Clinical Manifestations Of Cardiovascular Disease Research Articles

Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases

Aim. To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction.Material and methods. Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6).Results. According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p<0,001). A higher level of NT-proBNP was associated with hypertension — odds ratio (OR) 3,64 [1,02-13,04] (p=0,005), a decrease in LV ejection fraction — OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy — OR 4,84 [1,43-16,41] (p=0,011) and decreased GLS — OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) — OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) — OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction <-18% were 86 and 27%, respectively. The hsCRP level, within the reference values, was significantly higher in the T2D and prediabetes groups compared to the control group (p<0,001) and demonstrated a direct linear relationship with E/A, IVRT, early diastolic deceleration time (p<0,05). A higher level of hsCRP was significantly associated with diastolic dysfunction — OR 1,16 [1,02-1,32] (p=0,023), as well as with a GLS decrease <-18% — OR 1,58 [1,12-4,65] (p=0,03).Conclusion. In patients with T2D without clinical manifestations of cardiovascular disease, the presence of concentric LV myocardial hypertrophy, LV diastolic dysfunction and decreased GLS (<-18%) is associated with higher blood levels of NT-proBNP and hsCRP. However, in all cases, the levels of biomarkers do not exceed the reference values, which does not allow their use in the early diagnosis of subclinical LV dysfunction in T2D.

Therapeutic mechanisms of ginseng in coronary heart disease.

Coronary heart disease (CHD) is the most common clinical manifestation of cardiovascular disease. It is characterized by myocardial ischemia, which is caused by coronary atherosclerosis. CHD is a significant global health problem with increasing prevalence every year because of significant changes in the lifestyles and diets. Ginseng is a traditional Chinese medicinal herb that has been used in food preparations and traditional medicine for several centuries. Several studies have demonstrated that ginseng improved cardiac function by normalizing blood glucose levels and decreasing blood pressure, oxidative stress, platelet aggregation, and lipid dysregulation in vivo. This review describes the current understanding of the mechanisms by which ginseng alleviates CHD, and provides a reference for the clinical development and application of ginseng as an alternative therapy for CHD.

Aging of the Arterial System.

Aging of the vascular system is associated with deep changes of the structural proprieties of the arterial wall. Arterial hypertension, diabetes mellitus, and chronic kidney disease are the major determinants for the loss of elasticity and reduced compliance of vascular wall. Arterial stiffness is a key parameter for assessing the elasticity of the arterial wall and can be easily evaluated with non-invasive methods, such as pulse wave velocity. Early assessment of vessel stiffness is critical because its alteration can precede clinical manifestation of cardiovascular disease. Although there is no specific pharmacological target for arterial stiffness, the treatment of its risk factors helps to improve the elasticity of the arterial wall.

Significance of standard and speckle-tracking echocardiography for early diagnosis of asymptomatic left ventricular dysfunction in type 2 diabetes

Aim. To study the relationship between echocardiographic parameters of left ventricular (LV) function and carbohydrate metabolism indicators, as well as to evaluate value of speckle-tracking echocardiography (STE) in the early diagnosis of subclinical LV dysfunction in type 2 diabetes (T2D) in individuals without clinical manifestations of cardiovascular disease (CVD).Material and methods. The study included 120 people of both sexes aged 45 to 75 years. Patients were divided into three following groups: 1 — with T2D (n=53), 2 — with prediabetes (n=20), 3 — control, without carbohydrate metabolism disorders (n=47). All participants underwent transthoracic two-dimensional echocardiography with an assessment of standard systolic and diastolic parameters, as well as quantitative STE indicators. In addition, all participants underwent laboratory diagnostics of carbohydrate metabolism disorders, which included the determination of blood fasting glucose, glycated hemoglobin (HbA1c), insulin, and C-peptide, as well as insulin resistance index estimation.Results. In patients with T2D, in comparison with the control group, diastolic function parameters were significantly different as follows: a lower value of early to late diastolic transmitral flow velocity (E/A) ratio, the ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e'), mitral annular velocity (e') and higher isovolumic relaxation time (IVRT), as well as early diastolic flow deceleration time (DT). According to multivariate analysis, not only T2D, but also prediabetes was an independent predictor of diastolic dysfunction. The Simpson's LV ejection fraction was preserved in all study participants. In patients with T2D, in comparison with the control, according to STE, a decrease in global longitudinal strain (GLS), an increase in apical rotation, and also LV twist were revealed. In a multivariate regression analysis, the HbA1c level had an inverse relationship with GLS and was an independent predictor of its decrease, and the T2D duration was a significant predictor of twisting changes, apical and basal rotation. At the same time, GLS and LV twist had a high sensitivity in determining the decrease in E/A, e'/a', e', as well as the increase in IVRT.Conclusion. In patients with T2D without CVD manifestations, sub-clinical signs of diastolic dysfunction were revealed, such as delayed LV relaxation; systolic dysfunction with preserved ejection fraction was manifested by a decrease in GLS, as well as an increase in apical rotation and LV twisting, identified by STE. The severity of asymptomatic LV systolic-diastolic dysfunction was associated with the severity of glucose metabolism disorders and T2D duration.

