Development Of Cardiovascular Complications Research Articles

Role of plasmacytoid dendritic cells in vascular dysfunction in mice with renovascular hypertension

Endothelial dysfunction and inflammation are clinically significant risk factors for cardiovascular diseases in hypertension. Although immune cells play a role in hypertension, the impact of plasmacytoid dendritic cells in established renovascular hypertension-induced cardiovascular complications is not fully understood. We investigated plasmacytoid dendritic cells' contribution to arterial endothelial dysfunction and inflammation in renovascular hypertension.A two-kidney one-clip (2K1C) model for four weeks in both male and female mice was used to induce renovascular hypertension. We treated mice with or without anti-PDCA-1 antibodies for one week to deplete the plasmacytoid dendritic cells. Renovascular hypertension causes cardiac hypertrophy, lung edema, and microvascular endothelial dysfunction associated with inflammation induction in mice. Moreover, renovascular hypertension affects the profile of immune cells, including dendritic cells and macrophages, with variations between male and female mice. Interestingly, the depletion of plasmacytoid dendritic cells significantly reduces blood pressure, cardiac hypertrophy, lung edema, inflammation, and oxidative stress and improves microvascular endothelial function via the endoplasmic reticulum (ER) stress, autophagy, and mTOR-dependent mechanisms.Plasmacytoid dendritic cells significantly contribute to the development of cardiovascular complications in renovascular hypertension by modulating immune cells, inflammation, oxidative stress, and ER stress.

Modelling long-term outcomes and mortality risk in patients with post-stroke spasticity during abobotulinum toxin injections as part of rehabilitation

To date, there are no Russian or international studies investigating the long-term efficacy of botulinum therapy (abobotulinum toxin injections – AboBTX) during rehabilitation in patients with post-stroke spasticity in terms of its impact on the risk of death from all causes and the development of cardiovascular complications. A 10-year study conducted in the United Kingdom analyzed the effects of AboBTX injections in patients with post-stroke spasticity on long-term clinical (all-cause mortality, cardiovascular events, length and quality of life) and economic (direct medical costs) outcomes. For the first time ever, a model was developed to evaluate the clinical (quality-adjusted life expectancy) and economic benefits of AboBTX injections in the structure of rehabilitation compared to rehabilitation without botulinum therapy in patients with post-stroke spasticity. It was shown that the inclusion of regular injections of AboBTX in the rehabilitation process resulted in an 8.8% reduction in the risk of death from all causes, a 13% increase in life expectancy (and by 59% in quality-adjusted terms compared to rehabilitation without botulinum therapy) and proved to be cost-effective. The use of AboBTX injections in patients with post-stroke spasticity as part of rehabilitation is cost-effective in the long term and improves long-term outcomes, including post-stroke survival.

Prediction of in-hospital complications in takotsubo syndrome: prospective cohort study

BACKGROUND: Until recently, takotsubo syndrome (TS) was considered a fairly benign disease in both early and late periods. However, in recent years, in-hospital complications in the acute period of TS are common and can be life-threatening.
 AIM: Based on clinical and laboratory-instrumental data, this study aimed to build models for predicting the risk of developing in-hospital complications in patients with TS during the acute period.
 MATERIALS AND METHODS: This prospective cohort study included 60 patients with TS, with an average age of 65.5±13.4 years. In the acute period (7–14 days), standard clinical and laboratory examination, peripheral arterial tonometry using the «EndoPAT 2000» apparatus, and psychological testing using validated questionnaires (hospital anxiety and depression scale and Beck depression scale) were performed.
 RESULTS: The integrated model for predicting the risk of acute heart failure (AHF) development (pulmonary edema and cardiogenic shock) identified admission LVEF as the leading prognostic parameter. With LVEF ≤40.5%, the probability of AHF in patients with TS in the acute period was 62.5%, and in patients with TS and QTc interval 487 ms, the risk reached 100%. The sensitivity and specificity of the developed model were 72.7% and 97.4%, respectively. The integrated model for predicting the development of cardiovascular complications (CVCs) revealed that the number of leukocytes in the peripheral blood was the leading risk factor for adverse events in patients with TS in the acute period. With a leukocyte count 11.1×109/L, the risk of CVCs in patients with TS increased to 89.9%, and if the erythrocyte count was 4.69×1012/L or ≤4.29×1012/L, it could reach 100%. The sensitivity and specificity of the resulting model were 92.6 and 97.0%, respectively.
 CONCLUSION: The models proposed in this study for predicting the likelihood of developing severe AHF and the overall risk of CVCs in the acute period of TS are personalized and easy to use, allowing for the selection of optimized treatment techniques.

