Incidence Of Arterial Hypertension Research Articles

THE INFLUENCE OF ANNOYANCE DUE TO AIRCRAFT NOISE ON RENAL HEMODYNAMIC

Objective:Epidemiological evidence suggests a link between noise exposure and increased incidence of arterial hypertension and cardiovascular disease. The kidney as long-term regulator of blood pressure might play a role in the underlying pathophysiological mechanism. The aim of this study is to inv

Association between the living environment and the risk of arterial hypertension and other components of metabolic syndrome.

Metabolic syndrome (MS) is characterized by numerous metabolic risk factors. We investigated the associations between a long-term exposure to ambient air pollution and the residential distance to green spaces (GS) and major roads with the development of arterial hypertension (AH) and some components of MS. These associations were assessed among persons living in private and multi-story houses (MH). We selected 1354 participants for the population study from MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease Program). The exposures to PM10, PM2.5, and NO2 levels were assessed by using the LUR models for Kaunas City. In the participants who lived in MH, the residential distance to a major road closer than 200 m and the residential exposure to PM10 and PM2.5 levels above the median were associated with a higher risk of AH (the adjusted relative risks (RRs), respectively, were 1.41(1.10-1.81), 1.19(1.01-1.42) and 1.27(1.07-1.52)). In these participants, the residential exposure to a PM10 level above the median was associated with a higher risk of reduced high density lipoprotein (RHDL) (RR = 1.46(1.05-2.05)). A negative impact of the traffic air pollutants on the incidence of AH, RHDL cholesterol and high triglyceride levels was observed only in the participants who lived in MH.

The role of shift work and psychosocial stress in development of hemostasis disorders in employees of EMERCOM of Russia

Relevance. Shift work was found to induce pathological processes due to desynchronization of human circadian biorhythms.Intention. To determine incidence of hemostasis disorders and their relation to labour nature in employees of EMERCOM of Russia.Methodology.There were examined 37 employees of EMERCOM of Russia aged 32–58 (42.0 ± 6.8) with work experience (12.0 ± 6.9) years, high level of psychosocial stress and different work schedules: day (n = 11), shift (n = 14), irregular working hours (n = 12). The level of professional stress was studied using a specially developed questionnaire and the night sleep – using Pittsburgh Sleep Quality Index (PSQI). Сortisol circadian dynamics was evaluated, hemostasis state was fully assessed.Results and Discussion.The questionnaire showed irregularity of work schedule, additional working hours, decreased leisure time and high intensity of work in all study groups. High incidence of arterial hypertension (44 %) was registered without constant antihypertensive therapy. Pittsburgh Sleep Quality Index (PSQI) indicated sleep disorders among 24 (65 %) EMERCOM employees. Сortisol circadian dynamics test demonstrated increased level of the evening cortisol in 40 % of EMERCOM employees indicating widespread desynchronosis signs in the study group. Hemostatic system comprehensive assessment showed absence of considerable changes in thrombocytic component and a significant activation of plasma hemostasis according to the thrombodynamics assay. Hemostasis disorders were most expressed in the group with shift work and high psychosocial stress; they manifested in increased clots formation, spontaneous clots formation and increased VIII coagulation factor activity.Conclusion. The study confirmed the existing vision that chronic stress and desynchronosis change the hemostatic balance into chronic hypercoagulation state.

Adherence to Medical Appointments Among Living Kidney Donors After Donation Under a Monitored Approach and Long-term Clinical Outcomes: A Brazilian Single-center Cohort Study

