Cardiovascular Disorders In Patients Research Articles

Evaluation of cardiothoracic ratio as a potential predictor of cardiovascular abnormalities in individuals with type II diabetes mellitus: a case-control study.

Cardiovascular complications represent a significant health concern for individuals with diabetes mellitus. The relationship between diabetes and cardiovascular diseases is complex and multifaceted, involving a variety of pathophysiological mechanisms. This study aimed to investigate the potential role of the cardiothoracic ratio as a prognostic tool for cardiovascular disorders in patients with diabetes. A retrospective case-control study of 530 adult patients referred to a tertiary care hospital in Saudi Arabia was conducted. Medical records, including chest X-rays, were analyzed to determine the cardiothoracic ratio. Patients diagnosed with diabetes who experienced cardiac disorders had significantly higher cardiothoracic ratios compared to patients with diabetes alone and controls. HbA1c was significantly elevated among patients with diabetes and cardiovascular disorders (mean = 71.5 ± 25.43 mmol/mol) compared to the other patients. There was a significant positive correlation between the duration of diabetes and the cardiothoracic ratio (r = 0.64, P < 0.001). Furthermore, the cardiothoracic ratio above 0.51 was a good discriminator of cardiovascular disorders in patients with diabetes, with an area under the curve of 0.737, sensitivity of 97.1%, and specificity of 87.2%. This study provided comprehensive evidence supporting the association between cardiothoracic ratio and subsequent cardiovascular adverse outcomes in patients with diabetes. We recommend adopting the cardiothoracic ratio as a valuable prognostic tool for risk stratification among people with diabetes.

Differences in Heart Rate Variability in the Frequency Domain between Different Groups of Patients.

Background and Objectives: Heart rate variability (HRV) is defined as a physiological variation in duration between sinus beats. The aim of this study was to research and analyze the HRV between various groups of patients. Materials and Methods: A retrospective study was conducted in an outpatient setting. Patients who had undergone a tilt-table test were selected for this study and were divided into three groups based on their self-reported health anamnesis: group 1 (n = 84, mean age 45.8 ± 17.8) consisted of patients with no known orthostatic intolerance or neurodegenerative disease, group 2 consisted of patients with a known or suspected orthostatic intolerance (n = 50, mean age 46.5 ± 18.6), and group 3 consisted of patients with a known or suspected neurodegenerative disorder (n = 29, mean age 55.6 ± 20.4). During the tilt-table test, HRV frequency-domain parameters-normalized low frequency (LFnu) and high frequency (HFnu), absolute powers-absolute low frequency (LF-RRI), absolute high frequency (HF-RRI), and LF/HF ratio-were recorded during 5 min rest in the supine position. Results: Group 1 had a reduced LFnu at 52.93% (SD: 18.00) compared to group 2 at 58.57% (18.06) and group 3 at 61.80% (SD: 17.74), and group 1 had increased HFnu: group 1-47.08% (SD: 17.97), group 2-41.41% (SD: 18.03), and group 3-38.16% (SD: 14.7). LFnu and HFnu differences were statistically significant (p < 0.05). LF-RRI was reported as follows: group 1-531.32 ms2 (SD: 578.57), group 2-346.2 ms2 (SD: 447.96), and group 3-143.21 ms2 (SD: 166.96). HF-RRI was reported as follows: group 1-835.87 ms2 (SD: 1625.42), group 2-297.46 ms2 (SD: 507.15), and group 3-70.83 ms2 (SD: 75.67). LF-RRI and HF-RRI comparisons between groups were statistically significant (p < 0.001). LF/HF ratios were reported as follows: group 1-1.91 (SD: 2.29), group 2-2.43 (SD: 2.33), and group 3-2.54 (SD: 2.17). LF/HF ratio comparisons between groups were statistically significant at p < 0.05. Conclusions: This study shows that patients with known or suspected orthostatic intolerance and neurodegenerative disorders have reduced HRV, possibly caused by reduced parasympathetic modulation. HRV in patients with known or suspected neurodegenerative disorders is reduced more severely than in patients with orthostatic disorders. Other studies in HRV have indicated a possible increase of risk in cardiovascular disorders in patients with reduced HRV, and therefore, HRV analysis could be a potential clinical diagnostic tool. However, the lack of universally agreed upon methodology, reference values, and possible external and internal factor influence hinders the introduction of HRV examinations into wider clinical practice.

