Presence Of Arterial Hypertension Research Articles

POOR PROGNOSIS PREDICTOR IN ISCHEMIC HEART DISEASE PATIENTS WITH CONFIRMED HEMODYNAMICALLY SIGNIFICANT CORONARY ARTERY ATHEROSCLEROSIS IN THE DYNAMICS OF LONG OBSERVATION

The purpose of the study - to determine the clinical-anamnestic, instrumental parameters, and genetic factors, that that determine the development of adverse cardiovascular events (ACVE) in patients with ischemic heart disease (IHD) with a verified hemodynamically significant coronary artery (CA) atherosclerosis at long follow-up.Materials and methods. The study involved 318 patients with IHD with the presence of hemodynamically significant stenoses (stenosis> 50%) at least one CA according to selective coronary angiography (SCG). Evaluation of patients included determination of the ankle-brachial index (ABI), Doppler sonography of the lower extremities vessels (LEV) and carotid artery (CARA) with a quantitative assessment of the intima-media thickness (IMT), carrying a load test by the modified Bruce protocol and determination of glomerular filtration rate (GFR) by MDRD. The observation period lasted (28,4 + 4,8) months. Study endpoints were cardiovascular death, myocardial infarction (MI), unstable angina, need for revascularization, and cerebrovascular accident. Study of the angiotensin converting enzyme (ACE) I/D polymorphism and endothelial NO-synthase (eNOS) gene promoter T-786S polymorphism was performed using polymerase chain reaction.Results and discussion . 82 (25.8%) patients in whom the study endpoints occurred were included in group I, 236 patients without ACVE - group II. According to odds ratios (OR) chance of developing ACVE in the examined patients was increased in the presence of hypertension (AH) (OR = 2,06, 95 % CI [1,05-3,84], p <0,05), diabetes mellitus (DM), type 2 (OR = 2,12, 95 % CI [1,15-3,92], p <0,05), abdominal obesity (OR = 1,82, 95 % CI [1,10-3,01], p <0,05), smoking (OR = 2,03, 95 % CI [1,21-3,36], p <0,05), family history of cardiovascular disease (CVD) early onset (OR = 1,81, 95 % CI [1,0-2,95], p <0,05), more than one MI in anamnesis (OR = 2,06, 95 % CI [1,11-3,84], p <0,05), reducing EF < 45% ( OR = 1,77, 95 % CI [1,05-2,99], p <0,05), decline in renal function (OR = 1,89, 95 % CI [1,1-3,25] p < 0.05), as well as by atherosclerotic lesions of CARA (OR = 2,28, 95 % CI [1,23-4,23], p <0,05) and LEV (OR = 1,93, 95 % CI [1,11-3,35], p <0,05), the lesions of three CA (OR = 1,77, 95 % CI [1,06-2,94], p <0,05) and diffuse type of lesion according SCG (OR = 3,56, 95 % CI [1,15-5,59], p <0,05). In the I patients group frequency of mutant DD genotype of ACE gene I/D polymorphism was greater than in Group II (37,8% vs 24,6%, p <0,05). The presence of DD genotype was associated with an increased likelihood of ACVE in patients with verified CA atherosclerosis (OR = 1,87, 95% CI [1,10-3,18], p = 0,03). The frequency of eNOS gene promoter T-786C polymorphism mutant CC genotype occurrence was also higher In the first patients group than in the II group (37.6% vs. 14,8%, p <0,05). Chance of poor prognosis for carriers of mutant CC genotype and C allele of eNOS gene promoter T-786C polymorphism was significantly higher (OR = 3,46, 95% CI [1,37-8,48], p = 0.014).Conclusions. An adverse cardiovascular events development in patients with stable IHD with verified coronary artery (CA) atherosclerosis is associated with the presence of arterial hypertension, type 2 diabetes mellitus, smoking, family history of CVD early onset, as well as more than one MI in anamnesis, with atherosclerotic lesions of the carotid arteries and blood vessels of the lower extremities, lesions of the three CA and diffuse type of lesion according to SCG, reduced left ventricular ejection fraction less than 45% and declining of renal function according to GFR. The DD genotype of angiotensin-converting enzyme I/D polymorphism and the CC genotype of endothelial NO-synthase gene T-786S promoter polymorphism associated with poor prognosis in patients with stable IHD. The probability of adverse cardiovascular events in the presence of these polymorphic markers increases in 1.87 and 3.46 times, respectively.