BackgroundThere is little information about living donor long-term follow-up among Brazilian living donors. The aim of this study was to evaluate the main outcomes among living donors and to measure their adherence to regular medical appointments. MethodsThis is a Brazilian single-center cohort study that included 397 living donors with 87.1 months of follow-up and measured adherence to clinical appointments. Before 2010, the appointments were scheduled only spontaneously; after that an approach was structured to check the returns of donors, who were monitored actively. We also evaluated long-term outcomes such as survival and chronic kidney disease development and, secondarily, the incidences of hypertension, diabetes mellitus (DM), and dyslipidemia after donation. ResultsThe donors' adherence to annual clinical appointments was 75.8% (54.7% of them presenting annual regularity). Before 2010 the adherence was lower than 40%; 10-year cumulative incidences of hypertension, DM, and dyslipidemia were 20.4%, 5.7%, and 23.5%, respectively. The crude mortality was 1% and 10-year donor survival was 98.5%. The incidence of chronic kidney disease 5 years after donation was 19%, with 16.4% of patients staged in 3a and 2.6% in 3b. ConclusionA structured approach to check donor returns to long-term clinical appointments has doubled the adherence to visits returns (compared to historical data). We identified lower incidence of arterial hypertension and DM among donors as compared with the incidence of arterial hypertension and DM in the Brazilian general population, but the 5-year chronic kidney disease incidence was considered high, taking into consideration data that have been published in the last years.

Trends in the Incidence of Arterial Hypertension and its Association with 24-Hour Shift Work in the Enterprises of the Circumpolar Region

Work in the Arctic and a circumpolar region is associated with great risks for workers. In these regions there are a cold, strong wind, darkness during the polar night, constant light in the summer during the polar day and other factors. As a rule, the majority of employees works in shifts. The company organizes a 24-hour work schedule in shifts. Adverse weather conditions are superimposed on working conditions on shifts and cause nervous tension for workers. Nervous breakdowns can cause an exacerbation of cardiovascular diseases. We assumed that during shift work in the circumpolar region workers develop Arterial Hypertension. During the year we have been examining 2 groups of employees of a mining enterprise: 697 employees who worked 15/15 days in shifts, including night shifts, and 768 employees who worked in 5/2 days at 8-hour working day. Statistical processing of the initial data showed there are statistically significant differences in systolic pressure between people having two various working conditions. These differences have not been found for diastolic pressure.

Assessment of the Influence of Cardiovascular Risk Factors on the Prevalence of Arterial Hypertension in an Organized Population

Objective: to determine the prevalence of arterial hypertension (AH), as well as the influence of the risk factors on the AH incidence rate in the organized population of the personnel of the plant «Polimir», OJSC «Naftan». Material and methods. Over 200-2014 a clinical and epidemiological examination of the personnel of the plant «Polimir», OJSC «Naftan, was performed and included 1,431 subjects, 460 of whom did not work in an adverse working environment and 971 did. Results. The organized population revealed a rather high prevalence rate of AH, which apart from age and sex is associated with heredity (p V1 + R V5-V6 (p V1 + R V5-V6 and in 10-years` time with the factors of working conditions.

Protocol of Jidong Women Health Cohort Study: Rationale, Design, and Baseline Characteristics

ObjectiveThe Jidong Women Health Cohort Study is a prospective cohort study on female-specific characteristics and risks of chronic diseases in Chinese women and focuses on the potential association between menopause and risks of cardiovascular disease (CVD). MethodsThe study includes 4,179 female participants with an age of older than 18 years from Caofeidian district, Tangshan city, northern China. Baseline information on female-specific characteristics and potential cardiovascular risk factors was collected and all the participants underwent a physical examination with blood samples collected in 2013. To establish a better risk assessment tool of female CVD, updated information from questionnaire investigation, physical examinations and occurrence of outcome events will be collected through a longitudinal follow-up annually up to the year 2024. ResultsAt baseline, Mean age of the participants was 42.3 ± 12.8 years. Reproduction occurred in 2,948 participants (70.5%), menopausal transition in 173 (4.3%), and postmenopause in 1,058 (25.3%). The incidence of arterial hypertension, dyslipidemia, and diabetes showed significant difference across different groups stratified by Stage of Reproductive Aging Workshop (STRAW) system (P < 0.05). ConclusionThe Jidong Women Health Cohort Study will contribute to the scientific evidence on association between female-specific characteristics and cardiovascular risks, and will also be helpful to provide a new path for early detection and prevention of CVD.