Klotho G-395A Gene Polymorphism: Impact on Progression of End-Stage Renal Disease and Development of Cardiovascular Complications in Children on Dialysis

Klotho G-395A Gene Polymorphism: Impact on Progression of End-Stage Renal Disease and Development of Cardiovascular Complications in Children on Dialysis

Features of arterial pressure dynamics according to results of blood pressure monitoring in elderly patients

All over the world, special attention is paid to cardiovascular diseases in patients. According to epidemiological studies, a large contribution to mortality from them is high blood pressure, effective normalization of blood pressure will lead to an increase in life expectancy. The purpose of the study: to study the features of the daily blood pressure profile in elderly patients with hypertension. It was revealed that hypertension in elderly patients is more severe and has significantly higher rates of rise in systolic and diastolic pressure during the day and night hours, high variability, and insufficient (non-dipper) night-time decrease in blood pressure.Therefore, sick groups have a high risk of developing target organ damage, which is a predictor of the development of cardiovascular complications.

"When," "Where," and "How" of SARS-CoV-2 Infection Affects the Human Cardiovascular System: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory coronavirus-2 (SARS-CoV-2). Several explanations for the development of cardiovascular complications during and after acute COVID-19 infection have been hypothesized. The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. The myocardial injury in COVID-19 patients has been associated with coronary spasm, microthrombi formation, plaque rupture, hypoxic injury, or cytokine storm, which have the same pathophysiology as the three clinical variants of Kounis syndrome. The angiotensin-converting enzyme 2 (ACE2), reninaldosterone system (RAAS), and kinin-kallikrein system are the main proposed mechanisms contributing to cardiovascular complications with the COVID-19 infection. ACE receptors can be found in the heart, blood vessels, endothelium, lungs, intestines, testes, neurons, and other human body parts. SARS-CoV-2 directly invades the endothelial cells with ACE2 receptors and constitutes the main pathway through which the virus enters the endothelial cells. This causes angiotensin II accumulation downregulation of the ACE2 receptors, resulting in prothrombotic effects, such as hemostatic imbalance via activation of the coagulation cascade, impaired fibrinolysis, thrombin generation, vasoconstriction, endothelial and platelet activation, and pro-inflammatory cytokine release. The KKS system typically causes vasodilation and regulates tissue repair, inflammation, cell proliferation, and platelet aggregation, but SARS-CoV-2 infection impairs such counterbalancing effects. This cascade results in cardiac arrhythmias, cardiac arrest, cardiomyopathy, cytokine storm, heart failure, ischemic myocardial injuries, microvascular disease, Kounis syndrome, prolonged COVID, myocardial fibrosis, myocarditis, new-onset hypertension, pericarditis, postural orthostatic tachycardia syndrome, pulmonary hypertension, stroke, Takotsubo syndrome, venous thromboembolism, and thrombocytopenia. In this narrative review, we describe and elucidate when, where, and how COVID-19 affects the human cardiovascular system in various parts of the human body that are vulnerable in every patient category, including children and athletes.

Increased circulating FGF21 level predicts the burden of metabolic demands and risk of vascular diseases in adults with type 2 diabetes