Transthyretin Cardiac Amyloidosis: A Cardio-Orthopedic Disease.

Orthopaedic manifestations of wild-type transthyretin amyloidosis are frequent and characteristic, including idiopathic bilateral carpal tunnel syndrome, idiopathic lumbar canal stenosis, atraumatic rupture of the brachial biceps tendon, and, more rarely, finger disease and rotator cuff. These manifestations often coexisting in the same patient, frequently male and aged, steadily precede cardiac involvement inducing a rapidly progressive heart failure with preserved ejection fraction. Although transthyretin cardiac amyloidosis remains a cardiac relevant disease, these extracardiac localisation may increase diagnostic suspicion and allow for early diagnosis assuming the role of useful diagnostic red flags, especially in light of new therapeutic opportunities that can slow or stop the progression of the disease. For the cardiologist, the recognition of these extracardiac red flags is of considerable importance to reinforce an otherwise less emerging diagnostic suspicion. For orthopedists and rheumatologists, the presence in an old patient with or without clinical manifestations of cardiovascular disease, of an unexpected and inexplicable constellation of musculoskeletal symptoms, can represent a fundamental moment for an early diagnosis and treatment is improving a patient's outcome.

Nephrolithiasis: A Red Flag for Cardiovascular Risk.

Epidemiological evidence shows that nephrolithiasis is associated with cardiovascular (CV) morbidities. The association between nephrolithiasis and CV disease is not surprising because both diseases share conditions that facilitate their development. Metabolic conditions, encompassed in the definition of metabolic syndrome (MS), and habits that promote nephrolithiasis by altering urine composition also promote clinical manifestations of CV disease. By inducing oxidative stress, these conditions cause endothelial dysfunction and increased arterial stiffness, which are both well-known predictors of CV disease. Furthermore, the subtle systemic metabolic acidosis observed in stone formers with CV disease may have a pathogenic role by increasing bone turnover and leading to reduced mineral content and osteoporosis/osteopenia. Heart valves and/or coronary artery and aortic calcifications are frequently associated with reduced mineral density. This is known as the ‘calcification paradox’ in osteoporosis and has also been observed in subjects with calcium nephrolithiasis. Evidence supports the hypothesis that osteoporosis/osteopenia is an independent risk factor for the development of CV calcifications. In the long term, episodes of renal stones may occur from the onset of metabolic derangements/MS to arterial stiffness/atherosclerosis and CV morbidities. These episodes should be considered a warning sign of an ongoing and silent atherosclerotic process. The evaluation of cardiometabolic risk factors and MS components should be routine in the assessment of renal stone formers. This would allow for treatment and prevention of the development of CV complications, which are much more severe for the patient and for public health.

