasizes that the icosapent ethyl ester drug is not currently available in the Russian Federation. According to the latest versions of international guidelines, it is considered a first-line drug to reduce the risk of developing CV complications in patients with an established diagnosis of CVD (i.e. for the purpose of secondary prevention). In this context, the significance of fenofibrate as a drug to lower blood triglyceride levels, specifically in secondary prevention of CV complications, can remain quite high in our country. The appearance of a rosuvastatin and fenofibrate combination drug on the pharmaceutical market of the Russian Federation will increase adherence to the therapy, if a fibrate is required to be added to statin therapy.

The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

Background. Chronic pancreatitis and malnutrition are associated with cardiovascular diseases and cardiovascular events, while the role of exocrine pancreatic insufficiency as a risk factor for cardiovascular events is unknown. The purpose of the study was to evaluate the level of pancreatic fecal elastase-1 in patients with chronic pancreatitis combined with hypertension and to determine the relationship with cardiovascular risk. Materials and methods. One hundred and ten patients (46 men, 64 women) aged 45–65 years with chronic pancreatitis were included in the study. The first group consisted of people with a combined course of chronic pancreatitis and hypertension; the second — with chronic pancreatitis alone. The levels of total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density cholesterol, pancreatic fecal elastase-1, total protein, serum content of albumin, iron, vitamin D, zinc and magnesium were evaluated in all patients. Results. In the group 1, there were significantly more cases of severe exocrine pancreatic insufficiency and a significantly lower number of patients with a normal level of pancreatic fecal elastase-1 (p < 0.05). In addition, a very high cardiovascular risk was detected significantly more often in this group — 11.5 % (p < 0.05). The main cardiovascular risk factors among patients with chronic pancreatitis, in addition to hypertension, included obesity and increased body weight — 70.9 % of cases. Elevated levels of TG, LDL, and total cholesterol were observed in 86.4, 94.5, and 91.8 % of patients with chronic pancreatitis combined with hypertension, respectively, and a reduced content of HDL-C was found in 34.5 % (p < 0.05). Significantly higher levels of TG, LDL-C, total cholesterol, and a lower level of HDL were revealed in the group 1 compared to the group 2 (p < 0.05). In patients of the group 1, a reliable inverse correlation was found between the pancreatic fecal elastase-1 and TG, atherogenic index, the SCORE2 scale (r = –0.43, p < 0.05; r = –0.52, p < 0.05; r = –0.48, p < 0.05, respectively), as well as a reliable direct correlation with HDL level (r = 0.50; p < 0.05). Conclusions. The combined course of chronic pancreatitis with exocrine pancreatic insufficiency and hypertension is associated with an increased cardiovascular risk. A decrease in the level of pancreatic fecal elastase-1 and malnutrition may be associated with an increase in the frequency of dyslipidemia and in the risk of cardiovascular events among these patients.

Incidence and Impact of Acute Pericarditis in Hospitalized Patients With COVID-19.

Background Acute pericarditis (AP) is considered a cardiovascular complication in patients with COVID-19. We aimed to ass-ess the incidence, associated complications, and clinical impact of AP on hospitalized patients with COVID-19. Methods and Results In this retrospective cohort study, International Classification of Diseases, Tenthth Revision, Clinical Modification (ICD-10) codes were used to identify patients with COVID-19 with or without AP in the National Inpatient Sample 2020 database. We compared outcomes between AP and non-AP groups before and after propensity-score matching for patient and hospital demographics and relevant comorbidities. A total of 211 619 patients with a primary diagnosis of COVID-19 were identified, including 983 (0.46%) patients who had a secondary diagnosis of AP. Before matching, patients with COVID-19 with AP were younger (59.93±19.24 years old versus 64.29±16.82 years old) and more likely to have anemia (40.5% versus 19.9%), cancer (6.7% versus 3.6%), and chronic kidney disease (29.3% versus 19.6%) (all P<0.05). After matching, patients with COVID-19 with AP (n=980), when compared with the matched non-AP group (n=2936), had higher rates of mortality (21.3% versus 11.1%, P<0.001), cardiac arrest (5.0% versus 2.6%, P<0.001), cardiogenic shock (4.2% versus 0.5%, P<0.001), ventricular arrhythmia (4.7% versus 1.9%, P<0.001), acute kidney injury (38.3% versus 28.9%, P<0.001), acute congestive heart failure (14.3% versus 4.8%, P<0.001), and longer length of stay (7.00±10.00 days versus 5.00±7.00 days, P<0.001) and higher total charges ($75066.5±$130831.3 versus $44824.0±$63660.5, P<0.001). Conclusions In hospitalized patients with COVID-19, AP is a rare but severe in-hospital complication and is associated with worse in-hospital outcomes.

Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus's predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood. To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB). The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17. A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB. In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.

Drugs influencing on PCSK9 activity: modelling of efficacy in patients who had myocardial infarction with uncontrolled dyslipidemia

Cardiovascular diseases are the leading cause of death worldwide. It is possible to influence the development of these diseases by influencing their main pathogenetic link — dyslipidemia.Aim: to evaluate, using the example of alirocumab, the potential effect of drugs affecting the activity of PCSK9 on the achievement of goals for the prevention of the development of cardiovascular diseases and cardiovascular complications in patients of working age who had an acute myocardial infarction (MI) less than a year ago, with uncontrolled dyslipidemia.Materials and methods. The target group was created based on the Russian clinical guidelines; its number was calculated using Russian registry data. Based on the published results of the clinical trial of alirocumab ODYSSEY OUTCOMES in a group of patients with LDL cholesterol levels of more than 2.6 mmol/l (100 mg/dl), a model was built to estimate the number of fatal and non-fatal outcomes in the target group with standard therapy and with alirocumab.Results. The effect of alirocumab administration was modeled in patients of working age who had a myocardial infarction less than 12 months ago with an LDL cholesterol level of more than 5.0 mmol/l, the number of this group in the Russian Federation was estimated to be 3,029 people. It has been shown that with therapy in this group, mortality can be reduced by 29%, and the number of non-fatal cardiovascular events — by 22%, i. e. alirocumab therapy in this group for 2 years can prevent 29 deaths and 185 non-fatal events, with an increase in the duration of therapy to 5 years, the number of lives saved will be 117 and 401 non-fatal cardiovascular events will be prevented.Conclusion. Modeling has shown that alirocumab therapy in patients with recent myocardial infarction and LDL cholesterol levels above 5.0 mmol/L will significantly reduce mortality in this group and prevent the development of serious nonfatal cardiovascular complications, which will also reduce the burden on specialized hospitals, as well as prevent patients from becoming disabled. At the same time, decision making requires a balanced consideration of all ethical, clinical and economic aspects, including the assessment of costs and potential effects from the position of the of a willingness to pay and the formation of the budget of the health system.

Significance of myocardial injury on in-hospital clinical outcomes of in-hospital and COVID-19 patients.

Acute Myocardial injury defined by increased troponin I level is associated with poor in-hospital outcomes and cardiovascular complications in patients with COVID-19. The current study was designed to determine the implications and clinical outcome of myocardial injury in COVID-19. This retrospective study included hospitalized COVID-19 patients. Myocardial injury was defined by high sensitivity Troponin I (hs-TNI)≥26ng/l. Cardiac biomarkers, inflammatory markers and clinical data were systemically collected and analyzed. Hazard ratio for in-hospital mortality and logistic regression for predictors of acute myocardial injury were analyzed. Of the 1821 total patients with COVID-19, 293(16.09%) patients died and 1528 (83.91%) patients survived. Patients who died had significantly higher association with presence of cardiovascular risk factors, severe CTSS ( CT severity score ) and myocardial injury as compared to survived group. 628 (34.5%) patients had evidence of myocardial injury and they had statistically significant association with cardiovascular risk factors, in-hospital mortality, procalcitonin; higher hospital, and ICCU stay. We found significant hazard ratio of diabetes (HR=2.66, (CI:1.65-4.29)), Severe CT score (HR=2.81, (CI:1.74-4.52)), hs-TNI≥26 ng/l (HR=4.68, (CI:3.81-5.76)) for mortality. Severe CTSS score (OR=1.95, CI: 1.18-3.23, P=0.01) and prior CVD history (OR=1.65, CI:1.00-2.73, P=0.05) were found significant predictors of myocardial injury in regression analysis. Almost one third of hospitalized patients had evidence of acute myocardial injury during hospitalization. Acute myocardial injury is associated with higher hospital and ICCU stay, mortality, higher in-hospital infection which indicates more severe disease and the poor in-hospital outcomes.

