Concomitant Metabolic Syndrome Research Articles

Cerebral hemodynamic disorders in patients with schizophrenia with concomitant metabolic syndrome

To identify the differences or comparability of parameters of cerebral hemodynamics between patients with schizophrenia with or without concomitant metabolic syndrome (MS). The study included 94 patients with schizophrenia (48 men and 46 women). A control group consisted of 40 mentally and somatically healthy individuals (17 men and 23 women) comparable in sex and age to the main group of patients. The diagnosis of metabolic syndrome was carried out according to the criteria of the International Diabetes Federation (IDF). Assessment of cerebral hemodynamics was carried out by 4 - channel rheoencephalography (REG) at rest with closed eyes. Data analysis was carried out using the Kraskel-Wallis ANOVA criterion with the procedure of automatic a posteriori pairwise comparison, the χ2 criterion and Spearman correlation analysis. According to the IDF criteria, 37 (39.4%) patients were diagnosed with MS. REG results revealed significantly (p<0.05) lower indicators of blood filling in the carotid basin, elasticity of the wall of the main arteries, the tone of small-caliber arteries and arterioles, as well as higher values of the tone of medium-caliber arteries in the carotid and vertebrobasilar basins, in both groups of patients with schizophrenia compared with the control group. In patients with schizophrenia with MS, compared with patients without MS, there were lower indicators of blood filling (p=0.044 and p=0.016) and elasticity of the wall of the main arteries (p=0.044 and p=0.028) in the carotid basin on the left and right sides. The presence of MS in patients with schizophrenia was accompanied by more pronounced disorders of cerebral blood flow in the form of a decrease in blood filling and elasticity of the wall of the main arteries in the carotid basin. The results indicate that patients with schizophrenia with MS should be considered as a group at increased risk of cerebrovascular diseases.

MODERN VIEWS ON THE PATHOGENESIS OF IMMUNE DYSFUNCTION AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME IN ISCHEMIC HEART DISEASE

Introduction. Today, the pathology of the cardiovascular system is one of the most common and fatal diseases. Cardiovascular diseases are the cause of disability among the younger and younger population. Taking into account the frequency of cardiovascular diseases, the severity of the course and their lethality, the study of this topic remains one of the most urgent problems of medicine, in particular cardiology.&#x0D; The aim of the study. Consider modern views on the pathogenesis of coronary heart disease against the background of metabolic syndrome and the role of the immune system.&#x0D; Conclusions. Ischemic heart disease is the leading cause of mortality in Ukraine and the world. In recent years, there has been convincing evidence of a significant prevalence of cardiovascular disease in patients with metabolic syndrome. The presence of concomitant metabolic syndrome in patients with coronary heart disease worsens the course of the underlying disease and has an unfavorable prognosis, and even fatal cases.&#x0D; Therefore, the detection of an increase in the level of body mass index, dyslipidemia, hyperglycemia, arterial hypertension in a patient strengthens the effects of each other, that is, they have a synergistic effect, and in general, the risk of developing CHD becomes quite high.&#x0D; IL-6 is one of the cytokines released by both macrophages and adipocytes and its levels have been shown to be increased in insulin resistance and obesity. In fact, IL-6 is known to regulate fat and glucose metabolism, mediating insulin resistance through various complex mechanisms. This cytokine acts on various tissues, leading to the metabolic effects of obesity. In the liver, IL-6 increases the production of acute phase reactants, including CRP. Several studies have demonstrated that high CRP levels have the strongest correlation with cardiac events, T2DM, and MS. IL-6 also contributes to a prothrombotic state by increasing the level of fibrinogen, another acute phase reactant. In addition, IL-6 targets other tissues, such as endothelial cells, to promote the expression of vascular cell adhesion molecules, leading to vascular wall atherosclerosis, inflammation, and dysfunction.&#x0D; These data support the role of IL-6 in the development of insulin resistance, but do not support the hypothesis that IL-6 is involved in β-cell failure.&#x0D; IL-18 is a pro-inflammatory cytokine associated with insulin resistance and T2DM risk. IL-18 stimulates the production of gamma interferon (IFN-γ), which, in turn, is probably involved in the pathogenesis of atherosclerosis. IL-18 is a cytokine that is a predictor of metabolic syndrome.&#x0D; TNFα is another cytokine produced in adipose tissue, mainly from local macrophages, and its production also varies with adipose tissue mass and correlates with insulin resistance, both hallmarks of MS. TNFα exerts its pathogenic effects by disrupting insulin signaling in adipocytes and hepatocytes through serine phosphorylation and inactivation of insulin receptors and downstream signaling molecules, leading to decreased metabolic effects of insulin. TNFα also contributes to insulin resistance by inducing hepatic lipolysis.