Oil-producing enterprise

Arterial hypertension is an urgent health problem worldwide causing an increase in temporary and permanent disability, invalidity and mortality due to cardiovascular diseases. Researchers recognize the multifactorial nature of arterial hypertension, but environmental factors are of particular potential importance. The working conditions at oil production enterprises are characterized by a more pronounced influence of these factors which may predispose for early development of disadaptation disorders, functional changes in immune and humoral regulation, and, finally, for increased risk of cardiovascular diseases in people engaged in oil production. The aim of the present work was to study the features of immunity and humoral risk factors of arterial hypertension in hypertensive employees at an oil-producing enterprise. To this purpose, a comparative analysis of lymphocyte subpopulations (CD3+CD4+, CD3+CD25+), markers of apoptosis (CD3+CD95+, TNFR, p53, Bax, Annexin V-FITC+7AAD), phagocytic activity of leukocytes (absolute phagocytosis index), and the levels of vascular humoral factors (nitric oxide and homocysteine) was performed in employees of an oil production enterprise exposed to adverse production factors. The observational group consisted of employees with established episodes of increased blood pressure. A comparison group consisted of individuals without clinical manifestations of cardiovascular disease. As a result of the clinical and laboratory examination of employees at the oil-producing enterprise with arterial hypertension, some functional changes in immune regulation were revealed. This group was characterized by a significantly (p 0.05) decreased CD3+CD4+, and CD3+CD25+ lymphocyte contents, along with increased levels of regulatory CD127 lymphocytes against the comparison group (p 0.05). The workers at an oil production enterprise with arterial hypertension are characterized by decreased (p 0.05) phagocytic activity of peripheral blood leukocytes using the criteria of absolute phagocytosis. We found some signs of inhibited lymphocyte apoptosis (p 0.05), i.e., a decrease in CD95+, TNFR, and p53 over the background values, as well as increased Bax levels over the comparison group (p 0.05). However, the content of TNFR and p53 significantly (p 0.05) exceeded the reference level, regardless of previous arterial hypertension episodes. Development of the high blood pressure episodes among the employees at oi-producing plant showed a significant association (p 0.05) with elevated levels of homocysteine and nitric oxide concentrations which are known to induce endothelial dysfunction, atherogenesis and, hence, a persistent increase in blood pressure.

Atherosclerosis in Brazil: An ecological study

Background and Aims : Atherosclerosis is a subclinical chronic inflammatory disease. It is a multifactorial and complex process with fatty plaques, calcium and other elements appearing in the intimal layer of vessels that precedes clinical manifestations of cardiovascular diseases. Physical activity is an important protective factor for its prevention.The aim of this study is to analyse the epidemiological profile of patients with atherosclerosis in Brazil in the last 10 years.

Clinical manifestations of cardiovascular disease in children as a sequela of coronavirus disease (COVID-19) (a clinical case)

The aim of the work: to provide medical practitioners with a clinical case of cardiovascular affection with ST-segment elevation in a child as a result of coronavirus disease (COVID-19). Materials and methods. Here is a clinical case of our own observation of the clinical course of post-COVID cardiovascular system involvement with ST-segment elevation in the child who was treated at the City Children’s Hospital No. 5 of Zaporizhzhia City Council. Results. The patient with severe post-COVID cardiovascular implication, COVID in anamnesis confirmed by COVID-19 IgG positivity with negative IgM and PCR test results. The following laboratory findings were also detected when the child was admitted to the hospital: Troponin I was 136 ƞg /ml (referent value – less than 0.32 ƞg/ml), Lactate Dehydrogenase – 4199 U/l (referent value – 110–295), Creatine Phosphokinase-MB – 25.4 U/l (referent value – 0–24), CRP was increased to 6.2 mg/l, D-dimer – to 3221.12 ng/mL (referent value – less than 500 ng/mL). ECG showed QS-waves in leads V3–V6, I, 2.0–2.5 mm ST-segment elevation in leads V4–V6, and Р-mitrale. The clinical course was characterized by cardiogenic shock development. During intensive care, there was moderate positive clinical and laboratory dynamics. Peculiarities of post-COVID myocarditis in children were characterized based on the comparative analysis of this clinical case and results of relevant clinical studies, world recommendations and guidelines. Conclusions. Peculiarity of the case is severe post-COVID syndrome after almost asymptomatic COVID-19. Physicians should be aware after coronavirus disease while providing a close follow-up for six months. Myocardial ischemia is among casuistic post-COVID manifestations in children. The basic treatment is a complex therapy of heart failure, anticoagulant and antiplatelet therapy, as well as corticosteroids administration, which is pathogenetically justified and leads to regression of major clinical and laboratory symptoms.