Management of cardiovascular disease in patients with schizophrenia

Background: Individuals with schizophrenia experience premature mortality by approximately 15 to 20 years compared to the general population. The most common cause of death in schizophrenia is cardiovascular disorder, yet cardiovascular disease-related conditions are often neglected in the treatment of schizophrenia.Current Concepts: The overall incidence rate of cardiovascular disorders in patients with schizophrenia is about 10%. Diverse risk factors likely contribute to the association, with increased risk of metabolic syndrome, unhealthy lifestyle behaviors like smoking and a sedentary lifestyle, and an unhealthy diet playing a prominent role. While the effects of certain psychotropic medications, particularly atypical antipsychotics, may contribute to the presence of metabolic syndrome, their ability to reduce the psychiatric symptom burden reduces mortality. Shared pathophysiological mechanisms, including genetic, psychological, and inflammatory factors, have also been suggested. In particular, increased inflammation directly associated with disease-related brain activity may further impact the cardiovascular risk.Discussion and Conclusion: Regular monitoring of metabolic syndrome, with psychoeducation for patients and their caregivers, is crucial to promote optimal cardiovascular health. Implementation of active psychosocial interventions targeted at behavior change is necessary. In addition, education to reduce stigma among medical professionals is warranted to improve communication between patients and medical professionals.

The impact of COVID-19 on cardiovascular disorders in patients who admitted to cardiology outpatient unit

The coronavirus outbreak is an important challenge and has affected the world since December 2019. Little is known, however, regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular disorders in the cardiology outpatient unit. This trial aimed to examine the nature of patients who were admitted the cardiology outpatient unit before and after the COVID-19 pandemic. Totally, 6254 patients who were admitted to the cardiology outpatient unit from January 1, 2020 to December 31, 2020 and January 1, 2022 to December 31, 2022 were included. The patients who admitted from January 1, 2020 to December 31, 2020 were defined as pre-pandemic group. The patients who were admitted from January 1, 2022 to December 31, 2022 were defined as post-pandemic group. There were 2575 (mean age 57.9±16.9 years, male 47%) patients in pre-pandemic group, while 3679 (mean age 59.1±17.0 years, male 47%) patients in post-pandemic group. The patients in post-pandemic group were significantly older than those in pre-pandemic group (60.0 (46.0-71.0) vs. 62.0 (47.0-73.0) years, p = 0.005). The number of patients who were admitted for hypertension (HT) significantly higher in post-pandemic group compared to pre-pandemic group (930 (36%) vs. 1646 (45%), p&lt;0.001). The new-onset HT was significantly higher in post-pandemic group than in pre-pandemic group (407 (11%) vs. 186 (7%), p&lt;0.001). Admission for atrial fibrillation (AF) was significantly increased after coronavirus pandemic when compared to before (324 (13%) vs. 670 (18%), p&lt;0.001). New-onset AF was also significantly higher in post-pandemic group than in pre-pandemic group (35 (1%) vs. 95 (3%), p=0.001). Not all cardiovascular disorders but admission for HT and AF were significantly increased in the post-pandemic period. With the end of pandemic, physicians should be more careful in the risk prediction of patients who potentially have HT and AF in cardiology outpatient unit.