IMPLEMENTATION OF ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS WITH COLORECTAL CANCER AND CONCOMITANT METABOLIC SYNDROME

Introduction. Implementation of enhanced recovery after surgery protocol (ERAS) is becoming more and more widespread due to their effectiveness and safety. At the same time, there is a rather limited number of studies focusing on the opportunities of ERAS in the context of its association with metabolic syndrome in patients with colorectal cancer. This study represents the results of our early experience implementing elements of the ERAS program in the perioperative management of patients with colorectal cancer associated with metabolic syndrome.&#x0D; The aim. To conduct a comparative analysis and evaluate the results of surgical treatment using the enhanced recovery after surgery protocol in patients with colorectal cancer and accompanying metabolic syndrome.&#x0D; Materials and methods. This study included 106 patients with colorectal cancer and accompanying metabolic syndrome, divided into two groups: the first group with the use of elements of the ERAS protocol in colorectal surgery from 2018 – 56 patients, and the second group in which the principles of ERAS were not used (50 patients).&#x0D; Results. In the first group, with a statistically significant difference, a less severe pain syndrome was observed according to VAS (p&lt;0.001), as well as a lower necessity for prescribing opioid analgesics in the postoperative period. Activation of patients, restoration of enteral nutrition and peristalsis occurred earlier in first group (p&lt;0.001).&#x0D; Mean hospital stay in the first group was 5.7±1.5 days, and in second group – 7.7±1.7 days (p&lt;0.001). In the 2nd group, the percentage of complications such as: postoperative wound seroma, abdominal organ eventration, and anastomotic leaks in the 30-day postoperative period were higher than in the group with ERAS elements included.&#x0D; Conclusion. The implementation of elements from the Enhanced Recovery After Surgery (ERAS) protocol for the treatment of patients with colorectal cancer and concomitant metabolic syndrome is effective and safe. It is associated with a decreased duration of hospitalization, less postoperative pain, earlier return to enteral nutrition, quicker patient mobilization, and restoration of peristalsis. Additionally, it reduces the frequency of postoperative complications and readmission rates.

Efficacy of topical forms of sertaconazole in treatment of mycoses of skin

Published research results indicate the high effectiveness of sertaconazole in the treatment of mycoses of the skin. According to a number of studies, it is superior to other antifungal agents in terms of cure rate and speed of action, and also has anti-inflammatory and antipruritic activity.Material and methods. The aim of the observational study was to evaluate the effectiveness of Zalain cream (sertaconazole 2%) in patients with mycosis of the smooth skin of the groin area. We observed 21 patients (13 men and 8 women) aged from 37 to 72 years with a verified diagnosis of mycosis of smooth skin, confirmed by microscopic and cultural methods. In patients, during a cultural study, a mixed fungal-bacterial infection was isolated in various combinations: 14 (66.7%) – Trichophyton rubrum and Staphylococcus, 7 (33.3%) – Candida albicans and Staphylococcus. Of the concomitant pathologies, the following diseases were most often diagnosed: hypertension (52.4%), obesity (BMI &gt; 30) (47.6%), type 2 diabetes mellitus (42.9%), gastrointestinal diseases (23.8%), diseases of the hepatobiliary system (19.1%). The effectiveness was assessed taking into account the VAS index (erythema, infiltration, desquamation, cracks, itching, burning) and special methods (microscopic and cultural) of the study at control points B1 (before therapy) and B2 (after 4 weeks of therapy). Long-term results of observations (disease relapse) were assessed after 6 months.Results. The total VAS at control point B 2 decreased by 94.9% (p &lt; 0.01). After therapy (4 weeks), in 18 (85.7%) patients, pathogenic fungi (Trichophyton rubrum, Trichophyton mentagrophytes var. interdigitale) were not sown during cultural examination. Patients with no laboratory cure were recommended to continue therapy with sertaconazole for 2–4 weeks until complete eradication of pathogenic fungi. Long-term results of observations (6 months) showed relapse of the disease in 28.6% of patients with concomitant metabolic syndrome and type 2 diabetes mellitus. Also, among patients with relapses, males predominated – 66.7%.Conclusions. Sertaconazole has a wide spectrum of antimycotic activity, which makes it possible to quickly achieve clinical and mycological recovery in patients with mycosis of smooth skin in the groin area.

