Risk Factor For Cardiovascular Mortality Research Articles

Serum uric acid concentration (SUAC): A useful tool to assess extent and severity of chronic plaque psoriasis in Pakistani population.

Objectives: Psoriasis is a systemic chronic inflammatory autoimmune disease. Psoriasis can lead to multiple complications and co-morbidities. It has also been observed that raised serum uric acid levels predispose to gouty arthritis and also thought to be a risk factor for cardiovascular mortality and morbidity. The basic aim of this study was to ascertain level of serum uric acid in patients with chronic plaque psoriasis and control cases which might be a useful tool for assessing the extent and severity of chronic plaque psoriasis. Study Design: Case control study. Setting: At Outpatient’s Department (OPD) of Department of Dermatology, PNS Shifa, Karachi. Period: From January 2013 to December 2016. Material & Methods: One hundred and ninety four (194) patients were taken in this study and 97 patients were biopsy proven cases of psoriasis and 97 other participants included as control cases reporting to OPD with other complaint like acne, hair fall and fungal infections. After written and informed consent, 5ml of venous blood was drawn in sterile syringe and using gel sample tube to see the serum uric acid levels. On the basis of laboratory reports the elevated serum uric acid level in psoriatic versus normal controls was recorded on a pre-designed proforma. Results: There were 54.6% (106/194) male and 45.4% (88/194) female. Elevated serum uric level was 4.5 times (Approximate of 4.46) more common in cases than control group (OR: 4.46 95%CI: 1.83 to 10.91). Conclusion: Raised levels of serum Uric acid have been seen frequently in psoriatic patients. Early treatment for higher levels of serum uric acid might play a critical role in the better treatment of psoriatic patients. These results revealed that serum uric acid concentration (SUAC) of psoriasis may play a vital role in assessing the complex multifactorial etiology of the psoriasis, severity and other possible metabolic factors.

Medication adherence of rheumatic heart disease patients: a cross-sectional study in Bangladesh

Rheumatic heart disease (RHD) is a significant public health problem and Non-adherence to treatment is an important and often unrecognized risk factor for cardiovascular mortality. The study aimed to assess self-reported medication adherence by 8-item Morisky Medication Adherence Scale (MMAS-8) among rheumatic heart disease patients and determine the associated factors. A cross-sectional study was carried out by applying a structured interview to Rheumatic heart disease patients aged 18 or higher in a tertiary hospital in Bangladesh. Among Rheumatic heart disease patients, 63.5% showed medium adherence, 36.5% showed low adherence to medication. Walking habit (P= 0.000), exercise habit (P=0.000), smoking habit (P=0.000), and duration of RHD (P=0.005) found significantly associated with medication adherence. Multiple logistic regression analysis also revealed, don't have walking habit more than 10 minutes at a time (AOR=2.416, 95% CI: 1.212-4.816), don't having exercise habit (AOR=2.420, 95% CI: 1.206 – 4.859), don't having habit of smoking (AOR=0.392, 95% CI: 0.183 – 0.841), duration of RHD for less than 15 (AOR=4.190, 95% CI: 0.851 – 20.631) are independent predictors of adherence. Our study demonstrated medium to low medication adherence in the Morisky Medication Adherence Scale among rheumatic heart disease patients.
 Asian J. Med. Biol. Res. June 2019, 5(3): 186-191

P1960Endothelial progenitor cells are associated with cardiovascular outcome in patients with peripheral artery disease