DEPENDENCE OF CARDIOTROPHIN-1 ON BIOCHEMICAL AND HORMONAL FACTORS IN PATIENTS WITH COMORBID PATHOLOGY: ARTERIAL HYPERTENSION, DIABETES MELLITUS TYPE 2 AND OBESITY

The prevalence of arterial hypertension, type 2 diabetes mellitus (type 2 DM), and obesity is constantly increasing worldwide. Today, a complex of factors, which primarily include chronic emotional stress, pandemics of infectious diseases, military conflicts, have led to a significant increase in chronic non-communicable diseases. The aim of the study. To determine the dependence of Cardiotrophin-1 on a number of biochemical and hormonal indicators in patients with arterial hypertension, type 2 DM, and obesity, representatives of the Ukrainian population. Materials and methods. The study included 211 patients aged 49 to 65 years, who were divided into groups depending on the pathology: patients with arterial hypertension – 49 persons, Group I; patients with arterial hypertension in combination with class 1 obesity – 54 persons, Group 2; patients with arterial hypertension in combination with type 2 DM – 57 persons, Group 3; patients with arterial hypertension, type 2 DM, class 1 obesity – 51 persons, Group 4; as well as 20 persons – the Control group. Determination of the content of Cardiotrophin-1, catestatin, leptin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), N-terminal brain natriuretic peptide (NT-proBNP), 25-OH of common vitamin D (Vitamin D3), blood levels was carried out by enzyme immunoassay on Labline-90 analyzer (Austria), using commercial test systems manufactured by FineTest (ELISA, China), BT LAB (ELISA, China), DBC (ELISA, China), Elabscience (ELISA, Canada), Monobind Inc. (ELISA, USA). Statistical data analysis was performed, using the statistical software package Statistica, 12 (Stat Soft Inc, USA), Microsoft Office Excel 2013. Data are shown as mean (M) and standard deviations (δ). An error of less than 5% was considered to be significant (p&lt;0.05). Stepwise regression analysis was used to determine the extent of exposure of the studied indicators to the CTF-1 level, with its effectiveness assessed by one-way analysis of variance (ANOVA). Results. Thus, the study indicates that comorbid patients with arterial hypertension, type 2 DM, and obesity are predicted to develop complications from the cardiovascular system and Cardiotrophin-1 is a marker of their development. In the examined patients as a whole, the level of Cardiotrophin-1 is closely related to the peptide-hormonal complex: catestatin, leptin, cystatin C, brain natriuretic peptide, and lipocalin associated with neutrophil gelatinase. Conclusions: The serum concentration of Cardiotrophin-1 in patients with arterial hypertension increases significantly in a progression with the rate of accession of comorbid pathology and its severity. The Cardiotrophin-1 level in patients with comorbid pathology is affected by catestatin, leptin, cystatin C, NT-pro BNP, as well as the level of triglycerides, HDL-C, creatinine, and BMI. Cardiotrophin-1 can be considered as a universal biomarker for the development and progression of cardiovascular disorders in patients with comorbid pathology of arterial hypertension, type 2 DM, and obesity.

Risk of myocardial infarction in Parkinson's disease: A systematic review and meta-analysis.

Previous studies investigating cardiovascular disorders in patients with Parkinson's disease (PD) showed heterogeneous results regarding whether there is a higher or lower risk of myocardial infarction (MI) in these patients compared to the general population. Because of the inconsistency in findings, herein the aim was to perform a systematic review and meta-analysis to investigate the risk of MI in patients with PD. A comprehensive literature search was performed using four databases, PubMed, Web of Science, Scopus and Embase, in June 2022. Peer-reviewed observational studies comprising case-controls, cohort, cross-sectional and longitudinal studies that reported MI in the PD population were included. After the screening, 20 studies with a total of 80,441 patients with PD and 802,857 controls were included in our qualitative and quantitative synthesis. The pooled estimated odds ratio for MI in PD patients compared to controls was 0.80 (95% confidence interval [CI] 0.56-1.05) which indicates that there is no association. The pooled prevalence of MI was 5% (95% CI 3%-7%) with a range of 1%-20% amongst patients with PD. The men (6%, 95% CI 1%-13%) and women (6%, 95% CI 1%-14%, Q = 29.27, I2 = 98.50%, p < 0.001) had similar MI prevalence. This comprehensive systematic review and meta-analysis provide compelling evidence that PD is associated with a reduced risk of MI. Whilst the exact mechanism underlying this association remains to be fully elucidated, it is clear that certain risk factors for cardiac events appear to be less present in PD patients, which may serve as a protective factor. However, given the reports of increased risk for cerebrovascular events in PD patients, it is possible that the major risk factors for MI and cardiovascular accidents in this population differ. These findings have important implications for clinical management and further research in this area is warranted.

