Cardiovascular Risk Factors In Patients Research Articles

The effect of empagliflozin on main cardiovascular risk factors in patients with type 2 diabetes with normal and excessive body weight

The effect of empagliflozin on main cardiovascular risk factors in patients with type 2 diabetes with normal and excessive body weight

The impact of health apps on lifestyle behaviours and cardiovascular risk factors in patients with cardiovascular risk factors or established cardiovascular disease: a systematic review

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme Background Adequate levels of physical activity (PA) and a healthy diet can contribute to weight loss, improved blood pressure, improved lipid levels and higher insulin sensitivity and thus decrease the risk for the development of cardiovascular disease (CVD). Recently, mobile technologies, such as mobile applications (apps) have been developed for supporting adherence to a healthy lifestyle in an individualized and interactive manner. Purpose The aim of this systematic review was to summarize the effectiveness of such mobile apps targeting PA and/or dietary behavior and cardiovascular risk factors in primary and secondary prevention. Methods Four databases (Pubmed, Sportdiscus, Cinahl, Embase) were searched to identify prospective studies evaluating mobile apps targeting healthy diet and/or PA. Rayyan software was used for screening articles. Only interventional trials that assessed the effectiveness of health apps on diet, PA and/or cardiovascular risk factors were included. Quality assessment was performed using the MINORS tool. Qualitative synthesis was performed providing data summaries according to different subgroups: healthy adults, adults who are overweight, have obesity, hypertension, CVD or diabetes. Results Out of 7073 records identified, 52 articles, reporting on 44 studies with variable study designs, could be included in qualitative synthesis. Interventions targeted diet, PA and/or adherence to therapy/healthy lifestyle and reported on at least one cardiovascular risk factor. In 20 studies, weight loss was a target of the mobile intervention, the vast majority (17/20 studies) reported weight loss following app usage of at least similar extent as usual care. Twenty-six mobile interventions targeted PA and/or exercise training and 23 of them resulted in an increase in PA in the short term. Four studies performed in patients with CVD showed that health app usage could be related to increased PA and improved diet, resulting in similar health benefits as usual care. The most commonly employed behavioural change methods were goal setting and self-monitoring, the use of financial incentives for inducing beneficial lifestyle changes yielded inconclusive results. Main limitations of the studies were small sample sizes, short follow-up duration and lack of controlled trial design. Conclusion Mobile apps targeting healthy lifestyle for the management of cardiovascular risk factors seem to be valuable tools to add to current practice in preventive medicine. However, larger, controlled studies with longer follow-up duration are needed to confirm these early findings.

Effects of COVID-19 lockdown on physical activity in coronary patients on a phase III cardiac rehabilitation program

Funding AcknowledgementsType of funding sources: Other. Main funding source(s): College of Physiotherapists of CataloniaIntroductionAt the start of the COVID-19 pandemic, all over Europe imposed population lockdowns. In our country, the government approved a nationwide confinement from March 14 to April 12, which restricted the movement of people to a very specific schedule. The lockdown was then relaxed, but remained in place until June 7. Cardiac rehabilitation (CR) is a class I level A recommendation with clinical benefits that are now well documented. The COVID-19 lockdown made it particularly difficult to achieve the goals of CR, that is, the maintenance of physical exercise and the control of cardiovascular risk factors (CVRF) in cardiac patients. Little is known about its effects on phase III of CR program (CRP).PurposeTo assess the effect of the COVID-19 pandemic lockdown on physical activity and on the adherence to a cardio-healthy lifestyle in post-acute coronary syndrome (ACS) patients.MethodsA nested cross-sectional substudy of all patients included in a randomised clinical trial before the lockdown by means of a telephone survey during the month of May. We are conducting a randomized clinical trial to assess the efficacy of a phase III CRP, based on counselling in the maintenance of physical exercise (time of physical exercise per week) and on reinforcing the control of CVRF for patients with ACS, once the hospital-supervised physical exercise program of a phase II CRP had been completed.ResultsThirty-two patients were included. Mean age was 60.3 (SD 10.1) and 81.3% were men. Related to baseline, no statistically significant differences were observed between groups. One patient (3.1%) had symptoms of COVID-19. The lockdown altered the dynamics of physical exercise in 21 patients (65.6%), 20 of whom (95.2%) reported taking fewer minutes of exercise per week. After the end of the lockdown period and outdoor physical exercise was allowed once again, 11 patients (55.0%) in the control group and 9 patients (75.0%) in the intervention group found it easy to restart physical exercise. With regard to nutrition, most patients (78.1%) followed the recommendations to eat a Mediterranean diet. Five (15.6%) modified their alcohol consumption, and three smokers (33.3%) modified their tobacco consumption. When asked about their mood during the lockdown, 22 (68.8%) reported feeling well. Finally, 96.9% of patients adhered to medical treatment.ConclusionsThe lockdown reduced the level of physical activity but more intervention group patients resumed recommended physical activity. The COVID-19 pandemic is likely to result in care disruptions of varying degrees in the near future. To counteract the damaging effects of giving up physical exercise, health professionals should stay in contact with patients to motivate them to take physical exercise and encourage them to perform indoor exercise-based personalized programs to keep up the amount of exercise they take each week.

