Risk Factor For Cardiovascular Complications Research Articles

Retrospective Study of Aging and Sex-Specific Risk Factors of COVID-19 with Hypertension in China.

Background Coronavirus disease 2019 (COVID-19) has been a global threat that pushes healthcare to its limits. Hypertension is one of the most common risk factors for cardiovascular complications in COVID-19 and is strongly associated with disease severity and mortality. To date, clinical mechanisms by which hypertension leads to increased risk in COVID-19 are still unclear. Furthermore, additional factors might increase these risks, such as the consideration of age and sex, which are of interest when in search of personalized treatments for hypertensive COVID-19 patients. Methods We conducted a retrospective cohort study of 543 COVID-19 patients in seven provinces of China to examine the epidemiological and clinical characteristics of COVID-19 in this population and to determine risk factors of hypertensive COVID-19 patients. We also used univariable and multivariable logistic regression methods to explore the risk factors associated with hypertensive COVID-19 patients in different age and sex subgroups. Results Among the enrolled COVID-19 patients, the median age was 47 years (interquartile range (IQR) 34.0–57.0), and 99 patients (18.23%) were over 60 years old. With regard to comorbidities, 91 patients (16.75%) were diagnosed with hypertension, followed by diabetes, coronary disease, and cerebrovascular disease. Of the hypertensive COVID-19 patients, 51 (56.04%) were male. Multivariable analysis showed that old age, comorbid diabetes or coronary heart disease on admission, increased D-dimer, increased glucose, and decreased lymphocyte count were independent risk factors associated with hypertensive COVID-19 patients. Elevated total bilirubin (odds ratio [OR]: 1.014, 95% confidence interval [CI]: 0.23–1.05; p = 0.043) and triglycerides (OR: 1.173, 95% CI: 0.049–1.617; p = 0.007) were found to be associated with elderly hypertensive COVID-19 patients. In addition, we found that decreased lymphocytes, basophil, high-density lipoprotein, and increased fibrinogen and creatinine were related to a higher risk of disease severity in male patients. The most common abnormal clinical findings pertaining to female hypertensive COVID-19 patients were hemoglobin, total bile acid, total protein, and low-density lipoprotein. Conclusions Factors associated with increased risk of hypertensive COVID-19 patients were identified. Results to the different age and sex subgroups in our study will allow for better possible personalized care and also provide new insights into specific risk stratification, disease management, and treatment strategies for COVID-19 patients with hypertension in the future.

CIRCADIAN BLOOD PRESSURE PROFILE IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Objective: Disturbed circadian blood pressure (BP) profile is a risk factor for cardiovascular complications in adults. The study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). Design and method: The study included 112 children (79 boys, 33 girls, 14.7 ± 2.7 years) with untreated PH. Circadian BP profile was assessed by 24-hour ABPM. Disturbed circadian BP profile (non-dipping) was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%. A nocturnal drop in SBP or DBP > 20% was defined as extreme dipping. Patients were evaluated for central BP, HMOD (left ventricular mass index - LVMI, aortic pulse wave velocity, augmentation index (AIx75HR), intima-media thickness, albuminuria), and clinical and biochemical parameters, including sodium-potassium balance. Results: In the study group, the mean nocturnal drop in SBP was 10.9 ± 5.9 [%] and in DBP - 16.2 ± 8.5 [%]. Non-dipping was found in 50 (44.6%) children and extreme-dipping in 29 (25.9%) patients. The nocturnal drop in SBP correlated negatively with Z-scores of body weight (r = -0.191, p = 0.043) and BMI (r = -0.242, p = 0.010) and with LVMI [g/m2.7] (r = -0.395, p = 0.006). The nocturnal drop in SBP and DBP correlated positively with urinary potassium excretion [mmol/kg/24 h] (r = 0.656, p = 0.001 and r = 0.540, p = 0.011, respectively). Patients with disturbed circadian blood pressure profile were characterized by higher LVMI (44.5 ± 12.5 vs. 36.8 ± 8.8 [g/m2.7]) and albuminuria (median: 10.8, IQR: 5.3–53.3 vs. median: 8.1, IQR: 5.5–16.4 [mg/24 h], p = 0.043) and lower urinary potassium excretion (0.6 ± 0.2 vs. 1.1 ± 0.3 [mmol/kg/24 h]). Extreme-dipping patients had a higher AIx75HR than the other patients (median: + 3.3, IQR: -6.3- + 17.7 vs. -4.6, IQR: -17.3- + 4.0 [%], p = 0.048). Conclusions: 1. Disturbed circadian BP profile is common in children with PH and should not be considered a marker of secondary hypertension. 2. Disturbed circadian BP profile may be associated with higher body weight and lower dietary potassium intake. 3. Pediatric patients with PH and disturbed BP profile are at risk for HMOD: left ventricular hypertrophy and microalbuminuria. 4. Extreme-dipping may be associated with increased arterial stiffness in children with PH.