Comorbid depression and cardiovascular disorders in patients with type 2 diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

PREVALENCE AND CONTROL OF THE HYPERTENSION IN PATIENTS SUFFERING FROM RHEUMATOID ARTHRITIS

Hypertension or high blood pressure (BP) is a long-term ailment in which blood pressure in the arteries raises persistently. Blood pressure can be determined using two methods, systolic pressure which is the uppermost pressure and diastolic pressure which is the lowermost blood pressure in the arterial system. It is estimated that worldwide around 1.13 billion persons are suffering from hypertension. In addition, the World Health Organization (WHO) has reported that 13% of all deaths in the world are caused by hypertension. Furthermore, they set a target to reduce its frequency by 25% from the year 2010 to 2025.1,2 Rheumatoid arthritis (RA) is a systemic autoimmune disease that leads to inflammation of the joints and pain. Approximately 1% of the global population is diagnosed with this disease. Rheumatoid arthritis can be associated with multiple comorbidities that can reduce a patient's quality of life (QoL), upturn the economic burden of the disease, and may increase the rate of mortality. Cardiovascular comorbidities are quite common in patients with rheumatoid arthritis. Cardiovascular comorbidity is estimated to be about 1.5 times more frequent in patients with rheumatoid arthritis than in healthy people. Many studies have suggested that of all cardiovascular disorders, hypertension is the most important and changeable risk factor in subjects suffering from rheumatoid arthritis. Based on a pool of 115,867 insurance claims, about 76% of rheumatoid arthritis patients in America were diagnosed with hypertension. These results are similar to studies conducted in Europe and Canada that have shown a higher incidence of hypertension in patients with rheumatoid arthritis compared to the normal group. It is unknown why patients with rheumatoid arthritis pose such a high risk for hypertension. Reduced physical activity, obesity, systemic inflammation, and medications used to treat rheumatoid arthritis can increase the risk of high blood pressure.3 Around 0.55% of the urban population in northern Pakistan suffers from rheumatoid arthritis, while the incidence rate is close to 0.14% in southern Pakistan.4 There are many reasons why people with rheumatoid arthritis have high blood pressure. Chronic inflammation in rheumatoid arthritis results in increased rigidity of arteries leading to increase systolic blood pressure. The first presumed link between low-grade systemic inflammation and hypertension has been identified in previous studies conducted on the general population. In rheumatoid arthritis, elevated levels of C-reactive protein (CRP) increase the likelihood of developing high blood pressure. Several mechanisms may be implicated in the development of hypertension with a high concentration of C-reactive protein. For example, nitric oxide synthesis may be reduced because of the increased concentration of the C-reactive protein that will cause vasoconstriction, platelet activation and thrombosis. Additionally, increased expression of the type 1 angiotensin receptor and stimulation of the plasminogen activator inhibitor-1 (PAI-1) may contribute to the progression of hypertension. Occasionally, restriction on exercise due to the fear of worsening disease condition is recommended (unwarranted) by healthcare professionals, and it could be a reason for the inactive and sedentary lifestyle of patients with rheumatoid arthritis. In turn, physical idleness can lead to obesity, which may be linked independently to high blood pressure in rheumatoid arthritis. Obesity and familial history of hypertension are significant predictors of premature death. A study has also demonstrated that an increase in sodium (Na) intake and a decrease in potassium (K) intake can play a significant role in the pathogenesis of rheumatoid arthritis and high blood pressure. The urinary Na/K quotient may be useful as an important parameter of hypertension in patients suffering from rheumatoid arthritis and in normal subjects. Optimal cardiovascular risk management continues to be a major challenge. In this regard, increased awareness and management are needed to reduce the high risk of cardiovascular disorders in patients with rheumatoid arthritis. To date, only a few studies have investigated the potential relationship between high blood pressure and these factors in patients with rheumatoid arthritis. A lifestyle shift (i.e. exercise, smoking cessation, eating a balanced diet, reducing the use of ethanol and salt) is needed in patients suffering from rheumatoid arthritis to manage their high blood pressure and improve their quality of life (QoL). To treat rheumatoid arthritis, many medications are routinely prescribed, including cyclooxygenase, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and disease-modifying anti-rheumatic drugs (DMARDs). The use of these drugs in rheumatoid arthritis should always be considered in conjunction with comorbid hypertension. Clinicians should closely monitor such patients for prior diagnosis and, where appropriate, aggressive management of hypertension. Systems for diagnosis, proper treatment, and continuous surveillance of these patients need to be in place in primary and secondary healthcare setups. Furthermore, specially designed clinical trials are required to determine the finest approaches to treat hypertension in patients of rheumatoid arthritis.5-8