The role of triglyceride-glucose index in predicting cardiovascular and metabolic outcomes in patients with type 2 diabetes mellitus

Diabetes mellitus type 2 is a global medical and social problem, which, in terms of population coverage around the world, is becoming a pandemic. The main cause of premature death in patients with type 2 diabetes is diseases of the cardiovascular system. The presence of diabetes is associated with an increase in the risk of developing coronary heart disease by two-four times, and every sixth patient has signs of myocardial infarction in the past. The risk of developing ASCVD in patients with type 2 diabetes is early onset, rapid progression, and asymptomatic course. It is known that patients with type 2 diabetes develop ASCVD 8–10 years earlier than people of the same age group who do not have diabetes. Along with chronic hyperglycemia, an independent risk factor for cardiovascular complications in patients with type 2 diabetes is dyslipidemia, which occurs in 30–40% of patients. Insulin resistance, the state of chronic hyperglycemia, dyslipidemia play a key role in the development of the metabolic syndrome and atherosclerosis. The TyG index and the parameter of non-HDL-C have convincingly established themselves as predictors of the development of CVD, as well as markers reflecting signs of the presence of independent factors of the metabolic syndrome that increase the risk of CVD. Conducted clinical studies have confirmed the predictive value of these parameters in relation to CVD. This review focuses on the pathogenesis, development mechanisms, and methods for correcting lipid disorders that underlie the development of CV complications in patients with type 2 diabetes.

#4747 THE APPLICATION OF MODERN MEDICAL INFORMATION SYSTEMS WITH ARTIFICIAL INTELLIGENCE ELEMENTS FOR PERSONALIZED TREATMENT OF PATIENTS ON HEMODIALYSIS

Abstract Background and Aims The quality of life and survival of patients on hemodialysis significantly depend on modern technology. Treatment requires control of dynamically changing large volume of data, which must be analyzed and interpreted in real time. Achieving the ideal balance between adequate fluid removal, effective dialysis dose, and low risk of adverse events on the hemodialysis procedure is a complex multifactorial problem. The heterogeneity of the dialysis population, comorbid burden, the use of concomitant medications, nutritional status and adherence to diet, patient compliance are a noncomplete list of factors that must be considered when setting the dialysis regimen. Thus, despite significant progress in the technical aspects of the “artificial kidney devices”, personalization of the treatment regimen remains an important and difficult task. Introduction of modern automated medical information systems (MIS) for management of treatment and diagnostic process can provide invaluable assistance in treatment process and improve treatment outcomes. The aim of our study was to improve the prevention and treatment of hemodynamic disorders in hemodialysis patients using a special own program “Maximus”, which collects and analyzes indicators from dialysis machines in real time. Method The study was conducted from May to November 2022. The study included 120 patients on hemodialysis. The average age of the participants was 62.3±25.4 years. All participants underwent bioimpedance testing with a hydration score (InBody S10) compared to the prescribed dry weight at inclusion. A total of 9360 hemodialysis procedures (all HDF) were analyzed. The data of all procedures were collected directly from dialysis machines and analyzed in MIS in real time, identifying deviations from the target values. Episodes of both hypertension (140/90 mm Hg) and hypotension (100/60 mm Hg) were considered. MIS analyzed the actual duration of the procedure, blood flow rate, volume of fluid removal, rate of ultrafiltration and level of Na. In case of deviations from the established normal values, the system actively notified the doctor (via SMS/messengers) about detected deviations and proposed solutions. The medical staff timely corrected dry weight, duration of procedures, UF rate, volume of fluid removal, sodium content and blood pressure. Results In patients with arterial hypertension (63% of patients), mean systolic BP decreased by 12±6 mmHg and diastolic BP by 10±8 mmHg before dialysis procedure. In this group mean systolic BP decreased by 11±10 mmHg and diastolic BP by 9±8 mmHg during the procedure of hemodialysis. In patients with hypotension, due to “dry weight” increase, correction of Na level, stabilization of BP level was achieved, and mean systolic BP increased by 14±5 mmHg, and diastolic BP by 9±5 mmHg before dialysis procedure. Correction of hemodynamically significant parameters led to a decrease in the incidence of both intradialytic hypotension and hypertension during the hemodialysis procedure. Conclusion Correction of treatment, carried out using MIS with SMS notification of medical staff, improved hemodynamic parameters. Modern medical information systems with a Decision Support System can improve the quality and efficiency of treatment, reduce the risk of cardiovascular complications in patients on hemodialysis.