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study.

BackgroundCatecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations. Although there are reviews of reported cases, these reviews lack detailed data, which makes it impossible to perform an accurate analysis. In this study, we conducted a comprehensive analysis of cardiovascular complications (CCs), including PPGL-related myocardial injury, cardiogenic shock, and arrhythmias requiring antiarrhythmic therapy, in a large cohort of patients with PPGL.MethodsWe retrospectively analyzed the clinical data of consecutive patients with PPGL admitted between January 2018 and June 2020. The prevalence and the characteristics of patients with CCs were investigated. Moreover, comparisons were made between patients with and without CCs.ResultsCompared with the non-CC group, the percentage of men was significantly lower (14/41 vs.92/175, 34.1% vs. 52.6%, p = 0.034) and the proportion of patients with paroxysmal hypertension was significantly higher (13/41 vs.29/173, 31.7% vs.16.8%, p = 0.03) in the CC group. More patients showed excessive sweating (19/41 vs 64/175, 46.3% vs. 24.0%, p = 0.004) and PPGL crisis (7/41 vs. 10/175, 17.1% vs.5.7%, p=0.035) in the CC group. In terms of laboratory findings, higher white blood cell [7.36 (6.49, 20.23) vs. 5.95 (5.1, 6.97)×109/L, p<0.001] and platelet [339.28 ± 108.54 vs. 250.66 ± 70.83(×109/L), p = 0.021] counts were more common in the CC group. There was also a higher prevalence of combination-producing PPGL in the CC group (13/24 vs.20/149, 54.2% vs.13.4%, p<0.001). However, the tumor size, invasive behavior on histology, and hemorrhage or necrosis on histology did not differ between the two groups. Platelet count [odds ratio (OR): 1.009; 95% confidence interval (CI) 1.001–1.016; p=0.023] and combination-secreting PPGL (OR: 5.009; 95% CI 1.365–18.38; p=0.015) are independent risk factors for CCs in patients with PPGL.ConclusionsIn patients with PPGL, even in the absence of signs and symptoms of CCs, a work up of cardiology should be strongly considered. Importantly, if patients with PPGLs have higher platelet counts and the combination-secreting pattern, they are more likely to have CCs. Thus, a careful cardiac evaluation should be performed.

Interdependence of Ischemic Heart Disease with Diabetes and Hypertension, A Clinically Comparative Study

Aims and objectives: The aims and objectives of this study were to raise awareness among persons who have ischemic heart disease and other underlying conditions such as diabetes and hypertension. Methodology: Total 150 individuals of age 50-60 years old were selected for this study. In control group 25 male and 25 females were selected. On the other hand, 75 male and 25 female were in Group-B. All patients of Group-B visited in Cardiology Department of MTI Lady Reading Hospital and Abbottabad International medical college Abbottabad with different cardiac complications like chest pain, high blood pressure, short breathing and sweating etc. Results: In this study different variables were considered and compare these parameters within the group by applying p&lt;0.05 significant regression test. BMI, systolic and diastolic blood pressure, oxygen saturation, intensity of chest pain, smoking habit and random serum glucose levels of both male and female were measured. A significant changes (p&lt;0.05) regarding above parameters in individuals of Group-B were noted as compared with normal individuals of Group-A. Conclusion: In conclusion, there were strong and concrete evidences that diabetes and hypertension are a major risk factors for cardiovascular complications therefore these two metabolic abnormalities were correlated with ischemic illness. There were multiple evidences that structural and biochemical cardiac abnormalities begin in the pre-diabetic state. Keywords: systolic and diastolic blood pressure, oxygen saturation, diabetes mellitus, ischemic heart disease

Incidence and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery.