The effect of extra virgin olive oil on anthropometric indices, lipid profile, and markers of oxidative stress and inflammation in patients with depression, a double-blind randomised controlled trial.

Epidemiological evidence suggests a mutual association between depression and obesity and also an anti-obesity effect for olive oil. We examined the effect of extra virgin olive oil (EVOO) on weight, waist circumference, and a number of cardiovascular risk factors in patients with depression. The randomised double-blind controlled trial was conducted on 62 patients with depression. Patients were randomly allocated to EVOO and sunflower oil groups (n=31 for each) that consumed 25mL/day of the corresponding oils for 52days. An isocaloric diet was prescribed to each patient according to his/her previous energy intake with considering the energy provided by the administered oils. Weight, body mass index (BMI), waist circumference, blood lipids, malondialdehyde, and hs-C reactive protein (CRP) analysis were performed using the intention-to-treat approach. BMI was significantly decreased in sunflower oil group (-0.20±0.53kg/m2 , P=.047) and waist circumference was significantly decreased in EVOO group (-2.15±2.09cm, P<.001); however, only reduction of waist circumference was significantly different between groups (P<.001). High-density lipoprotein (HDL) cholesterol was significantly increased in EVOO group (3.02±6.79mg/dL, P=.03), without showing a significant between-group difference. Other lipids, malondialdehyde, and hs-CRP did not change. Overall, the results suggest that both EVOO and sunflower oil may benefit overweight patients with depression, as they respectively decreased waist circumference and BMI without need for administration of a low-calorie diet.

Pooled prevalence of three major cardiovascular risk factors in patients undergoing left main bifurcation stenting: a systematic review and meta-analysis.

Prevalence of the major risk factors in patients with Left Main (LM) bifurcation disease has not been yet clearly assessed, although it would be important for building up bifurcation computational models. We perform a systematic review and meta-analysis on the three major cardiovascular risk factors in patients treated for LM bifurcation disease using either single or two-stent strategy. In accordance with the PRISMA guidelines, Cochrane Library, Embase, PubMed and Google Scholar were queried to locate articles published between January 2015 to October 2020, comparing single- versus two-stent strategy and reporting the prevalence of arterial hypertension (HT), hyperlipidemia (HyperL) and diabetes mellitus (DM). Out of a total of 230 articles, seven articles were included into the final analysis. A total of 4559 patients were enrolled: 2666 (58.4%, mean age 60.4 years, 2318 males) and 1933 patients (42.3%, mean age 64.8 years, 1763 males) received a single- and two-stent stenting strategies, respectively. A random effect model revealed a pooled prevalence of HT, HyperL and DM in 69.4%, 38.9% and in 31% of cases, respectively. Prevalence of HT was lower in patients treated with single versus two-stent strategy (63 versus 66.7% of patients, P=0.01) while HyperL and DM were more represented in single versus two-stent strategy: 41.6 versus 34.1% (P<0.001), and 32.5 versus 31.8% of patients (P=0.61), respectively. In patients with LM bifurcation disease undergoing either single or two-stent strategy, HT, HyperL and DM are frequent comorbidities. In severe LM disease requiring two-stent technique, HT is the most prevalent risk factor.