ИЗМЕНЕНИЕ ИНТЕРВАЛА QT У БОЛЬНЫХ АНКИЛОЗИРУЮЩИМ СПОНДИЛИТОМ

Ankylosing spondylitis causes morphological or functional damage to the cardiovascular system in 22% of cases. Using modern methods of heart function research, such as Holter ECG monitoring, it is possible to detect rhythm and conduction disorders, long QT syndrome. Changes in the parameters of the QT interval, such as its duration and variance, can be considered as a predictor of the development of cardiovascular catastrophes and fatal arrhythmias. The article analyzes the values of QT/RR and QTc during Holter ECG monitoring in 92 patients diagnosed with Ankylosing spondylitis, depending on the stage of the disease, the activity of the pathological process, and seropositivity for HLA B27. There was a significant increase in QT/RR and QTc during the active and passive periods of Holter ECG monitoring in comparison with the control group. In patients with ankylosing spondylitis, ventricular arrhythmias were detected, which are associated with prolongation of the QT interval. Standardized Holter ECG monitoring in patients with Ankylosing spondylitis, taking into account the daily variance of the QT interval, can become a universal, minimally invasive and low-cost method for assessing the risk of cardiovascular disorders in patients with Ankylosing spondylitis.

Patterns of development of cardiovascular disorders in patients with COVID-19 (brief review)

Introduction. Cardiovascular diseases remain the leading cause of death, both in Russia and in most other countries, and the problem of cardiovascular disorders in patients with COVID-19 is currently extremely important.Aim. To summarize the literature data on patterns of development of cardiovascular disorders in patients with COVID-19.Results. The article presents a literature review of the PubMed and Google Scholar databases on the patterns of development of cardiovascular disorders in patients with COVID-19. The pathogenetic relationship of the viral spike S-protein with angiotensin-converting enzyme 2 in the mechanisms of regulation of the cardiovascular and immune systems was shown. The role of pro-inflammatory cytokines in the formation of inflammation and fibrosis in cardiovascular pathology has been determined. The changes in the cardiovascular system against the background of COVID-19 were demonstrated. The basic principles of the interaction of the SARS-CoV-2 virus with endotheliocytes and cardiomyocytes, the mechanisms of inflammatory reactions that underlie the development of cardiovascular pathology in COVID-19 are described.Conclusion. An analysis of current data regarding damage to the cardiovascular system in COVID-19 led to the conclusion that, despite considerable achievements in this field of research, many aspects are not fully understood and require further study. The practical significance of this review is determined in the identification of potential therapeutic targets for the prevention of complications in COVID-19, as well as in expanding the possibilities of diagnosing SARS-CoV-2. Probably the crucial importance to reduce complications, as well as associated mortality, is the development of an effective method for modulating the immune response.

Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus.

BackgroundDiabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients.AimTo assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM.Patients and MethodsThis work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score.ResultsPatients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001).ConclusionThe presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.

