Higher Prevalence Of Subjects Research Articles

Obstructive Sleep Apnea in Metabolic Syndrome.

The metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is associated with obstructive sleep apnea (OSA). OSA is a major contributor to cardiac, cerebrovascular, and metabolic disorders as well as to premature death. This cross-sectional study was done for 1 year in 103 patients of MetS diagnosed by the International Diabetes Federation criteria. All patients were subjected to the STOP-Bang questionnaire, and they were classified into low, intermediate, and high risks depending on the score. Patients falling in intermediate-high risk (score 3-8) were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea-hypopnea index [AHI] ≥5) and were considered Group I. Patients with STOP-Bang score ≤2 or score ≥3 with AHI <5 were considered Group II (non-OSA). Out of 103 MetS patients enrolled in the study, only 70 (68.0%) were diagnosed with OSA, so the prevalence of OSA in MetS patients was 68%. The majority of the OSA cases had moderate-to-severe OSA (68.5%), and only 31.4% had mild OSA. The age of patients enrolled in the study ranged between 29 and 78 years, and the mean age of patients was 54.8 ± 9.4 years. Out of 103 MetS enrolled in the study, 59 (57.3%) were male and the rest were female, so the prevalence of severe OSA was higher in males than in females. The prevalence increases with an increase in age groups. Weight, body mass index (BMI), circumference, and waist circumference (WC) of cases of OSA were found to be significantly higher as compared to that of non-OSA. An incremental trend of increase in weight, BMI, neck circumference, and WC was observed with the increase in the severity of OSA. Patients of OSA as compared to non-OSA had significantly increased WC, blood pressure (BP), fasting, postprandial, random blood sugar, and triglyceride (TG) levels. A trend of increase in WC, BP fasting, postprandial, random blood sugar, and TG levels was associated with an increase in the severity of OSA. Snoring and daytime sleepiness were observed in a significantly higher proportion of OSA cases as compared to non-OSA cases. This study shows that OSA has a high prevalence in subjects with MetS. A high index of clinical suspicion is required for early diagnosis.

Lipid profile of postmenopausal women

Objectives: The main objectives of the research are to examine the incidence of hyperlipoproteinemia in postmenopausal women and to determine the differences in lipid profile considering age, duration of menopause and body mass index in postmenopausal women. Respondents and methods: The research is structured as cross-sectional with historical data. The research used data collected during regular check-ups in primary health care clinics in Osijek Health Center from November 2021 to March 2022. Collected data: demographic data, information on the duration of menopause, body mass, body height, body mass index, values of total, LDL, HDL cholesterol and triglycerides, and data on associated diseases. Results: 98 postmenopausal women were included in the research, of which over 50% had elevated total and LDL cholesterol values, and 39.8% had elevated triglyceride values. Subjects aged 45 to 65 years and subjects with a duration of menopause of 10 or more years had significantly higher values of total and LDL cholesterol while no difference was observed in the lipid profile with regard to the body mass index. Using the SCORE2 table, it was estimated that 65% of the subjects had a very high cardiovascular risk, and only 6% of the subjects achieved the target values of LDL cholesterol in accordance with the cardiovascular risk. Conclusion: There is a very high incidence of hyperlipoproteinemia in postmenopausal women, and the age and duration of menopause have an impact on the poorer achievement of the target values of the lipid profile, while the body mass index showed no impact. Given the high prevalence of subjects with a very high cardiovascular risk (SCORE 2 tables), intensive interventions are needed at all levels of health care, especially at the primary level of health care, which include non-pharmacological and pharmacological methods of treating hyperlipoproteinemia.

Assessment of dyspneic sensation in patients with type 2 diabetes.