Could the type of treatment for chronic kidney disease affect the auditory system? : O tratamento da doença renal crônica pode afetar a audição?

IntroductionChronic kidney disease (CKD) is defined as the presence of renal injury that leads to the slow and progressive loss of kidney function. AimTo compare audiological tests between patients with CKD receiving different types of treatment. Material and methodThis was a clinical and experimental study. Groups were divided according to treatment: hemodialysis (n = 35), peritoneal dialysis (n = 15), and conservative (n = 51), and were compared to 27 healthy controls. Patients older than 60 years; those with congenital hearing loss, genetic syndromes, and middle-ear infections; and those who had been submitted to a kidney transplant were excluded. Audiologic evaluation included pure-tone audiometry, transient evoked otoacoustic emissions, and auditory brainstem response (ABR). The variables considered were gender, age, diagnosis of arterial hypertension, time since the diagnosis of diabetes and hypertension, CKD stage, duration of CKD, and duration of treatment. ResultsThe variables age, presence of arterial hypertension, and time of CKD were statistically significant and controlled. The auditory thresholds measured by pure-tone threshold audiometry were worse for the conservative treatment group, and the III-V interval of the ABR of the conservative treatment group was significantly greater than that of the hemodialysis groups. ConclusionThe conservative treatment group presented worse audiological tests, regardless of hypertension and diabetes, reinforcing that patients need to undergo a complete hearing assessment for better understanding of the disease and its effects on the auditory system.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Atrial tachyarrhythmia causes atrial imbalance of the Ace/Ace2 ratio in aged and hypertensive rats

Purpose: Arterial hypertension and age are the most predominant factors causing atrial fibrillation (AF). The exact proarrhythmogenic pathways involved are still unknown. The present study was designed to examine changes in the composition of atrial members of the renin-angiotensin system (RAS) in response to tachyarrhythmia in the presence of arterial hypertension at different ages. The local RAS plays a crucial role in remodelling processes in the heart, primarily through the action of angiotensin II (AngII), which is generated by angiotensin converting enzyme (ACE). ACE2 counterbalances the action of ACE by cleaving of AngII into peptides that act protective. Methods: Atrial tissue from spontaneously hypertensive male rats (SHR; n=6) and their normotensive controls, Wistar-Kyoto (n=6), were analysed at the age of 12 weeks and 6-8 months. Atrial slices were rapidly stimulated at 5 Hz up to 20h to resemble AF (n=4 per group and age). The changes in the expression of RAS components (ACE, ACE2, angiotensin receptors) as well as RAS-associated downstream effectors were estimated at the mRNA and protein levels. Moreover, the activation of MAPK and NF-κB signalling were analysed by immunoblotting. Results: Our data revealed that left atrium of SHR expressed constantly high levels of ACE protein (3.8±0.7; p=0.03) and mRNA (1.7±0.7; p=0.04) compared to normotensive controls (1.0) in each age group. ACE2-mRNA levels did not show any changes at 12 weeks between normotensive and hypertensive rats. With age the mRNA levels of ACE2 diminished in SHR (0.79±0.04; p=0.02). These molecular changes were accompanied by activation of MAPK, NF-κB signalling and the presence of the active caspase-3 in SHR. In response to the stimulation in the electrical field, the atrial tissue from hypertensive rats showed 1.6-fold (p=0.01) and of normotensive rats 3.0-fold increase (p=0.01) in the expression of ACE. In normotensive young rats, ACE2 counterbalanced this action at the mRNA (1.5±0.12; p=0.01) and protein level (2.7±0.80; p=0.11). This protective action of ACE2 decreased with age in normotensive rats, and it disappeared completely in SHR (mRNA: 0.94±0.13; protein: 0.98±0.11). Conclusions: Our data show that hypertension in SHR is accompanied by enhanced atrial expression of angiotensin-converting enzyme. This fact strongly implies a sustained exposure of atrial tissue to elevated levels of local AngII. The observed imbalance of the ACE/ACE2 ratio in aged hypertensive rats might facilitate the susceptibility to arrhythmia especially in this clinical scenario.