Cardiovascular disorders in patients with Zika Virus: integrative review

Objective: To describe the primary cardiovascular disorders manifested in patients infected with the zika virus and understand the pathophysiological process. Methods: This integrative literature review occurred in January 2021 through the PICO strategy, which answered the guiding question: “What are the main cardiovascular disorders manifested in patients infected with zika virus?” For this, a time interval of 5 years was defined, using the descriptors “Zika Virus”,“Heart” and “Cardiovascular Diseases” in English, Portuguese and Spanish. The contemplated databases were MEDLINE, LILACS, and BDENF. Results: There were a total of 77,872 articles, of which, after the exclusion and inclusion processes, it was summarized in eight articles included in this review. The main cardiovascular findings present were apical muscular ventricular septal defect and ostium secundum, in addition to atrial fibrillation and heart failure with reduced ejection fraction. Conclusions: Further studies with more robustness that clearly establish the mechanism of cellular tropism for cardiac muscle cells and involve the pathophysiological process of cardiac alterations more clearly and reliably are needed.

Risk Factors Promoting Early Cardiovascular Structure Disorders in Patients with Primary Hypothyroidism

Objective. To develop the pattern of early cardiovascular disorders in patients with primary hypothyroidism based on the analysis of relationship between patient’s thyroid status and some functional cardiovascular parameters depending on compensation status. Materials and methods. The examination of 163 women aged 62 [55;67] years with primary hypothyroidism was performed. The patients were divided into groups: 1 group included 54 patients aged 62.0 [57;68] years with subcompensated disease, 2 group consisted of 15 patients aged 59 [53;66] years with non-compensated disease and 3 group included 94 patients aged 63 [53;66] years with compensated hypothyroidism. Physical examination, transthoracic echocardiography, assessment of global left ventricle longitudinal strain by speckle tracking method, endothelial function and laboratory tests were performed to all patients. Regression analysis using thyroid stimulating hormone, free T4, age, duration of the disease, cause of hypothyroidism, menopause presence and natural thyroid stimulating hormone logarithm as predictors and some cardiovascular parameters of heart condition and lipid metabolism as dependent valuables was made. Results. Mathematic modeling demonstrated that the combination such factors as age, duration of disease and thyroid stimulating hormone level is the most important in left ventricle remodeling processes. However, the age only has significant influence on intima media thickness. Conclusion. Left ventricle remodeling, morphologic functional status of blood vessel wall and decrease of glomerular filtration rate are basically determined by such modified and non-modified factors as body mass index, age, duration of hypothyroidism and thyroid stimulating hormone level.

Assessment of Obesity, Dyslipidemia, Hyperglycemia, and Pro-Inflammatory Cytokines as Cardiovascular Disease Risk Factors in Acromegaly Patients

Cardiovascular disease is one of the most common comorbidities associated with enlarged extremities, occurring in 60 % of patients with acromegaly. The aim of this study is to evaluate the relationship of growth hormone and insulin such as growth factor-1 with obesity, dyslipidemia, hyperglycemia, and pro-inflammatory cytokines (IL-2, IL-6, IL-10), as risk factors for cardiovascular disorder in acromegaly patients. Eighty subjects were included and categorized into two groups: 40 acromegaly patients and 40 of the control group. The results indicated weight excess, hyperglycemia, hypertension, lipid disorder, and elevated levels of interleukins (2, 6, and 10). The correlation of both GH and IGF-1 with each of weight, BMI, systolic blood pressure, diastolic blood pressure, FBS, HbA1c, cholesterol, triglyceride, LDL, IL6, IL2, and the atherogenic index was found to be positive and significant. Meanwhile, only IGF-1 was significantly correlated with IL10. We conclude that elevated levels of IL2, IL6, IL 10 and their association with both GH and IGF-1 as well as to lipid disorder, hyperglycemia, and hypertension criteria of acromegaly patients are all risk factors for cardiovascular disease, suggesting the necessary clinical examination for cardiovascular disorder in patients with acromegaly patients.