Leptin modulates the differentiation of keratinocytes via autophagy in patients with psoriasis and metabolic syndrome

Objective: Psoriasis is associated with a high prevalence of metabolic syndrome (MS), and patients with concomitant psoriasis and MS are more severely affected and less responsive to treatment. However, the molecular mechanisms behind these effects are unknown. Recent studies have shown that leptin may serve as a molecular link between psoriasis and MS, suggesting that high leptin concentrations may exacerbate psoriasis. However, the molecular mechanism of this effect is still unclear. We aimed to investigate the effect of leptin on autophagy in patients with psoriasis. Methods: We measured the epidermal leptin, P62, and LC3 concentrations by immunohistochemistry, and measured the serum leptin concentrations by enzyme-linked immunosorbent assay. We then performed correlation analyses to compare these concentrations between groups. Additionally, we performed western blotting after in vitro culture of HaCaT cells with different concentrations of leptin and measured the expression levels of the autophagy markers Beclin1, LC3B, and P62; the differentiation markers K10, K16, and K17; and PI3K/AKT/mTOR signaling pathway-related proteins. Next, we transfected ATG5 to revert autophagy and used the specific PI3K inhibitor LY294002 to block PI3K/AKT/mTOR signaling. The expression levels of K10, K16, and K17 were again measured. One-way ANOVA was used for the comparison of means of multiple samples, and Tukey's post hoc test was used for comparison between the 2 groups. The counting data were analyzed by the chi-square test. Correlations were evaluated by Pearson correlation analysis. Results: The serum and epidermal leptin concentrations were significantly higher in patients with concomitant psoriasis and MS than in healthy control individuals and patients with psoriasis without MS (serum leptin concentrations: 1330 ± 244.2, 1041 ± 282.7, and 760.4 ± 361.1 pg/mL, P&lt;0.0001; epidermal leptin concentrations 0.589 ± 0.151, 0.393 ± 0.125, and 0.266 ± 0.191 pg/mL, P&lt;0.0001). The level of the autophagy marker LC3 was strongly reduced and that of P62 was strongly increased in the epidermis of patients with concomitant psoriasis and MS compared with healthy control individuals and patients with psoriasis without MS (LC3: 0.274 ± 0.113, 0.291 ± 0.128, and 0.462 ± 0.169, P&lt;0.0001; P62: 0.185 ± 0.075, 0.132 ± 0.030, and 0.099 ± 0.031, P&lt;0.0001). We also observed a positive correlation between leptin and P62 concentrations in the blood (r=0.4028, P=0.0002) and epidermis (r=0.2721, P=0.0174), and a negative correlation between serum leptin concentrations and epidermal LC3 concentrations (r=-0.3944, P=0.0004). In vitro, leptin significantly decreased the autophagy markers Beclin1 and LC3B and increased P62. Western blotting showed that leptin treatment resulted in decreased expression of the differentiation marker K10, and increased expressions of K16 and K17; when the decrease in autophagy was restored by ATG5, this phenomenon was reversed. In addition, leptin treatment significantly upregulated the expressions of phosphorylated PI3K, AKT, and mTOR in HaCaT cells compared with the control treatment; when the expression of p-PI3K was significantly inhibited by LY294002, leptin did not reverse the decreased expression of these proteins. Conclusion: Leptin is negatively associated with autophagy in psoriasis, and leptin markedly decreased autophagy and affected keratinocyte differentiation by downregulating autophagy via the PI3K/AKT/mTOR pathway. It is very important to optimize the treatment of patients with concomitant psoriasis and MS. Our study enhances the understanding of the link between MS and psoriasis and provides potential therapeutic targets for patients with concomitant psoriasis and MS.

Angiogenin Levels and Carotid Intima-Media Thickness in Patients with Type 1 Diabetes and Metabolic Syndrome.