Individuals with type 2 diabetes (T2D) should be considered a susceptible group for pulmonary dysfunction. So, we aimed to evaluate the sensation of breathlessness in this population by administering two well-validatedquestionnaires. This is a crosssectional study with 592 people without known respiratory disease (353 with T2D) who answered the modified Medical Research Council (mMRC) questionnaire. In addition, 47% also responded to the St George Respiratory Questionnaire, a specific instrument designed to be applied to patients with obstructive airway disease. Patients with T2D showed a higher mMRC score in comparison to the control group [1.0 (0.0 - 4.0) vs. 0.0 (0.0 - 4.0), p<0.001]. A higher prevalence of subjects with mMRC ≥2 was observed in T2D that in the control group (20.2% vs. 11.6%, p=0.004). Participants with T2D and mMRC ≥2 showed a higher HbA1c (8.2 ± 1.6% vs. 7.8 ± 1.6%, p=0.048), longer T2D evolution and higher prevalence of nephropathy. In the multivariate analysis, the presence of T2D [OR=1.95 (1.19 to 3.22), p=0.008] in all the population, and HbA1c [OR=1.19 (1.01 to 1.41), p=0.034] and the presence of diabetic nephropathy [OR=2.00 (1.14 to 3.52), p=0.015] in patients with T2D, predicted a mMRC ≥2. Finally, no differences were observed regarding the SGRQ score among groups. Patients with T2D showed a greater sensation of dyspnea than subjects with normal carbohydrate metabolism. Risk factors included poor metabolic control and the presence of renal disease.

Obstructive Sleep Apnea in Developmental Age: 22-Item Pediatric Sleep Questionnaire for an Observational Descriptive Investigation.

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3-4-5 years, followed by the 6-7-8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3-8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS.

Association of socioeconomic status with hypertension prevalence and control in Nanjing: a cross-sectional study

BackgroundThe role of socioeconomic status (SES) on hypertension prevalence and hypertension control has gotten much attention but with conflicting results. This paper aimed to quantify the association of SES with both hypertension prevalence and hypertension control rate in Nanjing, China.MethodsA community-based cross-sectional study was conducted using multistage random sampling on 60,283 adults aged more than 18 years between March 2017 and June 2018. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or self-reported diagnosis of hypertension or respondent's report of taking antihypertensive medications. The controlled hypertension was defined by systolic BP < 140 mmHg and diastolic BP of < 90 mmHg among the subjects that self-reported exhibiting hypertensive and taking antihypertensive medications. The associations between SES with hypertension prevalence and hypertension control were quantified using generalized mixed model regression analysis and reported as odds ratios (ORs) and 95% confidence interval (CI).ResultsThere was a high prevalence of subjects with primary educational level (49.6%) or unemployed and retired (49.5%) or lower annual household income level (44.9%) in each SES group, respectively. After adjustments for potential confounding factors, there were higher odds of hypertension among those with primary educational level (OR = 1.56), but lower odds for controlled BP (OR = 0.51). Higher odds of hypertension could be found among unemployed and retired, and higher odds of controlled BP was observed in the mental laborers or students (OR = 1.30), compared with the other categories, respectively. The lower-income group was more likely to be hypertensive (OR = 1.35) and less likely to have controlled hypertension (OR = 0.73).ConclusionSocioeconomic status played an important role in hypertension prevalence and hypertension control among adults in Nanjing, China. Strategies for hypertension prevention and control should especially focus on people in the vulnerable lower SES groups.

Open Issues in the Transition from NAFLD to MAFLD: The Experience of the Plinio Study.

