Decrease In Intima-media Thickness Research Articles

Mediative role of body mass index in cardiorespiratory fitness-associated vascular remodeling in youth.

Data on fitness-associated arterial remodeling in children is limited. We assessed the relation between cardiorespiratory fitness (CRF) and intima-media thickness (IMT), diameter, IMT:diameter-ratio (IDR), and tensile stress of the common carotid artery (CCA) in 697 healthy German schoolchildren. Further, we explored how body mass index (BMI) may influence these associations. We measured the vascular parameters with a high-resolution ultrasound device. We determined CRF using the FITNESSGRAM® PACER test and calculated each child's allometrically scaled peak oxygen uptake capacity (VO2peak). VO2peak, reflecting CRF, showed positive direct effects on IMT (girls: p < 0.001; boys: p = 0.02) and diameter in girls (p < 0.001). Considering BMI as a mediator, higher CRF was indirectly linked to decreases in IMT (girls: p = 0.04; boys: p = 0.02) and diameter (both p < 0.001), reflecting a competitive mediation. CRF indirectly mitigated the BMI-associated decrease in IDR (both p < 0.001) and increase in tensile stress (both p < 0.001) without affecting any of these parameters directly. CRF appears to be linked to uniform arterial remodeling with balanced hemodynamics and to further alleviate BMI-associated, potentially adverse vascular alterations, highlighting its significant role in cardiovascular health in youth. Data on CRF-associated arterial remodeling in youth is limited. Higher VO2peak, reflecting higher CRF, was positively associated with IMT in girls and boys and diameter in girls. These direct effects were counteracted by the indirect BMI-mediated effect of CRF on IMT and diameter, reflecting a competitive mediation. A higher CRF indirectly mitigated the BMI-associated decrease in IDR and increase in tensile stress without directly affecting any of these parameters. Our findings indicate homogenous remodeling and balanced hemodynamics with increasing CRF-and opposite effects with increasing BMI.

Follow-up ultrasound examination in patients with newly diagnosed giant cell arteritis.

Ultrasound is a standard tool to diagnose giant cell arteritis (GCA). Until now, only few studies investigated the role of ultrasound in the follow-up of GCA. The aim of this study was to assess the changes in the intima media thickness (IMT), total number of affected arteries and provisional OMERACT GCA ultrasonography score (OGUS) in a 12-months follow-up period. Patients with newly diagnosed GCA were prospectively enrolled. Ultrasound examinations of facial, temporal, carotid, vertebral and axillary arteries were performed at baseline, after three, six, nine and 12 months. Changes of IMT, total number of affected arteries, and OGUS values were evaluated. In a subgroup of patients, exams were conducted weekly in the first 100 days. Fifty patients were enrolled, 36 completed the follow-up. Significant reductions in IMT, total number of affected arteries and OGUS were observed. Eighteen patients presented to weekly exams. The mean IMT of the axillary artery normalized after seven days, while IMT of the common temporal artery normalized after 50 days. The mean OGUS values were below one after six months. There were no differences in IMT changes between GCA patients with or without PMR or between those with and without additional tocilizumab treatment. A relapse occurred in 4 patients. At relapse, mean IMT and OGUS were higher as compared with the preceding assessment. No predictive values indicating a relapse were identified. Vascular ultrasound is sensitive to change in GCA. The presence of PMR or treatment with tocilizumab did not affect IMT decrease.

Effects of Proteasome Inhibitor on Catalase Expression and Intima-media Thickness in the Aorta of Atherosclerotic Rats