Literature Review-Transthoracic Echocardiography, Computed Tomography Angiography, and Their Value in Clinical Decision Making and Outcome Predictions in Patients with COVID-19 Associated Cardiovascular Complications.

The sudden outbreak of the COVID-19 pandemic posed a great threat to the world's healthcare systems. It resulted in the development of new methods and algorithms for the diagnosis and treatment of both COVID-19 and its complications. Diagnostic imaging played a crucial role in both cases. Among the most widely used examinations are transthoracic echocardiography (TTE) and computed tomography angiography (CTA). Cardiovascular complications in COVID-19 are frequently associated with a severe inflammatory response, which results in acute respiratory failure, further leading to severe complications of the cardiovascular system. Our review aims to discuss the value of TTE and CTA in clinical decision making and outcome prediction in patients with COVID-19-associated cardiovascular complications. Our review revealed the high clinical value of various TTE findings and their association with mortality and the prediction of patients' clinical outcomes, especially when used with other laboratory parameters. The strongest association between increased mortality and findings in TTE was observed for tachycardia and decreased left ventricular ejection fraction (odds ratio (OR) 24.06) and tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (TAPSE/PASP ratio) < 0.31 mm/mmHg (OR 17.80). CTA is a valuable tool in diagnosing COVID-19-associated pulmonary embolism, but its association with mortality and its predictive role should always be combined with laboratory findings and patients' medical history. D-dimers > 3000 ng/mL were found as the strongest predictors of pulmonary embolism (PE) (OR 7.494). Our review indicates the necessity for an active search for cardiovascular complications in patients with severe COVID-19, as they are linked with an increased probability of fatal outcomes.

#2511 ASSOCIATION OF CONSTIPATION, MICROBIAL TRANSLOCATION, AND INFLAMMATION IN HD PATIENTS

Abstract Background and Aims Increased gut permeability and intestinal dysbiosis may contribute to chronic inflammation, leading to accelerated atherosclerosis and cardiovascular complications in patients on haemodialysis (HD). Constipation is highly prevalent in HD patients and growing evidence suggested constipation can aggravate gut microbiota dysbiosis and gut inflammation. The aim of this study was to evaluate the association between markers of microbial translocation, intestinal permeability and inflammation in HD patients with and without constipation. Method A cross-sectional, observational study was conducted and 200 stable prevalent HD were enrolled. Serum zonulin, eotaxin-1, amyloid A, intestinal fatty acid-binding protein (iFABP), IL-6, endotoxin core antibodies (EndoCAb) and lipopolysaccharide binding protein (LBP) levels were measured. Functional constipation was defined according to the Rome IV criteria. Results Serum levels of zonulin and eotaxin-1 but not LPS, endo-Cab IgG, amyloid A and IL-6 were significantly higher in HD patients with constipation than in non-constipated HD controls. The multiple logistic regression analysis in constipated HD patients after adjustment for age, and BMI demonstrated that serum zonulin and eotaxin-1 were independently associated with constipation with an odds ratio (OR) of 1.24 (95% CI = 1.09-1.42, p = 0.0016) and 1.02 (95% CI = 1.01-1.03, p = 0.0001), respectively. Conclusion We demonstrate that there was association between serum eotaxin-1 and zonulin levels in constipated HD patients. This may indicates that increased intestinal inflammation or intestinal permeability in these patients but the significance of these findings need further investigation.