Metabolic associated fatty liver diseases (MAFLD) definition was proposed to identify fatty liver condition associated to metabolic disorders and to replace non-alcoholic fatty liver disease (NAFLD). We aimed to explore the effect of the application of the new MAFLD criteria on a pre-existing cohort of NAFLD patients. The consequences of the reclassification were investigated by applying the MAFLD criteria to a prospective cohort (The Plinio Study) of dysmetabolic patients examined for the presence of NAFLD. In the Plinio cohort, 795 patients had NAFLD and 767 of them (96.5%) were reclassified as MAFLD patients. Out of these, 94.9% had overweight/obesity or diabetes, while the remaining were lean and had metabolic dysregulation defined by the presence of at least two metabolic risk abnormalities. By contrast, 3.5% of the NAFLD patients were reclassified as no-MAFLD due to the absence of overweight/obesity, diabetes, or metabolic risk abnormalities. The only significant difference between the NAFLD and MAFLD groups was the higher prevalence of subjects with BMI ≥ 25 kg/m2 in the latter (88.6% vs. 92%; p = 0.018). In the cohort, 68 subjects were defined as “lean NAFLD”. Of these, 40 were reclassified as MAFLD and 28 as no-MAFLD. In conclusion, when applying MAFLD criteria to the Plinio cohort, there is a substantial overlap between NAFLD and MAFLD diagnosis. However, some specific subgroups of patients, such as those currently defined as lean NAFLD, were excluded by the new MAFLD definition.

A cross-sectional study to assess the risk factors for the presence and severity of obstructive sleep apnea among patients with type 2 diabetes mellitus at a tertiary care hospital, Gangtok

Background and Objectives: Diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common disorders that not only often coexist but also have a bidirectional association where each condition exacerbates the other. The present study was performed to ascertain the occurrence and predictors of risk factors of OSA in patients with type 2DM. Materials and Methods: A cross-sectional hospital-based study recruiting 164 patients for over 2 months was conducted, in which each diabetic patient was assigned to complete a questionnaire on various variables followed by a general physical examination for associated comorbidities diabetic complications (neuropathy, nephropathy, and retinopathy). Their fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded, following which they were administered and assessed using Berlin Questionnaire and Epworth Sleepiness Score for risk category and daytime sleepiness. Patients with already diagnosed OSA including ones receiving treatment for it were excluded from the study. Results: Of the 164 diabetic patients recruited in the study, 64 (39%) were at high risk for OSA in contrast to the 100 (61%) who were at low risk for OSA. Neck circumference, waist circumference, presence of hypertension and more than one comorbidities along with patients who experienced witnessed apnea at least three times a week, excessive daytime sleepiness, and habitual snorers found to be significant risk factors and practices in posing DM patients at a higher risk for OSA. Patients with body mass index ≥25 were more likely to have a high risk of OSA. FBG and HbA1c were not significant risk factors for OSA. Conclusions: OSA has a high prevalence in subjects with T2DM which reinforces the clinicians to remain observant for signs and symptoms of OSA in diabetic patients and monitor their compliance in terms of weight management, diet control, and medication adherence.

Commentary: Obesity: The “Achilles heel” for COVID-19?

Commentary: Obesity: The “Achilles heel” for COVID-19?

Health profile of older adults assisted by the Elderly Caregiver Program of Health Care Network of the City of São Paulo.

ABSTRACTObjective To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo.Methods Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects’ consent.Results Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women.Conclusion The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.

Perfluoroalkyl substances and bone health in young men: a pilot study.

Perfluoroalkyl substances (PFAS) are a class of endocrine-disrupting chemicals. Toxicological studies indicate that PFAS accumulate in bone tissue and could cause alterations in bone metabolism. The primary objective of this study was to examine the association between PFAS exposure and bone status in a cohort of young men resident in a well-defined area with high PFAS environmental pollution. Bone status was assessed in 117 subjects aged 18-21 by quantitative ultrasound (QUS) at the heel. Subjects underwent an accurate medical visit. Socio-demographic characteristics, lifestyle, and medical histories were collected. We also verified the interaction between PFAS and hydroxyapatite by computational modelling. The organic anion-transporting peptide (OATP), the putative transporter of PFAS, was evaluated by qPCR in bone biopsies from femoral heads discarded during arthroplasty in three male subjects. Exposed subjects showed significantly lower stiffness index, which resulted in lower t-score and higher prevalence of subjects at medium-high risk of fracture (23.6%) compared with controls (9.7%). Data from computational modelling suggested that PFOA exhibits a high affinity for hydroxyapatite, since the estimated change in free energy is in the order of that exhibited by bisphosphonates. Finally, we observed consistent expression of OATP1A2 gene in primary human osteoblasts. This is the first study reporting increased osteoporosis risk in young men exposed to PFAS and provide preliminary information on molecular mechanisms that could explain this observation, in agreement with previous studies on animal models and humans. However, these results must be interpreted with caution given the cross-sectional study design and the small number of cases.