Various studies have been carried out to obtain proper management for atherosclerosis. Proteasome, a subcellular enzyme complex, is a potential therapeutic target for atherosclerosis. However, the effect of proteasome inhibitors on atherosclerosis still needs to be explored. It was an experimental study with a post-test-only control group design conducted at the Faculty of Medicine, Universitas Riau in Juni–November 2021. This study aimed to analyze the effects of proteasome inhibitors on catalase expression and intima-media thickness (IMT) in the thoracic aorta of atherosclerotic rats. Fifteen male Wistar rats were randomly divided into three groups (five rats per group), namely rats given standard feed (control, group I), rats induced atherosclerosis (group II), and rats induced atherosclerosis and given proteasome inhibitor (group III). The proteasome inhibitor, bortezomib, 50 µg/kgBW/day was given intraperitoneally on days one and three. After 4 days, rats were terminated, and the thoracic aorta was taken for the IMT analysis and catalase expression assessment using immunohistochemistry. Catalase expression was carried out quantitatively using Adobe Photoshop software. Analysis of variance test was used to compare the expression of catalase and IMT. A p value&lt;0.05 was considered statistically significant. The results showed a significant decrease in IMT in group III compared to group II and an increase in catalase expression in group III compared to group II but not statistically significant. This study concludes that administration of bortezomib 50 µg/kg in atherosclerotic rats could inhibit thickening tunica intima-media in the thoracic aorta, although not significantly increasing the catalase expression.

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

Background: Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by suppressing low-grade systemic inflammation as well as by inhibiting oxidative stress and endothelial dysfunction. The aim of this meta-analysis was to provide an answer to whether bariatric surgery has a significant effect on intima-media thickness (IMT) which is a surrogate marker of early atherosclerosis and has a good correlation with atherosclerotic coronary heart disease. Methods: A systematic literature search in PubMed, Scopus, Embase, and Web of Science as well as grey literature was performed from inception to 1 July 2022. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V3 software. Overall, the estimate of effect size was measured by a random effects meta-analysis. To account for the heterogeneity of studies regarding study design, characteristics of the populations, and treatment duration, a random-effects model (using the DerSimonian–Laird method) and the generic inverse variance weighting approach were used. To assess the existence of publication bias in the meta-analysis, the funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used. Results: The meta-analysis of 30 trials, including 1488 subjects, demonstrated a significant decrease in IMT after bariatric surgery. The reduction in IMT was also robust in the leave-one-out sensitivity analysis. It must be stressed that the results of the random-effects meta-regression did not suggest any relationship between the changes in IMT and delta body mass index (BMI) or duration of follow-up after the bariatric surgery. However, the subgroup analyses showed a better IMT reduction after laparoscopic sleeve gastrectomy (LSG) when compared to Roux-en-Y gastric bypass (RYGB). Within a year, the IMT follow-up values showed a further improvement. Conclusions: Bariatric surgery significantly reduced IMT. Significant associations were found between the surgery type and IMT changes, as well as a significant effect of follow-up duration on the changes of IMT after bariatric surgery.

Dengzhan Shengmai capsule versus Aspirin in the treatment of carotid atherosclerotic plaque: A single-centre, non-inferiority, prospective, randomised controlled trial

BackgroundAspirin is an effective antiplatelet agent for the treatment of carotid atherosclerosis. However, the high risk of bleeding events associated with the drug makes it necessary to seek a safer alternative, with similar or more efficacy than aspirin. Dengzhan Shengmai (DZSM) capsules have been widely used to treat carotid atherosclerosis, and if proven to be non-inferior to aspirin, it may be preferable over the latter for carotid atherosclerosis treatment due to its numerous advantages. We conducted a randomised trial to test the non-inferiority of DZSM to aspirin for the treatment of carotid atherosclerotic plaques. MethodsWe performed a single-centre, prospective, open-label, randomised non-inferiority trial. Patients with carotid atherosclerotic plaques were enrolled and randomly assigned (1:1) to receive either DZSM capsules or aspirin. The follow-up period was 12 months. The primary outcome was the mean change in carotid intima-media thickness (IMT). Secondary outcomes included ischaemic events, rate of lumen stenosis, lipid levels, and plaque scores, length, counts, and vulnerability. Adverse events and laboratory test results were recorded as safety outcomes. The non-inferiority of DZSM was demonstrated when the lower limit of the one-sided 97.5% confidence interval (CI) of the difference in IMT between groups was more than -0.06 mm (margin of non-inferiority). This trial has been registered at ClinicalTrials.gov (CHiCTR1900021365). ResultsFrom 1 April 2019 to 30 September 2019, 150 patients were enrolled, and there was no statistical difference in demographics between the groups. Intention-to-treat analysis showed that the decrease in IMT(∆IMT) was 0.216 ± 0.160 and 0.225 ± 0.149 mm in the DZSM and aspirin groups, respectively. The one-sided 97.5% CI for the difference between ∆IMTs was (-0.0593, +∞). The non-inferiority of DZSM was demonstrated (Pnon-inferiority = 0.0234). There was no significant difference in the incidence of ischaemic events between the groups (P = 1.0). The DZSM group had significantly reduced plaque scores (P < 0.0001), length (P < 0.0001), and counts (P < 0.0001), and improved plaque vulnerability (P < 0.0001). The DZSM group also had reduced levels of low-density lipoprotein cholesterol (LDL-C) (P < 0.0001). Finally, the DZSM group had a lower incidence of total adverse events (14.7% vs. 28%, P = 0.046), especially gastrointestinal discomfort (5.3% vs. 16%, P = 0.034). Although there was no significant difference in bleeding events (0 vs. 5.3%, P = 0.120), the DZSM group tended to have a lower incidence. ConclusionThis trial demonstrated that DZSM was not inferior, in efficacy, to aspirin in treating carotid atherosclerotic plaques, and was found to be superior to aspirin in terms of safety. This study provides a new approach for treating carotid plaques, especially in aspirin-intolerant patients.