Prognostic significance of gender and sexual risk factors in the development of arterial hypertension in an organized population

Relevance. Persistent high levels of morbidity and mortality of the working-age population from cardiovascular diseases (CVD) in Russia require the search for new targets for screening programs and subsequent development of evidence-based prevention models in organized populations showing their clinical and economic effectiveness in long-term prospective follow-up.Objective. To carry out a comprehensive assessment of the prognostic factors of arterial hypertension (AH) according to the data of 8-year prospective study of an organized sample taking into account gender and sex characteristics.Design and methods. We conducted a two-stage study: a one-stage integral study of an organized population (400 people) followed by a prospective 8-year follow-up of a group of relatively healthy subjects without clinical manifestations of CVD (193 people aged 21 to 64 years, mean age 49,0 [42,0; 58,0], of whom men 48,2%). Stage I indicators under study: sociodemographic characteristics; clinical and physical findings; behavioral factors; family history of early CVD; occupational interview and degree of work stress; psychological characteristics; biochemical indices of stress response; cardiovascular remodeling indices. Stage II indicators under study: newly diagnosed cases of AH.Results. The pattern of prognostic factors for AH depended on gender. Among women, prognostic factors for 8-year incidence of AH were: marital status (widow) (Hazard ratio (HR) 10,1), diastolic blood pressure level (HR1,1), and physical activity outside work (HR0,3). In men, in addition to behavioral (smoking history, HR1,1) and clinical (high normal blood pressure, HR4,1) factors, there was also an independent contribution of a psychological factor (personality anxiety, HR6,5).Conclusions. Our findings substantiate the need for a poly-professional approach (physician-internistpsychiatrist-medical psychologist) to the prevention of CVD in the studied organized population, taking into account gender-specific features.

Genetic associations with carotid intima-media thickness link to atherosclerosis with sex-specific effects in sub-Saharan Africans

Atherosclerosis precedes the onset of clinical manifestations of cardiovascular diseases (CVDs). We used carotid intima-media thickness (cIMT) to investigate genetic susceptibility to atherosclerosis in 7894 unrelated adults (3963 women, 3931 men; 40 to 60 years) resident in four sub-Saharan African countries. cIMT was measured by ultrasound and genotyping was performed on the H3Africa SNP Array. Two new African-specific genome-wide significant loci for mean-max cIMT, SIRPA (p = 4.7E-08), and FBXL17 (p = 2.5E-08), were identified. Sex-stratified analysis revealed associations with one male-specific locus, SNX29 (p = 6.3E-09), and two female-specific loci, LARP6 (p = 2.4E-09) and PROK1 (p = 1.0E-08). We replicate previous cIMT associations with different lead SNPs in linkage disequilibrium with SNPs primarily identified in European populations. Our study find significant enrichment for genes involved in oestrogen response from female-specific signals. The genes identified show biological relevance to atherosclerosis and/or CVDs, sex-differences and transferability of signals from non-African studies.

Statins for primary prevention among elderly men and women

Abstract Background The debate about statins in primary prevention of cardiovascular (CV) disease is still alive, especially in old and very old adults. Purpose We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly. Methods We included in our analysis 5,619 people aged 65 years or older from the ISACS (International Survey of Acute Coronary Syndrome) Archives (NCT04008173) who presented to hospital with a first manifestation of CV disease. Participants were stratified as statin users versus nonusers and as old (65 to 75 years) versus very old (76 years or over) adults. We estimated the effects of statins on the most severe clinical manifestation of CV disease, namely ST segment elevation myocardial infarction (STEMI), using inverse probability of treatment weighting models. Estimates were compared by test of interaction on the log scale. Results The risk of STEMI was much lower in statin users than in nonusers in both patients aged 65 to 75 years (14.7% absolute risk reduction; relative risk [RR] ratio: 0.55, 95% CI 0.45 to 0.66) and those aged 76 years and older (13.3% absolute risk reduction; RR ratio: 0.58, 95% CI 0.46 to 0.72). Estimates were similar in patients with and without history of hypercholesterolemia (interaction test; p value= 0.2408). Proportional reductions in STEMI diminished with female sex in the old (p for interaction=0.002), but not in the very old age (p for interaction=0.26). We also observed a remarkable reduction in the risk of 30- day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR ratio: 0.39; 95% CI 0.23 – 0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR ratio 0.37; 95% CI 0.17 – 0.82 for patients aged 65 to 75 years old; interaction test, p value=0.4570). Conclusion Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolemia. This effect persists after the age of 76 years. Benefits are less pronounced in women. Funding Acknowledgement Type of funding sources: None.