Relación entre los atributos del sueño y el cambio en la presión arterial. Análisis de la cohorte CHICAMOCHA

IntroductionArterial hypertension is responsible for large part of the cardiovascular disease load. However, the role of sleep in its aetiology remains controversial. ObjectiveTo determine the relationship between sleep attributes and the change in blood pressure. MethodsA prospective cohort study was carried out on a community basis in young adults asymptomatic for cardiovascular disease, followed up for 12.4 years. At baseline, sociodemographic and behavioural factors were determined. At the same, time nocturnal sleep was characterised in terms of quality, duration and presence of snoring. Standardised anthropometric indices and blood pressure were measured. Arterial hypertension was defined as a report of anti-hypertension treatment or blood pressure figures ≥140/90 mm Hg. ResultsA total of 1,032 participants were prospectively evaluated (mean age 36.8 years, 64% males; at baseline). The incidence of arterial hypertension was 15.1% (95% CI: 12.8 – 17. 4), with evidence of a higher risk in snorers, with a subsequent reduction on adjusting for adiposity (P>.05). A gradient was observed between the duration of sleep and the change in systolic/diastolic arterial pressure (2.2/1.3 mmHg in those who reported 6-8 hours/day, and 2.7/1.6 mmHg in those who reported > 8 hours/day, compared to < 6 horas/day). Neither the subjective quality of the sleep nor the report of a siesta was associated with the blood pressure. ConclusionThe results suggest that the prolonged duration of sleep could increase blood pressure in the population.

ROLE OF IMMUNE SYSTEM IN DEVELOPMENT AND PROGRESS OF COMBINED ARTERIAL HYPERTENSION AND GOUT

Introduction: Multiple data available indicate high prevalence of comorbid abnormalities in gouty arthritis patients, namely, high incidence of arterial hypertension, coronary artery disease, stroke, atherosclerosis of carotid arteries, vascular dementia. For instance, hypertension is found in 36-41% gout patients, and combined with metabolic syndrome it may reach 80%. The aim: Studying features of clinical course, lipid profile and immune status in patients with combined hypertension and gout. Materials and methods: The study involved examination of 137 male patients with stage II hypertension, average age 56.9±3.4. All patients underwent echocardiography with estimation of the left ventricular mass index to verify hypertension stage, blood chemistry test with estimation of uric acid level, as well as lipid profile and immune status. Results: We have found significant disorders in the lipid profile of blood serum in patients with combined hypertension and gout. Positively higher percentage of activated T-cells was found in patients with combined hypertension and gout, both with early (CD3+CD25+) and late (CD3+HLA-DR+) activation marker, as well as those expressing FAS receptor, and ready to enter into apoptosis. Conclusion: We have identified abnormalities in adhesion and cooperation of immune competent cells, resulting in more intense activation of the same, effector functions and migration to the area of inflammation in the vessel wall.

Crescents and Global Glomerulosclerosis in Chinese IgA Nephropathy Patients: A Five-Year Follow-Up

Background/Aims: This study aims to evaluate the clinical significance of crescent and global glomerulosclerosis formation on renal outcome in patients with IgA nephropathy (IgAN). Methods: Biopsy-proven primary IgAN patients from West China Hospital of Sichuan University were studied retrospectively between 2008 and 2015. Clinicopathological features and treatment modalities were recorded. The patients were divided into several groups on the basis of cellular and/or fibrocellular crescents scores and global glomerulosclerosis scores. Crescent (C) was scored according to the updated Oxford classification (C0/C1/C2). Global glomerulosclerosis (G) was scored according to the frequency of global glomerulosclerosis: G0 (≤25% of glomeruli), G1 (26–50% of glomeruli), and G2 (> 50% of glomeruli). The primary endpoint was defined as a 50% reduction in renal function or end stage renal disease. Patients were followed up for at least 12 months, or shorter if they reached study endpoints. 1328 patients with IgAN were recruited. Mean follow-up time was 46.1±23.6 months. The percentage of patients with C1 and C2 was 19.3% and 5.9% respectively. Higher crescent scores was associated with lower estimated glomerular filtration rates (eGFR), decreased serum albumin levels, increased amounts of urine protein, higher serum creatinine, as well as greater proportions of M1 and E1. The percentage of patients with G0, G1 and G2 was 70.5%, 20.7% and 8.8%, respectively. Elevated glomerulosclerosis scores were associated with lower eGFR levels, increased amounts of urine protein, higher levels of serum creatinine, higher incidences of arterial hypertension, as well as greater proportions of M1. There was a significantly higher proportion of T1/2 in patients with G2. In a multivariate model, crescent and global glomerulosclerosis were identified as independent predictors of decreased renal survival. Conclusion: Global glomerulosclerosis and crescents, as detected in renal biopsies, are strong predictors of long-term renal outcome of IgAN.