Telomere length is associated with intima-media thickness in pediatric liver transplant patients: A prospective cohort study.

Leukocyte telomere length (LTL) is a marker for biological age. Pediatric liver transplant recipients show a high rate of subclinical atherosclerosis, indicated by elevated intima-media thickness (IMT). We hypothesized that atherosclerosis is associated with biological age in these patients and investigated the course of LTL over time. We measured LTL from peripheral blood leukocytes by quantitative polymerase chain reaction and IMT from 97 pediatric patients after liver transplantation in a prospective cohort study. Of the patients, 71% (n=69) had two or more assessments (total, 228 observations; median follow-up, 1.1 years). Lower LTL was associated with higher IMT (β=-0.701, p=0.01) and higher aspartate aminotransferase (β=-0.001, p=0.02), adjusted for age, sex, and age at transplantation. Of the patients, 45% showed decreasing LTL over time, whereas 55% exhibited stable LTL. Patients with stable LTL showed a decrease in IMT (median, -0.02 mm/year) and a decrease of tacrolimus trough levels (median, -0.08 μg/L/year). LTL is associated with IMT independent of age in pediatric liver transplant patients, suggesting that early aging contributes to the high burden of subclinical cardiovascular damage and may furthermore negatively affect the graft.

Effect of proteasome inhibitor on serum 8-OHdG and aortic SOD2 in a rat model of atherosclerosis

Background: Numerous studies have been performed to analyze the effect of proteasome inhibitors on atherosclerosis. However, there is still controversy and the mechanism of action of proteasome inhibitors is still not clearly understood. This study aimed to analyze the effect of proteasome inhibitor on 8-hydroxy-2′-deoxyguanosine (8-OHdG) level in the serum of atherosclerotic rats and the antioxidant expression of Superoxide Dismutase 2 (SOD2) in the aorta. Methods: The sample was 18 rats with the strain Wistar rats aged 2-3 months. The sample was grouped into normal (N) group got a standard feed, A1 induced by atherosclerosis, and A2 induced by atherosclerosis and given proteasome inhibitor. The proteasome inhibitor was a bortezomib dose of 50 µg/kg BW/day given on days one and three. After four days of treatment, rats were sacrificed, and the aorta removal was done for analyzing the tunica intima-media thickness (IMT) and SOD2 expression assessment using immunohistochemistry, and serum 8-OHdG measurement was done using the ELISA method. SOD2 expression assessment was carried out quantitatively using Adobe Photoshop. Results: We established a decrease in IMT in the A2 group compared to the A1 group and an enhancement of SOD2 expression and a decrease in 8-OHdG levels in the A2 group compared to the A1 group, although not statistically significant. Conclusion: In our findings showed bortezomib can prevent thickening tunica intima-media in the aorta, although does not reduce serum 8-OHdG levels and did not significantly increase SOD2 expression in the aorta.