It is well documented that in patients with type 1 diabetes (DM1), decreased levels of angiogenin are associated with the development of overt nephropathy. However, little is known about angiogenin levels and subclinical macrovascular organ damage in patients with DM1 and concomitant metabolic syndrome (MS). Therefore, we analyzed the relationship between angiogenin levels and carotid intima-media thickness (cIMT) in DM1 patients with and without MS. We found that angiogenin concentration was significantly lower in DM1 patients compared to controls, while the cIMT measurements were comparable. Exclusion of patients with MS, patients with hypertension, undergoing treatment, or cigarette smokers did not change these findings. Of note, when comparing the subgroups of DM1 patients with and without MS, there was no significant difference between angiogenin levels. However, we did note a significant difference in these levels after the exclusion of smokers. The comparison of cIMT in these subgroups showed a significant difference between the study subgroups. This difference was no longer observed when the age of the patients was taken into account. In summary, it can be concluded that metabolic syndrome in patients with type 1 diabetes does not appear to impact angiogenin levels or cIMT.

Optimization of treatment of morphea associated with metabolic syndrome

Objective. To study the efficacy of statins in the treatment of morphea in patients with metabolic syndrome and to study the dynamics of inflammatory markers on the background of atorvastatin use.Materials and methods. Atorvastatin at a dose of 20 mg per day was included in the treatment of patients with morphea asociated with metabolic syndrome. Clinical efficacy was evaluated after 3, 6, and 9–12 months on the basis of the dynamics of the modified localized scleroderma skin severity index mLoSSI, changes of laboratory markers of inflammation (C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha)), which was evaluated in 27 patients.Results. In patients whose treatment complex included atorvastatin, there was a persistent clinical improvement, which was manifested in a more pronounced decrease in the modified severity index of morphea mLoSSI relative to the control group after 6, 9-12 months of taking the drug, a marked decrease in the number of recurrences of the disease. When taking atorvastatin in patients with morphea with concomitant metabolic syndrome, there was a statistically significant decrease in the levels of inflammatory markers: CRP and TNF-alpha (p &lt; 0.05).Conclusion. The use of Atorvastatin at a dose of 20 mg per day in patients with limited scleroderma in combination with metabolic syndrome showed pronounced clinical efficacy, reduced the number of recurrences of the disease. There was a decrease in the levels of proinflammatory markers (CRP, TNF-alpha) when taking atorvastatin in patients with morphea associated with metabolic syndrome. The use of atorvastatin in patients with morphea and concomitant metabolic syndrome is effective in preventing relapses of morphea, reducing its severity.

Quality of life in patients with chronic kidney disease and metabolic syndrome

Quality of life often deteriorates in patients with chronic kidney disease. Metabolic syndrome also is associated with impaired quality of life. Patients with chronic kidney disease concomitant metabolic syndrome may have even more impaired quality of life and clinical condition. In this paper, the latest data on quality of life and its impairments in patients with chronic kidney disease and metabolic syndrome have been summarized with critical review. Furthermore, influence of chronic kidney disease stages and metabolic syndrome components on quality of life have been shown in the paper.

Comparative Analysis of the Structure and Function of the Pancreas in Patients with a Combination of Chronic Pancreatitis and Metabolic Syndrome

Metabolic syndrome (MS) is the most urgent problem of modern medicine, which is associated with an unhealthy lifestyle. This is a complex metabolic disorder based on insulin resistance and compensatory hyperinsulinemia. MS is a risk factor for the development of a significant number of various diseases. The objective: to determine the structural and functional state of the liver and pancreatic gland (PG) in patients with chronic pancreatitis (CP) depending on the presence of MS. Materials and methods. 137 patients with CP of biliary genesis (CBP) were included in the study. Patients were divided into two groups: the 1st group – 22 persons with isolated CBP, the 2nd group – 115 patients with CBP+MS. The control group included 20 practically healthy subjects. The age of the study participants ranged from 30 to 71 years. The presence of MS was determined, the state and structure of the PG and liver were examined. Results. A statistically significant higher content of HbA1c was determined in patients with CBP and MS compared to the group of patients with only CBP (6.10±0.14% vs. 5.47±0.15%). A significantly higher blood glucose level was found in the patients with CBP+MS (5.99±0.29 mmol/l vs. 5.31±0.12 mmol/l) compared to patients with CBP. A significantly higher level of the HOMA index was also determined in the group of patients with CBP+MS compared to the CBP group (2.60±0.10 vs.1.84±0.09). A higher level of liver stiffness was found in patients with CBP compared to the control group. The indicator of fecal α-elastase in patients with CBP+MS was 114.52±2.79 mcg/g, which was significantly lower than that in the group of patients with CBP without MS (158.60±5.55 mcg/g). Conclusions. In the presence of MS in patients with chronic biliary pancreatitis, more significant structural disorders in the liver and pancreas were established in the direction of increased density according to shear wave elastometry. The results of the study demonstrated the aggravating effect of concomitant MS on the structural state of the liver and on the structural and functional state of the pancreas in patients with chronic biliary pancreatitis.

