Lower Risk Of Cardiovascular Complications Research Articles

The Interaction of Dietary Patterns and Genetic Variants on the Risk of Cardiovascular Diseases in Chinese Patients with Type 2 Diabetes.

Diabetes is an important risk factor for cardiovascular disease (CVD), which in turn is the most common and serious complication of diabetes. This study analyzes dietary patterns and single nucleotide polymorphisms (SNPs) in 543 diabetes patients with new-onset cardiovascular events and 461 diabetic patients without. SNPs are determined and analyzed using real time PCR and gene chip method. Factor analysis and logistic regression are used to determine dietary patterns and evaluate the level of associations and interaction effects, respectively. The legumes and edible fungi pattern and vegetable pattern show a significant negative correlation with complication risk. ADIPOQ rs37563 and legumes and edible fungi pattern have a significant interactive effect on disease, and patients with a high score of C polymorphism genotype (GC+CC) have a lower risk of disease. 5-10-Methylenetetrahydrofolate reductase (MTHFR) rs1801131 and vegetable pattern have a borderline interaction effect on disease, and those patients with TT genotype have a lower risk of disease. These findings provide new insights into the role of the interactive protection of dietary patterns and SNPs. And participants with specific alleles show a lower risk of cardiovascular complications.

Quantitative profiling and diagnostic potential of one-carbon and central metabolism pools in MODY2 and T1DM

BackgroundMaturity-onset diabetes of the young type 2 (MODY2) is a rare genetic disorder characterized as mild fasting hyperglycemia with low risk of vascular complications caused by glucokinase gene mutation. This study aims to investigate metabolites alteration associated with MODY2, exploring possible mechanism underlying characteristic clinical manifestations and low cardiovascular risks of MODY2 and providing serum metabolite biomarkers to facilitating MODY2 diagnosis.MethodsFasting serum samples from MODY2, type 1 diabetes (T1DM) and healthy individuals were collected. By using targeted metabolomics via liquid chromatography–tandem mass spectrometry platform, we quantified the metabolites involved in tricarboxylic acid (TCA) cycle and one-carbon metabolism.ResultsMetabolomic profiling revealed significant difference of intermediates from central metabolism cycle, methionine cycle and several amino acids between MODY2 and T1DM groups. Among these, serum citrate, α-ketoglutaric acid, serine, glycine, glutamine and homocysteine were significantly elevated in MODY2 patients compared with T1DM patients; and compared with healthy subjects, malate and methionine levels were significantly increased in the two groups of diabetic patients. The correlation analysis with clinical indexes showed that α- ketoglutarate, serine, glycine, and glutamine were negatively correlated with blood glucose indicators including fasting blood glucose, HbA1c, and GA, while citrate was positively correlated with C-peptide. And homocysteine displayed positive correlation with HDL and negative with C-reactive protein, which shed light on the mechanism of mild symptoms and low risk of cardiovascular complications in MODY2 patients. A panel of 4 metabolites differentiated MODY2 from T1DM with AUC of 0.924, and a combination of clinical indices and metabolite also gained good diagnostic value with AUC 0.948.ConclusionIn this research, we characterized the metabolite profiles of TCA cycle and one-carbon metabolism in MODY2 and T1DM and identified promising diagnostic biomarkers for MODY2. This study may provide novel insights into the pathogenesis and clinical manifestations of MODY2.

Bone fragility in type 1 diabetes: new insights and future steps

Bone fragility is a recognised complication of type 1 diabetes.1 People with type 1 diabetes have lower bone mineral density (BMD) and greater fracture risk than individuals without diabetes (more than five times for hip fracture and two times for non-vertebral fractures).2 The mechanisms underlying the lower BMD and greater fracture risk in this population include absence of insulin, long diabetes duration, poor glycaemic control, oxidative stress, and impaired Wnt signalling.3,4 People with long-term type 1 diabetes with a low risk of cardiovascular complications also have low rates of osteoporosis and fractures,5 suggesting that bone fragility is associated with vascular complications.