Abstract Background and introduction Endothelial dysfunction and associated cells are an important cornerstone in the development and progression of peripheral artery disease (PAD). Endothelial progenitor cells (EPC) are released from the bone marrow and have exhibited the potential for cardiovascular repair. Higher EPC levels have been linked to longer event-free survival in coronary artery disease. Similar evaluation of EPC on mortality in PAD is lacking. Purpose The current study aimed to evaluate the possible association between EPC levels and mortality in PAD patients. Methods EPC were measured in 367 PAD patients (age 69.22±10.3, 66.5% male, Fontaine stage I-II) by flow cytometry using the cell surface marker CD34+ and CD309+. Patients were followed for seven years to assess all cause and cardiovascular mortality. Patients were categorized into quartiles according to EPC levels for further analyses. Statistics included Kaplan-Meier and Cox regression. Results 89 patients died over the observation period. ICD-codes indicated a cardiovascular cause in 58 patients. The group with the highest count of EPC showed a trend towards higher all-cause mortality (p=0.070) and a significant association with cardiovascular mortality (p=0.002). Multivariable adjustment for age, c-reactive protein, systolic blood pressure, renal function (creatinine and urinary albumin), low density lipoprotein cholesterol, HbA1c, and smoking status revealed the EPC quartile to be an independent risk factor for cardiovascular mortality (p=0.016). Conclusion Increased levels of CD34+CD309+ cells are independently associated with long-term cardiovascular mortality in PAD patients.

Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries.

Background: This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. Methods: Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. Results: Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990–2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. Conclusions: Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.

Abstract 258: Elucidating Sex Differences in Stress-related Atrial Remodeling and AF Risk in a Mouse Model of Atrial Dysfunction

Atrial fibrillation (AF) is the most common arrhythmia and a major risk factor for cardiovascular mortality and stroke. Despite significant advances in AF diagnosis and management, major gender discrepancies in treatment and clinical outcomes remain. It is unclear if these are related to treatment disparities or to underlying differences in the structure and biochemical makeup of the female versus male heart. How lifestyle, diet, comorbidities and risk factors contribute to this clinical dimorphism are not well understood. My laboratory has recently developed a double-transgenic mouse line that recapitulates this gender dimorphism. These mice were generated by crossing lines with cardiac expression of an amino and carboxyl terminal fragment, βARKnt (residues 50-145) and βARKct (residues 495-689), of the prototypical G protein-coupled receptor (GPCR) kinase GRK2 (originally βARK1). This line was created to investigate the therapeutic potential of dual regulation of β-adrenergic receptor signaling independent of canonical GRK2 activity. Since preliminary data demonstrate atrial dysfunction in both genders, but structural remodeling in females only, this model presents a unique tool to investigate sex differences in the molecular and cellular mechanisms of atrial remodeling. Masson’s trichrome staining of 4-chamber paraffin sections demonstrated an increase in wall thickness in the βARKnt and βARKnt/βARKct mice in agreement with the increased heart weight. Interestingly, these data revealed a significant increase in left and right atrial size in the double transgenic female hearts only, with no apparent alteration in the male atria. Preliminary echo recordings demonstrated significant alterations in E/A ratio (ventricular relaxation/atrial contraction) in the βARKnt and even more pronounced in the βARKnt/βARKct male and female mice. These data suggest that although no remodeling is evident at baseline, the male βARKnt/βARKct mice have underlying atrial dysfunction that may be more susceptible to additional cardiovascular stress. A better understanding of gender differences in the underlying mechanisms of atrial susceptibility may facilitate the development of safer and more effective approaches for AF management and prevention.

Sclerostin levels predict cardiovascular mortality in long-term hemodialysis patients: A prospective observational cohort study.

Sclerostin is a protein which is involved in bone metabolism and probably also in vessel wall function. This prospective observational cohort study evaluated the prognostic significance of sclerostin in hemodialysis (HD) patients. In total, 106 HD patients and 25 healthy controls participated in the study. HD patients were prospectively followed up for five years. Sclerostin was measured in serum using standard ELISA kits by Biomedica. Sclerostin concentrations in serum were higher in HD patients compared to the controls (89.2±40.3 pmol/l vs. 32.8±13.0 pmol/l, p<0.001). Sclerostin levels were significant for cardiovascular mortality but not for overall mortality and mortality due to infection. A higher cardiovascular risk was connected to sclerostin concentrations above the median (>84 pmol/l), HR (95 % CI): 2.577 (1.0002-10.207), p=0.04. When sclerostin was evaluated together with residual diuresis in Kaplan-Meier analysis the worst prognosis due to cardiovascular events was observed in the group with high sclerostin and zero residual diuresis compared to all other patients (p=0.007). In summary, serum sclerostin levels in HD patients were increased when compared to healthy subjects. High sclerostin levels were demonstrated as a risk factor for cardiovascular mortality. Further studies are required to clarify the pathophysiological mechanisms of sclerostin action in patients with renal failure before therapeutic measures can be established.