Sphingolipids Are Depleted in Alcohol-Related Liver Fibrosis

Alcohol disturbs hepatic lipid synthesis and transport, but the role of lipid dysfunction in alcohol-related liver disease (ALD) is unclear. In this biopsy-controlled, prospective, observational study, we characterized the liver and plasma lipidomes in patients with early ALD. We performed mass spectrometry-based lipidomics of paired liver and plasma samples from 315 patients with ALD and of plasma from 51 matched healthy controls. We associated lipid levels with histologic fibrosis, inflammation, and steatosis with correction for multiple testing and adjustment for confounders. We further investigated sphingolipid regulation by means of quantitative real-time polymerase chain reaction sequencing of microRNA, prediction of liver-related events, and tested causality with Mendelian randomization. We detected 198 lipids in the liver and 236 lipids in the circulation from 18 lipid classes. Most sphingolipids (sphingomyelins and ceramides) and phosphocholines were co-down-regulated in both liver and plasma, where lower abundance correlated with higher fibrosis stage. Sphingomyelins showed the most pronounced negative correlation to fibrosis, mirrored by negative correlations in both liver and plasma with hepatic inflammation. Reduced sphingomyelins predicted future liver-related events. This seemed to be characteristic of "pure ALD," as sphingomyelin levels were higher in patients with concomitant metabolic syndrome and ALD/nonalcoholic fatty liver disease overlap. Mendelian randomization in FinnGen and UK Biobanks indicated ALD as the cause of low sphingomyelins, and alcohol use disorder did not correlate with genetic susceptibility to low sphingomyelin levels. Alcohol-related liver fibrosis is characterized by selective and progressive lipid depletion in liver and blood, particularly sphingomyelins, which also associates with progression to liver-related events.

A Novel Symbiotic Formulation Reduces Obesity and Concomitant Metabolic Syndrome in Rats by Raising the Relative Abundance of Blautia.

Obesity is regarded as an abnormal or excessive buildup of fat that may be bad for health and is influenced by a combination of intestinal flora, genetic background, physical activity level and environment. Symbiotic supplementation may be a realistic and easy therapy for the reversal of obesity and associated metabolic problems. In this study, we chose two Bifidobacterium species, three Lactobacilli species and four prebiotics to make a new symbiotic formulation. High or low doses of the symbiotic were administered to rats, and biochemical indicators were recorded to assess the biological effects in a high-fat-diet-induced rat model. The underlying mechanisms were explored by integrating 16S rRNA sequencing with an extensively targeted metabolome. High-dose symbiotic supplementation was effective in reducing obesity and concomitant metabolic syndrome. The high-dose symbiotic also significantly increased the abundance of Blautia, which was negatively correlated with taurocholic acid and the main differential metabolites involved in amino acid and bile acid metabolism. While the low-dose symbiotic had some therapeutic effects, they were not as strong as those at the high dose, demonstrating that the effects were dose-dependent. Overall, our novel symbiotic combination improved plasma glucose and lipid levels, shrunk adipocyte size, restored liver function, increased the abundance of Blautia and adjusted bile acid and amino acid metabolism.

Effect of mini-gastric bypass surgery for morbid obesity on indicators of carbohydrate metabolism

Objective. To analyze the long-term results of the effect of mini-bypass surgery for morbid obesity on the state of carbohydrate metabolism and the dynamics of changes of BMI.Materials and methods. A prospective uncontrolled randomized study was conducted on the basis of the Clinical Hospital ‘Russian Railways – Medicine’ ofCity of Barnaul (Russia), which included patients aged 22 to 56 years with an average body mass index of 45.23 kg/m2 and having a violation of carbohydrate metabolism: 17 patients with an established diagnosis of type 2 diabetes, 20 patients with insulin resistance. Patients with DM were canceled prior to surgery and short-acting insulin preparations were prescribed situationally. Laparoscopic minigastric bypass surgery was performed, for which anesthesia with limited use of opioids was used. Indicators were determined: fasting blood glucose in the pre- and early postoperative period, after 6 months and 2 years, glycated hemoglobin, HOMA-IR index, BMI before surgery and in control measurements.Results. The positive dynamics of the studied indicators was demonstrated in patients with impaired carbohydrate metabolism by the time of discharge from the hospital, which was performed on 4–5 days from the moment of surgery. In most patients, this trend persisted for 2 years after surgery. Positive changes in carbohydrate metabolism occurred against the background of a significant decrease of BMI.Conclusions. Laparoscopic mini-bypass surgery is an effective method of treating morbid obesity with concomitant metabolic syndrome for a long time.