Red Cell Distribution Width and Patient Outcome in Cardiovascular Disease: A ''Real-World'' Analysis.

Red cell distribution width (RDW) has been shown to predict adverse outcomes in specific scenarios. We aimed to assess the association between RDW and all-cause death and a clinically relevant composite endpoint in a population with various clinical manifestations of cardiovascular diseases. We retrospectively analyzed 700 patients (median age 72.7 years [interquartile range, IQR, 62.6–80]) admitted to the Cardiology ward between January and November 2016. Patients were divided into tertiles according to baseline RDW values. After a median follow-up of 3.78 years (IQR 3.38–4.03), 153 (21.9%) patients died and 247 (35.3%) developed a composite endpoint (all-cause death, acute coronary syndromes, transient ischemic attack/stroke, and/or thromboembolic events). With multivariate Cox regression analysis, the highest RDW tertile was independently associated with an increased risk of all-cause death (adjusted hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.63–4.56) and of the composite endpoint (adjusted HR 2.23, 95% CI 1.53–3.24). RDW showed a good predictive ability for all-cause death (C-statistics: 0.741, 95% CI 0.694–0.788). In a real-world cohort of patients, we found that higher RDW values were independently associated with an increased risk of all-cause death and clinical adverse cardiovascular events thus proposing RDW as a prognostic marker in cardiovascular patients.

Ateroesclerosis

Atherosclerosis is the pathogenic process that underlies the different clinical manifestations of cardiovascular disease. Through the progressive reduction of the diameter of the vessel lumen or the sudden development of a thrombus, the normal blood flow to the different tissues is obstructed, which can affect the heart (ischaemic heart disease), brain (stroke) or limbs (peripheral arterial disease). Atherosclerosis is now considered a chronic inflammatory process that precedes clinical manifestations by several decades. The initial process that promotes plaque development is the disruption of endothelial integrity and function. Plaque formation is caused by the accumulation of lipid particles in predisposed areas and is facilitated by processes of inflammation, necrosis, fibrosis, and calcification. Its development is closely linked to prolonged exposure to certain risk factors, which interact with other environmental factors, genes, and individual susceptibility. The disease usually progresses indolently over the individual's lifetime, until the progression of plaque causes it to destabilise and rupture, leading to ischaemia of the affected organ.

PSYCHOCORRECTIONAL PROBLEMS OF EMOTIONAL STATES OF ELDERLY WOMEN WITH CARDIOVASCULAR DISEASES

The article considers the method of development and implementation of a comprehensive program of psychocorrection of emotional states of elderly women with cardiovascular diseases. The basic provisions of the program, the list and sequence of actions taking into account the certain components of psychoemotional states of patients with cardiovascular diseases are substantiated. The main components of the psycho-emotional state of elderly women with cardiovascular diseases, which consist of a set of psychophysiological factors, including: the specifics of emotionally negative states: anxiety, depression, asthenia, hostility; clinical manifestations of cardiovascular diseases and concomitant changes in the psycho-emotional sphere; personality traits, including aggression, anxiety, neuroticism and depression in the structure of personal characteristics. An important pathogenetic role in depression is assigned to increase the activity of the sympathetic - adrenal system, which leads to increased heart rate, blood pressure, myocardial contractility and, accordingly, myocardial oxygen consumption, which leads to cardiovascular disease. Depression also revealed a decrease in vagal activity. It was determined that elderly women with cardiovascular disease are characterized by high levels of anxiety, as well as pronounced manifestations of anxiety and depression. The main idea of ​​the proposed comprehensive program of psychocorrection was the following statement: the established components of the psycho-emotional state of elderly patients with cardiovascular disease can purposefully influence the pathogenetic factors of their development and reduce their level through special psychocorrectional and psychoprophylactic measures. features. The main goal of psychocorrection of elderly women with cardiovascular diseases was based on systemic and genetic modeling approaches and is to maintain physical and mental status. The following components were included in the complex program: methodological, methodical and system. The set of psychocorrection measures consisted of 3 blocks that had different goals and content: pedagogical, block to improve the psycho-emotional characteristics of the individual, block to improve physical condition, increase endurance and efficiency. Game therapy, art therapy and body-oriented therapy were used to achieve psycho-correctional goals of emotional states. According to the formative experiment, the impact on such psycho-emotional characteristics as anxiety - 30%; depression - 38%; asthenia - 42%; hostility - 60%, which proves the effectiveness of the technique.