#5536 CIRCULATING LEVELS OF COPEPTIN, GROWTH DIFFERENTIATION FACTOR 15 (GDF15) AND INTERLEUKIN 6 (ILA-6) IN PATIENTS WITH ADVANCED KIDNEY DISEASE

Abstract Background and Aims The search for new serum biomarkers of cardiovascular risk and mortality in patients with CKD is relevant to improve the monitoring of these patients. Copeptin is a glycopeptide that is released equimolarly with arginine-vasopressin. GDF-15 is a cytokine involved in macrophage activation processes and is a marker of response to oxidative stress, and IL-6 as a marker of systemic inflammation. Objective: To study the serum levels of copeptin, GDF-15 and IL-6 in patients with advanced CKD. Method Cross-sectional study in 32 patients with advanced CKD. In all patients, the estimated glomerular filtration rate (eGFR) was determined by CKD-EPI, the albumin/creatinine ratio (CrAI) and the serum concentrations of copeptin (immunofluorescence, Thermo Fisher), GDF-15 (chemiluminescence, Roche Diagnostics International) and IL-6 (Siemens Healthineers). Results were compared to laboratory reference values (RVs) for copeptin (VN&amp;lt;4.2 pmol/L) and IL-6 (VN&amp;lt;4.4 pg/mL). The VR of GDF-15 (708±227 pg/ml) corresponds to own data from 10 Blood Bank donors. Results for copeptin and GDF-15 (normal distribution) are shown as mean ± SD. IL-6 results (without normal distribution) as median and interquartile range. Results In CKD we observed an increase in copeptin (26.9±22 pmol/l, 90% &amp;gt;4.2 VR) and GDF-15 (4703±2683 pg/ml p&amp;lt;0.0001 vs. control population). Median IL6 3.2 pg/ml (IQR: 2.7-5.1, 35% &amp;gt;4.4 VR). We did not find differences in the levels of copeptin, GDF-15 or IL-6 based on age, sex and presence or absence of diabetes. A significant correlation was found between GDF15 levels and eGFR (r=-0.54 p&amp;lt;0.002). Conclusion Serum levels of copeptin and GDF-15, but not IL6, are increased in CKD patients. Our data suggest a significant inverse relationship between GDF15 and eGFR. More studies are needed to know the possible role of GDF-15 on the progression of kidney damage and cardiovascular complications in patients with CKD.

Estimated glomerular filtration rate-dip after medical target therapy associated with increased mortality and cardiovascular events in patients with primary aldosteronism.

The correlation of the changes of estimated glomerular filtration rate (eGFR) with long-term cardiovascular complications in patients with primary aldosteronism (PA) following mineralocorticoid receptor antagonists (MRA) treatment remains ambiguous. This prospective study aims to determine factors associated with all-cause mortality and de novo cardiovascular events of PA patients against the eGFR-dip. A total of 208 newly diagnosed PA patients were enrolled from January 2017 to January 2019. MRA was administered with at least a 6-month follow-up. The 'eGFR-dip' was defined as the difference between eGFR at 6 months after MRA treatment and respective baseline eGFR divided by the baseline eGFR. After a mean 5.7 years follow-up, an eGFR-dip more than 12%, which was detected in 99 (47.6%) of the 208 patients, was a significant independent risk factor predicting composite outcomes (all-cause mortality, de-novo three-point major adverse cardiovascular events, and/or congestive heart failure). Multivariable logistic regression showed that age [odds ratio (OR), 0.94; P = 0.003], pretreatment plasma aldosterone concentration (PAC; OR, 0.98; P = 0.004), and initial eGFR (OR, 0.97; P < 0.001) had a positive linkage with the eGFR-dip more than 12%. Nearly half of PA patients had an eGFR-dip more than 12% after 6 months of MRA treatment. They had a higher incidence of all-cause mortality and de novo cardiovascular events. Elder age, higher pretreatment PAC, or higher initial eGFR could be associated with an elevated risk of an eGFR-dip more than 12%.

Predictive accuracy of cardiac risk indices for cardiovascular complications in patients undergoing noncardiac surgery

Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery.Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications.Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively.Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery.

Correlation between GAL-3, Klotho, Calcium and Phosphorus Metabolism Indexes and Cardiovascular Complications in patients with Chronic Kidney Disease.