Ankle‐Brachial Index and Cardiovascular Mortality in Nondiabetic Hemodialysis Patients

Atherosclerosis is a leading cause of morbidity and mortality in hemodialysis (HD) patients. Low (<0.90) and high (>1.40) ankle-brachial index (ABI) is known as a non-invasive diagnostic marker for generalized atherosclerosis associated with higher cardiovascular (CV) mortality in the general population. Less is known about associations between ABI and CV mortality in HD patients. The aim of our study was to determine the impact of the ABI on CV mortality in nondiabetic HD patients. Fifty-two nondiabetic HD patients (mean age 59 years, range 22 - 76 years) were enrolled in our study. Twenty-three (44%) were women and 29 (56%) men. The ABI was determined using an automated, non-invasive, waveform analysis device. All patients were divided according to the ABI into three groups: low ABI (<0.9), normal ABI (0.9-1.4) and high ABI (>1.4). The presence of arterial hypertension and smoking was established. Serum cholesterol (HDL and LDL) and triglycerides were measured by routine laboratory methods. Survival rates were analyzed using Kaplan-Meier survival curves. The Cox regression model was used to assess the influence of the ABI on CV outcomes. The model was adjusted for age, arterial hypertension, smoking, cholesterol and triglycerides. Mean ABI value was 1.2 ± 0.3 (range 0.2-2.2). Patients were observed from the date of the ABI measurement until their death or maximally up to 1620 days. Kaplan-Meier survival analysis showed that the risk for CV death was higher for HD patients with low and high ABI compared to normal ABI (log rank test: P < 0.006; P < 0.0001). In the adjusted Cox multivariable regression model low and high ABI (P < 0.011; P < 0.003) remained predictors of mortality in our patients. The results indicate a U-shaped association between the ABI and CV mortality in nondiabetic HD patients and showed that low and high ABI were directly associated with higher mortality of our patients.

Necesidad de tratamiento periodontal en adultos diabéticos controlados y no controlados en una población chilena. Estudio de corte transversal

ObjectiveTo observe the Periodontal Treatment Need (PTN) in adult patients without Diabetes Mellitus type 2 (noDM2) and with Diabetes Mellitus type 2 (DM2) controlled and non-controlled in a chilean population. Materials and MethodsCross sectional study. A periodontist recorded the PTN according to the Periodontal Treatment Need Community Index (CPITN), from a sample of patients with noDM2, controlled DM2 (Hemoglobin A, Glycosylated HbA1c ≤ a 6.5%) and non-controlled DM2 (HbA1c >6.5%) from the Army Clinical Center in Valdivia-Chile between april and july 2012. The age, sex and presence of arterial hypertension were recorded. The sociodemographic variables and the statistical association between PTN in patients with noDM2, with controlled and non-controlled DM2 (chi-squared test, p<0.05) were also analyzed. ResultsNinety six patients were analyzed. The average age was 55.2±8.3 years old, 45 of them (48.9%) were diabetics. 96.88% of the samples presented a PTN by the specialists (CPITN codes 3 and 4), there were no significant differences between DM2 and noDM2 patients (p=0.63). No significant differences were observed in PTN between patients with controlled and non-controlled diabetes (p=0.43). ConclusionsPrevious reports related the presence and lack of control of DM2 as a risk factor of periodontal disease. Nonetheless, in our study, there was a high index of PTN in all the different types of patients examined.

The place of Indapamide retard in the treatment of patients with left ventricular dysfunction and preserved systolic function in the presence of arterial hypertension

The issue of blood pressure levels is practically very important in patients with chronic heart failure (CHF). As is known, combination therapy for the latter implies the use of several groups of hemodynamically relevant agents; diuretics are an important component of CHF therapy. However, diuretics are the most unstudied medications in the treatment of patients with CHF in the context of evidence-based medicine. On the one hand, their efficacy and necessity for the treatment of patients with cardiac decompensation are beyond question and, on the other, even if you want, placebo-controlled trials using diuretics look difficult to perform.

Hipertensión Secundaria a Hiperaldosteronismo primario: reporte de caso

Resumen&#x0D; El hiperaldosteronismo primario es la causa más frecuente de hipertensión de origen endocrino. El exceso de aldosterona se asocia a elevación de la presión arterial, hipokalemia, hiperglucemia e hipertrofia ventricular. La presencia de hipertensión arterial y niveles bajos de potasio en sangre, alertan al clínico que debe buscarse una causa secundaria de hipertensión arterial. &#x0D; Se presenta el caso de un hombre de 39 años de edad con síndrome de Conn (hiper aldosteronismo primario por adenoma suprarrenal), en quien se hace el estudio bioquímico e imaginológico, con posterior cirugía exitosa (adrenalectomía unilateral). Se presenta el enfoque del paciente con sospecha de hiperaldosteronismo, la interpretación de las pruebas actuales en nuestro medio y su pronóstico.