ObjectivesType 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by chronic hyperglycemia and metabolic stress, involved in the stepwise development of cardiovascular complications. Fibroblast growth factor 21 (FGF21) is a novel hepatokine involved in regulating glucose and lipid metabolism, and has been linked to the prediction, treatment, and improvement of prognosis in multiple cardiovascular diseases (CVDs). The aim of this study is to explore the relationship between FGF21 levels and vascular diseases (VDs) including carotid atherosclerosis (CAS) and hypertension (HP) in patients with T2DM.MethodsBaseline serum FGF21 was determined in a cross-sectional study of 701 patients with T2DM and 258 healthy control.ResultsThe morbidity of CAS was increased in T2DM patients with HP as compared with those without (p < 0.001). The average serum FGF21 level of healthy was [123.9 (67.2-219.3)]. Baseline FGF21 was significantly higher in those who developed CAS or HP than in those who did not [305.9 (177.2-508.4) vs. 197.2 (129.7-308.3) pg/mL, p < 0.001]. In addition, an elevated serum FGF21 was observed in T2DM patients with HP and CAS than that of T2DM patients with CAS or HP [550.5 (312.6-711.3) vs. 305.9 pg/mL, p < 0.001]. Serum FGF21 levels were positively correlated with body mass index and carotid intima media thicknes (p < 0.05), the association remained significant after adjusting for age and T2DM duration. Furthermore, the multinomial logistic regression showed that serum FGF21 was independently associated with CAS and HP in patients with T2DM after adjustment for demographic and traditional VDs risk factors (p < 0.001).ConclusionsBaseline FGF21 is elevated in VDs during diabetes, changes of serum FGF21 levels were appropriately matched to metabolic stress. FGF21can be used as an independent predictor for diagnosing VDs and predicting prognosis.

High Blood Pressure amongst Adolescents in Lagos, South West Nigeria

Adolescent high blood pressure (HBP), now a growing significant health problem with lasting consequences on cardiovascular health, was considered rare at a time. Several end-organ complications could occur if this asymptomatic condition is uncontrolled, and tracks into adulthood. The 2004 Fourth Report was developed to address the cumbersome challenges in the detection of adolescent hypertension. &#x0D; Aims: This study sought to determine high blood pressure prevalence amongst adolescents in Mushin Local Government Area (LGA) using the 2004 Fourth report.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Fourteen secondary schools, in Mushin Local Government Area (LGA) between August 2020 and December 2020.&#x0D; Methodology: A two-stage sampling method was utilized in selecting 14 secondary schools. Within selected schools; participants were recruited from each class by proportional allocation using the school’s register. Students were stratified as males and females using the class register. Subjects were selected from each stratum by simple random sampling method. We included 1490, (744 male, 746 female), 10-19 years old students. A structured proforma was used to obtain socio-demographic information and relevant clinical data. The blood pressure measurements were taken according to standard protocol (elevated blood pressure is systolic and/or diastolic pressure ≥ 90th but ≤ 95th percentile for age, gender and height). Descriptive data was used to describe socio-demographic and anthropometric characteristics. Frequency, percentages, mean and standard deviation were used to summarize categorical and numerical variables. P-values of 0.5 was termed significant&#x0D; Results: Among the 1490 subjects, 49.9% (744) were male and 50.1% (746) females (male: female ratio was 1: 1). Prevalence, of high blood pressure, elevated pressure and hypertension were 14.5% (number =216), 6.1% (number =92), and 8.4% (number =124). The prevalence of high blood pressure rose progressively with the age group in the early and mid adolescent age group, while the prevalence was lowest in the oldest age group.&#x0D; Conclusions: Adolescent hypertension, elevated blood pressure, high blood pressure, prevalence, was high. Development of cardiovascular complications could be obviated by early detection, life style modification and treatment.

Characteristics of patients with non-specific aortoarteritis and arterial hypertension based on retrospective analysis