A 78-year-old female with severe tongue pain: benefit of modern ultrasound

BackgroundGiant cell arteritis (GCA) is the most common form of systemic vasculitis in persons aged 50 years and older. Medium and large vessels, like the temporal and axillary arteries, are commonly affected. Typical symptoms are headache, scalp tenderness, jaw claudication and ophthalmological symptoms as loss of visual field, diplopia or amaurosis due to optic nerve ischemia. Tongue pain due to vasculitic affection of the deep lingual artery can occur and has so far not been visualized and followed up by modern ultrasound.Case presentationWe report the case of a 78-year-old woman with typical symptoms of GCA, such as scalp tenderness, jaw claudication and loss of visual field, as well as severe tongue pain. Broad vasculitic affection of the extracranial arteries, vasculitis of the central retinal artery and the deep lingual artery could be visualized by ultrasound. Further did we observe a relevant decrease of intima-media thickness (IMT) values of all arteries assessed by ultrasound during follow-up. Especially the left common superficial temporal artery showed a relevant decrease of IMT from 0.49 mm at time of diagnosis to 0.23 mm on 6-months follow-up. This is the first GCA case described in literature, in which vasculitis of the central retinal artery and the lingual artery could be visualized at diagnosis and during follow-up using high-resolution ultrasound.ConclusionHigh-resolution ultrasound can be a useful diagnostic imaging modality in diagnosis and follow-up of GCA, even in small arteries like the lingual artery or central retinal artery. Ultrasound of the central retinal artery could be an important imaging tool in identifying suspected vasculitic affection of the central retinal artery.

Association between the systemic treatment of psoriasis and cardiovascular risk.

Association between the systemic treatment of psoriasis and cardiovascular risk.

Effect of testosterone on lipid metabolism and endothelium in men with type 2 diabetes mellitus and hypogonadism

Abstract Background To date, knowledge about the effects of testosterone (T) on the cardiovascular system of men remains controversial and requires additional research. Especially the putative impact of T replacement therapy (TRT) on lipid metabolism and endothelial dysfunction as a starting mechanism for the development of cardiovascular pathology in men with type 2 diabetes mellitus (T2DM) presenting with T deficiency has to be elucidated. The aim of this work was to evaluate the effect of T replacement therapy on lipid metabolism and function of endothelium in men with T2DM and hypogonadism. Methods The study included 95 men (mean age 55,3±2,4 years) with T2DM and late onset hypogonadism, established according to EAU 2015 criteria. Parameters of carbohydrate and lipid metabolism, as well as ultrasound assessment of flow-mediated dilatation of the brachial artery (FMD-BA) and intima-media thickness (IMT) of brachial arteries were performed at baseline and after 9 months. Patients were randomized into 2 groups: 1 - 45 men receiving TRT, using 1% transdermal T-gel and 2 (control group) - 50 men, who were not assigned to TRT. Statistical analysis was carried out using the Wilcoxon - test for repeated measurements (STATISTICA 10 software package). Results During the treatment period no serious adverse events were registered. The study revealed a significant decrease in HbA1c (p&amp;lt;0.001), total cholesterol (p=0.009), triglycerides (p=0.004) and LDL (p=0.01) levels as well as an increase in HDL level (p=0.001) in the 1st group vs baseline and compared to the 2nd one. There was a decrease in IMT (from 1.0 [0.8; 1.1] to 0.7 [0.6; 0.9] mm, p=0.002) in the 1st group compared to the 2nd (p&amp;lt;0.001). The endothelium-dependent FMD-BA increased 1.5 - fold in men applying T-Gel vs baseline as well as compared to the control group at the time point of follow- up (p&amp;lt;0.001). At the same time TRT leaded to acceleration of the time until maximal vasodilation – it became twice faster (from 120 [90; 120] to 60 [60; 90] sec, p&amp;lt;0.001) compared to baseline and the 2nd group (p&amp;lt;0.001). Linear blood flow velocity increased markedly in the 1st group compared to the 2nd at the time point of follow-up (p=0.03). Conclusion TRT in men with T2DM and T deficiency leads to an improvement in carbohydrate and lipid metabolism together with a significant decrease in IMT and enhancement of endothelium vasomotor function, seems to facilitate a reduction in cardiovascular risk. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Russian Science Foundation

Sleeve Gastrectomy and Gastric Bypass Decrease the Carotid Intima-Media Thickness in Obese Men: Association with Weight Loss, Cardiovascular Risk Factors, and Circulating Testosterone.