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

ВАРИАБЕЛЬНОСТЬ СЕРДЕЧНОГО РИТМА У ПАЦИЕНТОВ С МЕТАБОЛИЧЕСКИМ СИНДРОМОМ И ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ С СОХРАНЕННОЙ ФРАКЦИЕЙ ВЫБРОСА

Background. The development of life-threatening rhythm and conduction disorders occupies a special place in the mortality structure of patients with chronic heart failure with preserved ejection fraction (HFpEF). Therefore, an accessible, non-invasive marker is needed to stratify the risk of adverse arrhythmogenic events in individuals with this pathology. The possibility of using heart rate variability (HRV) parameters for this purpose is of great interest. Aim. To study the time domain parameters of heart rate variability, as well as to perform a correlation analysis of the HRV data obtained with echocardiography indicators in patients with metabolic syndrome and heart failure with preserved ejection fraction. Material and methods. The study included 130 patients (75 women and 55 men), whose average age was 65.9±5.8 years. Three study groups were formed, represented by patients with heart failure with preserved ejection fraction and criteria of metabolic syndrome (MS), IDF, 2005: two-component MS and HFpEF (n=30), three-component MS and HFpEF (n=30), HFpEF without MS (n=30). The control groups included individuals with MS, but without signs and/or symptoms of heart failure (n=20), as well as practically healthy (n=20). The complex of examinations included taking anamnesis, physical and general clinical laboratory examinations, echocardiography and Holter monitoring of the electrocardiogram. Results. Patients with HFpEF according to echocardiography differ significantly higher values of the ratio E/e'med, lat (p &lt;0.0001), pulmonary arterial systolic pressure (p&lt;0.01), as well as the rate of tricuspid regurgitation peak velocity (p&lt;0.01). Significant differences in the parameters of relative wall thickness and left ventricular mass index (p&lt;0.05) were recorded in the groups with concomitant MS and HFpEF. The analysis of daily HRV values demonstrated a decrease in the parameters of general vegetative tone and sympathetic link. However, significant differences were obtained only in the groups with MS and HFpEF (SDNN p&lt;0.05, SDNNi p&lt;0.05, SDANN p&lt;0.01). The same pattern of changes is recorded both during the day and at night parameters HRV (SDNN, SDNNi, SDANN p&lt;0.05). The most significant correlations between HRV and echocardiography parameters were found only in patients with three-component MS and HFpEF (left atrial volume index and SDNN (r=-0.47, p=0.013), SDANN (r=-0.54, p=0.004), ejection fraction and SDNN (r=-0.5, p=0.009), SDANN (r=-0.44, p=0.02), SDNNi (r=-0.42, p=0.03) and left ventricular mass index and SDNNi (r=0.47, p=0.01)). Conclusions. Heart rate variability in the time domain in patients with HFpEF are characterized by a decrease in a number of indicators. The addition of metabolic syndrome, as well as an increase in the number of its components, have the most depressing effect on HRV values in individuals with this phenotype of heart failure.

Clinical Characteristics of Target Organ Damage in Primary Aldosteronism with or without Metabolic Syndrome.

The aim of this study is to investigate the prevalence of metabolic disorders in patients with primary aldosteronism (PA) and target organ damage (TOD) in different subtypes of patients with PA with or without metabolic syndrome (MS). Patients with PA were screened out from those with secondary hypertension and then subtyped via adrenal venous sampling (AVS). Baseline clinical characteristics (blood pressure, blood glucose, abdominal circumference, and lipid profile) were collected for the diagnosis of MS. Organ damage was evaluated according to cardiac and carotid ultrasound and urine microalbumin measurements. In all 261 patients with PA, 113 patients had concomitant MS and experienced more severe cardiac hypertrophy and increased intima-media thickness (IMT). The incidence of MS and diabetes mellitus (DM) had no statistic difference between the two groups, moreover, the rates of TOD were not different except microalbuminuria. However, metabolic disorders caused more remarkable TOD in PA patients with unilateral hypersecretion. It showed that cardiac hypertrophy was associated with obesity while microalbuminuria was related to plasma aldosterone concentration (PAC) in PA patients. In this retrospective study, our findings suggest that the effect of metabolic disorders on organ damage is more remarkable in patients with unilateral PA.