THU0532 Distribution of Body Mass Index and Metabolic Syndrome in Patients with Inflammatory Autoimmune Diseases from a Single Italian Centre

BackgroundObesity is at now considered as a mild, long-lasting inflammatory disease associated with an increased cardiovascular (CV) risk. On the other hand, rheumatic diseases have been associated with increased CV...

AB0450 Laboratory tests, neurologic complications and modality of referral in 36 patients affected by temporal arteritis: differences between biopsy proven and not biopsy proven patients.

ObjectivesTo compare laboratory and clinical parameters in patients with biopsy proven and not biopsy proven temporal arteritis. To evaluate if the incidence of neurologic complications would be influenced by other...

Clinical heterogeneity of patients with complex sleep apnea syndrome

BackgroundThe definition of complex sleep apnea (CompSAS) encompasses patients with obstructive sleep apnea (OSA) who develop central apnea activity upon restitution of airway patency. Presence of arterial hypertension (HTN), coronary artery disease (CAD) and heart failure (HF) have been proposed as risk factors for CompSAS among OSA patients. Using our database of patients with CompSAS, we examined the prevalence of these risk factors and defined other clinical characteristics of patients with CompSAS.MethodsThrough retrospective search of the database, we examined the medical and clinical characteristics of consecutive patients diagnosed with CompSAS between 11/1/2006 and 6/30/2011 at NorthShore University HealthSystem.ResultsOne hundred and fifty patients with CompSAS were identified. Among patients included in the study, 97 (64.7 %) had at least one risk factor for CompSAS, while 53 (35.3 %) did not have any of them. Prevalence of low left ventricular ejection fraction and hypocapnia were low. Therapeutic interventions consisted of several positive airway pressure therapies, mainly adaptive servo ventilation. A hundred and ten patients (73.3 %) complied with recommended therapy and improved clinically.ConclusionsAlthough most patients with CompSAS have cardiac comorbidities, about one third of patients do not have any risk factors of CompSAS prior to sleep testing. Further research on factors involved in development of CompSAS will allow for better tailoring of therapy to pathophysiology involved in an individual case.

Spectrum of mutations and phenotypic expression in patients with autosomal dominant hypercholesterolemia identified in Italy

ObjectiveTo determine the spectrum of gene mutations and the genotype–phenotype correlations in patients with Autosomal Dominant Hypercholesterolemia (ADH) identified in Italy. MethodsThe resequencing of LDLR, PCSK9 genes and a selected region of APOB gene were conducted in 1018 index subjects clinically heterozygous ADH and in 52 patients clinically homozygous ADH. The analysis was also extended to 1008 family members of mutation positive subjects. ResultsMutations were detected in 832 individuals: 97.4% with LDLR mutations, 2.2% with APOB mutations and 0.36% with PCSK9 mutations. Among the patients with homozygous ADH, 51 were carriers of LDLR mutations and one was an LDLR/PCSK9 double heterozygote. We identified 237 LDLR mutations (45 not previously reported), 4 APOB and 3 PCSK9 mutations. The phenotypic characterization of 1769 LDLR mutation carriers (ADH-1) revealed that in both sexes independent predictors of the presence of tendon xanthomas were age, the quintiles of LDL cholesterol, the presence of coronary heart disease (CHD) and of receptor negative mutations. Independent predictors of CHD were male gender, age, the presence of arterial hypertension, smoking, tendon xanthomas, the scalar increase of LDL cholesterol and the scalar decrease of HDL cholesterol. We identified 13 LDLR mutation clusters, which allowed us to compare the phenotypic impact of different mutations. The LDL cholesterol raising potential of these mutations was found to vary over a wide range. ConclusionsThis study confirms the genetic and allelic heterogeneity of ADH and underscores that the variability in phenotypic expression of ADH-1 is greatly affected by the type of LDLR mutation.

Асоціація поліморфізму rs966221 гена фосфодіестерази 4D з ризиком розвитку інфаркту міокарда

The aim of the paper was to study an association of rs966221 phosphodiesterase 4D (PDE4D) gene’s polymorphism with risk of myocardial infarction (IM). One hundren sixty six persons were observed. The I (main) group included 97 patients with IM in anamnesis and the II (control) group consisted of 65 persons without IM. The study of polymorphism was performed by polymerase chain reaction with restriction of products. An increased frequency of TT genotype in the main group (20.6 %) comparing with controls (7.7 %; P = 0.026) was found. The differences were significant in men over 60 years old, having presence of arterial hypertension and signs of dyslipidemia.