2 ASSOCIATION BETWEEN SALT SENSITIVE-RELATED GENE POLYMORPHISM AND HYPERTENSION IN RURAL INDONESIAN SUNDANESE POPULATION

Background: Salt sensitivity is a trait in which blood pressure “changes parallel to changes in salt intake.” It is counted as a risk factor for cardiovascular mortality and morbidity, independent of and as powerful as blood pressure. Previous studies have reported the involvement of G Protein-Coupled Receptor Kinase 4 (GRK4) A486 V gene polymorphism with hypertension and salt sensitivity based on ethnic and geographic region. Risk stratification and therapeutic potential associated to salt sensitivity are common background for studies on this gene. As our knowledge, this is the first report of GRK4 A486 V gene polymorphism on hypertension in Indonesian population. Objectives: To investigate the association of GRK4 A486 V gene polymorphism and hypertension in rural population of Indonesia. Methods: A total of 412 Sundanese adults from Gunung Sari Village in Bogor Indonesia, consist of 211 hypertensive subjects and 201 non-hypertensive subjects as a control group were enrolled in this population based case-control study. The genotypes of the GRK4 A486 V were determined by a TaqMan assay. Odds ratio with 95% confidence interval was used to assess the risk of association. Results: Frequency of GRK4 A486 V gene polymorphism were 68.2% and 59.2% in hypertensive and non-hypertensive subjects respectively. After adjustment of age, body mass index, waist circumference, and diabetes mellitus, we observed association between GRK4 A486 V gene polymorphism with hypertension (OR 1,7; 95% CI 1,1–2,7) Conclusions: There is an association between GRK4 A486 V gene polymorphism and hypertension in rural population of Indonesia.

SYSTEMATIC REVIEW WITH NETWORK META-ANALYSIS

Objective:Hypertension (HTN) is the leading risk factor for cardiovascular mortality globally. Numerous studies have compared safety and efficacy between antihypertensive classes, but in-class comparisons of angiotensin II receptor blockers (ARBs) in fixed-dose combinations (FDC) with a calcium chan

Long- and short-term association of low-grade systemic inflammation with cardiovascular mortality in the LURIC study

The present study aimed to evaluate biomarkers representing low-grade systemic inflammation and their association with cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. The included 3134 consecutive patients underwent coronary angiography between June 1997 and May 2001 with a median follow-up of 9.9years. Plasma levels of IL-6, and acute-phase reactants serum amyloid A (SAA) and C-reactive protein (CRP) were measured. SAA and IL-6 polymorphisms were genotyped. During a median observation time of 9.9years, 949 deaths (30.3%) occurred, of these 597 (19.2%) died from cardiovascular causes. High plasma levels of IL-6, CRP and SAA were associated with unstable CAD, as well as established risk factors including type 2 diabetes mellitus, smoking, low glomerular filtration rate, low TGs and low HDL-C. After adjusting for established cardiovascular risk markers and the other two inflammatory markers, SAA was found to be an independent risk factor for cardiovascular mortality after a short-term follow-up (6months-1year) with a HR per SD of 1.41. IL-6 was identified as an independent risk factor for long-term follow-up (3, 5, and 9.9years) with HRs per SD of 1.21, 1.22 and 1.18. CRP lost significance after adjustment. Although 6 out of 27 SAA SNPs were significantly associated with SAA plasma concentrations, the genetic risk score was not associated with cardiovascular mortality. The present findings from the large, prospective LURIC cohort underline the importance of inflammation in CAD and the prognostic relevance of inflammatory biomarkers that independently predict cardiovascular mortality.