Патогенетичні механізми та ознаки серцево-судинних уражень при цукровому діабеті 2-го типу

Актуальність. Висока захворюваність та поширеність цукрового діабету (ЦД) зумовлює ранню інвалідизацію та смертність через розвиток хронічних ускладнень. При цьому головна причина смерті при ЦД 2-го типу пов’язана із серцево-судинними захворюваннями. Мета дослідження: з’ясувати частоту, механізми та прояви уражень серцево-судинної системи у хворих на ЦД 2-го типу. Матеріали та методи. Обстежено 49 пацієнтів з ЦД 2-го типу віком понад 50 років, у тому числі 25 чоловіків, 24 жінки. Визначали показники метаболізму, зміни електрокардіограми. Результати. У групі спостереження у 55,1 % пацієнтів виявлена ішемічна хвороба серця (ІХС), у 77,6 % — артеріальна гіпертензія, у 28,6 % — перенесені кардіоваскулярні події. Переважали хворі (83,7 %) з надлишковою масою тіла і ожирінням. У 57,1 % виявлені порушення ліпідного обміну за наявної декомпенсації ЦД в 61,2 %, що підтверджено збільшенням рівня глікованого гемоглобіну до 8,8 ± 0,3 %. Зареєстровані порушення процесів автоматизму, збудливості та провідності серця: у 12,2 % — синусова тахікардія, у 6,1 % — синусова брадикардія, у 4,1 % — синусова аритмія, у 10,2 % — миготлива аритмія, у 8,2 % — суправентрикулярна і шлуночкова екстрасистолія, у 30,6 % — внутрішньошлуночкові блокади. Прояви гіпоксії мали 32,7 % пацієнтів, зміни зубця Q — 8,2 %, зміни інтервалу ST — 8,2 %. Висновки. Дисметаболічні порушення є підґрунтям для розвитку хронічних діабетичних ускладнень, що формують, зокрема, кардіальну автономну нейропатію, діабетичну кардіоміопатію та атеросклеротичні ураження серцево-судинної системи з маніфестацією ІХС, артеріальної гіпертензії, синдрому порушень ритму і провідності, гіпоксії.

Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p&lt;0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.

Effect of garlic powder supplementation on blood pressure and hs-C-reactive protein among nonalcoholic fatty liver disease patients: A randomized, double-blind, placebo-controlled trial.

Based on the anti‐inflammatory and antihypertensive properties of garlic, the current study was designed to evaluate the garlic powder effects on blood pressure and high‐sensitivity C‐reactive protein (hs‐CRP) among Nonalcoholic Fatty Liver Disease patients (NAFLD). This randomized, double‐blind, placebo‐controlled trial study was conducted on 110 patients with NAFLD. The patients were randomly divided into 2 groups, receiving two tablets of either 400 mg garlic or placebo daily for 15 weeks. At baseline and the end of the study, blood pressure and hs‐CRP were determined. Of 110 patients enrolled in the trial, 98 subjects were included in the final analysis. After the intervention, systolic blood pressures (SBP) (mean: −7.89; 95%CI:‒11.39 to −4.39 mm Hg), diastolic blood pressure (DBP) (mean: −5.38; 95%CI: −7.77 to −3 mm Hg), and Mean Arterial Pressure (MAP) (mean: −6:95%CI: −8.4 to −3.6 mm Hg) decreased significantly in the garlic group as compared to the placebo group. Also, the percentage of reduced hs‐CRP was significantly higher in the intervention group compared with the control group (mean: −16.1; 95%CI: −32.7 to −0.53; p = .035). Moreover, a positive correlation was observed between the percentage change in hs‐CRP and percentage changes in SBP (r = 0.221; p = .029), DBP (r = 0.166; p = .012), and MAP (r = 0.210; p = .038). Garlic supplementation can be a safe and potentially adjunct treatment to reduce blood pressure and the risk of cardiovascular disorders in patients with NAFLD.