ADRB3 and PPARγ2 gene polymorphisms and their association with cardiovascular disease risk in postmenopausal women

Objectives The contribution of heritability to the development of cardiovascular disease (CVD) is of interest as the identification of genes enhancing the susceptibility of individuals to CVD may help the design of clinical interventions optimized for the individual's genome.Methods We studied the associations of polymorphism of ADRB3 and PPARγ2 genes with obesity indices, unfavorable lipid profile parameters and insulin resistance index HOMA in 343 postmenopausal women.Results No association was found between tested polymorphisms and CVD risk factors such as total cholesterol ≥ 5.0 mmol/l, high density lipoprotein cholesterol < 1.2 mmol/l, low density lipoprotein cholesterol > 3.0 mmol/l and triacylglycerols > 1.7 mmol/l. The presence of arterial hypertension and HOMA value ≥ 1.95 were also not related to these polymorphisms. A significant association between PPARγ2 gene polymorphism and total body fat mass (odds ratio = 1.90 at p = 0.037) as well as android fat deposit mass (odds ratio = 1.82 at p = 0.048) was found.Conclusions CVD risk factors in postmenopausal women are not directly associated with the polymorphisms of PPARγ2 and ADRB3 genes. We suggest that some indirect link between PPARγ2 gene polymorphism and susceptibility of postmenopausal women to CVD may exist. This suggestion is based on our finding that high total body fat mass and high android fat deposits are associated with the presence of the Pro12Ala allele of the PPARγ2 gene.

Altered Cardiovascular Rhythmicity in Children Born Small for Gestational Age

Low birth weight is frequently associated with a disproportionately high incidence of cardiovascular disease, diabetes mellitus, and kidney disease in adulthood. Epidemiological studies have identified an inverse association between low birth weight or being small for gestational age and hypertension in adulthood. We hypothesized that children born with low birth weight might have altered circadian and ultradian cardiovascular rhythmicity independent of the prevailing blood pressure level. Twenty-four-hour ambulatory blood pressure and heart rate rhythmicity was prospectively evaluated by Fourier analysis in a cohort of healthy children born with low birth weight and compared with normative pediatric data. Seventy-five children born small for gestational age (mean age, 8.1±2.2 years) and 139 controls matched for age and sex were investigated. In addition to increased 24-hour, daytime, and especially nighttime blood pressure levels (P<0.05), children born small for gestational age exhibited blunted circadian (24-hour) and ultradian (12-, 8-, and 6-hour) blood pressure rhythmicity (P<0.05). In a multivariate analysis including children born with low birth weight and controls, being born with low birth weight independently influenced ultradian blood pressure rhythmicity, whereas in a multivariate analysis including children born with low birth weight only, circadian and ultradian rhythms were independently influenced by catch-up growth, gestational age, and blood pressure level. This study demonstrates blunted circadian and ultradian cardiovascular rhythmicity in prepubertal children born small for gestational age, independent from the presence of arterial hypertension. Circadian and ultradian rhythms may be sensitive indicators for detecting subtle early abnormalities of cardiovascular regulation.