Abdominal aortic aneurysm and virus infection: A potential causative role for cytomegalovirus infection?

An abdominal aortic aneurysm (AAA) is a multifactorial disease with a variety of genetic and environmental risk factors, but the exact mechanism of AAA formation and progression is still not well understood. The present study investigated the frequency of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and papillomavirus types 6 and 11 (HPV6 and HPV11), their impact on clinical manifestations of cardiovascular diseases, and their possible association with inflammation in patients with AAA and healthy volunteers. Genotyping of CMV UL75, EBV LMP-1, and HPV6 and HPV11 E6 was performed by polymerase chain reaction (PCR), while the viral DNA loads were measured by quantitative real-time PCR (qRT-PCR). Cytokine levels were determined by enzyme-linked immunosorbent assays (ELISAs). The CMV UL75 was detected more frequently in the blood of patients with AAA than in the blood of healthy volunteers (32.7% vs. 6.3%, p < 0.0001). Neither EBV LMP-1 nor HPV6 E6 was found in blood and aortic wall biopsies, while the HPV11 E6 was detected in 36.4% of AAA walls. The CMV infection in patients with AAA was associated with an increased risk of hypertension and coronary artery disease (CAD) (OR 9.057; 95% CI: 1.141 - 71.862, p = 0.037; OR 2.575; 95% CI: 1.002 - 6.615, p = 0.049, respectively). Additionally, CMV-infected patients with AAA had higher TNF-α levels compared with non-infected subjects (p = 0.017). Our findings suggest that CMV infection can stimulate local inflammation in the aorta but is not a direct cause of most abdominal aortic aneurysms. This article is protected by copyright. All rights reserved.

Associations of physical activity, sedentary time, and diet quality with biomarkers of inflammation in children

ABSTRACT We investigated the associations of physical activity (PA), sedentary time (ST), and diet quality with biomarkers of inflammation in 390 children (192 girls, 198 boys) aged 6–8 years. PA energy expenditure (PAEE), light PA, moderate PA (MPA), vigorous PA (VPA), moderate-to-vigorous PA (MVPA), and ST were assessed by combined movement and heart rate sensor. Finnish Children Healthy Eating Index was calculated using data from 4 d food records. Body fat percentage (BF%) was measured by dual-energy X-ray absorptiometry. High-sensitivity C-reactive protein (Hs-CRP), leptin, interleukin-6 (IL-6), adiponectin, tumour necrosis factor-α, and glycoprotein acetyls were measured from fasting blood samples. PAEE, MPA, VPA, and MVPA were inversely associated with hs-CRP (β=−191 to −139, 95% CI=−0.294 to −0.024), leptin (β=−0.409 to −0.301, 95% CI=−0.499 to −0.107), IL-6 (β=−0.136 to −0.104, 95% CI=−0.240 to −0.001) and PAEE, MPA, and MVPA were inversely associated with glycoprotein acetyls (β=−0.117 to −0.103, 95% CI=−0.213 to −0.001). ST was directly associated with hs-CRP (β=0.170, 95% CI=0.070–0.269), leptin (β=0.355, 95% CI=0.265–0.445), and IL-6 (β=0.105, 95% CI=0.005–0.205). VPA was inversely associated with hs-CRP, leptin, and IL-6 in children with higher BF% (β=−0.344 to −0.181, 95% CI=−0.477 to −0.033) but not among children with lower BF% (β=−0.007–0.033, 95% CI=−0.183–0.184). In conclusion, PA was inversely and ST directly associated with circulating levels of biomarkers of inflammation among children. Furthermore, we observed that PA was inversely associated with these biomarkers for inflammation in children with a higher BF%. Highlights Systemic inflammation, as indicated by increased circulating concentrations of biomarkers for inflammation, may be important in causal pathways leading to insulin resistance, sub-clinical atherosclerosis, and eventually clinical manifestations of cardiovascular diseases. Higher levels of physical activity and lower levels of sedentary time were associated with more favourable inflammatory profile. Body fat percentage modified these associations and especially vigorous intensity physical activity was inversely associated with biomarkers of inflammation on children with higher body fat percentage but not in children with lower body fat percentage.