Effect of HRP Upon the Expression and Intracellular Signaling of PRR in Cardiovascular and Renal Systems in Preeclamptic Rats Offspring

Introduction Preeclampsia (PE) is a condition that affects both, the mother and the child, conditioning in both a greater susceptibility to develop cardiovascular diseases in future stages. It has been studied that prorenin renin receptor (PRR) has a broad participation in the cardiovascular system of PE products, it seems to play an important role in the development of future conditions, such as arterial hypertension, involving the renin angiotensin aldosterone system (RAS). RAS hyperactivity has been implicated as a cardiovascular risk factor in patients who come from a pregnancy complicated by preeclampsia. Mechanisms mediating fetal programming of adult arterial hypertension are numerous, including vascular dysfunction and reduction of the density of the arterioles and capillaries. Handle Region Peptide (HRP) is a decoy peptide that can inhibit the binding of prorrenin to the PRR receptor. HRP mimics the loop region and therefore competitively binds to the receptor, thus preventing receptor-mediated activation of prorenin and reducing its activity in tissue. Objective To evaluate the HRP blockade upon the PRR receptor and its transduction pathways: WNT and MAPK in cardiovascular and renal tissue in offspring from a pre-eclampsia model. Material and methods Male and female offspring from PE and healthy pregnant wistar rats, with 30 and 120 days of age, where set up in groups with or without HRP treatment (0.2 mg/Kg, subcutaneously for 7 days before sacrifice). We measured blood pressure by tail-cuff method. At the end of the treatment the expression of PRR, DVL1, beta-catenin, PKC-alpha were measured by immunoblot and RT-PCR in cardiovascular and renal tissue. Results Offspring from PE rats showed sustained high blood pressure, both male and female at 30 and 120 days. HRP treatment reverted partially this increase. All PE-derived groups showed an increase in PRR expression in aorta, heart and kidney. WNT and MAPK pathways also seemed to be activated in PE-derived animals, as shown by β-catenin, DVL-1 and PKCa increased expression. These findings are important because WNT signaling pathway is associated with kidney diseases and cardiac hypertrophy. Besides, this work shows that PRR participates in high blood pressure development in offspring derived from PE pregnancies.

The World Heart Federation Global Study on COVID-19 and Cardiovascular Disease.

Background:The emergence of novel coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase, and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions facilitated by international travel, leading to a pandemic. To guide effective control and interventions, primary data is required urgently, globally, including from low- and middle-income countries where documentation of cardiovascular manifestations and risk factors in people hospitalized with COVID-19 is limited.Objectives:This study aims to describe the cardiovascular manifestations and cardiovascular risk factors in patients hospitalized with COVID-19.Methods:We propose to conduct an observational cohort study involving 5000 patients recruited from hospitals in low-, middle- and high-income countries. Eligible adult COVID-19 patients will be recruited from the participating hospitals and followed-up until 30 days post admission. The outcomes will be reported at discharge and includes the need of ICU admission, need of ventilator, death (with cause), major adverse cardiovascular events, neurological outcomes, acute renal failure, and pulmonary outcomes.Conclusion:Given the enormous burden posed by COVID-19 and the associated severe prognostic implication of CVD involvement, this study will provide useful insights on the risk factors for severe disease, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients particularly from low and middle income countries from where the data remain scant.

Vitamin K and vascular calcification.

Vascular calcification is a common and important cardiovascular risk factor in patients with chronic kidney disease (CKD). Recent advances in the understanding of the biology of vascular calcification implicate vitamin K-dependent proteins as important regulators in this process. This review highlights recent key advances in vascular biology, epidemiology, and clinical trials in this rapidly evolving field. Vitamin K deficiency is associated with increasing severity of vascular calcification among patients with CKD, but the relationship with cardiovascular disease and mortality is inconsistent. Vitamin K may reduce calcification propensity by improving the activity of vitamin K-dependent calcification inhibitors or by down-regulating components of the innate immune system to reduce inflammation. However, recent randomized controlled trials in patients with diabetes, CKD, renal transplant, and on hemodialysis have failed to demonstrate improvement in vascular calcification or stiffness after vitamin K treatment. Current evidence does not support a clinically useful role for vitamin K supplementation to prevent or reverse vascular calcification in patients with CKD. Knowledge gaps remain, particularly whether higher doses of vitamin K, longer duration of supplementations, or use a vitamin K as a part of a package of measures to counteract vascular calcification might be effective.