Effects of initial treatment on the dynamics of renal functional reserve in stage-I hypertensive patients

Objective: To determine the functional state of the kidneys in patients with the I stage essential hypertension with different total risk of cardiovascular complications and to assess the effect of early medication (angiotensin II receptor blocker) on the dynamics of changes in the functional renal reserve. Material and Methods: This study included 80 patients with the established diagnosis - the I stage essential hypertension of the I-III grade in age from 18 to 60 years (28 women (35 %), the average age is 40,1 (35,0-56,0) years; men - 57 (71%), average age – 40,2 (37,0-53,0) years. A risk factor count was used to assess the overall risk of cardiovascular complications in hypertension. Functional renal reserve and endothelium-independent vasodilation of the brachial artery were defined. Statistical analysis was performed using SPSS Statistics. Results: In patients with high risk, the depleted and decreased functional renal reserve was most often detected, which was 55% of patients. It is also important to note that patients with even a low risk of cardiovascular complications have already had renal damage as a reduced or depleted functional renal reserve. Patients with a low risk of cardiovascular complications who had not started drug treatment on their first visit had a 2.3-fold (95% CI 1,048-4,896) higher relative risk of developing kidney damage in comparison with patients who had started medication therapy without delay. Conclusion: Diagnosis of functional renal reserve in patients with a low risk of developing cardiovascular complications in stage I arterial hypertension is an important component for predicting the further development of kidney damage and timely prevention of its progression. The early onset of drug treatment reduces the relative risk of developing kidney damage by 2.3 times in patients with arterial hypertension.

Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.

EFFICACY OF INTERMITTENT NORMOBARIC HYPOXIC TRAINING IN THE TREATMENT OF ARTERIAL HYPERTENSION ASSESSED BY 24-HOUR BLOOD PRESSURE MONITORING

The study performs the results of our own researches regarding the method of intermittent normobaric hypoxic training as drug-free treatment in patients with arterial hypertension with low risk of cardiovascular complications. Clinical efficacy was assessed according to office blood pressure changes using dynamic 24-hour blood pressure monitoring before and after treatment. High clinical efficacy and safety of hypoxic training method is demonstrated in this work.

Effect of statins on LDL cholesterol and lower risk of cardiovascular complications. Which medication to choose?

Primary and secondary prevention of cardiovascular complications (CVC) has been one of the key areas in modern cardiology over the past decades. The article examined the relationship between the risk of CVC and the lipid metabolism parameters. The article discussed the major clinical trials the results of which constitute the evidence base for statins use to reduce the risk of acute coronary and cerebrovascular events.

Comparative analysis of therapeutic efficiency and costs (experience in Bulgaria) of oral antidiabetic therapies based on glitazones and gliptins.

Type 2 diabetes mellitus is a serious, chronic, progressive and widespread disease. Metformin is the most commonly prescribed initial therapy, but combination with other antidiabetic agents usually becomes necessary due to the progression of the disease. Pioglitazone is recommended as a second-line therapy because of its strong antihyperglycemic effect and its ability to reduce insulin resistance. Treatment with pioglitazone is associated with a significantly lower risk of cardiovascular complications and hypoglycemia, while simultaneously improving the lipid profile and the symptomatic and histological changes in the liver. Gliptins (sitagliptin and vildagliptin) are a new class of oral antidiabetic drugs which reduce glycated hemoglobin by a different mechanism. Although the efficacy of sitagliptin and vildagliptin is close to that of pioglitazone, the lack of long-term safety data and the higher price question their predominant use. The objective of this review is to highlight the advantages of mono- and combination therapy with pioglitazone in comparison with gliptins and to underline the inconsistencies in the medicinal and reimbursement policy in Bulgaria.