The aim was to study the medical history, laboratory and instrumental data, the trends of arterial hypertension (AH), risk factors for cardiovascular events, target organ damage (TOD), and the development of cardiovascular complications in patients with NSAA (Non-Specific Aortoarteritis).Materials and Methods. The study included 33 women with confirmed NSAA who had been treated at the 5th Cardiology Department of the E.I. Chazov National Medical Research Center of Cardiology since 2005. Complete blood count, biochemical blood analysis, urine analysis, the following instrumental examinations, such as, ECG, echocardiography, ultrasound of the brachial, femoral, aortic, and renal arteries, MRA or CT angiography with contrast, blood pressure measurement in the arms and legs were performed for all patients. Telephone interviews were conducted to assess some patient's condition over time.Results. The most common symptom (84% of patients) was AH, the average age of AH onset was 30 [19; 40] years and the AH average duration is 7,5 [2; 13] years. Nearly half of the patients (45%) had AH as the leading symptom that led them to perform the examination that helped to the diagnosis of NSAA. The average systolic and diastolic blood pressure values were 123±35 mmHg and 66±17 mmHg in the upper extremities, and 166±31 mmHg and 78±18 mmHg in the lower extremities, respectively. About half of patients (51%) had stage 3 AH, and almost all of them had type 3 according to E. Lupi-Herrera classification. The most common risk factors for cardiovascular events were dyslipidemia (82%), a family history of early cardiovascular events (51%), resting heart rate above 80 bpm (25%), and carbohydrate metabolism disorders (21%). When assessing cardiovascular risk, moderate risk of developing cardiovascular events was observed in 3 patients (10,7%), high risk in 16 patients (57,1%), and very high risk in 9 patients (32,1%). The most common TODs were nervous system damage (53%), including cerebrovascular ischemic events (14%) and left ventricular hypertrophy (42%). This group of patients was characterized by resistant hypertension, and combination with other risk factors for cardiovascular events, it leds to severe TOD and influenced survival rate. In terms of antihypertensive therapy, 61% of patients received combination therapy, with CCB, beta-blockers, and imidazoline receptor agonist being the most prescribed. Two fatal cases were identified in the long-term follow-up, and cardiovascular events, most frequently stroke, were the main complications observed. Additionally, AH progression and its uncontrolled course despite going through multiple drug therapy were characteristic.Conclusion: AH is often difficult to diagnostic in patients with NSAA, and it significantly contributes to the structure of complications and mortality in this patient cohort, progressively worsening over time. It is important to measure blood pressure in both arms and legs to detect elevated values early. The main goals of treatment are achieving NSAA remission and blood pressure control and preventing cardiovascular events.

Circulating Levels of Fibroblast Growth Factor 23 Selective for C-Terminal (FGF23-CT) in Hemodialysis Patients

Background: In hemodialysis patients, fibroblast growth factor 23 (FGF23) has reportedly been associated with the development of cardiovascular complications and a high risk of mortality. Our objective here was to study the cleavage characteristics of FGF23 in hemodialysis patients. Methods: This study design is a cross-sectional observational investigation of three facilities without intervention. To assess FGF23 concentrations, we obtained plasma samples from 97 hemodialysis patients before the hemodialysis session and from 16 healthy volunteers. We measured the FGF23 C-terminal fragment and intact FGF23 concentrations by using a commercial enzyme-linked immunosorbent assay. Results: Serum levels of the FGF23 C-terminal fragment were 189 ± 121 ng/mL in healthy volunteers and 306 ± 206 ng/mL in hemodialysis patients. The ratios of intact FGF23 to total FGF23 were 0.03 ± 0.03 in healthy volunteers and 0.44 ± 0.28 in hemodialysis patients. The ratios were positively correlated with levels of inorganic phosphate in hemodialysis patients (p &lt; 0.001, r = 0.52). Conclusion: We measured actual levels of the serum FGF23 C-terminal fragment in hemodialysis patients by using a new commercial kit for the first time. The ratio of intact FGF23 to total FGF23 was lower in healthy controls than the ratio in hemodialysis patients. The cleavage percentage of FGF23 was considerably higher in both groups of subjects than previously thought. We suggest that hyperphosphatemia in hemodialysis patients was associated with impaired cleavage of FGF23.