Obesity surgery has shown to decrease the carotid intima-media thickness (IMT), but studies that compare different surgical techniques are scarce, especially in men. To evaluate the changes in IMT in men after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and its association with circulating testosterone. Academic Hospital. We studied 40 men with severe obesity, of whom 20 were submitted to laparoscopic RYGB and 20 to SG. Twenty control men matched for age and degree of obesity were also included. Both patients and controls were evaluated at baseline and 6months after surgery or conventional treatment with diet and exercise, respectively. The mean carotid IMT decreased after surgery irrespective of the surgical technique whereas no changes were observed in the control men submitted to conventional therapy (Wilks' λ = 0.745, P < 0.001 for the interaction, P < 0.001 for RYGB vs. controls, P = 0.001 for SG vs. controls, P = 0.999 for RYGB vs. SG). The decrease in the carotid IMT correlated with the increase in total testosterone (r = 0.428, P = 0.010) and lost BMI (r = 0.486, P < 0.001). Multivariate linear regression retained only the decrease in BMI (β = 0.378, P = 0.003) after adjustment (R2 = 0.245, F = 9.229, P = 0.001). Both RYGB and SG decrease carotid IMT in men with obesity compared with conventional treatment with diet and exercise.

Thyroid Dysfunction and Atherosclerosis: A Systematic Review.

Thyroid dysfunction, both hypo- and hyperthyroidism, has been associated with cardiovascular disease. The aim of this study was to evaluate the association between thyroid dysfunction and atherosclerosis measured mostly by carotid intima-media thickness, as well as discuss whether L-T4 replacement is able to reverse or slow down the progression of atherosclerosis. The review was conducted according the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from May 2004 to January 2020, using the search terms 'subclinical hypothyroidism' or 'thyroid disorders' and 'carotid artery', 'carotid intima-media thickness (IMT)', 'levothyroxine', and 'atherosclerosis'. Twenty-six studies were eligible and included in the analysis. Overall, the studies encompassed a total of 36.434 patients included in this review. Most studies indicated a proportional correlation between IMT and thyroid dysfunction. Levothyroxine (L-T4) replacement led to significant decrease of IMT after 1 year in most studies. Most studies have concluded that thyroid dysfunction is associated with arterial wall remodeling and, thus, with increased cardiovascular risk. However, the exact mechanistic background of pathological structural changes in the arterial wall is still unsettled. Large randomized controlled studies are required to definitively address the extent to which T4 replacement therapy might benefit patients with subclinical thyroid disorders.

Exercise training-induced changes in metabolic syndrome parameters, carotid wall thickness, and thyroid function in middle-aged women with subclinical hypothyroidism.

This study analyzed the differences in effects of a 12-week combination of exercise training program with resistance training and aerobic exercises on the risk factors of metabolic syndrome, carotid wall thickness, and thyroid function, between subclinical hypothyroidism patients and obese groups, in middle-aged women. Subjects consisted of either 20 middle-aged women in the subclinical hypothyroidism (SCH) group or 20 obese (body mass indices [BMI], ≥ 25kg/m2) women without hypothyroidism in the obese (OB) group. The body composition, blood lipid factors, hormones associated with thyroid functions, blood pressure (BP), and carotid intima-media thickness were measured, while physical fitness was ascertained. In the SCH group, waist circumference (WC) and high-density lipoprotein cholesterol values were outside the normal ranges, while WC and systolic BP (SBP) were outside the normal ranges in the OB group. Following the 12-week training program, significantly positive changes occurred in body fat percentage, sit and reach test results, and SBP (p < 0.05) in the SCH group, while in the OB group, significantly positive changes in BMI, WC, sit and reach test results, SBP, and diastolic BP (DBP, p < 0.05) were observed. In addition, both groups showed significant decreases in intima-media thickness of the right carotid bifurcation (p < 0.05). However, in the two groups, the 12-week exercise training program did not have similar significant impact on the hormones related to thyroid functions and blood lipids. Therefore, further research on exercise training that can effectively induce changes in the hormones associated with thyroid functions in patients with subclinical hypothyroidism is necessary.

