Early Marker Of Cardiovascular Disease Research Articles

Amino acid profile in overweight and obese prepubertal children - can simple biochemical tests help in the early prevention of associated comorbidities?

It is accepted that plasma branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) are closely related to metabolic risk. Arterial hypertension, metabolic syndrome, endothelial dysfunction, inflammation, and metabolic dysfunction-associated fatty liver disease (MAFLD) are frequently seen in obese patients. Many attempts have been made to find biochemical indicators for the early detection of metabolic complications in children. It is not known if different amino acid profiles and BCAA and AA concentrations in overweight and obese children correlate with chemerin, proinflammatory, and simple biochemical markers. Thus, the study aimed to find out the early markers of cardiovascular disease and MAFLD in overweight and obese children. The study included 20 overweight and obese children (M/F 12/8; mean age 7.7 ± 2.3 years; BMI 26.8 ± 5.0 kg/m2) and 12 non-obese children (control group) (M/F 4/8; mean age 6.5 ± 2.2 years; BMI 14.8 ± 1.5 kg/m2). The following plasma amino acids were measured: aspartic acid, glutamic acid, serine, asparagine, glycine, glutamine, taurine, histidine, citrulline, threonine, alanine, arginine, proline, tyrosine, methionine, valine, isoleucine, leucine, phenylalanine, tryptophan, ornithine, and lysine. Chemerin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and basic biochemistry parameters were measured. The mean plasma levels of leucine, isoleucine, valine, phenylalanine, tyrosine, glutamic acid, and alanine were significantly higher in overweight and obese children than in the control group (p<0.03-p<0.0004). Conversely, the mean values of serine, asparagine, glutamine, and citrulline were significantly lower in overweight and obese children than in the control group (p<0.03-p<0.0007). Isoleucine, leucine, valine (BCAAs) tyrosine, and phenylalanine (AAAs) levels showed a positive correlation with uric acid, ALT, hs-CRP, and chemerin (r=0.80-0.36; p<0.05-p<0.00001), but not with IL-6. The mean values of glucose, IL-6, hs-CRP, chemerin, uric acid, and ALT were significantly higher in overweight and obese children than in the control group (p<0.03-p<0.00002). In contrast, the lipid profile did not differ between groups. An abnormal amino acid profile in overweight and obese pre-pubertal children, accompanied by elevated ALT and UA observed in the studied cohort, may suggest early metabolic disturbances that can potentially lead to metabolic syndrome, or MAFLD, and increased cardiovascular risk.

Vascular and Myocardial Structure and Function in Adolescents with Type 1 Diabetes: The CARDEA Study

Introduction. Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We compared risk factors (blood pressure (BP) and dyslipidemia) and early markers of CVD between adolescents with and without type 1 diabetes and explored effect modification by sex. Methods. Cross-sectional study using data from the CARdiovascular Disease risk in pEdiatric type 1 diAbetes (CARDEA) study. We recruited 100 adolescents with type 1 diabetes at the Sainte-Justine University Hospital Center and 97 adolescents without diabetes (14–18 years). We measured arterial stiffness by carotid-femoral pulse wave velocity, endothelial function by brachial artery flow-mediated dilation test, as well as left ventricular (LV) mass, papillary mass, and wall thickness by cardiac MRI. We used multivariable linear regression models to assess the impact of type 1 diabetes on each outcome adjusting for age, sex, ethnicity, adiposity, and familial income. Results. Adolescents with type 1 diabetes had 0.21 standard deviations (SD) (95% CI: 0.04; 0.38) higher diastolic blood pressure z-score (zDBP), 0.21 mmol/L (95% CI: 0.02; 0.40) higher low-density lipoprotein cholesterol (LDL-c) levels, and 17% (95% CI: 4; 29) higher triglyceride levels and lower endothelial function based on acceleration (−77.4 cm/s2, 95% CI: −133.1; −21.6) compared with adolescents without diabetes. Girls with type 1 diabetes had higher systolic blood pressure z-score (zSBP), and boys with type 1 diabetes had lower LV mass and wall thickness compared to healthy peers. Conclusions. In addition to higher BP and abnormal lipid profiles, adolescents with type 1 diabetes present endothelial dysfunction and alterations in cardiac structure (in boys) compared to adolescents without diabetes, suggesting that CVD prevention should be incorporated into type 1 diabetes management early in the disease.