Mechanisms for forming endothelium dysfunction in insulin-resistant conditions

In pathogenesis and clinic of arterial hypertension, atherosclerosis, diabetes mellitus and their complications, one of the important aspects is the violation of the structure and function of the endothelium. In these diseases, it appears as the primary organ of the target, as the endothelial lining of the vessels participates in the regulation of vascular tone, hemostasis, immune response, migration of blood cells to the vascular wall, the synthesis of inflammatory factors and their inhibitors, and performs barrier functions. Endothelial dysfunction (ED) is characterized by a shift in the endothelium towards decreasing vasodilation, proinflammatory state and prothrombotic properties. Currently, ED is considered as a universal mechanism for the formation and progression of any vascular pathology, especially in patients with type 2 diabetes. In routine clinical practice, the detection of ED is not carried out, but it must be understood that endothelial dysfunction is one of the first manifestations of vascular pathology, which appears long before the clinical manifestation of cardiovascular diseases. The review provides data on the functions and dysfunctions of the vascular endothelium, and also presents the modern concept of ED as the central link in many chronic diseases.

Subclinical atherosclerosis in systemic sclerosis: Different risk profiles among patients according to clinical manifestations.

Like other autoimmune diseases, systemic sclerosis (SSc) has been described to be associated with accelerated atherosclerosis (ATS). Before clinical manifestations of cardiovascular disease (CVD) occur, subclinical ATS can be investigated in different ways. To evaluate the presence of subclinical ATS in a group of patients with SSc, and to identify different risk profiles among patients. Subclinical ATS was reviewed in 43 SSc patients and 27 healthy controls, using 2 methods: carotid ultrasound and flow mediated dilation (FMD) of the brachial artery. Plaques were statistically more frequent in SSc patients than in controls (65% vs 30%, P=.006); intima-media thickness of common carotid artery (CCA-IMT) resulted in statistically higher (median value 0.8mm vs 0.55mm; P<.0001) while FMD was significantly lower (median value 9% vs 14%; P=.0086) in patients compared to healthy controls. Among the SSc patients, thickening of CCA-IMT was significantly associated with the presence of diastolic dysfunction of left ventricle (absence of diastolic dysfunction: odds ratio [OR] 0.2, 95% CI 0.04-0.92, P=.038) and with a higher Framingham score (OR 1.3, 95% CI 1.03-1.6], P=.024). The diffuse cutaneous form was slightly protective against pathological FMD (OR 0.12, 95% CI 0.022-0.71, P=.019). This study confirms the involvement of macrocirculation in SSc patients, detecting the presence of subclinical ATS markers more frequently in patients compared to healthy controls. Framingham score, diastolic dysfunction of left ventricle and limited cutaneous form of the disease appeared to be associated with a higher risk of developing ATS.

Cardiovascular disease in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are at increased risk for kidney failure, cardiovascular disease (CVD), and death. In fact, the likelihood of dying from CVD is markedly higher than that for reaching end-stage renal disease. Evidence-based management of comorbidities such as CVD remains challenging in patients with advanced CKD, as they were usually excluded from randomized controlled trials. This review focuses on the epidemiology, risk factors, and clinical manifestations of CVD in patients with advanced CKD. Specific topics of interest include diagnostic and therapeutic challenges of heart failure, coronary artery disease, and atrial fibrillation.