To study the prevalence of obstructive sleep apnoea in type 2 diabetes patients in Western Rajasthan, India

Background: Obstructive Sleep Apnoea (OSA) has been too common yet under diagnosed clinical entity. It is associated with the metabolic syndrome, a cluster of cardio-metabolic parameters including central obesity, insulin resistance, hypertension and dyslipidemia. Obesity predisposes to both OSA and disorders in glucose metabolism. There is growing evidence that OSA confers an independent risk of adverse glucose metabolism.Methods: The present study conducted in the Department of Medicine at MDM Hospital attached to Dr. S.N. Medical College, Jodhpur, Rajasthan, India. Participants after understanding the study protocol and procedure, asked to give their written consent for the study. It was a cross sectional hospital based study in patients, screened at Diabetic clinic and those referred from the periphery. Berlin questionnaires and Epworth score are tools to screen for OSA attending the Medicine OPD and IPD, Dr. S. N. Medical College, Jodhpur. 50 patients with type 2 DM and 20 age and sex-matched controls were studied. Randomly selected T2DM subjects of age 20 to 75 years both sex with obesity, BMI&gt;25 kg/m2, clinical history suggestive of OSA, Epworth score&gt;6, Positive Berlin questionnaires were included in the study. Acute and unstable medical condition e.g. CHF, CRF, COPD, Recent stroke, Acute ACS, Pregnant women were excluded.Results: In the study OSA was prevalent in the diabetic population (54%), Mean age of the study population was 54.96±9.35 years. OSA was found to be increased with increasing age with maximum prevalence in ≥60 year’s age group. OSA was more prevalent in the male population (64.29%), in urban population. Snoring, observed sleep apnoea, restless sleep/insomnia, excessive daytime sleepiness and non-refreshing sleep were significantly associated with OSA. (P&lt;0.001). Prevalence of OSA was more in high BMI group (≥35 kg/m2), OSA increased with increase in neck circumference. OSA was more in subjects with uncontrolled diabetes (blood sugar&gt;200 mg/dl), smokers and alcoholics.Conclusions: This study shows that OSA has a high prevalence in subjects with T2DM and identify several factors that may be associated with its presence in the diabetic population. OSA can be usefully and easily assessed in an outpatient setting by using a portable device such as Apnea Link. Clinicians should increase patients' awareness of the signs and symptoms of OSA and refer for sleep studies when appropriate. Once diagnosed, patients should be encouraged to adhere to CPAP treatment in order to halt progression and prevent complications.

Mental Disorders in Subjects with Diabetes: A Systematic Review

Depression has been a common comorbidity and reduces the quality of life, the poor glycemic control and consequently worsens the diabetes course. The goals of this systematic review are searching of a population who have higher mental disorders in type 1 and 2 patients with diabetes and if there is a direct relationship between glycemic control and psychiatric disorders in this population. A total of 2527 references, review and review articles were excluded, 19 scientific studies were selected: 9 cross-sectional studies, 6 prospective observational studies, 3 retrospective observational studies, and 1 case-control study. Depression and anxiety have a high prevalence in subjects with diabetes. Therefore, the relevance of this study is showing that those mental disorders have a direct correlation in both types of diabetes treatments and decrease the quality of life. Also, the rates of depression could be up to three times higher in patients with type 1diabetes and twice as high in individuals with type 2 diabetes compared with the general population. Patients live in fear of complications from diabetes over the long term and also have damage due to the high psychiatric comorbidity of these chronic patients.