Granulomatous skin lesions in a renal transplant patient

In April 2011, a 54-year-old male from Southern Italy presented with multiple asymptomatic nodular lesions involving the lower limbs. He reported some of these nodules had appeared 5 months earlier, while others, of which many had resolved, dated back in time 3–4 years. Treatment with topical antibiotics and corticosteroids repeatedly failed to cause any evident improvement of these lesions. Patient’s history revealed the presence of arterial hypertension, ulcerative colitis since 1981, and nephrotic syndrome secondary to mesangial glomerulonephritis, since 1976, which led him to hemodialysis at first and eventually to bilateral kidney transplantation in 2001. Consequently, the patient took the following medications mesalazine, methylprednisolone, azathioprine, tacrolimus, propranolol and amlodipine. On physical examination, there were a solitary pinkcolored nodule on the right ankle area and a few discrete lesions on the left knee, presenting as violaceous, indurated nodules and spreading across the area in an arciform pattern, some of which showed signs of ulceration (Fig. 1). The lower limbs showed also a few hyperchromic and atrophic changes resulting from lesions previously occurred. Bilateral inguinal lymphadenopathy was present, with enlarged, non-tender, mobile and firm discrete elements. A series of examinations were carried out consisting of blood count, hematochemistry, urinalysis, serum IgE, ECG, chest radiography, urine and stool cultures, tuberculin skin test, QuantiFERON-TB Gold test, VDRL, TPHA, cutaneous swab from ulcerative lesions for microscopic examination, skin biopsies and microbiological tissue cultures for mycobacteria, fungi, and Leishmania, as well as real-time polymerase chain reaction (PCR) and PCR microarray detection of Mycobacterium tuberculosis and atypical mycobacteria. Microbiological assessments were negative, and laboratory examinations disclosed no abnormal findings, except for mild proteinuria, microhematuria and high creatinine serum levels. Pathological study of a skin specimen showed foci of granulomatous inflammation with lymphocytes, plasma cells and abundant eosinophils, with the formation of numerous eosinophilic abscesses. Several vessels with flattened endothelial cells were also visible (Fig. 2). Many of the clinical and histopathological findings were consistent with the diagnosis of Kimura’s disease (KD). Based on such findings, a lymph node biopsy was taken into consideration to better define the nature of concomitant lymphadenopathy in our patient, who, however, refused this procedure. After consultation with nephrologists, treatment already received by the patient was not changed and a wait-and-see approach was chosen. At a follow-up assessment 6 months later, nodular lesions had regressed spontaneously without the development of any new lesions. The immunosuppressive therapy was not modified, and the only relevant event in the patient’s history was an episode of deep vein thrombosis of the left leg. KD is a benign chronic inflammatory disease with unknown etiology, which is endemic in Asia [1, 2]. Long considered synonym to angiolymphoid hyperplasia with eosinophilia (AHLE) is now regarded as a distinct entity. D. Bonamonte (&) C. Foti N. Cassano M. Vestita P. Greco G. A. Vena Unit of Dermatology and Venereology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy e-mail: d.bonamonte@dermatologia.uniba.it

HORMONAL MARKERS OF DEVELOPMENT OF ARTERIAL HYPERTENSION IN ADOLESCENTS WITH OBESITY

The aim of the study was to analyze of hypertension epidemiology in adolescents with obesity. 36,15 % of adolescents with obesity revealed the presence of arterial hypertension by measuring the level of «office» blood pressure. It was established that the main factors that contributed to the development of arterial hypertension were hyperleptinaemia, insulin resistance and activation of the RAAS.

Low cardiometabolic risk in Parkinson's disease is independent of nutritional status, body composition and fat distribution

To investigate if the reduced cardiometabolic risk in Parkinson's disease (PD) is independent of nutritional status, body composition and fat distribution. We designed a case-control study comparing 80 non underweight PD patients with 80 controls matched for sex, age and body mass index (BMI). Nutritional assessment included: anthropometry (BMI and waist circumference [WC]), body composition estimated by impedance and biochemistry (fasting glucose, serum lipids and transaminases). The presence of arterial hypertension, diabetes mellitus and metabolic syndrome (MetS) were noted. Compared to controls and independently of gender, PD patients showed lower percentage of body fat (P < 0.001) and biochemical parameters (glucose, P < 0.001; total cholesterol, P < 0.001; LDL, P < 0.001; triglycerides, P = 0.002; alanine aminotransferase, P < 0.001 and aspartate aminotransferase, P = 0.015) but similar WC (P = 0.324). The prevalence of hypertension and MetS was similar in the two groups, as well as the frequency and the number of MetS criteria. The relationship between PD and low cardiometabolic profile was independent of age, gender, current smoking and BMI. After adjusting for WC and body fat, most of the associations remained significant. PD patients seem to have a more favorable cardiometabolic risk profile, independently of nutritional status, body composition and fat distribution.

Risk factors associated with ischemic heart disease occurence in acute ischemic stroke patients

At specific time periods following ischemic stroke (IS), acute coronary syndrome as ischemic heart disease (IHD) represents a higher risk of death than IS. Not all IS patients can undergo specific examination for IHD detection. The aim of this study was to assess exclusive risk factors (RFs) associated with IHD occurrence in IS patients. Knowledge of these RFs should help in stratifying IS patients for IHD detection. This was a hospital-based, retrospective, single centre study. The sample consisted of 192 consecutive IS patients, divided into two subgroups - Subgroup 1 (54 patients without IHD; 55.6% males; 63.1 ± 11.8 years) and Subgroup 2 (138 patients with IHD; 39.1% males; 76.3 ± 9.6 years). The following factors were identified: age; sex; presence of arterial hypertension, atrial fibrillation, diabetes mellitus; plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol; body mass index; presence of carotid plaques. Logistic regression analysis was used for statistical evaluation. Of all identified risk factors only age (OR=1.109; 95% CI: 1.069 - 1.150, P=0.001) and the presence of arterial hypertension (OR=6.298; 95% CI: 2.215 - 17.905, P=0.003) were exclusively and significantly associated with the presence of IHD in IS patients. Age and arterial hypertension may be exclusive risk factors associated with IHD in IS patients.