The Impact of Alpha-Lipoic Acid on Insulin Resistance and Inflammatory Parameters in Patients with Type 2 Diabetes Mellitus and Cardiac Autonomic Neuropathy

Development of chronic complications in type 2 diabetes mellitus (T2DM), namely cardiac automonic neuropathy (CAN), had been implicated as an independent risk factor for cardiovascular mortality. This paper presents the results obtained during the study of possible alpha-lipoic acid (ALA) impact on the state of insulin resistance (IR), the content of some pro- and anti-inflammatory factors in patients with T2DM and definite stage of CAN. Our study involved 33 persons with diagnosed T2DM and definite CAN, which were allocated to one of two groups. The control group (15 patients) received standard hypoglycemic treatment, whereas the intervention group (18 patients) received ALA 600 mg in film-coated tablets/q.d. in addition to standard therapy. Treatment period was 3 months in duration. Levels of glycated hemoglobin A1c, glucose, immunoreactive insulin (IRI), leptin, interleukin (IL) IL-6 and IL-8, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha) in the blood were measured. TNF-alpha/IL-10 ratio and Homeostasis model assessment IR (HOMA-IR) were calculated. The significant reduction in glucose, IRI, leptin concentration and HOMA-IR parameters; decrease in the pro-inflammatory link activity, namely hs-CRP, TNF-alpha, IL-6 and IL-8 levels, TNF-alpha/IL-10 ratio, with no changes in IL-10 content after 3 months of treatment was found. The results of our study demonstrated the decrease in the pro-inflammatory link activity after treatment and allow us to consider ALA as one of the promising drug for complex treatment of definite stage of CAN in patients with T2DM.

Effects of Calcium, Magnesium, and Potassium Concentrations on Ventricular Repolarization in Unselected Individuals

BackgroundSubclinical changes on the electrocardiogram are risk factors for cardiovascular mortality. Recognition and knowledge of electrolyte associations in cardiac electrophysiology are based on only in vitro models and observations in patients with severe medical conditions. ObjectivesThis study sought to investigate associations between serum electrolyte concentrations and changes in cardiac electrophysiology in the general population. MethodsSummary results collected from 153,014 individuals (54.4% women; mean age 55.1 ± 12.1 years) from 33 studies (of 5 ancestries) were meta-analyzed. Linear regression analyses examining associations between electrolyte concentrations (mmol/l of calcium, potassium, sodium, and magnesium), and electrocardiographic intervals (RR, QT, QRS, JT, and PR intervals) were performed. The study adjusted for potential confounders and also stratified by ancestry, sex, and use of antihypertensive drugs. ResultsLower calcium was associated with longer QT intervals (−11.5 ms; 99.75% confidence interval [CI]: −13.7 to −9.3) and JT duration, with sex-specific effects. In contrast, higher magnesium was associated with longer QT intervals (7.2 ms; 99.75% CI: 1.3 to 13.1) and JT. Lower potassium was associated with longer QT intervals (−2.8 ms; 99.75% CI: −3.5 to −2.0), JT, QRS, and PR durations, but all potassium associations were driven by use of antihypertensive drugs. No physiologically relevant associations were observed for sodium or RR intervals. ConclusionsThe study identified physiologically relevant associations between electrolytes and electrocardiographic intervals in a large-scale analysis combining cohorts from different settings. The results provide insights for further cardiac electrophysiology research and could potentially influence clinical practice, especially the association between calcium and QT duration, by which calcium levels at the bottom 2% of the population distribution led to clinically relevant QT prolongation by >5 ms.