Crosstalk between proteinuria, plasma oxalic acid and inflammation in glomerulonephritis patients: an exploratory study

Abstract. In the present exploratory cross-sectional cohort study, we evaluated whether plasma and urine oxalate concentrations in patients with primary glomerulonephritis depend not only on the glomerular filtration rate but also on the proteinuria level and influence the inflammatory response.&#x0D; Methods. We enrolled 100 participants, including 76 patients with glomerulonephritis having chronic kidney disease stage (CKD) 1–3b (69.7% of them with nephrotic syndrome) and 24 healthy volunteers. We excluded patients with diabetes, cardiovascular disease and those with glomerulonephritis with an estimated GFR (eGFR) &lt; 30 mL/min/1.73 m2. In addition to routine hematological and biochemical tests, plasma oxalate concentration, urinary oxalate excretion, and serum interleukin (IL)-6 and monocyte chemoattractant protein-1 (MCP-1) levels were assessed in all study participants.&#x0D; Results. We observed that plasma oxalic acid concentration was significantly higher in patients with glomerulonephritis (19.0 [5.9–45.2] µmol/L) than in healthy volunteers (5.5 [3.8–7.3] µmol/L, p &lt; 0.0001). Moreover, nephrotic proteinuria was significantly associated with plasma oxalic acid elevation independent of the patients’ age, sex, glomerular filtration rate, and body mass index (odds ratio = 1.42, 95% confidence interval = 1.13–1.77, p = 0.002). In turn, the increased plasma oxalic acid concentration was associated with high levels of serum IL-6 and MCP-1, which may be cardiovascular risk factors in patients with primary glomerulonephritis.&#x0D; Conclusions. Nephrotic proteinuria was significantly associated with the elevation of plasma oxalic acid concentration and hyperoxaluria in glomerulonephritis patients with CKD stages 1–3b. Plasma oxalate at least partly promotes inflammation, which may be a cardiovascular risk factor in patients with glomerulonephritis in the early stages of CKD. Future studies should recruit at least 156 participants to confirm our preliminary results, validate nephrotic proteinuria as a risk factor for oxalate metabolism violation or determine the role of impaired oxalate homeostasis in clinical outcomes in patients with glomerulonephritis.

The Effect of Thyroxine Therapy on Cardiovascular Risk Factors in Patients with Subclinical Hypothyroidism

Aim: Subclinical hypothyroidism (SH) has a deleterious effect on cardiovascular risk factors (CVR); however it should be treated or not is stil controversial. The aim of our study is to determine CVR in patients with SH, and to investigate the short term effect of thyroxine treatment on CVR. Material and Methods: Patients with SH (n=30), and age- and sex-matched control group (n=40) were included in this retrospective study. SH patients were treated by 50μg/day thyroxine for 3 months. Pre-treatment CVR was compared with post-treatment CVR. Results: Sex distribution and mean age were similar between control (female 66.7%; age 45.76±14.55 years) and SH (female 77.3%; age 45.23±12.02 years) groups (p>0.05). Body mass index (BMI) was high in SH group (32.66±5.57 kg/m2) than in control group (25.13±3.20 kg/m2, p<0.05). At baseline, serum glucose (83.76±9.51 vs 91.73±9.96 mg/dl), total cholesterol (162.36±13.41 vs 184.21±51.91 mg/dl), low-density lipoprotein-cholesterol (LDL-C; 91.73±22.04 vs 104.61±11.36 mg/dl), and C-reactive protein (hs-CRP; 1.53±0.66 vs 2.63±0.93 mg/L) levels were higher in SH group than in the control group (p<0.05). After treatment, BMI value decreased (31.35±5.54 kg/m2) along with decreasing serum LDL-C (97.30±9.63 mg/dl) and hs-CRP (1.96±0.42 mg/L) levels in SH group (p<0.05). Thyroid stimulating hormone was independently associated with LDL-C (OR=2.17,%95CI [1.26-2.54], p=0.005). Conclusion: In this study, it was determined that cardiometabolic disorders in patients with subclinical hypothyroidism partiel improved with thyroxine treatment. Thyroxine treatment may contribute to the reduction of increased cardiovascular risk in subclinical hypothyroidism.