Testosterone, atherosclerosis and cardiovascular risks

The study highlighted the most significant scientific works that examined the influence of androgen deficiency and its drug correction in coronary heart disease. The effects of androgens on metabolic parameters, development of atherosclerosis, inflammation, coagulation and thromboembolism, blood pressure, and development of cardiovascular complications were also evaluated. The importance of conducting long-term randomized international studies evaluating the effects of testosterone in men with androgen deficiency and cardiovascular diseases, a cautious approach to androgen replacement therapy, and the need for individualization of therapy were discussed. Cardiovascular diseases are the leading cause of mortality. Thus, the study of the role of sex steroids in the development of atherosclerosis and coronary heart disease is of great interest. Testosterone is the main sex hormone that determines a mans health. With age, testosterone levels gradually decrease, and mortality from cardiovascular complications increases. Low testosterone levels are associated with erectile dysfunction, decreased libido, decreased skeletal muscle mass, metabolic disorders, osteoporosis, and depression, and the importance of androgens for the circulatory system remains insufficiently studied. Many men receive testosterone replacement therapy, which leads to the improvement of well-being, sexual function, surge of strength, and favorable metabolic changes. The scientific literature describes the possible cardioprotective effect of testosterone, and it is believed to have vasodilating properties, shorten the QT interval, and normalize the ratio of fat and muscle mass. However, the expediency and safety of prescribing testosterone drugs to patients with hypogonadism and high cardiovascular risk is debatable because only several studies have described an increase in the number of cardiovascular complications in the androgen therapy group relative to the placebo group. Most studies on testosterone replacement therapy did not assess cardiovascular risks and excluded people with a recent stroke, heart attack, or severe heart failure. In addition, data interpretation is complicated by the lack of generally accepted international standards of testosterone for men of different ages, and most studies do not consider the change in androgen status relative to peak values at a young age and features of the receptor apparatus.

Study of changes in the activity levels of purine nucleoside phosphorylase and the role of nitric oxide in the development of pathology in alloxan-diabetic rats

The problem of treating diabetes mellitus has not been resolved to this day; it requires a detailed study of various links of pathogenesis at the molecular level. In diabetes, conditions arise for the formation of oxidative stress. Diabetes mellitus is associated with the early development of cardiovascular complications, the immune e system is destroyed. Endothelial cells produce nitric oxide (NO), a substance that is able to maintain a balance of vascular tone, coagulation and inflammation. Purine nucleoside phosphorylase (PNP) is one of the most important enzymes of purine metabolism, which characterizes the immune status of the organism. The aim of this study was to study the enzymatic activity of PNP, as well as to determine the levels of nitric oxide in the blood serum, liver and pancreas in albino rats with simulated alloxan diabetes. The results of our studies on the detection of changes in the activity of PNP in the pancreas on the model of alloxandiabetic rats showed that at the late stage, the activity of PNP in the pancreas is completely suppressed, which indicates significant changes in the immune status of the body, the content of nitric oxide increases. Understanding the complex metabolic disorders that interact with the NO system may provide us with additional therapeutic options to reduce cardiovascular morbidity and mortality in diabetes mellitus. Indicators of NO and PNP can be used as additional paraclinical indicators for early diagnosis and to identify and clarify the degree of activity of the pathological process, the nature of the course, the stage of the disease, which contributes to the appointment of individualized adequate therapy.

Plasma catestatin levels are related to metabolic parameters in patients with essential hypertension and type 2 diabetes mellitus.