Clinical Efficacy and Safety of Psoriasis Treatments in Patients with Concomitant Metabolic Syndrome: A Narrative Review.

Metabolic syndrome (MetS) is well recognized as a frequent comorbidity of psoriasis with important implications for efficacy and safety of psoriasis treatment. The presence of concomitant MetS is associated with decreased efficacy response to biologic treatment for psoriasis in observational studies. In post hoc analyses of clinical trial data, the anti–IL-23p19 antibody tildrakizumab appears to maintain efficacy in patients compared to those without MetS; no published subgroup analyses by MetS status are yet available for other biologics. However, there is some evidence that obese patients have decreased psoriasis treatment efficacy with biologics with certain mechanisms of action relative to overweight patients. This confounds interpretation of the effect of MetS due to the association between MetS and body weight. Because of the association between MetS and cardiovascular risk, treatment of psoriasis in patients with concomitant MetS requires special consideration for cardiovascular safety and attention to potential for exacerbation of MetS and related conditions, including nonalcoholic fatty liver disease. Additional studies are needed to clarify the risks for treatment failure and cardiovascular safety concerns in patients with psoriasis and concomitant MetS.

Tildrakizumab efficacy and safety in patients with psoriasis and concomitant metabolic syndrome: post hoc analysis of 5‐year data from reSURFACE 1 and reSURFACE 2

BackgroundLimited data are available on long‐term efficacy and safety of biologics in patients with psoriasis and metabolic syndrome (MetS), a common comorbidity.ObjectivesThis analysis updates tildrakizumab efficacy and safety for up to 5 years in patients with and without MetS.MethodsThis was a post hoc analysis of the double‐blind, randomized, placebo‐controlled, phase 3 reSURFACE 1 (NCT01722331) and reSURFACE 2 (NCT01729754) trials in adult patients with moderate to severe chronic plaque psoriasis. Analyses included data through Week 244 from patients who continuously received tildrakizumab 100 (TIL100) or 200 mg (TIL200) and entered the extension studies, stratified by baseline MetS status. Efficacy was assessed via Psoriasis Area and Severity Index (PASI) scores. Safety was evaluated from exposure‐adjusted incidence rates (EAIRs) of treatment‐emergent adverse events (TEAEs).ResultsreSURFACE 1 and reSURFACE 2 analyses included 26 and 44 TIL100‐treated patients with MetS, 98 and 167 TIL100‐treated patients without MetS, 34 and 30 TIL200‐treated patients with MetS, and 111 and 130 TIL200‐treated patients without MetS, respectively. There were no clinically relevant differences in PASI 75/90/100 response rates at Week 244 between patients with vs without MetS. The proportion of patients with vs without MetS achieving absolute PASI score <3 at Week 244 was 53.8% vs 69.4% and 77.3% vs 80.8% in reSURFACE 1 and 2, respectively, for TIL100‐treated patients and 58.8% vs 72.1% and 63.3% vs 72.3%, respectively, for TIL200‐treated patients. In both studies, median reduction from baseline PASI score at all time points in patients with vs without MetS was >83% vs >89% for TIL100 and >85% vs >90% for TIL200. Pooled EAIRs of TEAEs, serious TEAEs, and TEAEs of special interest were similar in patients with and without MetS.ConclusionsTildrakizumab maintains efficacy and a favorable safety profile over 5 years in patients with psoriasis regardless of MetS status.