Vascular Endothelial Growth Factor-1 Level and Functional Neurologic Recovery after Ischemic Hemispheric Stroke

Background: Vascular endothelial growth factor-1 (VEGF-1) acts as endogeneous angiopoetic and neuroprotective factor. The aim of the study to investigate an interrelationship between VEFG-1 elevation and neurologic recovery in short-term period among patients with ischemic hemispheric stroke. Methods: Seventy eight patients with ischemic hemispheric stroke were included in the study. Neurological impairment at presentation was assessed according National Institute of Health Stroke Scale. The Barthel Index and the modified Rankin Scale (mRS) were used to assess functional disability. Concentrations of VEGF-1 were measured at baseline using ELISA laboratory kit. Results: The total prevalence of hypertension was 100% (78 patients). 79.5% patients had dyslipidemia, 18% were diabetic, 15.4% of the total population was smokers. Among study patient population a total of 19.2% subjects had a past history of ischemic heart diseases in their families and 11.5% had experienced a previous ischemic heart episode. Within 6 month after baseline the favorable neurologic recovery defined as mRS ≤ 2 was found in 64 patients (82.1%). We calculated Modified Rankin Score ≥ 3 in 14 patients (17.9%). Depending on Modified Rankin Score at 6 month (≤ 2 and ≥ 3) we have divided all patients into two sub-groups respectively. We found a higher prevalence of subjects with dyslipidemia (P=0.044), diabetes mellitus (P=0.024), smokers (P=0.025) and as well as those with ischemic heart disease in their family histories (P=0.026) and previous ischemic heart episode (P=0.032) in subgroup with mRS ≥ 3. At baseline VEGF-1 concentration in entire patient cohort was 348.55 pg/ mL (IQR=241.70-493.80 pg/mL). We found higher VEGF-1 level in mRS ≥ 3 vs mRS ≤ 2 population sub-groups (P<0.05). Using multivariate Cox regression analysis we reported that VEGF-1 (increased per 125 pg / mL) and type two diabetes mellitus (present versus absent) were found as independent predictors for favorable neurologic recovery. Conclusion: In Conclusion, We found that VEGF-1 (increased per 125 pg / mL) measured at baseline positively predicts improved neurologic recovery at six month among subjects with acute ischemic stroke who were not enrolled for invasive or thrombolytic strategy. Type two diabetes mellitus (present versus absent) were found as independent predictor for favorable neurologic recovery in follow up period.

Prevalence of Chewing Side Preference in the Deciduous, Mixed and Permanent Dentitions

This study evaluated the prevalence of the chewing side preference (CSP) in the deciduous, mixed and permanent dentitions. Three-hundred subjects were divided in three groups (n = 100): Group 1 - children with deciduous dentition; group 2-children with mixed dentition; group 3 - subjects with permanent dentition. The CSP was determined using a direct method (visual observation) developed by McDonnell et al. (2004). Descriptive statistic was used to observe the prevalence of CSP. The Pearson's Chi-square was used to investigate signicant associations between gender, presence of CSP and preferred side (right/left). Eighty-seven percent of group 1 had a CSP. Eighty-two percent of group 2 had a CSP. Seventy-six percent of group 3 had a CSP. There was no statistically significant association between presence of CSP and gender in all groups. There was no statistically significant association between preferred side (right/left) and gender in all groups. There is a higher prevalence of subjects in deciduous, mixed and permanent dentition that presented chewing side preference. The early diagnosis of the presence of chewing side preference can prevent the unilateral chewing pattern with prophylactic therapy applied to the first teeth (deciduous).