DNA methylation and 28-year cardiovascular disease risk in type 1 diabetes: the Epidemiology of Diabetes Complications (EDC) cohort study

BackgroundThe potential for DNA methylation (DNAm) as an early marker for cardiovascular disease (CVD) and how such an association might differ by glycemic exposure has not been examined in type 1 diabetes, a population at increased CVD risk. We thus performed a prospective epigenome-wide association study of blood leukocyte DNAm (EPIC array) and time to CVD incidence over 28 years in a childhood-onset (< 17 years) type 1 diabetes cohort, the Pittsburgh Epidemiology of Diabetes Complications (EDC) study (n = 368 with DNA and no CVD at baseline), both overall and separately by glycemic exposure, as measured by HbA1c at baseline (split at the median: < 8.9% and ≥ 8.9%). We also assessed whether DNAm-CVD associations were independent of established cardiometabolic risk factors, including body mass index, estimated glucose disposal rate, cholesterol, triglycerides, blood pressure, pulse rate, albumin excretion rate, and estimated glomerular filtration rate.ResultsCVD (first instance of CVD death, myocardial infarction, coronary revascularization, ischemic ECG, angina, or stroke) developed in 172 participants (46.7%) over 28 years. Overall, in Cox regression models for time to CVD, none of the 683,597 CpGs examined reached significance at a false discovery rate (FDR) ≤ 0.05. In participants with HbA1c < 8.9% (n = 180), again none reached FDR ≤ 0.05, but three were associated at the a priori nominal significance level FDR ≤ 0.10: cg07147033 in MIB2, cg12324048 (intergenic, chromosome 3), and cg15883830 (intergenic, chromosome 1). In participants with HbA1c ≥ 8.9% (n = 188), two CpGs in loci involved in calcium channel activity were significantly associated with CVD (FDR ≤ 0.05): cg21823999 in GPM6A and cg23621817 in CHRNA9; four additional CpGs were nominally associated (FDR ≤ 0.10). In participants with HbA1c ≥ 8.9%, DNAm-CVD associations were only modestly attenuated after cardiometabolic risk factor adjustment, while attenuation was greater in those with HbA1c < 8.9%. No pathways were enriched in those with HbA1c < 8.9%, while pathways for calcium channel activity and integral component of synaptic membrane were significantly enriched in those with HbA1c ≥ 8.9%.ConclusionsThese results provide novel evidence that DNAm at loci involved in calcium channel activity and development may contribute to long-term CVD risk beyond known risk factors in type 1 diabetes, particularly in individuals with greater glycemic exposure, warranting further study.

259-OR: Arterial Stiffness and Diabetes-Associated Complications in the SEARCH for Diabetes in Youth Study

Arterial stiffness and vascular complications contribute to the burden of disease in diabetes, and it is unclear how they relate to each other. The relationship between arterial stiffness, an early marker of cardiovascular disease, and microvascular complications has not been comprehensively assessed in youth-onset diabetes. This study included 1226 individuals (mean age 22.8 years, 58% female, 53% Non-Hispanic White, 22% Non-Hispanic Black, 20% Hispanic) with type 1 (n=999) and type 2 (n=227) diabetes. Arterial stiffness measures included pulse wave velocity for carotid-femoral (PWVcf), carotid-radial (PWVcr), and femoral-foot (PWVff) and augmentation index (AIx). Microvascular complications included diabetic kidney disease, peripheral neuropathy, and retinopathy. Logistic regression was used to analyze associations between arterial stiffness and microvascular complications. PWVcf and AIx were associated with higher odds of having any microvascular complication, p&amp;lt;0.05 (Table). PWVcf, PWVff, and AIx were each associated with diabetic kidney disease. PWVcf was associated with peripheral neuropathy and PWVcr and AIx were associated with retinopathy. Arterial stiffness is related to diabetes microvascular complications in youth-onset diabetes. Future work will determine whether arterial stiffness is a marker for early onset and progression of microvascular complications. Disclosure R.Brady: None. L.Sancrainte: None. A.S.Shah: None. E.M.Urbina: Advisory Panel; Astellas Pharma Inc., Other Relationship; Targus Medical, Inc. Z.Gao: None. L.M.Dolan: None. D.Dabelea: None. E.Lustigova: None. A.K.Mottl: Advisory Panel; Bayer Inc., Chinook Therapeutics Inc., Consultant; Bayer Inc., Research Support; Bayer Inc., Alexion Pharmaceuticals, Inc., Pfizer Inc., Boehringer Ingelheim Inc., Calliditas. C.Pihoker: None. K.Reynolds: Research Support; Novartis Pharmaceuticals Corporation. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK127208-01); Centers for Disease Control and Prevention (00097, DP-05-069, DP-10-001)