Cardiological health in patients with schizophrenia. A prospective cohort study

IntroductionPatients with schizophrenia have a four-fold increased all-cause and a doubled cardiovascular mortality rate as compared to the general population.ObjectivesThe study overall investigates the point-prevalence and prospective changes in cardiovascular risk factors in patients with schizophrenia, with baseline demographics of participants presented here.MethodsA prospective study of patients diagnosed with schizophrenia divided into two subpopulations consisting of newly diagnosed (≤2 years from baseline in study (group A)) or chronic (diagnosed ≥10 years from baseline in study (group B)).ResultsA total of 199 patients (57 diagnosed ≤2 years preceding baseline and 142 diagnosed ≥10 years ago) were included. Group A had been diagnosed for an average of 1.13±0.58 years and 21.19±7.62 years in group B. The majority (n=135 (67.8%)) were diagnosed with paranoid schizophrenia. At baseline PANSS total (median[Q1;Q3]) for group A was 61.0[51.0;76.0] and 60.0[48.0;76.0] for group B, with PANNS Positive being 17.0[13.0;20.0] and 15.0[12;19], PANSS Negative being 16.0[11.0;20.0] and 14.5[10.0;20.0], and PANSS General being 28.0[22.0;35.0] and30.0 [25.0;37.0], respectively. No difference in Clinical Global Impression was observed between groups ((median[Q1;Q3): 4.0[3.0;4.0] in both groups). Lastly, global assessment of function was similar between groups ((median[Q1;Q3): group A symptom: 38.5[37.0;46.0] and group B 41.0[37.0;52.0], and with function being 48.0[44.5;53.5] in group A and 45.5[41.0;53.0] in group B).ConclusionsProspective studies investigating prevalence of and prospective changes in cardiovascular risk in patients with schizophrenia are essential to understand the increased all-cause and cardiovascular specific mortality. Demographic descriptions of participants are essential to estimate generalizability in different treatment settings.DisclosureNo significant relationships.

Increased serum ferritin is associated with oxidized low-density lipoprotein in prediabetes patients: A pilot study

AimsThis pilot study aimed to determine if increased serum ferritin (SF) is associated with cardiovascular risk factors in patients with prediabetes. MethodsEighteen patients with prediabetes and 36 subjects without prediabetes (control), non-white Hispanic, non-indigenous origin, Mexican mestizo descent were included. Participants had no inflammation, or vascular complications. SF and metabolic markers were evaluated in both groups. ResultsSF and oxidized low-density lipoprotein (oxLDL) were increased in prediabetes subjects. Moreover, in prediabetes and control groups as a whole, natural logarithm (ln)-SF correlated with oxLDL and ln-oxLDL/LDL after adjustment for sex, ln-age, ln-fasting plasma glucose (FPG), ln-body mass index, ln-triglyceride (TG), total cholesterol (TC), and high-density lipoproteins. Finally, ln-SF was an independent contributor to ln-oxLDL/LDL ratio in control and prediabetes subjects (β = 0.2915) after the introduction of potential confounders such as FPG, TC, TG, and hypertension. ConclusionsThe results of this study indicate that hyperferritinemia is associated with oxLDL, considered one of the main cardiovascular risk factors, which allows us to suggest that an increase in SF could contribute to the progression of prediabetes, prior to the appearance of diabetes. Further research is required to establish a causal relationship of iron disruption metabolism in oxLDL generation under prediabetes conditions.

Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review.

Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.

Galanin and glypican-4 levels depending on metabolic and cardiovascular risk factors in patients with polycystic ovary syndrome.