Background:An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods:This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results:Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (odds ratios (OR): 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (OR: 120.97; 95% CI: 2.12-6898.80). Conclusion:The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Perioperative Esophagectomy Outcomes in Older Esophageal Cancer Patients in Two Different Time Eras

To investigate perioperative outcomes of esophagectomies by age groups. Retrospective analysis of esophageal cancer patients undergoing esophagectomy from 2005 to 2020 at a single academic institution. Baseline characteristics and outcomes were analyzed by 3 age groups: <70, 70-79, and ≥80 years-old. Sub-analysis was done for 2 time periods: 2005-2012 and 2013-2020. Of 1135 patients, 789 patients were <70, 294 were 70-79, and 52 were ≥80 years-old. Tumor characteristics, and operative technique were similar, except positive longitudinal margins rates (all <3%) (P = 0.008). Older adults experienced increased complications (53.6% vs 69.7% vs 65.4% respectively; P < 0.001) attributable to grade II complications (41.4% vs 62.2% vs 63.5% respectively; P < 0.001). Hospital length of stay (LOS) and rehabilitation requirements were higher in older adults (both P < 0.05). 30-day readmissions, reoperation, and 30-day mortality rates (all <2%) showed no association with age group. Overall complications, LOS, discharge disposition and re-operative rates improved from 2005 to 2012 to 2013-2020 for all (P < 0.05). Increasing age was an independent risk factor for cardiovascular complications (OR 1.7, 95% CI 1.23-2.46 for ages 70-79 and OR 2.7, 95% CI 1.37-5.10 for ages ≥80 ), inpatient rehabilitation (OR 3.3, 95% CI 2.26-5.05 for ages 70-79 and OR 12.1 95% CI 5.83-25.04 for ages ≥80), and prolonged LOS (OR 1.64 95% CI 1.16-2.31 for ages 70-79 and OR 3.6 95% CI 1.71-7.67 for ≥80. After adjusting for time period, older age remained associated with complications (P < 0.05). Highly selected older adults at a large volume esophagectomy center can undergoesophagectomy with increased minor complication and rehabilitation needs.

Blood Viscosity in Subjects With Type 2 Diabetes Mellitus: Roles of Hyperglycemia and Elevated Plasma Fibrinogen.

The viscosity of blood is an indicator in the understanding and treatment of disease. An elevated blood viscosity has been demonstrated in patients with Type 2 Diabetes Mellitus (T2DM), which might represent a risk factor for cardiovascular complications. However, the roles of glycated hemoglobin (HbA1c) and plasma fibrinogen levels on the elevated blood viscosity in subjects with T2DM at different chronic glycemic conditions are still not clear. Here, we evaluate the relationship between the blood viscosity and HbA1c as well as plasma fibrinogen levels in patients with T2DM. The experimental data show that the mean values of the T2DM blood viscosity are higher in groups with higher HbA1c levels, but the correlation between the T2DM blood viscosity and the HbA1c level is not obvious. Instead, when we investigate the influence of plasma fibrinogen level on the blood viscosity in T2DM subjects, we find that the T2DM blood viscosity is significantly and positively correlated with the plasma fibrinogen level. Further, to probe the combined effects of multiple factors (including the HbA1c and plasma fibrinogen levels) on the altered blood viscosity in T2DM, we regroup the experimental data based on the T2DM blood viscosity values at both the low and high shear rates, and our results suggest that the influence of the elevated HbA1c level on blood viscosity is quite limited, although it is an important indicator of glycemic control in T2DM patients. Instead, the elevated blood hematocrit, the enhanced red blood cell (RBC) aggregation induced by the increased plasma fibrinogen level, and the reduced RBC deformation play key roles in the determination of blood viscosity in T2DM. Together, these experimental results are helpful in identifying the key determinants for the altered T2DM blood viscosity, which can be used in future studies of the hemorheological disturbances of T2DM patients.