Appearance of femoropopliteal segment aneurysms in patients with abdominal aortic aneurysm

To promote better treatment outcome, as well as economic benefit it is very important to find out patients with simultaneous occurrence of both aortic and arterial aneurysms. The aim of this prospective study was to determine the frequency and factors affecting femoropopliteal (F-P) segment aneurysms appearance in patients with abdominal aortic aneurysms (AAA). This study included 70 patients who had underwent elective or urgent surgery of AAA from January 1, 2006 to December 31, 2007. After ultrasonographic examination of F-P segment, all the patients were divided into two groups--those with adjunctive F-P segment aneurysm (n = 20) and the group of 50 patients witho no adjunctive F-P segment aneurysm. In both groups demographic characteristics (gender, age), risk factors (diabetes mellitus, elevated serum levels of cholesterol and triglycerides, arterial hypertension, smoking, obesity) and cardiovascular comorbidity (cerebrovascular desease, ischemic heart desease) were investigated. Twenty (28.57%) patients who had been operated on because of AAA, had adjunctive aneurysmal desease of F-P segment. Diabetes was no statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (chi2 = 0.04; DF = 1; p > 0.05). Also, in both groups there was no statistically significant difference in gender structure (chi2 = 2.05; DF = 2; p > 0.05), age (chi2 = 5.46; DF = 1; p > 0.05), total cholesterol level (chi2 = 0.89; DF = 1; p > 0.05) and triglyceride (chi2 = 0.89; DF = 1; p > 0.05) levels, the presence of arterial hypertension (chi2 = 1.38; DF = 2; p > 0.05), smoking (chi2 = 1.74; DF = 1; p > 0.05), obesity (chi2 = 1.76; DF = 1; p > 0.05) and presence of cerebrovascular desease (chi2 = 2.34; DF = 1; p > 0.05). Conversly, ischemic heart desease was statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (chi2 = 5.45; DF = 1; p < 0.05). Twenty patients, beside AAA, had adjunctive F-P segment aneurysm. The results of this study suggest the necessity of preforming ultrasonographic examination of F-P segment in all patients with proven AAA.

Risk factors for gout: Gender differences

Objective: to comparatively assess risk factors for gout in male and female patients with this condition. Subjects and methods. The study enrolled 340 gouty patients (289 men and 51 women) examined in the period 2002 to 2009. The diagno sis corresponded to the criteria developed by S.L. Wallace. The mean age was 52.3±11.4 years for the women and 52.3±10.4 years for the men. The study group included female patients with gout and a comparison group comprised male patients with this condition. All the patients were interviewed using a questionnaire to identify risk factors for gout: the regular use of diuretics or alcoholic beverages before the onset of this disease, the presence of arterial hypertension (AH), and menopause in women. Results. The intake of diuretics before gout was reported by 57% of the women and 19.7% of the men (p < 0.00001). The drugs were given to all the men according to medical indications; 10 of 29 women took diuretics to lose weight. Alcohol was consumed more than twice week ly by 17.6% of the women and 33.6% of the men (p = 0.032). The median weekly alcohol consumption was 2 (range 1-4) conventional units (CU) in the women and 4 (range 2-10) CU in the men (p = 0.002). AH occurring the onset of gout was found in 30 (59%) women and 136 (47%) men (p = 0.13). Menopause developing prior to the onset of gout was noted in 26 (51%) women. Conclusion. Among possible causes of gout, the use of diuretics is more common in the women than in the men, moreover, the former take them unfairly in one third of cases. The women consume alcohol less frequently and in smaller quantities, but the rate of female intake of alcoholic beverages is associated with younger age at the onset of gout. In early menopause or amenorrhea, gout more frequently occurs at a young age. AH is a common risk factor for gout in both the women (59%) and the men (47%).