Ab initio Everolimus-Based vs. Standard CNI Immunosuppression-Regimen in Liver Transplant Recipients

Aim We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio vs. standard-dose Tac after liver transplantation (LT). Methods: Between September 2009 and June 2015 seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from post-operative day 1 (EVR group), were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. Results Baseline characteristics for the two groups were comparable. The median study follow-up was 27 months (range: 0-82). The overall patient and graft survival were similar (p=0.908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in 2 cases (2.8%), while chronic rejection in one (1.4%). The EVR group experienced a better renal function already after 2 weeks [eGFR: 89.85 (36.46-115.3) ml/min/1.73m2 vs. 68.77 (16.11-115.42)ml/min/1.73m2, (p=0.013)], which was also observed after a median time of 27 (range 0-82) months from LT [eGFR: 80 (45-118.3)ml/min/1.73m2 vs. 70.9(45-88.4)ml/min/1.73m2, (p=0.04)]). After a median time of 27 months, the EVR-group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. Conclusion Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk of post-LT renal impairment.

COMPARISON OF RISK FACTORS FOR THE DEVELOPMENT OF ARTERIAL HYPERTENSION IN KAZAKHSTAN AND ALMATY

Objective: To study and compare the prevalence of risk factors: excess body weight, high blood pressure, elevated blood levels of glucose, cholesterol in Kazakhstan and Almaty. Design and method: 5,285 people from Kazakhstan were examined, including 1,395 men and 3,890 women (26.4% and 73.6%, respectively), and 744 people from Almaty, 157 (21%) men and 587 (79%) of women. Results: To determine the excess body weight and obesity, the value of body mass index (BMI) was used. In Almaty 423 people-57.5%, in Kazakhstan - 3214 people, this is 63.9%. One of the most important risk factors for diseases of the circulatory system is the presence of abdominal obesity. In Almaty, 65.3% - 481 respondents had abdominal obesity, in Kazakhstan - 3347 people - 68.6%. The lipid profile of the blood was analyzed. Elevated cholesterol among respondents from Almaty is found in 43.7% of cases, respectively, 331 people, in the country in 2017 people - 40%. The reduced level of high density lipoprotein cholesterol in Almaty among 112 persons is 15.1%, in Kazakhstan in 1688 persons - 32.5%. The increased level of low density lipoprotein cholesterol in respondents from Almaty - 43.8% - 332, in Kazakhstan - 1901 people - 37.4%. The level of triglycerides was increased in Almaty in 24.5% of cases - in 186 persons, in Kazakhstan in 25.2% - 1269 persons. The increased level of glucose in Almaty was in 12 respondents - 1.6%, in Kazakhstan in 505 - 9%. One of the most important modifiable risk factors for the development of diseases of the cardiovascular system is an elevated level of arterial pressure. In Almaty, hypertension was detected in 167 persons - 22.7%, in Kazakhstan in 1583 persons - 31.7%. Conclusions: Thus, in all regions, more than half of the surveyed persons were overweight. The smallest prevalence of overweight in relation to the country was noted in Almaty, and there was also a lower prevalence of hyperglycemia in relation to Kazakhstan. The prevalence of abdominal obesity and hypercholesterolemia was not significantly different. In Kazakhstan, the incidence of arterial hypertension is higher than in Almaty.