#5773 URINARY OROSOMUCOID IS ASSOCIATED WITH ALL-CAUSE MORTALITY IN THE GENERAL POPULATION

Abstract Background and Aims Urinary albumin excretion (UAE) is considered a risk factor for cardiovascular (CV) disease and all-cause mortality, but the pathophysiological mechanisms are not known, and studies are not consistent with regards to the effect of pharmacological UAE reduction on endpoints. Another protein, orosomucoid (41-43kDa), is a non-specific acute inflammatory protein and is a part of the glycolax that covers the endothelium. Under normal conditions the concentration in urine is low, but a marked increase is demonstrated under both acute and chronic inflammation and in cardiovascular disease. In patients with diabetes urinary orosomucoid excretion (UOE), was an independent predictor of all-cause and cardiovascular mortality even in normoalbuminuric patients. In this longitudinal study, our aim was to study both UAE and UOE in a middle-aged cohort from the general population. We hypothesized that UOE, but not UAE, is an independent predictor for all-cause mortality. Method The Tromsø Study is a population-based, prospective study with repeated health surveys of inhabitants of Tromsø (Northern Norway), and the first took place in 1974. From the sixth wave (Tromsø6, 2007/2008) we included all participants with urinary samples. Follow-up time was assigned from the attendance date of Tromsø6 until 31.08.2022. The associations between urinary markers and all-cause mortality were assessed by Cox regression analysis. Results The cohort included 7180 subjects (4094 women and 3086 men) with a mean (SD) age 63.5 (±9.2) years. Median urinary orosomucoid to creatinine ratio (UOCR) was 0.44 g/g, median albumin to creatinine ratio (UACR) was 0.36 mg/mmol, mean (SD) eGFR was 88.1 (±14.0) ml/min/1.73m² and 1689 died during follow-up. UOCR was independently associated with all-cause mortality (hazard ratio (HR) per g/g increase 1.02, 95% CI 1.01,1.03, p&amp;lt;0.001) adjusted for sex, age, UACR, eGFR and CV risk factors (diabetes, hypertension, smoke, cholesterol, BMI). The HR for UOCR above vs. below median adjusted for the same variables was 1.13 (95% CI 1.01, 1.27, p = 0.032). UACR above median with the same adjustments was not associated to all-cause mortality (hazard ratio 1.04, 95%CI 0.93, 1.15, p = 0.484). Conclusion In this study, we showed for the first time that UOE, but not UAE, was an independent predictor of all-cause mortality in a large cohort from the general population. Thus, UOE may be an earlier marker of vascular damage than UAE. Whether UOE is clinically useful as an early marker of CV disease should be further studied.

Dumansız Tütün "Maraş Otu"nun Homosistein ve Kardiyovasküler Risk Parametreleri Üzerine Etkileri

Objective: This study aims to investigate the relationship between smokeless tobacco (Maras powder) and cigarette consumption with homocysteine, Paraoxonase-1 (PON-1), Arylesterase (ARE), and Lipoprotein-a (Lp (a)), which are known as risk factors for cardiovascular diseases.&#x0D; Material and Methods: The individuals included in the study were divided into three groups as Maras powder users (n = 38), cigarette smokers (n = 38), and healthy volunteers who did not use either tobacco group (n = 38). Serum homocysteine, PON-1, ARE, and Lp (a) levels of all participants were examined.&#x0D; Results: When the groups are compared, the highest homocysteine level was in the Maras powder group. While the difference between the control group and the Maras powder group was statistically significant, the difference between the control and smokers groups was statistically insignificant. Although PON values were lower in both the Maras powder and smokers groups than the control group, the difference was significant only in the smoking group. ARE was significantly lower, and Lp (a) was significantly higher in both tobacco smokers groups compared to the control group.&#x0D; Conclusion: Serum homocysteine, PON-1, ARE, and Lp (a) level are associated with Maras powder use. Homocysteine may be a useful early marker for cardiovascular disease in those who use Maras powder.