THE EFFECT OF GOLIMUMAB ON ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of golimumab (GLM) on arterial stiffness in patients with different clinical and immunological subtypes of rheumatoid arthritis (RA). Material and methods. Examinations were made in 48 patients with RA meeting the 1987 ACR/2010 EULAR classification criteria. The investigators visualized carotid arteries with determination of local vessel wall stiffness and studied regional arterial stiffness with assessment of contour pulse wave analysis before and 52 weeks after initiation of therapy. Results and discussion . Young and middle-aged RA patients without any concomitant cardiovascular diseases were found to have subclinical great artery involvement that was characterized by increases in intima-media thickness (IMT) and stiffness index β of the common carotid artery (CCA); by rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the intensity of a change in which was associated with high DAS28 and seropositivity for rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (antiCCP) antibodies. GLM treatment in patients with RA was accompanied by a statistically significant decrease in DAS28 and a reduction in CCA IMT and local (carotid) stiffness of the vascular bed. More significant correction of the investigated parameters was achieved in patients with the seronegative subtype of the disease; in this group of patients, CCA IMT decreased by 29% by the end of observation (p=0.01), CCA SI β reduced by an average of 28.7% (p=0.0001). At 52 weeks after GLM therapy initiation, contour pulse wave analysis indicated that this subgroup of patients was observed to have decreases in AIp, SI, and RI to the control level; in RA seropositive for RF and/or anti-CCP, they reduced by an average of 1.8 (p=0.0001), 1.2 (p=0.005) and 1.6 (p=0.001) times, respectively. Conclusion. Along with high anti-inflammatory activity, GLM therapy in patients with RA has a vasoprotective effect on the walls of large elastic-type vessels (decreases in CCA IMT and SI β, AIp, and SI) and small muscular-type arteries (a reduction in RI).

Monitoring the efficacy of omega-3 supplementation on liver steatosis and carotid intima-media thickness: a pilot study.

SummaryPurposeTo determine the effects of omega‐3 supplementation on liver fat and carotid intima–media thickness (IMT) and to assess accuracy of ultrasound (US) for grading liver steatosis.Materials and MethodsIn this one‐way crossover pilot study, we assigned children with obesity and liver steatosis to receive 1.2 g daily of omega‐3 supplementation vs. inactive sunflower oil for 24 or 12 weeks. Liver fat content was assessed by magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI) and US, and common carotid IMT by US. Statistical analysis included Chi‐square, Student's t‐tests, ANOVA tests and receiver operating characteristic (ROC) curves.ResultsOmega‐3 supplementation was associated with a trend towards decrease in MRS‐determined liver fat fraction (0.7% and 2.1% decrease in the 24‐week and 12‐week omega‐3 group, respectively) compared with the sunflower oil group (1.0% increase). These changes were not significant, whether assessed by MRS (P = 0.508), MRI (P = 0.508) or US (P = 0.678). Using US, the area under the ROC curves were 0.964, 0.817 and 0.783 for distinguishing inferred steatosis grades 0 vs. 1–2–3, 0–1 vs. 2–3 and 0–1–2 vs. 3, respectively, indicating good accuracy of US‐based fat grading. Omega‐3 supplementation was associated with a decrease in US‐determined IMT (0.05‐mm decrease in the 24‐week omega‐3 group. A 0.015‐mm increase was found in the 12‐week omega‐3 group, and a 0.007‐mm decrease in the sunflower oil group (P = 0.003).ConclusionOmega‐3 supplementation had no significant effect on liver fat fraction, but led to carotid IMT decrease in children with obesity and liver steatosis.

STUDY OF CARDIOPROTECTIVE AND ANTI-ISCHEMIC EFFECTIVENESS OF STANDARD TREATMENT FOR ISCHEMIC HEART DISEASE WITH ADDITION OF PERINDOPRIL ARGININE, IN OLDER PATIENTS