PREVALENCE AND ASSOCIATIONS OF FRAILTY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME

Objective: The aim of the study was to assess the prevalence and clinical associations of frailty in elderly patients with acute coronary syndrome (ACS). Design and method: In 130 patients older 75 years (83 ± 5 years, arterial hypertension (AH) 92%, previous myocardial infarction (MI) 32%, atrial fibrillation 32%, diabetes 27%) admitted with MI (75%) or unstable angina (25%) frailty (national validated questionnaire), physical disability (Barthel index), functional mobility, nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination), mortality and hemorrhagic risk (GRACE, TIMI, CRUSADE scales) were assessed. Results: Frailty was revealed in 66% of patients. 68% of patients had > 140 points on GRACE scale, 53% > 5 points on TIMI, 73% > 40 points on CRUSADE. Patients with frailty were more likely women (72 vs 59%; p < 0,05), had higher incidence of AH (94 vs 86%; p < 0,01), MI in this hospitalization (86 vs 55%; p < 0,05), GFR < 60 ml/min/1,73 m2 (71 vs 48%; p < 0,05). Patients with frailty had higher risk of bleeding (47 ± 10 vs 41 ± 10 points on CRUSADE scale, p < 0,001) and higher risk of mortality (162 ± 36 vs 144 ± 22 points on GRACE scale, 4,9 ± 1,1 vs 4,5 ± 1,1 points on TIMI scale, p < 0,001). Patients with GRACE > 140 points had more pronounced cognitive dysfunction (26,6 ± 5,0 vs 29,9 ± 1,9 points, p < 0,05), decreased functional mobility (34,0 ± 3,6 vs 37,1 ± 1,2 points, p < 0,01). Patients with TIMI > 5 points had higher scores on a frailty scale (3,3 ± 1,1 vs 2,5 ± 0,5, p < 0,001), more physical disability of daily living (86,9 ± 9,4 vs 95,2 ± 5,1, p < 0,001). Patients with CRUSADE > 40 points had more pronounced score on frailty (3,1 ± 1,0 vs 2,0 points, p < 0,001), disorders of functional mobility (34,4 ± 3,4 vs 38,2 ± 1,1 points, p < 0,01), physical disability of daily living (89,3 ± 8,9 vs 100 points, p < 0,001). Duration of hospitalization was higher in group of patients with frailty (9,6 ± 3,8 vs 9,1 ± 2,2 days, χ2 = 36.3, p < 0.01). In-hospital mortality was found in group of patients with frailty (1,16%). In patients with frailty, mortality for six months was higher (24,6 vs 16,2%, p = 0,3). Conclusions: Frailty occurs in 66% of elderly patients with ACS, is associated with increased prevalence of cardiovascular diseases, higher risk of mortality and bleeding

THE INFLUENCE OF ANNOYANCE DUE TO NOISE ON RENAL HEMODYNAMIC

Objective: Epidemiological studies have found a link between noise exposure and increased incidence of arterial hypertension and cardiovascular disease. The kidney as long-term regulator of blood pressure might play a role in the underlying pathophysiological mechanism. The aim of this study is to investigate the influence of annoyance due to noise on renal hemodynamic in hypertensive and healthy subjects. Design and method: We analysed the influence of annoyance due to noise on renal hemodynamic (measured using steady state input clearance with infusion of paraaminohippuric acid and inulin, respectively) in 79 healthy normotensive subjects (NT) and 34 drug-naïve subjects with hypertension stage 1 or 2 (HT). All subjects ranked subjective annoyance due to noise in everyday life on a 7 grade likert scale. The median of all rankings was used as cut off point to divide the group into annoyed and non-annoyed subjects. Results: The prevalence of subjects with annoyance due to noise was higher in HT (25 out of 34 [73.5%]) compared to NT subjects (33 out of 79 [41.8%], p = 0.04). There was no difference in office blood pressure (124 ± 8.2/75 ± 7.8 vs 124 ± 7.4/73 ± 6.4 mmHg, p = 0.52/0.32) and heart rate (69 ± 1.4 vs 66 ± 9.0 bpm, p = 0.09) between annoyed and not-annoyed NT subjects. Annoyed NT subjects showed lower renal plasma flow (635 ± 95.7 vs 685 ± 116 ml/min, p = 0.04) compared to not-annoyed subjects. There was no difference in glomerular filtration rate between annoyed and not-annoyed NT subjects (133 ± 12 vs 138 ± 15 ml/min, p = 0.12). There was also no difference in office blood pressure (145 ± 8.4/87 ± 11 vs 148 ± 11/72 ± 11 mmHg, p = 0.34/0.07) and heart rate (73 ± 13 vs 72 ± 8.5 bpm, p = 0.76) in annoyed and not-annoyed HT subjects. In HT subjects there was no difference in renal plasma flow (553 ± 102 vs 552 ± 106 ml/min, p = 0.99) and glomerular filtration rate (132 ± 12 vs 136 ± 14 ml/min, p = 0.52) between annoyed and not-annoyed subjects. Conclusions: Annoyance due to noise in everyday life was found more frequently in HT compared to NT subjects and was associated with lower renal plasma flow in NT but not HT subjects. Our data suggest the hypothesis that annoyance due to noise triggers early renal changes in NT subjects potentially leading to hypertension.