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study.

Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.

Abstract 10043: Plasma Metabolite Dimethylguanidino Valeric Acid and Risk of Incident Coronary Heart Disease Among Women

Introduction: Circulating dimethylguanidino valeric acid (DMGV) has been related to visceral adiposity and unhealthy obesogenic lifestyle factors, and recently emerged as an early marker of cardiovascular disease. Hypothesis: We tested whether circulating DMGV was associated with the risk of coronary heart disease (CHD) among women. We also investigated obesogenic diet/lifestyle factors and biomarkers associated with higher DMGV levels. Methods: This prospective nested case-control study included 1518 women (759 incident cases of fatal CHD and nonfatal myocardial infarction and 759 controls) from the Nurses’ Health Study (NHS). Incident cases of CHD were identified over 10-14 years of follow-up time. Obesogenic lifestyle factors (such as physical inactivity and dietary intakes), adiposity, and cardiometabolic abnormalities (hypertension, dyslipidemia, and diabetes) were assessed in the NHS and the Women's Lifestyle Validation Study (WLVS; n=723). Results: In the NHS, higher plasma DMGV levels were related to greater risk of CHD (P for linear relation=0.007) after controlling for demographic factors, family history of myocardial infarction, and postmenopausal hormone. Compared with women in the lowest quartile of DMGV levels, those in the highest quartile had a relative risk (RR) of 1.70 (95% CI: 1.25, 2.31) for CHD. The RR in the highest quartile was attenuated after controlling for obesogenic factors and adiposity. Obesogenic diet/lifestyle factors, adiposity, altered adipokine levels, and cardiometabolic abnormalities were significant factors related to higher plasma DMGV levels in the NHS and WLVS. Conclusions: Circulating DMGV may be a significant metabolite related to obesogenic diet quality, lifestyles, and cardiometabolic abnormalities among women. High DMGV levels were associated with an increased risk of incident CHD among women.

Oxidative Stress and Early Cardiovascular Disease in Youth With Type 1 Diabetes: The CARDEA Study

Oxidative stress is implicated in the pathophysiology of cardiovascular disease (CVD) in individuals with type 1 diabetes (T1D), but little is known about mechanisms in youth. We examined associations between oxidative stress and early markers of CVD in youth with and without TID.

Increased Platelet Reactivity and Proinflammatory Profile Are Associated with Intima-Media Thickness and Arterial Stiffness in Prediabetes.

Alterations of glucose homeostasis are associated with subclinical vascular damage; however, the role of platelet reactivity in this process has not been fully investigated. In this cross-sectional study, we evaluated the correlation between markers of platelet reactivity and inflammation and markers of vascular disease in subjects with prediabetes. Markers of platelet reactivity such as 11-dehydro-thromboxane B2 urinary levels (11-dh-TXB2) and mean platelet volume (MPV) and inflammatory indexes such as platelet-to-lymphocyte ratio (PLR) were evaluated in subjects with prediabetes (n = 48), new-onset type 2 diabetes (NODM, n = 60) and controls (n = 62). Furthermore, we assessed the cardiovascular risk profile of the study population with arterial stiffness and quality intima–media thickness (qIMT). Subjects with prediabetes and NODM exhibited higher 11-dh-TXB2 urinary levels and MPV and a proinflammatory profile with an increased PLR, high-sensitivity C-reactive protein, ferritin and fibrinogen. Furthermore, after multiple regression analyses, we found that urinary 11-dh-TXB2 was one of the major determinants of IMT and arterial stiffness parameters. In conclusion, subjects with prediabetes exhibit increased platelet reactivity as well as a proinflammatory profile. Furthermore, this condition is associated with early markers of cardiovascular disease.