To investigate the correlation between GAL-3, Klotho, calcium and phosphorus indexes and cardiovascular complications in patients with chronic kidney disease (CKD). This is a retrospective study. Forty patients with CKD and cardiovascular complications admitted to the Affiliated Hospital of Hebei University from February 20, 2022 to February 20, 2023 were selected as the experimental group, and another 40 patients with CKD without cardiovascular complications were selected as the control group. The differences in serum Ca+2, PO- 4, GAL-3 and Klotho levels between the two groups were analyzed, and the correlations between the above indicators levels and creatinine levels were analyzed. The correlation between the above indicators levels and cardiac function classification was analyzed, and analyzed the risk factors of CKD complicated with cardiovascular complications. The levels of Ca+2, PO- 4 and GAL-3 in the experimental group were significantly higher than those in the control group, while the level of Klotho was significantly lower than that in the control group. The levels of Ca+2 and PO- 4 were positively correlated with the level of Creatinine (Cr), while the level of Klotho was negatively correlated with the Cr. The levels of Ca+2 and PO- 4 were positively correlated with cardiac function classification, while the level of Klotho was negatively correlated with cardiac function classification. Logistic regression analysis showed that hypertension, BMI, Cr, Ca+2, PO- 4 and VLDL were risk factors for cardiovascular complications, and Klotho level was a protective factor. A positive correlation can be seen between the levels of Ca+2, PO- 4 and cardiac function classification in patients with CKD. Klotho is a protective factor for cardiovascular diseases.

The role of stress and sleep disorders in the development of cardiovascular complications in patients with arterial hypertension: what is important for an internist to know? A review

This publication discusses the mechanisms underlying the development of arterial hypertension on the background of stress, discusses the current problems of blood pressure control in patients with stress-induced sleep disorders, the clinical features of patients with hypersympathicotonia as the main mechanism for the development of arterial hypertension and blood pressure variability in patients with comorbid pathology, a diagnostic algorithm, as well as presenting current recommendations in the strategy for choosing the optimal antihypertensive therapy with the possibility of personalized choice in various clinical situations.

The impact of HCV chronic positivity and clearance on extrahepatic morbidity in thalassemia major patients: an observational study from MIOT Network

BackgroundNo study has evaluated the effect of hepatitis C virus (HCV) infection on the wide spectrum of complications affecting patients with thalassemia. ObjectivesThis multicenter study prospectively assessed the relationship of HCV infection with diabetes mellitus and cardiovascular complications in patients with thalassemia major (TM). MethodsWe considered 1057 TM patients (539 females; 29.79±10.08 years) enrolled in the MIOT Network and categorized into 4 groups: negative patients (group 1a, N=460), patients who spontaneously cleared the virus within 6months (group 1b, N=242), patients who eradicated the virus after the treatment with antiviral therapy (group 2, N=102), and patients with chronic HCV infection (group 3, N=254). ResultsGroup 1a and 1b were considered as a unique group (group 1). For both groups 1 and 3, a match 1:1 for age and sex with group 2 was performed. The effective study cohort consisted of 306 patients (three groups of 102 patients).During a mean follow-up of 67.93±39.20months, the group 3 experienced a significantly higher % increase/month in aspartate transaminase levels and left ventricular mass index than both groups 1 and 2. The changes in iron overload indexes were comparable among the three groups.Compared to group 1, the chronic HCV group showed a significantly higher risk of diabetes (hazard ratio-HR=5.33; p=0.043) and of cardiovascular diseases (HR=3.80; p=0.034). ConclusionChronic HCV infection is associated with a significant higher risk of diabetes mellitus and cardiovascular complications in TM patients and should be approached as a systemic disease in which extrahepatic complications increase the weight of its pathological burden.