Prognosis and risk factors for cardiac valve calcification in Chinese end-stage kidney disease patients on combination therapy with hemodialysis and hemodiafiltration

Background Cardiac valve calcification (CVC) is an important risk factor for cardiovascular complications. However, limited data are available concerning the prevalence, clinical features and risk factors for CVC in end-stage kidney disease (ESKD) patients. In this study, we aimed to assess these parameters in Chinese ESKD patients receiving combination therapy with hemodialysis and hemodiafiltration. Methods We conducted a cross-sectional study on 293 ESKD patients undergoing combination therapy of hemodialysis and hemodiafiltration at the First Affiliated Hospital of Chongqing Medical University from October 2014 to December 2015. CVC was evaluated via echocardiography. Results ESKD patients with CVC had a higher prevalence of diabetes mellitus, aortic and/or coronary artery calcification, arrhythmia, heart failure and coronary heart disease; increased systolic, diastolic and pulse pressure; longer duration of hemodialysis and hypertension; reduced hemoglobin, albumin and high-density lipoprotein cholesterol levels; and increased serum calcium and calcium-phosphorus product levels compared with those without CVC. Logistic regression analysis showed that increased dialysis duration (p = 0.006, OR = 2.25), serum calcium levels (p = 0.046, OR = 2.04) and pulse pressure (p < 0.001, OR = 3.22), the presence of diabetes (p = 0.037, OR = 1.81) and decreased serum albumin levels (p = 0.047, OR = 0.54) were risk factors for CVC. The correlation analysis indicated a significantly increased CVCs prevalence with an increase prevalence of heart failure, aortic and coronary artery calcification. Conclusions CVC represents a common complication and a danger signal for cardiovascular events in ESKD patients undergoing combination therapy of hemodialysis and hemodiafiltration. The presence of diabetes, increased pulse pressure, long dialysis duration, hypoalbuminemia and high serum calcium levels were independent risk factors for CVC.

Incidence of and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery

Background: An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods: This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results: Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (relative risk: RR, 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (RR, 120.97; 95% CI: 2.12-6898.80). Conclusion: The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Clinical practice guidelines for management of hyperglycaemia in adults with diabetic kidney disease.

A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end-stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co-transporter-2 (SGLT-2) inhibitors. SGLT-2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno-protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology.

Clinical practice guidelines for management of hyperglycaemia in adults with diabetic kidney disease

A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end-stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co-transporter-2 (SGLT-2) inhibitors. SGLT-2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno-protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021 guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology.

Гіперурикемія й артеріальна гіпертензія — чи існує зв’язок?

На основі аналізу літературних джерел у статті відображено сучасний стан вивчення ролі гіперурикемії в розвитку та прогресуванні артеріальної гіпертензії. Описано еволюцію наукового уявлення про сечову кислоту — від етіологічного чинника подагри до так званого нового фактора ризику серцево-судинних ускладнень. Викладено результати досліджень, що засвідчують значення гіперурикемії у формуванні субклінічного гіпертензивного ураження серця й нирок, а також вплив різних антигіпертензивних препаратів на сироватковий рівень сечової кислоти. Обґрунтовано доцільність подальшого вивчення ролі гіперурикемії в прогресуванні артеріальної гіпертензії та можливостей її медикаментозної корекції.

Incidence of and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery.