Dietary Supplementation of Strawberry Improves Vascular Inflammation Without Altering Metabolic Milieu in High-fat Diet Fed C57BL/6 J Mice (P06-086-19)

ObjectivesMetabolic syndrome (MetS) is an important risk factor for cardiovascular mortality and vascular inflammation plays a major role in the development of vascular complications. We tested the hypothesis that dietary strawberries (SB) attenuate vascular inflammation in MetS and this is due to a direct effect of SB on the vasculature. MethodsSeven-week-old male C57BL/6 J mice consumed rodent diets with 10% kcal from fat (control diet fed mice; CD) or 60% kcal from fat (high-fat diet fed mice; HFD) for 12 weeks and subgroups of CD and HFD mice were fed a 2.35% freeze-dried SB supplemented diet (CD + SB or HFD + SB). This dose in mice is equivalent to two servings of SB (∼160 g) per day in humans. HFD model shares many vascular phenotypes with human MetS including vascular inflammation. The following analyses were completed after 12-week treatment: body weight; food intake; body composition; respiratory exchange ratio (RER), energy expenditure and activity (in light and dark cycle by Comprehensive Laboratory Animal Monitoring System); fasting and non-fasting blood glucose; glucose and insulin tolerance tests; and vascular inflammation (binding of fluorescent labelled mouse monocytes WEHI78/24 to aortic vessel). ResultsHFD mice exhibited increased body weight, reduced lean body mass, increased body fat, reduced RER (in both light and dark cycle), increased fasting and non-fasting blood glucose, and impaired glucose and insulin tolerance compared to CD mice (P < 0.05). SB supplementation does not alter body weight, body fat, lean body mass, blood glucose, glucose or insulin tolerance in CD + SB and HFD + SB mice. The energy expenditure and activity were similar among the groups. The aortic vessel from HFD exhibited an increased binding to WEHI 78/24 monocytic cells vs CD mice. However, SB supplementation reduced monocyte binding to the vessel in HFD + SB vs HFD mice (P < 0.05). ConclusionsStrawberry supplementation improves vascular inflammation in HFD mice without altering metabolic milieu. This study indicates that the beneficial vascular effects of SB may not be due to a secondary effect but could be a direct effect on the vasculature. Strawberry consumption may be a potential adjunct strategy to prevent vascular complications in MetS. Funding SourcesUSDA grant (to ABPV), University of Utah Undergraduate Research Opportunity Program Award (to MNP, JEM, ASO, SS).

Cardiovascular mortality in renal cell carcinoma: A population-based study.

e16085 Background: Patients with renal cell carcinoma (RCC) often harbor risk factors for cardiovascular disease and may receive anti-VEGF agents, which are associated with cardiovascular toxicity. However, the risk for cardiovascular mortality in this patient population is currently unknown. Methods: Utilizing the SEER database, we identified patients with RCC diagnosed between 2007 (approval of sunitinib) and 2015 and selected patients aged ≥ 45 years. We calculated standardized mortality ratios (SMRs) for cardiovascular mortality (ICD-10 codes I00-I99) by comparing the number of observed deaths in the database to the number of expected deaths in age-matched groups of the US general population drawn from the CDC WONDER database. Multivariable Cox regression was used to identify risk factors for cardiovascular mortality in patients with RCC. Results: We identified 36,576 patients with RCC, of which 33,748 (92.3%) were ≥ 45 years old and among these, 1650 (4.9%) died of cardiovascular diseases. The SMR for cardiovascular mortality was 2.85 (95% CI 2.72-2.99) for all patients, 2.78 (95% CI 2.62-2.95) for males and 2.86 (95% CI 2.64-3.10) for females. Among the various age groups, the SMR was 4.75 (95% CI 3.82-5.84) for patients aged 45-54 years, 3.35 (95% CI 2.93-3.83) for patients aged 55-64 years, 2.75 (95% CI 2.49-3.04) for patients aged 65-74 years, 2.25 (95% CI 2.07-2.45) for patients aged 75-84 years, and 1.47 (95% CI 1.33-1.61) for patients aged &gt; 85 years. In multivariate analysis, advancing age (HR 1.06, 95% CI 1.06-1.07), male sex (HR 1.18, 95% CI 1.05-1.33), black race (HR 1.48, 95% CI 1.27-1.73), stage IV disease (HR 1.21, 95% CI 1.01-1.45), and performance of surgery directed to the primary tumor (HR 0.33, 95% CI 0.29-0.38) were independently associated with cardiovascular mortality. Conclusions: Patients with RCC possess an almost 3-fold greater risk for cardiovascular mortality than the general population and this risk is even more pronounced in middle-aged patients. Aggressive management of modifiable cardiovascular risk factors in this patient population is thus warranted.