Early Markers of Cardiovascular Disease Associated with Clinical Data and Autosomal Ancestry in Patients with Type 1 Diabetes: A Cross-Sectional Study in an Admixed Brazilian Population.

Patients with type 1 diabetes (T1D) have a higher risk of developing cardiovascular disease (CVD), which is a major cause of death in this population. This study investigates early markers of CVD associated with clinical data and autosomal ancestry in T1D patients from an admixed Brazilian population. A cross-sectional study was conducted with 99 T1D patients. The mean age of the study sample was 27.6 years and the mean duration of T1D was 14.4 years. The frequencies of abnormalities of the early markers of CVD were 19.6% in the ankle-brachial index (ABI), 4.1% in the coronary artery calcium score (CACS), and 5% in the carotid Doppler. A significant percentage of agreement was observed for the comparison of the frequency of abnormalities between CACS and carotid Doppler (92.2%, p = 0.041). There was no significant association between the level of autosomal ancestry proportions and early markers of CVD. The ABI was useful in the early identification of CVD in asymptomatic young patients with T1D and with a short duration of disease. Although CACS and carotid Doppler are non-invasive tests, carotid Doppler is more cost-effective, and both have limitations in screening for CVD in young patients with a short duration of T1D. We did not find a statistically significant relationship between autosomal ancestry proportions and early CVD markers in an admixed Brazilian population.

Abstract 10371: Trajectories of Glycemic Control and Early Markers of Cardiovascular Disease in Canadian Adolescents with Type 1 Diabetes: The Cardea Study

Introduction: Adequate glycemic control can prevent or delay complications of diabetes. Little is known about the role of glycemic control trajectories on early markers of CVD in youth. Hypothesis: Poor glycemic control trajectory will be associated with increased vascular ageing and altered myocardial structure. Methods: Cross-sectional study of 100 youth with T1D recruited at Sainte-Justine Hospital, Canada. Trajectories of glycated hemoglobin (Hb A1c ) were estimated with group-based trajectory modelling, using 3 to 6 values retrieved from patients’ medical records over the preceding year. Vessel stiffness was assessed by pulse-wave velocity (PWV) and distensibility by velocity time integral (VTI) and acceleration during a brachial flow-mediated dilation test. Cardiac magnetic resonance assessed ejection fraction, left ventricular mass indexed by height (LVMH), papillary mass and wall thickness. Linear regression models were estimated between Hb A1c trajectory group and each CVD marker, with age, sex, ethnicity and duration of diabetes at baseline as covariates. Results: Mean age was 16.4 yrs (SD=1.3) and median diabetes duration 6.1 yrs (IQR=3.4-10.4). Forty-eight percent were girls, 63% were White and 43% had overweight/obesity. Three trajectories of Hb A1c were identified ( Figure ). Compared with the optimal trajectory, belonging to the high Hb A1c trajectory was associated with a lower ejection fraction (beta [95% CI]: -2.1% [-6.2; 2.0]), LVMH (-6.3 g/m [-15.4; 2.8]) and papillary mass (-1.2 g [-2.2; -0.2]). Youth in the high Hb A1c trajectory displayed higher PWV (0.2 m/s [-0.4; 0.8]) and lower VTI (-2.9 cm/s 2 [-8.4; 2.7]) and acceleration (-63.6 cm/s 2 [-188.7; 61.5]) compared with the optimal trajectory group. Conclusions: Poor glycemic control is linked to increased vascular ageing and a lower myocardial mass in youth with T1D, which is consistent with our prior finding that youth with T1D exhibit a lower myocardial mass than healthy controls.

Role of Physical Activity and Sedentary Behavior on Early Markers of Cardiovascular Disease in Adolescents With Type 1 Diabetes: The CARDEA Study

Modifiable determinants of cardiovascular disease (CVD) remain largely understudied in pediatric type 1 diabetes (T1D). We estimated associations of physical activity and sedentary behavior with markers of CVD in adolescents and tested whether associations differed based on T1D status.