Background:An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods:This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results:Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (relative risk: RR, 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (RR, 120.97; 95% CI: 2.12-6898.80). Conclusion:The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Risk factors for cardiovascular complications in COVID-19 patients

Risk factors for cardiovascular complications in COVID-19 patients

Clinical significance of insulin resistance and B-type natriuretic peptide in structural remodeling of the left ventricle in hypertensives with metabolic syndrome

Introduction. The metabolic syndrome is a combination of clinical (arterial hypertension, abdominal obesity) and metabolic (insulin resistance, dyslipidemia) disorders that are risk factors for cardiovascular complications. Among the numerous factors of structural remodeling of the myocardium, arterial hypertension, hyperinsulinemia and disorders of sodium-urethic peptide metabolism have an important pathogenetic value. The aim of the study is to evaluate the influence of insulin resistance in relation to B B-type natriuretic peptide (BNP) on indicators of structural remodeling of the left ventricle in hypertensives with metabolic syndrome. Materials and methods. Were examined 124 patients with arterial hypertension with metabolic syndrome. Endogenous insulin levels were determined under the conditions of an oral glucose tolerance test, BNP level in blood were measured and echocardiography was performed. Depending on the level of endogenous insulin, patients were divided into three groups. Research results and their discussion. In hypertensives with metabolic syndrome were found changes to varying degrees in the structural and functional indicators of the left ventricle, depending on the type of insulinemia. The presence of reactive and spontaneous hyperinsulinemia in hypertensives with metabolic syndrome contributes to the development of predominantly concentric myocardial hypertrophy with an increase in left ventricular myocardial mass index by 1.7 and 1.8 times, the occurrence of diastolic dysfunction of the left ventricle type I and an increase in BNP level in the blood &gt; 120 pg / ml. Were revealed direct correlations between the fasting endogenous insulin level and BNP. The maximum value of BNP is observed in patients with spontaneous hyperinsulinemia and heart failure. Conclusions. 1. In hypertensives with metabolic syndrome, the most pronounced changes in indicators of structural remodeling of the left ventricle were characteristic of reactive and spontaneous hyperinsulinemia. 2. A direct correlation between the left ventricular myocardial mass index and the level of endogenous insulin was revealed as the severity of insulin resistance increases with the development of predominantly concentric hypertrophy and the emergence of left ventricular diastolic dysfunction, which is associated with an increased risk of cardiovascular complications. 3. In hypertensives with metabolic syndrome, insulin resistance is accompanied by an increased level of BNP in the blood, which is associated with the occurrence and progression of heart failure and the activation of antihypertrophic processes to reduce myocardial remodeling.

Оптимізація ультразвукових методів дослідження в оцінці стану серця й судин у хворих на артеріальну гіпертензію за наявності або відсутності цукрового діабету 2-го типу

Мета роботи — вивчення особливостей стану серця й судин у хворих на есенціальну артеріальну гіпертензію (АГ) за наявності або відсутності цукрового діабету 2-го типу.Матеріали і методи. У дослідження були залучені 134 пацієнти: перша група — 44 пацієнти з есенціальною АГ II стадії другого та третього ступеня, друга група — 45 хворих з есенціальною АГ II стадії другого та третього ступеня в поєднанні з цукровим діабетом 2-го типу, група контролю — 45 здорових. Групи були порівнянні за віком, статтю, факторами ризику серцево-судинних ускладнень. Використано методи ультразвукової діагностики та багатовимірні статистичні методи.Результати. Серед 140 показників ехографічного дослідження, що рекомендуються Європейським товариством ехокардіографії, із використанням факторного аналізу як методу багатовимірної статистики було відібрано 14 показників та на їх підставі створено чотири інтегральних показники. З точки зору клінічної інтерпретації ці показники характеризують функціональний стан серця, макроциркуляцію, мікроциркуляцію та структурний стан серця. При цьому показники структури та мікроциркуляції можуть розглядатися як маркери цукрового діабету. Висновки. За допомогою факторного аналізу як методу багатовимірної статистики було отримано нові комбінації ультразвукових параметрів у вигляді факторів, що є системним описом відповіді органів-мішеней на коморбідну патологію: ремоделювання магістральних судин й мікросудин, структурного й функціонального ремоделювання серця. Цілісне, багатовимірне уявлення про процеси ремоделювання можливе лише з урахуванням значень усіх показників, що становлять фактор.