Evaluación del impacto clínico y la seguridad de una unidad de dolor torácico en pacientes con probabilidad baja e intermedia de síndrome coronario agudo

BackgroundChest pain units (CPU) are an accepted method to assess patients admitted to an emergency department with chest pain with a potential ischemic origin. Yet in Colombia, the customary admission to a CPU in a standardized fashion is scarce and, to our knowledge, the outcome of implementing recognized protocols for chest pain has not been evaluated. ObjectiveTo assess the clinical impact and security of CPU, in patients with, low and intermediate probability of acute coronary syndrome, in Medellín, Colombia. MethodsA descriptive study comprising 277 subjects who were consecutively admitted to the CPU. Variables included demographics, and performance measures to assess the process of care (timely action and process completion). A 30 days follow-up included survival and new admissions compatible with coronary syndromes. ResultsFrom the whole sample, 13.0% of patients were referred for hospitalization. However, only 2.5% had a final diagnosis of an acute coronary syndrome. Median time between reception and an electrocardiogram acquisition was 10minutes TIMI score and acute coronary syndrome probability were reported in 85.5 and 73.9% of subjects respectively. Comparison between early implementation and consolidation phases showed a sensible improvement of performance measure indicators (p<0.05). In addition, 30-day follow-up showed neither fatalities nor new coronary events. ConclusionChest pain observation unit based on clinical assessment of thoracic pain, TIMI risk score and ST segment changes interpretation in the ECG is a safe and efficacious way to stratify low and intermediate chest pain leading to a safe patient discharge with very low risk of cardiovascular complications.

Stiffness of the Arterial Wall and Central Hemodynamics During Long-Term Combination Antihypertensive Therapy

Aim of the METR study - to assess effect of antihypertensive therapy with fixed combination of angiotensin converting enzyme inhibitor lisinopril (10 mg) and calcium antagonist amlodipine (5 mg) on parameters of arterial wall stiffness and central hemodynamics in patients with stage I-II essential hypertension (EH) and functional class II-III ischemic heart disease. Combination therapy was associated with persistent lowering of central arterial pressure, decrease of augmentation index and other parameters of arterial wall stiffness, and reduction of left ventricular myocardial mass. These changes have a potential to lower risk of cardiovascular complications and improve prognosis of patients with EH.

Less but better: cardioprotective lipid profile of patients with GCK-MODY despite lower HDL cholesterol level

Patients with diabetes caused by single-gene mutations generally exhibit an altered course of diabetes. Those with mutations of the glucokinase gene (GCK-MODY) show good metabolic control and low risk of cardiovascular complications despite paradoxically lowered high-density lipoprotein (HDL) cholesterol levels. In order to investigate the matter, we analyzed the composition of low-density lipoprotein (LDL) and HDL subpopulations in such individuals. The LipoPrint© system (Quantimetrix, USA) based on non-denaturing, linear polyacrylamide gel electrophoresis was used to separate and measure LDL and HDL subclasses in fresh-frozen serum samples from patients with mutations of glucokinase or HNF1A, type 1 diabetes (T1DM) and healthy controls. Fresh serum samples from a total of 37 monogenic diabetes patients (21 from GCK-MODY and 16 from HNF1A-MODY), 22 T1DM patients and 15 healthy individuals were measured in this study. Concentrations of the small, highly atherogenic LDL subpopulation were similar among the compared groups. Large HDL percentage was significantly higher in GCK-MODY than in control (p = 0.0003), T1DM (p = 0.0006) and HNF1A-MODY groups (p = 0.0246). Patients with GCK-MODY were characterized by significantly lower intermediate HDL levels than controls (p = 0.0003) and T1DM (p = 0.0005). Small, potentially atherogenic HDL content differed significantly with the GCK-MODY group showing concentrations of that subfraction from control (p = 0.0096), T1DM (p = 0.0193) and HNF1A-MODY (p = 0.0057) groups. Within-group heterogeneity suggested the existence of potential gene–gene or gene–environment interactions. GCK-MODY is characterized by a strongly protective profile of HDL cholesterol subpopulations. A degree of heterogeneity within the groups suggests the existence of interactions with other genetic or clinical factors.