Galanin is a neuropeptide which has effects not only on metabolic syndrome but also on reproduction. Glypican-4 is an adipokine associated with insulin sensitivity by interacting directly with the insulin receptor. This study evaluated serum concentrations of galanin and glypican-4 in relation with the hormonal profile as well as metabolic and cardiovascular risk factors in patients with and without polycystic ovary syndrome (PCOS). A total of 44 women with PCOS and 44 age-matched controls were eligible. Hirsutism scores, hormonal profile, metabolic and cardiovascular risk factors as well as galanin and glypican-4 levels were evaluated in each subject. Women with PCOS exhibited lower levels of galanin (20.2 pg/mL versus 26.4 pg/mL, p = 0.002) and higher concentrations of glypican-4 (3.1 ng/mL versus 2.6 ng/mL, p < 0.001) than controls. Both adipokines were correlated positively with body mass index (BMI), insulin, triglyceride and Homeostasis Model Assessment (HOMA) index; glypican-4 also showed positive correlations with fasting blood glucose, free testosterone, modified Ferriman-Gallwey scores (p < 0.05). Multiple Linear Regression analyses showed that PCOS and BMI were the best predictors affecting galanin levels with a decreasing and increasing effect respectively; however BMI was the best predictor affecting glypican-4 levels with an increasing effect (p < 0.001). Galanin levels were lower and glypican-4 levels were higher in women with PCOS than controls. Further studies are needed to determine whether these adipokines could be used as additional markers for insulin sensitivity and lipid profile and whether they might play a role in the pathogenesis of PCOS, in which metabolic cardiovascular risks are increased.

Prediction model of isolated iliac and abdominal aneurysms.

We analyse the cardiovascular risk factors in patients undergoing screening for Isolated Iliac Aneurysm (IIA) and Abdominal Aortic Aneurysm (AAA) and propose a logistic regression model to indicate patients at risk of IIA and/or AAA. A screening programme was carried out to identify the presence of aneurysm based on Duplex scan examination. Cardiovascular risk factors information was collected from each subject. A descriptive analysis for the incidence of IIA and AAA stratified by age and sex was carried out to evaluate factors incidence. A logistic regression model was developed to predict the probability of developing an aneurysm based on the observed risk factor levels. A threshold probability of aneurysm risk for a datum patient was also identified to effectively direct screening protocols to patients most at risk. A cohort of 10842 patients was evaluated: 1.52% affected by IIA, 2.69% by AAA and 3.90% by at least one. Risk factors analysis showed that: IIA was correlated with cardiological status, diabetes, cardiovascular disease family history, and dyslipidaemia; AAA was correlated with cardiological status, body mass index, hypertension, and dyslipidaemia; diabetes and dyslipidaemia were the most relevant factors with at least one aneurysm. The prediction tool based on the logistic regression and the threshold probability predict the presence of IIA and AAA in 69.7% and 83.8% of cases, under k-fold cross-validation. The proposed regression model can represent a valid aid to predict IIA and AAA presence and to select patients to be screened.

RxIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre–post intervention study

Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.ObjectiveTo evaluate the effect of a pharmacist-led intervention...

Impact of Ramadan fasting on lipid profile and cardiovascular risk factors in patients with stable coronary artery disease

BackgroundThe effects of Ramadan fasting (RF) on cardiometabolic risk factors in patients with stable ischemic heart disease are not well known. AimThe aim of this study was to evaluate the impact of RF on lipid profile and cardiovascular risk factors in patients with a stable coronary heart disease. MethodsA prospective observational study carried out in the Cardiology department of Charles Nicolle Hospital (Tunisia). Eighty-four patients with a stable ischemic heart disease who intended to fast were enrolled during May 2020. Detailed clinical and biochemical assessments were performed before and after the holy month. Parameters of glycemic control, lipid profile, ultrasensitive C-reactive protein concentration (us-CRP) and homocysteine were performed before- and after- Ramadan (BR and AR, respectively). ResultsEighty-four patients including 79 males and 5 females, with a mean age of 57±7 years completed the study. Levels of cholesterol, triglycerides, low-density lipoprotein-cholesterol and apoprotein A were significantly improved AR fasting in comparison with their BR values. There was a significant decrease in blood fasting glucose, insulin level, Homeostasis model assessment of insulin resistance index and in us-CRP level. ConclusionIn patients with stable ischemic heart disease, RF may be accompanied by an improvement of lipid profile and glycemic parameters without increase in coronary events.

Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic.

To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic. Prospective, randomised, open label, blinded endpoint study. The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital. Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded. The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events. The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group. An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores. Australia New Zealand Clinical Trial Registry, ACTRN12617000615381 (retrospective).