Detecting Early Markers of Cardiovascular Disease in High-Risk Women With and Without PCOS

Women with polycystic ovary syndrome (PCOS) are at increased risk of cardiovascular disease (CVD). Currently, there is a need screen for early CVD in high-risk women with and without PCOS to effectively assess, manage, and prevent morbidity from CVD.

High glomerular filtration rate is associated with impaired arterial stiffness and subendocardial viability ratio in prediabetic subjects

Background and aimsHigh glomerular filtration rate (HGFR) is associated with cardiovascular damage in the setting of various conditions such as obesity and diabetes. Prediabetes was also associated with increased GFR, however, the association between prediabetes, HGFR and cardiovascular damage has not been investigated. In this study, we investigated the association between HGFR and early markers of cardiovascular disease in subjects with prediabetes. Methods and resultsAugmentation pressure (Aug), augmentation index (AIx), subendocardial viability ratio (SEVR), pulse wave velocity (PWV), intima-media thickness (IMT) and estimated GFR (eGFR) were evaluated in 230 subjects with prediabetes. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration formula. HGFR was defined as an eGFR above the 75th percentile.Prediabetic subjects were divided into two groups according to presence/absence of HGFR: 61 subjects with HGFR and 169 subjects without HGFR. Subjects with HGFR showed higher Aug, AIx and lower SEVR compared with prediabetic subjects with lower eGFR (14.1 ± 7.2 vs 10.8 ± 6.2, 32.9 ± 12.7 vs 27.6 ± 11.7, 153.5 ± 27.8 vs 162 ± 30.2, p < 0.05). No differences were found in PWV and IMT values between the two groups. Then, we performed multiple regression analysis to test the relationship between Aug, SEVR and several cardiovascular risk factors. In multiple regression analysis Aug was associated with age, systolic blood pressure (BP), HOMA-IR and eGFR; the major determinants of SEVR were systolic BP, HOMA-IR and eGFR. ConclusionSubjects with prediabetes and HGFR exhibited an increased Aug, AIx and a reduced SEVR. These alterations are associated with eGFR, insulin resistance and systolic BP.

Cardiovascular Disease, Hypogonadism and Erectile Dysfunction: Early Detection, Prevention and the Positive Effects of Long-Term Testosterone Treatment: Prospective Observational, Real-Life Data.

PurposeErectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD.MethodsSeventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015.ResultsIn hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001).ConclusionIn hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.

Waist Circumference is a Significant Indicator of the Atherogenic Index of Plasma and as an Early Marker for Cardiovascular Disease

Waist Circumference is a Significant Indicator of the Atherogenic Index of Plasma and as an Early Marker for Cardiovascular Disease

Is There Any Association Between Uric Acid to High-density Lipoprotein Cholesterol Ratio and Erectile Dysfunction?

Objective: Elevated uric acid (UA) and low levels of high-density lipoprotein (HDL) cholesterol are associated with cardiovascular events and mortality. Erectile dysfunction (ED) has been considered an early marker of cardiovascular disease (CVD). Therefore, this study aimed to investigate the uric acid/ HDL ratio (UHR) as a nowel marker in patients with ED. Materials and Methods: The study included 147 patients with a mean age of 50 years (range 32-76 years). Retrospective analyses were performed on the patients who were admitted to urology outpatient clinics. The laboratory parameter results were retrieved from the hospital medical records, and the UHR value was calculated. Patients were categorized into three groups according to the International Index of Erectile Function (IIEF) score. UHR was compared between groups, and its predictive value was evaluated using regression analysis and ROC curve analysis. Results: Age was found to be significantly different in all three groups (Groups 1-2, p=0.001; Groups 1-3, p=0.000; Groups 2-3, p=0.001). It was observed that the degree of ED increased with age. The values of UA and HDL were similar in all groups (p&gt;0.05). In contrast, the UHR value was statistically significantly higher 0.15 (0.083-0.288, p =0.047) in the moderate-severe ED (Group 3). ROC curve analyses revealed that UHR predicted severe ED (IIEF 5-11) with 42.9% sensitivity and 87.3% specificity (AUC:0.66, CI 95% 0.538-0.781, p=0.019). Conclusion: UHR may serve as a severe ED indicator in patients admitted to the cardiology outpatient clinic since it has a significant association with a low IIEF score.