Clinical and angiographic characteristics and short-term outcomes of patients with non-ST elevation acute coronary syndrome with metabolic syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Less evidence is available regarding clinical, angiographic characteristics and outcomes of patients with non-ST elevation acute coronary syndrome (ACS) with metabolic syndrome (MS). Purpose We aimed to assess the clinical, angiographic characteristics and short-term outcomes of patients admitted to our hospital with non-ST elevation ACS with MS. Methods 128 patients with non-ST elevation ACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups according to concomitant metabolic syndrome. Group I consisted of 64 patients with MS and Group II (n=64) without MS. Anthropometric, laboratory and instrumental data were assessed at baseline together with clinical and angiographic characteristics. All statistical analysis were done with STATA software. Results Non-ST elevation ACS patients with MS (Group I) tended to be younger (52.5 vs. 58.6, P&amp;lt;0.05), female gender (57% vs. 46%, P&amp;lt;0.05), smoked less (21.0 vs. 28.2%, P&amp;lt;0.05), having greater BMI (30.4 vs 26.8, P&amp;lt;0.05), having less pronounced symptoms (P&amp;lt;0.05) and greater extensive lesions in coronary angiography (P&amp;lt;0.05) than those without MS. There were similar single-vessel (52% vs. 55%, P&amp;gt;0.05) and multi-vessel (28% vs 26%, P&amp;gt;0.05) lesions in both groups in coronary angiography. New revascularization was higher in Group I than Group II (72% vs. 65%, P&amp;lt;0.05). In 12% of patients non-ST elevation ACS was occurred due to vasospasm in Group I and in 11% in Group II. There were similar hospitalization days in both groups (P&amp;gt;0.05), however short-term outcomes was better in Group II in 6 months (P&amp;lt;0.05). Conclusion MS is associated with higher rate of revascularization and worse outcome in patients presenting non-ST elevation ACS.

Current advances in biological therapy of psoriasis: efficacy of guselkumab in real clinical practice

Psoriasis is an immune-mediated, chronic inflammatory skin disease, which is currently regarded as a systemic process given its association with multiple comorbid conditions. In psoriasis, there is a complex interaction between T cells and keratinocytes. The pathogenesis of psoriasis is not fully understood, but the IL-23/Th17 pathway is known to play the key role in the developmentof the disease. With the advent of genetically engineered biological drugs (GEBD), the treatment of psoriasis has undergone significant changes due to their high efficacy through targeted effects. Guselkumab is the first drug for the treatment of moderate to severe psoriasis to target the p19 subunit of interleukin (IL) 23. The efficacy of guselkumab has been demonstrated in a number of clinical trials. To date, only a few case studies from actual clinical practice have been published in the literature reflecting the use of guselkumab in severe psoriasis, including long-term drug survival and continued efficacy in patients with comorbidities. The article reviews the results of key efficacy studies of guselkumab and presents its own clinical case studies of successful use of the drug. It is noted that guselkumab is able to replicate the results obtained in studies in real clinical prachttps tice. However, the cases presented are also of interest in view of their concomitant metabolic syndrome, obesity, which often makes it difficult to respond to therapy. This group of patients is usually characterised by a particularly torpid course of psoriasis and a certain refractoriness to the ongoing treatment. Thus, guselkumab has an effective and safe profile, in addition it is convenient to use, and the improvement in the quality of life of patients during therapy makes it promising as a first-line GEBD therapy in the treatment of psoriasis.

Adiponectin Gene Polymorphism (rs17300539) Has No Influence on the Occurrence of Metabolic Syndrome in Women with Polycystic Ovary Syndrome.

Adiponectin (rs17300539) is implicated in the pathogenesis of metabolic syndrome (MS), a common comorbidity of polycystic ovarian syndrome (PCOS). The aim of this study was to analyze the association between adiponectin gene polymorphism and incidence of MS in patients with PCOS. The study included 201 women (age 18 to 35 years), among them 81 patients with PCOS without concomitant MS, 70 subjects with PCOS and concomitant, and 50 regularly menstruating controls. Adiponectin gene polymorphism (11391 G/A, rs17300539) was determined by means of a real-time PCR. The study groups did not differ significantly in terms of their age and frequencies of various genotypes of the adiponectin gene polymorphism. The largest proportion in the whole group was Caucasian women (n = 178, 88.56%), who carried the GG genotype of the polymorphism; frequencies of GA and AA genotypes in the whole study group were 10.94% (n = 22) and 0.5% (n = 1), respectively. The presence of G or A allele of the rs17300539 adiponectin gene polymorphism was not associated with a greater likelihood of PCOS with/without concomitant MS. The hereby presented findings imply that MS is a common comorbidity in women with PCOS. However, the incidence of concomitant MS does not seem to be associated with adiponectin gene polymorphism.