Evaluation of Carotid Artery Intima-Media Thickness as a Cardiovascular Risk Factor in Patients With Polycystic Ovary Syndrome.

IntroductionThe purpose of this study is to assess cardiovascular risk factors in patients diagnosed with polycystic ovary syndrome (PCOS) by comparing dyslipidemia, insulin sensitivity, hyperhomocysteinemia, carotid artery intima-media thickness (CIMT) between women diagnosed with PCOS and healthy subjects.Materials and MethodsHundred women diagnosed with PCOS aged between 18 and 35 years and who applied to tertiary center gynecology clinic were included in the study. Hundred women who applied for menstrual irregularity to the same outpatient clinic with no systemic diseases, who were not under medical treatment for any condition, were included in the control group. Physical examination, hormone profile tests on the second day of the patients’ menstrual cycle, pelvic, and neck ultrasonography to evaluate CIMT were performed for all patients. CIMT values were compared with biochemical, hormonal, and anthropometric values. Sensitivity, specificity, Pearson correlation coefficient, mean, and standard deviation were calculated.ResultsIn the PCOS group, there was no statistically significant difference in homeostatic model assessment for insulin resistance (HOMA-IR) (<2.5 and >2.5) among all parameters. When we evaluate body mass index (BMI) (<30 and >30) for this PCOS group patients, a very highly significant difference (p < 0.001) between waist-hip ratio and hemoglobin A1c (HbA1c) was established statistically, and there was a significant difference (p < 0,05) between waist-hip ratio and luteinizing hormone (LH).After this statistical analysis, dehydroepiandrostenedione sulfate (DHEAS), free androgen index (FAI), LH, low-density lipoprotein (LDL), Ferriman-Gallwey score (FGS), homocysteine, mean CIMT, and waist to hip ratio were significantly different in the two groups (p < 0.01). The difference between HbA1c and cholesterol high-density lipoprotein (HDL) was significant (p < 0.05).ConclusionAs a result, in the PCOS group, when compared to the healthy subjects, dyslipidemia, HbA1c, waist to hip ratio, and CIMT were significantly different. It might be suitable to perform an ultrasound for CIMT in patients with higher Ferriman-Gallwey (FG) score.

Уровень эндокана у пациентов с хронической болезнью почек

The relevance of the work is due to the high prevalence of chronic kidney disease (CKD) among the population and high mortality from cardiovascular disease (CVD) in this population. In this connection, it is necessary to search for new biomarkers in order to early identify individuals with cardiovascular risk in patients with CKD. The purpose of this study to assess the endocan level in patients with CKD depending on the glomerular filtration rate (GFR), to study the relationship between the endocan level and other cardiovascular risk factors in patients with CKD. Material and methods. 153 respondents with various stages of CKD were examined. The study included socio-demographic, anthropometric data, blood pressure measurements, cholesterol, high density lipoprotein (HDL), triglycerides (TG), glucose and endocan. Data analysis was performed using the statistical software package SPSS 22. Results and discussion. The respondents in the groups did not differ in such indicators as gender, age, marital status, frequency of active smoking, diabetes, body mass index (BMI). Significant differences were found in the level of education (p=0.04), income (p=0.008), systolic pressure (SBP) (p=0.0001) and diastolic blood pressure (DBP) (p=0.0001). Levels of total cholesterol (cholesterol), (p=0.0001), uric acid (p=0.0001), cystatin C (p=0.0001) and endocan (p=0.0001) also had significant differences depending on GFR. Conclusion. A comparative analysis of the frequency of “traditional” cardiovascular risk factors among patients with various stages of CKD showed the absence of differences in the frequency of active smoking, diabetes mellitus, obesity and the presence of significant differences in blood pressure and total cholesterol (p = 0.0001). Evaluation of the endocan level depending on the stage of CKD showed that with the progression of CKD, the endocan level increases significantly (p = 0.0001), which may indicate the progression of endothelial dysfunction with impaired renal function. Further studies are needed to determine the prognostic value of endocan in the development of cardiovascular events in patients with CKD. Keywords: chronic kidney disease, cardiovascular disease, glomerular filtration rate, biomarkers, endocan.