Endothelial dysfunction as an early marker for cardiovascular disease in patients with chronic kidney disease on maintenance hemodialysis

Background Cardiovascular disease is a major cause of mortality in dialysis patients. Magnesium (Mg) level has been found to correlate positively with endothelial function. Moreover, it is suggested that low Mg is associated with increased all-cause and cardiovascular mortality in hemodialysis (HD) patients. Objective Therefore, this study was conducted to define the relationship between Mg level and endothelial dysfunction as an early marker of cardiovascular disease in patients with end-stage renal disease (ESRD) on maintenance HD. Patients and methods In this cross-sectional study, 85 patients with ESRD on maintenance HD were included. Serum angiopoietin-2 (Ang-2) level, brachial flow-mediated dilation (BFMD), and carotid intima-media thickness (CIMT) were measured as indicators of endothelial dysfunction and atherosclerosis. Patients’ serum Mg levels were measured. All data are presented as mean and SD or percent frequency. Statistical tests, mainly t test, Mann–Whitney test, or χ 2 test, are used in comparison between groups for quantitative and qualitative data correspondingly. Results Our results indicate that Ang-2 and BFMD are associated and can predict atherosclerosis early in HD patients (P=0.036 and 0.006, respectively). When the patients were divided according to their serum Mg, there was no significant difference regarding Ang-2, BFMD, and CIMT between the two groups. Conclusion This study demonstrated that endothelial dysfunction markers such as Ang-2 and BFMD are associated and can predict atherosclerosis early in HD patients. On the contrary, Mg might not affect neither endothelial function (FMD and Ang-2) nor CIMT as a marker of atherosclerosis in ESRD on HD.

Associations Of Fitness, Physical Activity, And Fatness With A New Index Of Endothelial Function

Current methods for assessing endothelial function, an early marker of cardiovascular disease (CVD), are either invasive or use noninvasive methods that are highly operator dependent or require nonreusable expensive probes, thereby limiting their use for CVD risk prediction. PURPOSE: To assess the relationship of fitness, physical activity (PA), and fatness, each a CVD risk factor, with a novel measure of endothelial function. METHODS: This was a cross-sectional data analysis in adults recruited for a study examining the clinical utility of a new device that measures endothelial vasodilator function using a standard BP cuff. The resulting EnDys score is derived from direct calibrated measurements of brachial arterial compliance throughout the entire transmural pressure curve during a staged cuff release after 5 minutes of upper arm occlusion. A higher score means better endothelial function. Fitness was assessed by a 6-minute walk test (6MWT). Self-report of PA was assessed by the Rapid Assessment of Physical Activity tool. Body mass index (BMI) was used as a marker of general fatness and waist circumference (WC) as a marker of abdominal fatness. RESULTS: In all 153 subjects, 51% were female, 7% were smokers, 7% had CVD, and 10% had type 2 diabetes. The mean ± SD for age was 49.3 ± 17.2, EnDys was 80.8 ± 30.4, BMI was 29.3 ± 6.9 kg/m2, WC was 37.5 ± 6.7 inches, and 6MWT was 495.4 ± 113.5 meters. EnDys was higher in females, 87.6 ± 30.5, vs males, 73.8 ± 28.9, p<0.01. EnDys did not differ by being sedentary, 80.8 ± 27.6, or active, 81.0 ± 33.0, p=0.97. Using bivariate analysis, a lower EnDys was associated with higher BMI, r=-0.23, higher WC, r=-0.33, lower 6MWT, r=0.32, and older age, r=-0.20, all p<0.02 or less. In a multivariate model, 6MWT (β=-0.06, p<0.01), WC (β=-1.02, p<.02), and sex (female, β=6.9, p<0.01) were each independently associated with EnDys. There were no interactions for sex with 6MWT and WC. CONCLUSION: Among measures of fitness, PA, and fatness, and in both sexes, a lower walking distance and a higher waist circumference were each independently associated with a lower EnDys, indicating worse endothelial function. A next logical step is to assess if EnDys improves with interventions like exercise and weight loss, thereby providing a novel and relatively simple way to track progress towards CVD risk reduction.