Predictors of Unfavorable Outcomes in Patients with Atrial Fibrillation and Concomitant Heart Failure with Different Ejection Fractions: RIF-CHF Register One-Year Follow-Up.

Background Atrial fibrillation (AF) and heart failure (HF) are tightly interrelated. The concurrence of these pathologies can aggravate the pathological process. The geographic and ethnic characteristics of patients may significantly affect the efficacy of different types of therapy and patients' compliance. The objective of this study was to analyze how the features of the course of the diseases and management of HF + AF influence the clinical outcomes. Methods The data of 1,003 patients from the first Russian register of patients with chronic heart failure and atrial fibrillation (RIF-CHF) were analyzed. The endpoints included hospitalization due to HF worsening, mortality, thromboembolic events, and hemorrhage. Predictors of unfavorable outcomes were analyzed separately for patients with HF and preserved ejection fraction (AF + HFpEF), midrange ejection fraction (AF + HFmrEF), and reduced ejection fraction (AF + HFrEF). Prevalence of HF + AF and compliance with long-term treatment of this pathology during one year were evaluated for each patient. Results The study involved 39% AF + HFpEF patients, 15% AF + HFmrEF patients, and 46% AF + HFrEF patients. AF + HFpEF patients were significantly older than patients in two other groups (40.6% of patients were older than ≥75 years vs. 24.8%, respectively, p < 0.001) and had the lowest rate of prior myocardial infarctions (25.3% vs. 46.1%, p < 0.001) and the lowest adherence to rational therapy of HF (27.4% vs. 47.1%, p < 0.001). AF + HFmrEF patients had the highest percentage of cases of HF onset after AF (61.3% vs. 49.2% in other patient groups, p=0.021). Among patients with AF + HFrEF, there was the highest percentage of males (74.2% vs. 41% in other patient groups, p < 0.001) and the highest percentage of ever-smokers (51.9% vs. 29.4% in other patient groups, p < 0.001). A total of 57.2% of patients were rehospitalized for decompensation of chronic heart failure within one year; the risk was the highest for AF + HFmrEF patients (66%, p=0.017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15.5% vs. 5.4% in other patient groups, p < 0.001) rather than ischemic stroke (2.4% vs. 3%, p=0.776). Patients with AF + HFpEF had lower risk to achieve the combination point (stroke + IM + CV death) as compared to patients with AF + HFmrEF and AF + HFrEF (12.7% vs. 22% and 25.5%, p < 0.001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and administered treatment had different effects on the risk of unfavorable outcomes depending on ejection fraction group. The clinical features and symptoms were found to be significant risk factors of cardiovascular mortality in AF + HFmrEF, while therapy characteristics were not associated with it. Conclusions Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with the development of unfavorable outcomes. The demographic and clinical characteristics of patients with midrange ejection fraction demonstrate that these patients need to be studied as a separate cohort.

Effect of High Blood Pressure and Other Cardiovascular Risk Factors on All-causes Mortality in Elderly People: A Joined Survival Analysis from Brazil, Argentina and Italy

Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. Then, the aim of this paper is to estimate the effect of High Blood Pressure on all-causes mortality among subjects aged ≥65 years old in three scenarios with different socio-economic backgrounds and urbanization processes by using flexible parametric survival models. Three cohorts coming from Brazil (n=365, 8 years of follow-up), Argentina (n=1800, 10 years of follow-up) and Italy (n=2472, 30 years of follow-up) were considered and only subjects older than 64 years included. Time to death (months) from enrolment and all-causes mortality were considered. Statistical analysis included Frailty Cox's Model and Flexible Parametric Survival Analysis. Due to the two-level structure of variability (subjects nested into cohorts), multilevel mixed-effect survival regression models were fitted. For modeling purposes, only the first twelve years of follow-up were considered. Frailty Cox model showed significant positive effects of age and an effect modification of High Blood Pressure and Non-communicable diseases, but not effects proportionality. Multilevel modeling evidenced a positive statistically significant effect of Age, Non-Communicable Chronic Diseases and Smoking. There was also an effect modification of Non-Communicable Chronic Diseases on High Blood Pressure. High Blood Pressure and Non-Communicable Chronic Diseases are important causal components and strong risk factors of cardiovascular mortality in these countries.

Analysis of Fatty Acid Esters of Hydroxyl Fatty Acid in Selected Plant Food.

Metabolic syndrome, characterized by obesity, low-grade inflammation, insulin resistance, hyperglycemia, dyslipidemia and hypertension, is a major risk factor for cardiovascular mortality. Preclinical studies on recently discovered classes of lipids - fatty acid esters of hydroxy fatty acids (FAHFA) have revealed their anti-inflammatory and insulin-sensitizing potential. The FAHFA levels are significantly decreased in insulin-resistant individuals, their application exhibited anti-inflammatory effects and restoring the glucose-insulin homeostasis. The aim of our research was to analyze the overall FAHFA composition in a common diet, as only a partial FAHFA composition has been revealed so far (only the PAHSA subclass was analyzed in a few foods). A new approach to the FAHFAs analysis includes nano-LC and post-column modifier followed by negative ion mass spectrometry, in order to obtain maximum sensitivity. Analysis of different foods - oat (whole grain, coarse flakes and fine flakes), apple, clementine, lemon, strawberry, blueberry, mango, kiwi, avocado, pineapple, banana, onion, garlic, cherry tomato, carrot, parsley root, pepper and radish - exhibited wide inter-food variation in the FAHFA profiles. Sixteen analyzed FAHFAs (palmitic, oleic, palmitoleic and stearic hydroxy-esters) showed microgram to low nanogram levels (0.165ng/g - 32μg/g FW), with the highest abundancy in oat, clementine, garlic and pineapple. Stearic acid hydroxy stearic acid (SAHSA) was the most abundant FAHFA, especially in the food with antioxidative, anti-inflammatory and beneficial metabolic effects. In contrary, the PAHSA - previously proven to have the strongest antihyperglycemic and insulin-sensitizing effects, was not present in some foods (radish, avocado, mango, lemon, cherry tomato, kiwi). Our study proves the importance of overall FAHFA analysis in food (especially in a functional food), because of their potential metabolic benefits and possible future incorporation in special diets.

The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy

Background : Cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus (T2DM), which is characterized by lesion of nerve fibers in parasympathetic and sympathetic nervous system is one of the leading causes of heart arrhythmias and an independent risk factor for cardiovascular mortality in patients with T2DM. Therefore, the problem of effective treatment of CAN is particularly relevant. Aims : To analyze the effect of long-chain polyunsaturated fatty acids (ω-3 PUFAs) on ambulatory blood pressure monitoring parameters in patients with T2DM and CAN. Materials and methods : 36 patients with T2DM and confirmed CAN were divided into two groups. First group received hypoglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) in addition were administered 1 capsule/q.d. of ω-3 PUFAs for three month. Results : Treatment with ω-3 PUFAs led to significant decrease of the diastolic blood pressure (DBP) (p<0,01), diastolic blood pressure load (p<0,05), time index of DBP (p<0,05) during the day; DBP (p<0,05), diastolic blood pressure load (p<0,05), time index of DBP (p<0,05), SD DBP (p<0,01) during the night (compared to the control group). Conclusions : The study showed that prescription of ω-3 PUFAs for three month was effective in decreasing diastolic blood pressure and its parameters among patients with T2DM and CAN.