Aim. To evaluate the cardioprotective, anti-ischemic and vasoprotective effectiveness of perindopril arginine (Prestarium А®, Les Laboratories Servier, France) in stable angina patients of older age, after myocardial infarction (MI). Material and methods. Totally, 68 patients of older age (72±12 y.) included, with stable angina, who had MI. All patients underwent echocardiography with dopplerographic analysis of transmitral blood flow, Holter monitoring of ECG, ultrasound dopplerography of carotid arteries. Patients from the 1 group (33 persons) were taking standard therapy of stable angina. Patients from the 2 group (n=35) as addition were taking PA 10 mg daily. Results. By the data of Holter ECG, in patients of both groups there was decrease of mean frequency of angina attacks (by 76,4% in 1 group, by 86,3% in 2), need for nitroglycerin use (by 68,7% and 71,3%, resp.), frequency of ischemia episodes (by 35,5% and 55,6%, resp.), total daily duration of ischemia (50,3% and 49,7%), depth of ischemic ST segment depression (44,6% and 58,6%, resp.). There was more prominent significant decrease of the parameters mentioned, in patients taking Prestarium А®. Also, in the 2 group patients the decrease of intima-media thickness of the right and left common carotid arteries was more significant than in the 1 group. In 2 group there was increase of relation of the peak velocities of the left ventricle (LV) filling in early phase of diastole and in atrium systole phase, by 14,6% and decrease of end-diastolic size of the LV by 10,9%. Conclusion. Usage of Prestarium А® in stable angina patients of older age, after MI, was effective, which presented with the decrease of the frequency and intensity of angina attacks, slowing of desadaptive LV remodeling processes, improvement of clinical condition, decrease of supraventricular rhythm disorders, positive influence on the heart and vessels, hence having vasoprotective and cardioprotective effect.

PP.35.26

Objective: Aim: to study of antihypertensive, antiremodelling efficacy and clinical tolerability of monotherapy with zofenopril in patients with mild to moderate arterial hypertension (AH). Design and method: The study included 30 patients with mild to moderate AH (I-II stage of AH, ESC/ESH 2013), in average age 49,93 ± 9,0 yrs. Blood pressure BP was measured by Korotkof method. Echocardiography performed according to Penn Convention Method, endothelium dependent vasodilatation (EDVD) of brachial artery was determined in reactive hyperemia test, intima-media thickness (IMT) of common carotid artery measured by ultrasound, blood lipid and glucose levels were determined using biochemical methods, all measurements performed before and after 12 weeks of treatment with zofenopril (Zocardis, Berlin-Chemi, Menarini Group). Results: During the 12 weekly monotherapy with zofenopril in daily dose 36.0 ± 19.54 mg there were significantly decrease of systolic and diastolic BP on 19.53 ± 5.93% and 18.64 ± 7.18% respectively, with achieved goal BP level in 83.3% cases. Cardioprotective efficacy of zofenopril expressed in significantly regress of left ventricular hypertrophy: left ventricular mass index reduce from 117.84 ± 32.5 m/g2 to 106.15 ± 28.6 m/g2, (p = 0.0001), with improvement and normalization EDVD of brachial artery: D% from 9.86 ± 3.82% to 14.13 ± 6.17% (p = 0.0001), and significantly decrease of IMT: from 1.0 ± 0.3 mm to 0.91 ± 0.24 mm (p = 0.002). There were no significantly changes in blood lipid and glucose levels. Tolerability of zofenopril was good without any side effects. All patients finished 12-weekly therapy. Conclusions: During the monotherapy with zofenopril were shown significantly high antihypertensive, antiremodelling efficacy with metabolic neutrality and good clinical tolerability of drug in patients with mild to moderate AH.

Association between fat amount of dairy products with pulse wave velocity and carotid intima-media thickness in adults.

BackgroundExamine the relation between consumption of low-fat vs. whole-fat dairy products with the carotid intima-media thickness and pulse wave velocity.FindingsMethods: Cross-sectional and multi-center study. A total of 265 subjects were selected by stratified random sampling. Measurements: Information about dairy products was assessed using a semi-quantitative food-frequency questionnaire. Carotid intima-media thickness (IMT) was measured by carotid ultrasonography. Pulse wave velocity (PWV) was measured using the SphygmoCor-System.ResultsSubjects (age 55.8 ± 12.2) had mean values of IMT 0.68 ± 0.10 mm and PWV 7.60 ± 2.0 m/sec. The relationship between PWV and IMT with whole-fat and low-fat dairy intake groups, adjusted for age, sex, energy intake and other confounders revealed lower values of PWV in subjects with a consumption higher than 125 g/day of low-fat dairy and in those who did not intake whole-fat dairy. In a risk-factor adjusted regression model, an increase in PWV of 0.109 m/sec (95% CI: 0.006 –0.213) was estimated for every 100 g/day increase in whole-fat dairy intake. Similarly, a decrease in PWV of 0.101 m/sec (95% CI: −0.178 –0.023) was estimated for every 100 g/day increase in low-fat dairy intake, (p = 0.038 and p = 0.011 respectively). While for every 100 g/day increase in low-fat dairy intake, the estimate decrease of IMT was 0.005 mm (95% CI: −0.010 –0.001), p = 0.011.ConclusionsPWV and IMT showed an inverse association with the intake of low-fat dairy and a positive association with the intake of whole-fat dairy, so the amount of fat in dairy products can play an important role in arterial stiffness and subclinical atherosclerosis.