Catestatin (CST) is a pleiotropic peptide with cardioprotective and metabolic effects. CST is involved in the pathogenesis of both arterial hypertension (AH) and type 2 diabetes mellitus (T2DM), which are the risk factors of cardiovascular diseases. In this study, we aimed to investigate the plasma CST levels in hypertensive patients, especially with T2DM, as well as compare those with healthy volunteers, and explore the relationship between CST levels and clinical, anthropometric and laboratory parameters. 106 Hypertensive patients, 55 of which had comorbidity T2DM, and 30 healthy volunteers were enrolled in the study. All subjects underwent clinical examination, including vital signs and anthropometric data assessment, medical history interview, and blood sample collection. Plasma CST levels were measured by an enzyme-linked immunosorbent assay (ELISA), using a commercial diagnostic kit. The plasma CST levels were significantly lower in hypertensive patients (N = 106) compared with healthy subjects (N = 30) (5.02 ± 1.09 vs. 6.64 ± 0.72; p < 0.001). Furthermore, hypertensive patients with T2DM (N = 55) have significantly reduced CST levels in comparison with those without T2DM (N = 51) (4.47 ± 1.16 vs. 5.61 ± 0.61; p < 0.001). CST significantly correlated with anthropometric characteristics, in particular, weight (r = -0.344; p < 0.001), BMI (r = -0.42; p < 0.001), neck (r = -0.358; p < 0.001), waist (r = -0.487; p < 0.001), hip (r = -0.312; p < 0.001), wrist circumferences (r = -0.264; p = 0.002), and waist-to-hip ratio (r = -0.395; p < 0.001). Due to its antihypertensive effect, CST has significant associations with systolic BP (r = -0.475; p < 0.001) and duration of AH (r = -0.26; p = 0.007). CST also has an inverse relationship with insulin (r = -0.382; p < 0.001), glucose (r = -0.45; p < 0.001), index HOMA-IR (r = -0.481; p < 0.001) and HbA1c (r = -0.525; p < 0.001), that indicate its involvement in T2DM development. Besides, CST has significant correlations with uric acid levels (r = -0.412; p < 0.001) as well as lipid parameters, especially HDL-C (r = 0.480; p < 0.001), VLDL-C (r = -0.238; p = 0.005), TG (r = -0.4; p < 0.001), non-HDL-C/HDL-C (r = -0.499; p < 0.001). Multiple linear regression analysis indicated BMI (β = -0.22; p = 0.007), AH duration (β = -0.25; p = 0.008), HbA1c (β = -0.43; p = 0.019) and HDL-C levels (β = 0.27; p = 0.001) as independent predictors of CST levels. The hypertensive patients have significantly decreased CST levels that are even more reduced in the presence of comorbid T2DM. The established correlations with anthropometric and laboratory parameters indicate not only antihypertensive but also metabolic effects of CST. Our results suggest the probable role of CST in the pathophysiology of cardiometabolic diseases and the development of cardiovascular complications.

Подовження інтервалу QT як значуще кардіоваскулярне ускладнення під час системного лікування хворих на рак

Стрімке впровадження нових протипухлинних засобів та технологій лікування сприяло підвищенню виживання хворих на рак. Однак, розвиток серцево-судинних ускладнень на тлі протипухлинного лікування нерідко призводить до зниження якості та тривалості життя онкологічних хворих.Одним з проявів серцево-судинних ускладнень при застосуванні протипухлинних лікарських засобів є подовження інтервалу QT з різними порушеннями серцевого ритму.Стаття базується на аналізі рандомізованих клінічних досліджень і метааналізів та рекомендаціях Європейського товариства кардіологів з кардіо-онкології. Наведено опис факторів ризику і класифікація подовження інтервалу QT, спричиненого протипухлинною терапією. Проаналізовані основні групи протипухлинних лікарських засобів, які індукують зміни інтервалу QT. Розглянуті етапи і кратність огляду онкологічних хворих при різних патологічних станах та порушеннях гемостазу, що можуть призводити до подовження інтервалу QT під час лікування та в різні періоди після його проведення.Огляд присвячений аналізу змін інтервалу QT та клінічному застосуванню алгоритмів прийняття рішень щодо мінімізації кардіотоксичності з метою підвищення ефективності протипухлинного лікування онкологічних хворих.

Clinical significance of adanced glycation end products and inflammation products in the development of vascular calcification and cardiovascular complications in chronic kidney disease