Intergenerational differences in prevalence and association with survival rates of major cardiovascular risk factors

The objective: determination of the prevalence of major cardiovascular risk factors (CVRF) and their association with the survival rate of cardiovascular disease (CVD) among generations 1905–1924 and 1925–1944 years of birth.Materials and methods. 384 patient case histories were analyzed from 1905 to 1944 with ischemic heart disease (IHD). According to the year of birth, the patients were divided into 2 groups: 1 group – born in the period 1905–1924 («pre-war» generation), 2 group – from 1925–1944 (a generation of «front-line soldiers»). The diagnosis was established on the basis of examinations, in accordance with the current recommendations for the diagnosis of IHD.Results. There are significant intergroup differences in the frequency and structure of arterial hypertension in the pre-war generation group, the incidence of arterial hypertension (AH) was 64,1%, of which 54,6% is isolated systolic hypertension (ISAH). In the frontline group, the AH frequency reached 74,1%, and ISAG accounted for only 27%. When analyzing the average of low density lipoprotein (LDL) values in the first and second generations, there were no significant differences. However, gender analysis revealed that in both groups of women, the average level of LDL was higher than that of men. The prevalence of elevated LDL in the first generation is higher (98,68%) than in 2 generations (94,12%) (р&gt;0,05). The prevalence of the increased level of glucose in the 1st generation is 4,4%, while in the 2nd generation it increases to 20,6% (p=0,0001). Although the diagnosis of diabetes mellitus is 1,94% in the 1st group and 3,68% in the second group, which indicates a significant increase in the cases of violation of carbohydrate metabolism in the 2nd generation.Conclusion. Also, with a detailed gender analysis within the group, attention is drawn to the distribution of overweight and obese individuals: if in the 1st generation of overweight men there was more (68,85%) than with obesity (31,15%), and women with increased body weight was 40,38%, with obesity 59,62%, then in 2 generations 61,8% of men were overweight and only 37% obese. In women, a mirror trend was observed – 36,1% were overweight and 63,9% were obese. These CWR factors were associated with various indicators of life. in the first generation there was no dependence of survival on the presence of individual CVR factors; in the second, survival was significantly lower in patients with obesity and hypertension.

The influence of proximity to city parks and major roads on the development of arterial hypertension.

The aim of this study was to examine the relation between residential distance from major roads and city parks and the development of arterial hypertension. In this study, we used data of the population included in the MONICA survey (Lithuania). In total, 739 participants without arterial hypertension were selected for the present study. Poisson regression with robust variance estimation was used to evaluate the associations between distances from a major road and a city park expressed as categorical variables and the incidence of arterial hypertension, adjusting for individual risk factors. For persons living at a distance of 151-300 m and > 300 m from city parks, relative risks were 1.49 (95% CI 1.03-2.15) and 1.51 (95% CI 1.10-2.07) respectively, as compared to a ≤ 150 m distance from city parks. For persons living further than 200 m away from a major road, the relative risk for the residential distance from city parks > 150 m was 2.36 ( p = 0.029) times higher, as compared to a ≤ 150 m distance from city parks. We found that an increased risk of arterial hypertension was associated with the distance from a city park > 350 m and the distance to a major road < 200 m (RR = 1.48, 95% CI 1.03-2.12) as compared to living ≤ 350 m to a city park and ≥ 200 m away from a major road. An increase in the incidence of arterial hypertension was associated with a shorter distance to a major road and a greater distance to a city park. The effect modification of a shorter distance to a major road on the association between a greater distance to city parks and the incidence of arterial hypertension was identified.