Influence of insulin and glargine on mobilization and outgrowth of endothelial progenitor cells in patients with type 2 diabetes: a partially double-blind, randomized, three-arm unicenter study

Introduction: Clinical trials have shown that the number of circulating endothelial progenitor cells (EPCs) correlates with cardiovascular risk factors and is an independent predictor of cardiovascular death. We were previously able to show that insulin stimulates the in vitro outgrowth of EPCs. Therefore we studied whether treating type 2 diabetic patients with insulin affects circulating EPCs or vascular function. Study design: 55 patients with type 2 diabetes mellitus on oral antidiabetics were randomized in 3 groups. For the following 4 months patients were treated additionally with insulin glargine (n = 20), NPH insulin (n = 22) or with a combination of oral antidiabetics (n = 13). Data for EPC- mobilization, EPC-differentiation, intima-media thickness (IMT) and HbA1c were documented/performed at the entry visit (visit 1); after 4 weeks (visit 2) and after 4 months (visit 3). Results: HbA1c levels were similarly high in all 3 groups at baseline (p = 0.71). HbA1c was equally decreased after 4 months in all 3 arm groups independently from the form of treatment without showing any statistical significance between the groups (p = 0.61). FACS analysis showed no significant difference between the 3 groups concerning the mobilization of EPCs 4 weeks (p = 0.96) and 4 months (p = 0.55) after treatment. However the number of EPCs as detected by ex-vivo outgrowth was in both insulin groups at visit 3 significantly higher than the oral group (p = 0.013). A statistically significant decrease of IMT from 0.80 mm (± 0.14) at visit 1 to 0.76 mm (± 0.12) at visit 3 could be observed in all patients (p = 0.03). Summary: The study shows that a 4-month treatment with insulin glargine or NPH insulin significantly increases the differentiation of EPCs on patients with type 2 diabetes mellitus, compared to those treated only with oral antidiabetics. Besides it could be shown that all groups achieved a significant decrease of HbA1c as well as a significant reduction of the intima-media thickness.

Spontaneous regression of restenosis after CEA: significance of preoperative plaque characteristics under duplex ultrasound; clinical investigation

Restenosis is a postoperative complication after carotid endarterectomy (CEA). The natural clinical course of restenotic lesions is not yet fully understood. This study was aimed at detecting the pattern of restenotic lesions by way of following the plaque thickness under duplex ultrasound, and the possible relationship between the postoperative changes of restenotic lesions and the preoperative plaque characteristics. Serial duplex ultrasound follow-up studies were conducted postoperatively, and intima-media thickness (IMT) was measured to detect restenosis changes. Among 381 cases of CEA, including 25 cases of restenosis, 11 were eligible for further analysis. Of the 11 cases of restenosis, four showed a gradual increase in IMT, and five showed a temporary increase followed by a decrease in IMT. All cases in the former group showed isoechogenic or hypoechogenic plaques under preoperative duplex ultrasound. In contrast, all cases in the latter group demonstrated calcified plaques together with acoustic shadows. These postoperative chronological IMT data demonstrate two changing patterns of restenosis, implying the existence of two distinct entities. In addition, these results suggest that restenosis after removal of a calcified plaque, which supposedly forms secondary to myointimal hyperplasia, may be a temporary phenomenon that acutely develops in response to a dissection maneuver during surgery. Because our speculation is based on a small number of cases, further study is warranted to better understand the pathophysiology of restenosis regression.