The Effect of Physical Activity on Diabetes Mellitus Patients with Hypertension

Physical activity plays an important role in controlling blood glucose levels and reducing the risk of cardiovascular disorders in patients with diabetes mellitus (DM). DM patients should follow the principle of FITT (frequency, intensity, type and time) while doing a physical activity, which has a direct effect on their health condition. However, the identification of physical activity in DM patients with hypertension is still limited. Therefore, this study aimed to describe the effect of physical activity on DM patients with hypertension. Accordingly, this cross-sectional study included patients with hypertension, aged 18–65 years, able to communicate verbally, and visiting a public healthcare centre in Semarang between February and March 2020. The Baecke Physical Activity Questionnaire (BPAQ) was used to identify the physical activities done by the participants. Quantitative data analysis revealed the distribution of frequency, percentage, mean, and standard deviation. A total of 150 respondents participated in the study, mostly in late adulthood (54.7%), women (68%), and having DM with hypertension for one–five years. The results showed that 40.7% of the respondents had a low level of physical activity, of which 46% did not play any sport and 92.7% had low occupational physical activity. The average leisure time index was 2.31 ± 0.6, which means that most of them did a few physical activities during leisure time. It is concluded that since many DM patients with hypertensions were categorized as having low level of physical activity, this may affect their blood glucose level and blood pressure.&#x0D; Keywords: blood glucose, blood pressure, diabetes mellitus, hypertension, physical activity

Oxidative Stress Markers among Obstructive Sleep Apnea Patients.

Obstructive sleep apnea (OSA) is a chronic respiratory disorder, which can be present in up to 50% of the population, depending on the country. OSA is characterized by recurrent episodes of partial or complete obstruction of the upper airways with consistent movement of the respiratory musculature during sleep. Apneas and hypopneas can lead to a decrease in oxygen saturation, an increase in carbon dioxide in the blood, and subsequent arousals and sleep fragmentation caused by repetitive activation of the central nervous system. As a consequence, intermittent hypoxemia and consequent reoxygenation result in the production of reactive oxygen species, leading to systematic oxidative stress, which is postulated to be a key mechanism of endothelial dysfunction and increased risk for cardiovascular disorders in patients with OSA. In this review, various biomarkers of oxidative stress, including high-sensitivity C-reactive protein, pregnancy-associated plasma protein-A, superoxide dismutase, cell-free DNA, 8-hydroxy-2-deoxyguanosine, advanced oxidation protein products, lipid peroxidation products, receptor for advanced glycation end-products, and thioredoxin are discussed. Biomarkers of oxidative stress have the potential to be used to assess disease severity and treatment response. Continuous positive airway pressure (CPAP) is one of the most common noninvasive treatments for OSA; it keeps the upper airways open during sleep. This reduces episodes of intermittent hypoxia, reoxygenation, and arousal at night. CPAP has been shown to have anti-inflammatory properties and decrease oxidative stress. The administration of certain compounds, like vitamins A, C, and E as well as N-acetylcysteine and allopurinol, can decrease oxidative stress markers. However, their role in the treatment of OSA remains unclear.

Поражение сердца при Лайм-боррелиозе

Acute infectious diseases can potentially affect the cardiovascular system. Objective. To demonstrate the need for dynamic monitoring and treatment of cardiovascular disorders in patients with tickborne borreliosis. Patients and methods. This study included 142 patients with laboratory-confirmed tick-borne borreliosis. We analyzed clinical symptoms, results of laboratory testing, and electrocardiography (ECG) findings. Results. Almost one-fifth of all patients (18%) had complaints indicating cardiovascular lesions (both in the group under 60 years of age and in the group of elderly patients). Thirteen patients (9.2%) presented with hypotension. Grade 1–2 hypertension was observed in 11 hospitalized patients (7.7%). Clinical manifestations were accompanied by various ECG abnormalities. Conclusion. We found that 13.4% of patients with confirmed borreliosis had symptoms of probable myocarditis with signs of coronary artery lesions. The disorders detected were shortly eliminated by basic therapy or additional treatment (when needed) by the time of discharge from hospital. Key words: borreliosis, Lyme borreliosis, myocarditis, ECG, extrasystole, erythema