MANIFESTATIONS OF FRAILTY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME

Background. Frailty is a high-priority issue in cardiovascular medicine because of the aging of patients. It reflects the complex functional disorders and is associated with high morbidity and adverse outcomes. The aim of the study was to examination prevalence of frailty, its associations with mortality and hemorrhagic risk in elderly patients with ACS. Materials and methods. In 130 patients ≥ 75 years (82,7 ± 4,7 years, arterial hypertension (AH) 91,5%, previous myocardial infarction (MI) 32,3%, atrial fibrillation 32,3%, diabetes 26,9%, admitted with MI 75,4% or unstable angina 24,6%, frailty (national validated questionnaire), nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination) were assessed. Results. Mean score on a national validated questionnaire was 2,9 ± 1,4 points. Only 8.5% of patients responded negatively to all questionnaire questions. None of the patients had 7 points. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% patients had 1, 2, 3, 4, 5 and 6 points. 8,5% of the patients were non-frail, 25,4% pre-frail and 66,1% frail. Patients with frailty were more likely women, had higher incidence of AH, MI in this hospitalization, GFR < 60 ml/min/1,73 m2. Conclusion. Frailty occured in 66,1% of elderly patients with ACS, was associated with increased prevalence of cardiovascular diseases.

Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients

AimWe designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). MethodsSeventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. ResultsBaseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P = .908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P = .013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P = .04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. ConclusionAb initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.

Understanding the relationship between lung function and cardiovascular phenotypes in the young: opportunity for a better cardiovascular risk prevention in adulthood?

Understanding the relationship between lung function and cardiovascular phenotypes in the young: opportunity for a better cardiovascular risk prevention in adulthood?

Similarities and Differences in Epidemiology and Risk Factors of Cerebral and Myocardial Ischemic Disease

AbstractIschemic heart disease and cerebral ischemia represent the leading causes of mortality worldwide. Both entities share risk factors, pathophisiology and etiologic aspects by means of a main common mechanism, atherosclerosis. The autors aimed to investigate differences and similarities in epidemiology and risk factors that could be found between both entities. In a retrospective sudy 403 patients were included and divided into two groups: group of 289 patients with history of myocardial infarction (AMI), and group of 114 patients with history of ischemic stroke (IS). All patients were evaluated for nonmodifiable risk faktors, which included age and sex, and modifiable, such as hypertension, dyslipidemia, diabetes, obesity, physical activity and smoking. Diff erences in some epidemiological aspects were also considered: occupation, marital status, alcohol consumption, exposure to stress. Patients with history of IS were significantly older then AMI patients (64.0 ± 9.9 vs 64.0 ± 9.9, p=0,028), with higher diastolic blood pressure (87,1 ± 10,2 vs 83,6 ± 10,4, p=0,003) and higher Sokolow-Lyon index in ECG, an also index of left ventricular hypertrophy (19,2 ± 9,1 vs 14,7 ± 6,5). Th ere were no significant differences between groups in the estimated body mass index and waist circumference. Differences between groups in stress exposure, occupation, alcohol consumption or physical activity were no significant. Patients in AMI group were more frequently male (199 (69%) vs 59 (52%), p=0,001), married (252 (87%) vs 88 (77%), p=0,037), smokers (162 (56%) vs 50 (44%), p=0,018) and with higher incidence od dyslipidemia (217 (75%) vs 73 (64%), p=0,019) compared with IS group. Incidence of arterial hypertension and diabetes was similar in both groups. Both entities share similar pathophysiological mechanisms and, consequently, main traditional risk factors. However, incidence of myocardial infarction increases with male sex, dyslipidemia, smoking and marital status, while incidense of ischemic stroke increases with age, higher diastolic blood pressure and also with ECG signs of left ventricular hypertrophy.