Lobeglitazone, a novel thiazolidinedione, for secondary prevention in patients with ischemic stroke: a nationwide nested case-control study

IntroductionIschemic stroke patients with diabetes are at high risk for recurrent stroke and cardiovascular complications. Pioglitazone, a type of thiazolidinedione, has been shown to reduce cardiovascular complications in patients with ischemic stroke and type 2 diabetes (T2D) or insulin resistance. Lobeglitazone is a novel thiazolidinedione agent that improves insulin resistance and has similar glycemic efficacy to pioglitazone. Using population-based health claims data, we evaluated whether lobeglitazone has secondary cardiovascular preventive effects in patients with ischemic stroke and T2D.MethodsThis study has a nested case-control design. From nationwide health claims data in Korea, we identified patients with T2D admitted for acute ischemic stroke in 2014–2018. Cases were defined who suffered the primary outcome (a composite of recurrent stroke, myocardial infarction, and all-cause death) before December 2020. Three controls were selected by incidence density sampling for each case from those who were at risk at the time of their case occurrence with exact matching on sex, age, the presence of comorbidities, and medications. As a safety outcome, we also evaluated the risk of heart failure (HF) according to the use of lobeglitazone.ResultsFrom the cohort of 70,897 T2D patients with acute ischemic stroke, 20,869 cases and 62,607 controls were selected. In the multivariable conditional logistic regression, treatment with lobeglitazone (adjusted OR 0.74; 95% CI 0.61–0.90; p = 0.002) and pioglitazone (adjusted OR 0.71; 95% CI 0.64–0.78; p < 0.001) were significantly associated with a lower risk for the primary outcome. In a safety outcome analysis for HF, treatment with lobeglitazone did not increase the risk of HF (adjusted OR 0.90; 95% CI 0.66–1.22; p = 0.492).ConclusionsIn T2D patients with ischemic stroke, lobeglitazone reduced the risk of cardiovascular complications similar to that of pioglitazone without an increased risk of HF. There is a need for further studies on the cardioprotective role of lobeglitazone, a novel thiazolidinedione.

Endothelial Function in Dyslipidemia: Roles of LDL-Cholesterol, HDL-Cholesterol and Triglycerides.

Dyslipidemia is associated with endothelial dysfunction. Endothelial dysfunction is the initial step for atherosclerosis, resulting in cardiovascular complications. It is clinically important to break the process of endothelial dysfunction to cardiovascular complications in patients with dyslipidemia. Lipid-lowering therapy enables the improvement of endothelial function in patients with dyslipidemia. It is likely that the relationships of components of a lipid profile such as low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides with endothelial function are not simple. In this review, we focus on the roles of components of a lipid profile in endothelial function.

Sodium-glucose cotransporter type 2 inhibitors in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Background. Epidemiological studies show that mortality among patients with heart failure and preserved left ventricular ejection fraction remains high. In recent clinical studies, inhibitors of sodium-glucose cotransporter type 2 are showing promise in reducing cardiovascular complications in patients with chronic heart failure who need effective drug treatment.&#x0D; Aim. We aimed to analyze published randomized controlled clinical trials evaluating the effectiveness of sodium-glucose cotransporter type 2 inhibitors, added to standard therapy, in a group of patients with chronic heart failure and a left ventricular ejection fraction over 40%.&#x0D; Materials and methods. A systematic review and meta-analysis of the scientific literature were performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed database for the period from January 2021 to December 2022 was performed. The search keywords included the following MeSH terms: heart failure preserved ejection fraction or HFpEF and empagliflozin or dapagliflozin or SGLT2. The search did not use filters for language or type of study. All statistical analyses were performed using the RevMan version 5.4 (Copenhagen, the Nordic Cochrane Centre, The Cochrane Collaboration, 2014).&#x0D; Results. The initial search retrieved 481 publications. After further screening and exclusions for non-compliance with the inclusion criteria, two clinical studies were included. There were 12 251 patients in total, 6128 received sodium-glucose cotransporter type 2 inhibitors, 6123 received placebo. Patients treated with these drugs were 20% less likely to have a combined endpoint (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.720.87; p 0.001). This was primarily due to a 26% decrease in the frequency of hospitalization for acute decompensation of heart failure (OR 0.74, 95% CI 0.660.83; p 0.001). There was a trend toward decreased mortality from cardiovascular causes (OR 0.88, 95% CI 0.771.01; p=0.06), while no effect was observed on all-cause mortality (OR 0.96, 95% CI 0.871.06; p=0.38).&#x0D; Conclusions. The meta-analysis shows the potential of sodium-glucose cotransporter type 2 inhibitors to reduce hospitalization for acute decompensation of heart failure in patients with a moderately reduced and preserved left ventricular ejection fraction.