Symptoms and diagnosis of asthma in a general population – longitudinal results from the SHIP database

Background. Against the background of an increasing prevalence of allergies, the epidemiology of asthma in relation to age is still a matter of debate. To further clarify the prevalence of asthma, asthmatic symptoms, and their change over time within a population sample, we analyzed longitudinal data from the Study of Health in Pomerania (SHIP). Methods. Standardized questionnaires for asthma and asthmatic symptoms were available in 4310 individuals aged 20–75 years. The population sample underwent a 5-year follow-up with 3300 subjects reexamined. The questionnaire evaluated estimates to describe the prevalence in wheeze, chest tightness, shortness of breath, coughing, nocturnal symptoms, and asthma attacks in the past 12 months, current medications, current asthma, and nasal allergies at baseline and its longitudinal net change. Results. The prevalence of current asthma at the baseline study was 1.8% [95% confidence interval (CI 1.4–2.2)], those of nasal allergies 16.7% (95% CI 15.6–17.9). Sixteen percent of asthmatic individuals were not medically treated. The net changes in asthmatic symptoms per 60 months of follow-up ranged between a decrease by 2.0% (chest tightness at night) and an increase by 1.2% (nocturnal attack of coughing). The proportions of subjects with current asthma remained unchanged. The prevalence of current asthma and symptoms was higher in young individuals, whereas the net change over time was slightly increasing at the age of 36 and above. Conclusion. Despite the fact of a high prevalence of subjects complaining of nasal allergies, the overall prevalence of current asthma remained low over time. The prevalence in asthma and asthmatic symptoms as well as its net changes over 5 years were age dependent.

The Relationship between the Transforming Growth Factorβ1 T29C Gene Polymorphism and Left Ventricular Geometry and Function in Hypertensive Subjects

The distribution of the T29C TGFβ1 gene polymorphism was analyzed in 198 hypertensives with left ventricular hypertrophy (LVH) and in 235 hypertensives without LVH. Circulating TGFβ1 levels, procollagen type III levels, microalbuminuria, and left ventricular geometry and function were evaluated in all the hypertensives with LVH subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 was evaluated by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, and left ventricular geometry and function by echocardiography. All groups were comparable for gender, age, and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (P < .05) higher in hypertensives with LVH than hypertensives without LVH TC and CC LVH hypertensives were characterized by a higher prevalence of subjects with microalbuminuria (P < .05 TC and CC versus TT), by increased levels of TGFβ1, procollagen type III, urinary albumin excretion, LVM, LVM/h2.7, and lower values of left ventricular ejection fraction (P < .05 TC and CC versus TT). Our data suggest that T29C TGFβ1 gene polymorphism was associated with clinical characteristics adequate to recognize a subset of LVH hypertensives with a higher severity of hypertension.

Genetic influence on left ventricular hypertrophy in endurance athletes

Exercise activates the renin-angiotensin system (RAS), thus modulating myocardial growth. A long period of training may upregulate of angiotensin-converting enzyme (ACE) so inducing the adaptive left ventricular hypertrophy (LVH), common in endurance athletes. LVH is multifactorial, but genetic factors seems to play the foremost role. Particularly, the presence of double deletion (D) of intron-16 of ACE gene is correlated to highest plasma and tissue enzyme levels, which seems to be associated with more extent of LVH in endurance athletes rather than presence of insertion/deletion (ID) genotype. ACE influences the myocardial cell growth also through the angiotensin type 1 receptors (AGTR1), the major mediator of cardio-circulatory effects of angiotensin II (AngII). It was identified a single nucleotide polymorphism of AGTR1 gene implicated in cardiovascular diseases. A1166C polymorphism is likely related to increased Ang II sensitivity, but its association with LVH remains still undemonstrated. Our aim was to evaluate the role of ACE and AGTR1 polymorphisms in LVH promoting in endurance athletes. A group of 74 male endurance athletes, aged 25-40 years, were enrolled. All participated primarily in isotonic sports, training for at least >10 h/week, for at least 5 years. The ACE genotypes were: DD 35, ID 36 and II in 3. The group II was excluded from the analysis due to its small size. LVMI was significantly higher in group DD rather than in ID. The group DD showed a slightly higher prevalence of subjects with LVH (LVMI >131g/m2) than ID, (p=0.120). No association was found between ACE-DD and LVH. Concerning the role of AGTR1 polymorphism, the highest LVMI was found in 15 athletes with ACE-DD and AGTR1-AC/CC genotypes; the lowest LVMI value was found in ACE-ID and AGTR1-AA, whereas LVMI in subjects with ACE-DD+AGTR1-AA was similar to ACE-ID+AGTR1-AC/CC group. The presence ACE-DD+AGTR1-AC/ CC was strongly associated with LVH(p=0.029). Subjects with LVH showed longer left ventricular isovolumetric relaxation time and higher end-systolic wall stress. LVMI may be greater in the presence of ACE DD and AGTR1-AC/CC polymorphisms.