The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy

Background: Cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus (T2DM), which is characterized by lesion of nerve fibers in parasympathetic and sympathetic nervous system is one of the leading causes of heart arrhythmias and an independent risk factor for cardiovascular mortality in patients with T2DM. Therefore, the problem of effective treatment of CAN is particularly relevant.&#x0D; Aims: To analyze the effect of long-chain polyunsaturated fatty acids (-3 PUFAs) on ambulatory blood pressure monitoring parameters in patients with T2DM and CAN.&#x0D; Materials and methods: 36 patients with T2DM and confirmed CAN were divided into two groups. First group received hypoglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) in addition were administered 1 capsule/q.d. of -3 PUFAs for three month.&#x0D; Results: Treatment with -3 PUFAs led to significant decrease of the diastolic blood pressure (DBP) (p0,01), diastolic blood pressure load (p0,05), time index of DBP (p0,05) during the day; DBP (p0,05), diastolic blood pressure load (p0,05), time index of DBP (p0,05), SD DBP (p0,01) during the night (compared to the control group).&#x0D; Conclusions: The study showed that prescription of -3 PUFAs for three month was effective in decreasing diastolic blood pressure and its parameters among patients with T2DM and CAN.

Mobile Phone-Based Intervention in Hypertension Management.

Hypertension is known as the major risk factor for cardiovascular mortality and morbidity. Antihypertensive agents are directed to prevent many of the harmful effects of elevated blood pressure, yet medication nonadherence hinders the effectiveness of these therapies. Nowadays the use of mobile phone has vastly spread among communities. The rapid adoption of smartphone technology creates a promising and interesting platform to overcome medication nonadherence. This review aimed to critically appraise whether mobile phone-based interventions are effective in increasing adherence in hypertensive patients. Literature searching was done in 3 databases: PubMed, Cochrane, and ProQuest. Findings were narrowed down using selection criteria. Relevant studies were to be critically appraised based on the guideline from Centre for Evidence-Based Medicine, Oxford University. We found that the reduction of blood pressure in participants who were given reminder through mobile phones was greater in comparison to control: systolic (94.4% vs 41.2%, p 0.003), diastolic (94.4% vs 76.5%, p0.04). Patients who were nonadherent at baseline benefit more from mobile phone-based intervention in comparison to adherent patients at baseline: RR 2.3 (95% CI: 1.4-4.4, p<0.001) vs RR 1.3 (95% CI: 1.0-1.6, p<0.05). In conclusion, mobile phone-based interventions were effective in increasing medication adherence in hypertensive patients. Clinical practice guidelines should consider this nonpharmacological method for a better blood pressure regulation.

Suppression of Gut Bacterial Translocation Ameliorates Vascular Calcification through Inhibiting Toll-Like Receptor 9-Mediated BMP-2 Expression.

Aims Vascular calcification (VC) is a primary risk factor for cardiovascular mortality in chronic renal failure (CRF) patients; thus, effective therapeutic targets are urgently needed to be explored. Here, we identified the role of intestinal bacterial translocation in CRF-related VC. Methods and Results Antibiotic supplementation by oral gavage significantly suppressed intestinal bacterial translocation, CRF-related VC, and aortic osteogenic gene and Toll-like receptor (TLR) gene expression in CRF rats. Furthermore, TLR4 and TLR9 activation in vascular smooth muscle cells (VSMCs) aggravated inorganic phosphate- (Pi-) induced calcification. TLR9 inhibition, but not TLR4 inhibition, by both a pharmacological inhibitor and genetic methods could significantly reduce CRF rats' serum or CRF-induced VC. Interestingly, bone morphogenic protein-2 (BMP-2) levels were increased in the aorta and sera from CRF rats. Increased BMP-2 levels were also observed in VSMCs treated with TLR9 agonist, which was blocked by NF-κB inhibition. Both siRNA knockdown of BMP-2 and NF-κB inhibitor significantly blocked TLR9 agonist-induced VSMC calcification. Conclusions Gut bacterial translocation inhibited by oral antibiotic significantly reduces CRF-related VC through inhibition of TLR9/NF-κB/BMP-2 signaling.