Sexual Activity and Cardiovascular Disease

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease (CVD), including many elderly patients.1 Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression.2,3 The intent of this American Heart Association Scientific Statement is to synthesize and summarize data relevant to sexual activity and heart disease in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity. Recommendations in this document are based on published studies, the Princeton Consensus Panel,4,5 the 36th Bethesda Conference,6–10 European Society of Cardiology recommendations on physical activity and sports participation for patients with CVD,11–13 practice guidelines from the American College of Cardiology/American Heart Association14–16 and other organizations,17 and the multidisciplinary expertise of the writing group. The classification of recommendations in this document are based on established ACCF/AHA criteria (Table). View this table: Table. Applying Classification of Recommendation and Level of Evidence Numerous studies have examined the cardiovascular and neuroendocrine response to sexual arousal and intercourse, with most assessing male physiological responses during heterosexual vaginal intercourse.18–24 During foreplay, systolic and diastolic systemic arterial blood pressure and heart rate increase mildly, with more modest increases occurring transiently during sexual arousal. The greatest increases occur during the 10 to 15 seconds of orgasm, with a rapid return to baseline systemic blood pressure and heart rate thereafter. Men and women have similar neuroendocrine, blood pressure, and heart rate responses to sexual activity.24,25 Studies conducted primarily in young married men showed that sexual activity with a person's usual partner is comparable to mild to moderate physical activity in the range of 3 to …

MODERN VIEWS ON THE VARIABILITY OF BLOOD PRESSURE

Nowadays conception of blood pressure (BP) variability (BPV) includes a number of indicators related to various physiological factors. All the indexes are calculated with the standard deviation (SD) or more complex formulas, including SD. BPV main varieties are considered a 24-hour BPV (measured by ambulatory BP monitoring – ABPM), midterm BPV (BP self-control or home BP – HBP), and long-term, visit-to-visit, BPV (traditional BP measurement or office BP – OBP). The 24-hour BPV was the main subject of study for many years. Recently significant attention has been paid to the visit-to-visit BPV assessment. Retrospective meta-analysis showed that in a cohort of patients after stroke or transient ischemic attack, this index was a strong and independent (from the average BP level) predictor of stroke. In ASCOT-BPLA study visit-to-visit systolic BPV also was a strong predictor of stroke and coronary events. Long-term BPV in patients of amlodipine/perindopril treatment group was significantly lower than this in patients of atenolol/diuretic group during the follow-up that was associated with a lower risk of cardiovascular complications. However , the concept of visit-to-visit BPV use for risk stratification and monitoring of antihypertensive therapy efficacy is associated with significant limitations (basic data is obtained in the post hoc analysis, difficulties in objective evaluation of prognostic significance of indicators, their dependence on medication adherence, etc.). The HBP self-control is a promising approach to the BPV analysis; it may be the happy medium between ABPM and OPB. New-designed prospective comparative studies are needed to evaluate the clinical significance of the various BPV parameters.

Thiazolidinediones, insulin resistance and obesity: finding a balance

The clinical efficacy of currently available thiazolidinediones (TZDs) in improving glycaemic control and ameliorating several risk factors for cardiovascular disease (linked to their insulin-sensitising actions as well as direct vascular effects) is well established. Treatment-associated weight gain, however, which has been identified as a class effect of the TZDs, is seen in a number of patients. The magnitude of weight gain correlates in part with improved metabolic control, i.e. better responders are more prone to increases in body weight. The cardiovascular risk associated with obesity appears to be depot specific; while peripheral obesity is associated with a low risk of cardiovascular complications, central obesity confers a greater degree of risk. Evidence is reviewed that increases in body weight associated with TZD treatment are associated with neutral effects (or even, decreases) in visceral fat, the adipose depot that is associated with central obesity.

Traitement de l'érection peropératoire par le bloc pénien

Erection during endoscopic or penile surgery is a troublesome event. In this case report, the erection was first treated with intracavernous injection of etilefrine (8 mg) and detumescence was obtained rapidly. However, one hour later, the erection occurred again. Therefore a dorsal penile nerve block was performed by the median route, using 8 mL of 0.25 % bupivacaine injected into the subpublic space. Mechanisms and treatments of intraoperative erections are discussed. Repeated intracavernous injections of vasoactive drugs may be dangerous, whereas a penile nerve block carries a lower risk of cardiovascular complications and provides an improved postoperative analgesia.