Background. Vascular calcification underlies cardiovascular complications, which remain the leading cause of high mortality in chronic kidney disease (CKD). Uremic toxins, including the advanced glycation end products, play a significant role in the formation of this process.The Aim of the study is to clarify the role of the advanced glycation end products (AGEs) and inflammationproducts in the processes of vascular calcification at different stages of CKD.Patients and Methods. 105 patients aged 18 to 66 years at different stages of CKD C1-C5D were examined, 75 of which were caused by diabetic nephropathy (DN), 30 by other nosological forms. Serum concentrations of AGEs, IL6, TNF-α, troponin I, parathyroid hormone (PTH) were determined by enzyme immunoassay (ELISA). To study the AGEs concentration, the serum was separated by centrifugation (in Eppendorf tubes). The samples were stored at – 70 °C. The left ventricular myocardial mass index (LVMI) was determined. Left ventricular hypertrophy (LVH) was diagnosed with LVH&gt;115 g/m2 for men and &gt;95 g/m2 for women. The peak systolic velocity of blood flow in the aortic arch (Vps) was studied by duplex scanning using the Doppler effect.Results. A significant increase in serum phosphorus concentration (p &lt; 0.05) and PTH (p&lt; 0.01) was revealed as the glomerular filtration rate decreased. An increase in the concentration of AGEs, IL6 and TNF-α was found at all stages of CKD, most pronounced at the later stages – C4-C5D ((p&lt; 0.01, p&lt; 0.05, p&lt;0.05, respectively). Pronounced changes in LVMI and Vps were associated with high levels of AGEs, IL6 and TNF-α. CONCLUSION. An increase in the level of glycation end products and inflammatory factors directly and reliably correlated with the severity of uremia and the severity of morphofunctional changes in the heart and aorta, which confirms their significant role in the development of cardiovascular complications in CKD. Keywords: advanced glycation end products, inflammation, vascular calcification, chronic kidney disease&gt;˂0.05, respectively). Pronounced changes in LVMI and Vps were associated with high levels of AGEs, IL6 and TNF-α.Conclusion. An increase in the level of glycation end products and inflammatory factors directly and reliably correlated with the severity of uremia and the severity of morphofunctional changes in the heart and aorta, which confirms their significant role in the development of cardiovascular complications in CKD.

The Role of Shear Stress in Coronary Artery Disease.

Coronary artery disease is the leading cause of morbidity and mortality worldwide, especially in developed countries, with an increasing incidence in developing countries. Despite the advances in cardiology, there are yet many unanswered questions about the natural history of coronary atherosclerosis. However, it has not been fully explained why some coronary artery plaques remain quiescent over time, whereas others evolve to a high-risk, "vulnerable" plaque with a predisposition to destabilize and induce a cardiac event. Furthermore, approximately half of the patients with acute coronary syndromes demonstrate no prior symptoms of ischemia or angiographically evident disease. Recent findings have indicated that apart from cardiovascular risk factors, genetics, and other unknown factors, local hemodynamic forces, such as endothelial shear stress, blood flow patterns, and endothelial dysfunction of the epicardial and microvascular coronary arteries, are associated with the progression of coronary plaque and the development of cardiovascular complications with complex interactions. In this review article, we summarize the mechanisms that affect coronary artery plaque progression, indicating the importance of endothelial shear stress, endothelial dysfunction of epicardial and microvascular vessels, inflammation, and their complex associations, underlying in parallel the clinical perspectives of these findings.

Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome.

People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.

The emerging role of heart‐on‐a‐chip systems in delineating mechanisms of SARS‐CoV‐2‐induced cardiac dysfunction

AbstractCoronavirus disease 2019 (COVID‐19) has been a major global health concern since its emergence in 2019, with over 680 million confirmed cases as of April 2023. While COVID‐19 has been strongly associated with the development of cardiovascular complications, the specific mechanisms by which viral infection induces myocardial dysfunction remain largely controversial as studies have shown that the severe acute respiratory syndrome coronavirus‐2 can lead to heart failure both directly, by causing damage to the heart cells, and indirectly, by triggering an inflammatory response throughout the body. In this review, we summarize the current understanding of potential mechanisms that drive heart failure based on in vitro studies. We also discuss the significance of three‐dimensional heart‐on‐a‐chip technology in the context of the current and future pandemics.