Optimizing the definition of dippers and nondippers: is a 70–86% full glass empty?

Optimizing the definition of dippers and nondippers: is a 70–86% full glass empty?

Transforming growth factor β1 T29C gene polymorphism and hypertension: Relationship with cardiovascular and renal damage

Distribution of T29C TGFβ1 gene polymorphism was analysed in 260 hypertensive and 134 normotensive subjects. Circulating TGFβ1 and procollagen type III levels, microalbuminuria, left ventricular geometry and function were evaluated in all the hypertensives subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, left ventricular geometry and function by echocardiography were determined. All groups were comparable for gender, age and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (p<0.05) higher in hypertensives than normotensives. TC and CC hypertensives were characterized by a higher prevalence of subjects with microalbuminuria (p<0.001 TC vs TT; p<0.05 CC vs TT), left ventricular hypertrophy (p<0.01 TC and CC vs TT), and by increased levels of procollagen type III (p<0.05 TC and CC vs TT). TC hypertensives were also characterized by a significant increase (p<0.05) of LVM and LVM/h2.7 and of urinary albumin excretion (p<0.05) values than those detectable in TT hypertensives. Our data suggest that T29C TGFβ1 gene polymorphism was associated to clinical characteristics suitable to recognize hypertensives with a higher severity of hypertension.

Association of the mutation for the human carboxypeptidase E gene exon 4 with the severity of coronary artery atherosclerosis

To test the hypothesis that the identification of mutation in the carboxypeptidase E (CPE) gene which leads to marked hyperproinsulinaemia is consistent with a possible role for mutations in CPE in the development of coronary atherosclerosis. The study subjects consisted of 1084 consecutive patients (812 males and 272 females) who will undergo coronary angiography. The severity of coronary atherosclerosis was defined by the Gensini's score system. The proinsulin level was measured using highly sensitive two-site sandwich ELISA methods. Screening for mutations of the 4th exon and exon-intron junctional region of the CPE gene was performed by polymerase chain reaction followed by bidirectional sequencing. Sequencing of the CPE gene exon 4 in 1084 consecutive patients revealed 2 genetic variants, the G-to-A substitution at nucleotide 2855 in exon 4 (synonymous mutation) and A-to-G substitution at nucleotide 2925 in intron 4. Although the proinsulin level was not influenced by the presence of the two point mutation, the Gensini score was significantly influenced by the presence of the A2925G mutant (P = 0.023). Furthermore, we found a higher prevalence of subjects with the A2925G heterozygous mutant among higher Gensini score subjects than it among lower Gensini score subjects, and this difference reached statistical significance (P = 0.006, OR 1.465, 95%CI 1.116-1.924). In addition, the frequency distribution of the G2855A mutant was differed in the higher Gensini score subjects than it in the lower Gensini score subjects belonging to high-risk category as smokers, and the statistical significance was reached (P = 0.043, OR 2.075, 95%CI 1.024-4.207). In the present study, the severity of the coronary atherosclerosis estimated by Gensini score was significantly influenced by the presence of the A2925G mutant and G2855A mutant of the CPE gene, and the exactly mechanism underlying the association needs further study.