ОСОБЕННОСТИ ФАКТОРОВ РИСКА РАЗВИТИЯ КАРДИОВАСКУЛЯРНЫХ ОСЛОЖНЕНИЙ ПРИ ОЖИРЕНИИ У ДЕТЕЙ

Introduction. The most common risk factors for the development of cardiovascular diseases are hypertension and obesity, which are formed in childhood, however, the most significant clinical and metabolic markers of cardiovascular risk have not yet been identified in pediatric practice. Aim. To study the characteristics and interrelations of cardiovascular risk factors in obese children and adolescents for planning correction at the stage of functional changes. Material and methods. The study included 141 obese children – 69 boys and 72 girls (in whom the degree of standard deviation of the body mass index was 2.88 [2.75; 3.41] and 2.93 [2.59; 4.05], respectively) and 78 healthy children (40 boys and 38 girls), comparable by sex and age. Results and discussion. In the examined children, there is an insufficient decrease in blood pressure at night from both systolic blood pressure and diastolic blood pressure, in the absence of clinically and statistically significant deviations in single measurements. The triglyceride-glucose index and the N-terminal inactive peptide of natriuretic hormone demonstrated high concentrations in normoglycemia and the absence of dyslipidemia. Against the background of obesity, trimethylaminoxide concentrations were lower than in healthy children. Conclusion. In order to timely correct blood pressure, it is necessary to use daily monitoring in obese children, even against the background of the absence of signs of arterial hypertension with single measurements. Even against the background of lean normoglycemia in obese children and adolescents, it is advisable to diagnose the formation of insulin resistance and hyperinsulinemia using indicators of insulin levels, calculation of the HOMA-IR index, triglyceride-glucose index. Correction of blood pressure variability is possible with changes in certain parameters of body composition (decrease in fat mass and increase in muscle mass) and hormonal and metabolic parameters (decrease in glycemia, very low-density lipoproteins, insulin and increase in high-density lipoproteins). The level of trimethylaminoxide showed lower rates of obesity in children compared to healthy peers, which differs from the literature data on the adult population and limits its use as a biomarker for the development of cardiovascular complications in obesity in children

RISK OF DEVELOPMENT CARDIOVASCULAR СOMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC SYNDROME

The combination of arterial hypertension and metabolic syndrome leads to an increased risk of development cardiovascular complications. Early detection of asymptomatic target organ damage to determine additional risk is important, because pressure-dependent subclinical damage to several organs reflects progression along the cardiovascular disease continuum. The SCORE scale is based on data from a number of recent European multicenter studies and takes into account all variants of fatal cardiovascular events over a 10-year period. However, the SCORE scale does not take into account the presence of such subclinical risk factors for the development of cardiovascular complications as insulin resistance, endothelial dysfunction, microalbuminuria&#x0D; The aim was to assess the ten-years risk of development of cardiovascular complications in hypertensive's with metabolic syndrome, depending on the type of insulinemia, endothelial dysfunction, and the presence of microalbuminuria.&#x0D; Materials and methods. Were examined 96 patients (34 men, 62 women) with arterial hypertension and metabolic syndrome, average age (57±9) years. Office blood pressure measurement, the level of total cholesterol in the blood and microalbuminuria in daily urine were determined for all patients. An oral glucose tolerance test was performed with parallel determination of the level of endogenous insulin, endothelin-1, and vasculoendothelial growth factor in blood serum by the immunoenzymatic method. Patients were divided into three groups. Group 1 included 29 patients with normal basal and postprandial levels of endogenous insulin; in the 2nd group – 39 patients with reactive hyperinsulinemia, in the 3rd group – 28 patients with spontaneous hyperinsulinemia. To estimate the total cardiovascular risk, the version of the SCORE scale for countries with high cardiovascular mortality was used. Moderate risk criteria are defined – SCORE index level 1-4%, high risk – 5-9% and very high risk – ≥ 10%.&#x0D; Research results. A moderate cardiovascular risk prevailed in almost 52% of patients of group 1 with a normal level of endogenous insulin, high – in 35% of patients group 2 with reactive hyperinsulinemia, very high – in 48% of patients group 2 and 43% of patients of group 3 with spontaneous hyperinsulinemia. The highest levels of systolic and diastolic blood pressure were characteristic of high-risk patients with spontaneous hyperinsulinemia combined with impaired glucose tolerance, with increasing of total cholesterol levels in 1.7 times under obesity, increasing of endothelin levels by 7 times, vasculoendothelial growth factor in 2.7 times and the presence of microalbuminuria in 75% of cases.&#x0D; Conclusions. More than half patients with arterial hypertensive and metabolic syndrome have a high and very high cardiovascular risk according to the SCORE scale, which is associated with hyperinsulinemia and insulin resistance, hypercholesterolemia and obesity, microalbuminuria and disorders of endothelial vasoregulation. The risk of cardiovascular complications based on subclinical signs of target organs damage to increases with the severity of insulin resistance and progression of endothelial dysfunction, which creates prerequisites for the development of atherosclerosis.