Hepatic Hyaline Arteriolosclerosis in Patients with Chronic Hyperglycemia

Abstract Introduction/Objective Hyaline arteriolosclerosis is a common feature of diabetic microangiopathy. It results from hyperglycemia-induced endothelial cell dysfunction and can be found in many sites including the retina, kidney, and skin. This histologic finding is important because studies have shown that in the kidney it is an independent risk factor for cardiovascular complications. To our knowledge, an association between hyperglycemia and hyaline arteriolosclerosis in the liver has not be studied. We aimed to investigate whether chronic hyperglycemia is associated with this histologic finding in liver arterioles. Methods/Case Report The first 50 liver biopsies performed at our institution starting January 1, 2020 were scanned into a digital pathology system (Philips, Cambridge, MA). For each biopsy, the patient’s highest recorded hemoglobin A1c (HbA1c) up to one year from the date of biopsy was recorded. The biopsies were then grouped into two groups: those from patients with a HbA1c greater than 6.5%, and those with a HbA1c value less than 6.5 %. Next, the digested periodic acid Schiff (DPAS) intensity of the arteriolar vessels in each biopsy was graded 0 to 3 by a single pathology resident who was blinded to its corresponding HbA1c group. Grade 0 to 1 was considered negative staining. Grade 2 to 3 was considered positive staining and indicative of hyaline arteriolosclerosis. By the end of the data collection, each case had been given a staining category and a HbA1c group. A 2 x 2 contingency table was constructed. Results (if a Case Study enter NA) 37 of 50 patients had a recorded HbA1c meeting the study criteria. Of these 37 patients, 11 had an HbA1c greater than 6.5 % while 26 had an HbA1c less than 6.5%. Seven of the 11 biopsies from patients with an elevated HbA1c showed positive staining. Six of the 26 biopsies from patients with an HbA1c less than 6.5% showed positive staining. Conclusion We hypothesized that patients living with hyperglycemia may be more likely to exhibit hepatic hyaline arteriolosclerosis. A chi-squared test of independence was performed to examine the association between a liver biopsy’s HbA1c group and staining category. The relation between these variables was significant at p = &amp;lt; .05, χ 2 (2, N= 36) = 5.57, p = .0182, indicating liver biopsies with a HbA1c greater than 6.5 % are more likely to have this histologic finding. Future studies are needed to characterize diabetic hepatopathy, and its relatedness to macrovascular complications.

Transforming growth factor, arterial stiffness and vascular aging in patients with uncontrolled arterial hypertension

Abstract Introduction Arterial stiffness and vascular aging is associated with a risk factors for cardiovascular complications in hypertension. It is known that, transforming growth factor β1 (TGF-β1), a pleiotropic cytokine, enhances proliferation and growth of smooth muscle cells, as well as the accumulation of extracellular matrix, that is, the processes underlying vascular remodeling in hypertension. But still there is no data about influence off TGF-β1 on arterial stiffness and vascular aging. Purpose The aim of our study was to identify the relationship between TGF-β1, arterial stiffness and vascular age in patients with uncontrolled arterial hypertension Materials and methods The study included 140 patients: 30 people with uncontrolled hypertension (UAH), 80 people with controlled hypertension (CAH) and 30 people in the control group. All patients underwent determination of arterial stiffness, vascular age using cardio-ankle vascular index (CAVI) by means of volumetric sphygmography and TGF-β1 concentration level. Results The TGF-β1 level was 19,2 [17,2; 24,7] ng/ml in the CAH group. In the UAH group – 22,6 [20,6; 25,6] ng/ml. In the control group - 17.4 [11,8; 19,3] ng/ml. Value of the CAVI was 9,2 [8,5; 9,9] in UAH group, 7.8 [7,0; 8,5] in CAH group and 7 [6,5; 7,5] in control group. The maximum and minimum values vascular age were observed in the group UAH 71,5 [64; 74] and control group 54 [44; 59], respectively (p&amp;lt;0,05), in the CAH group there was an intermediate value of the vascular age 59 [49; 69] (p&amp;lt;0,05). There was significant difference between vascular and passport age in CAH and UAH groups (p&amp;lt;0,05) and no significant difference between passport and vascular age in control group (p&amp;gt;0,05). The correlation analysis revealed a significant relationship between the TGF-β1 level and CAVI for patients with hypertension (CAH r=0,777; UAH r=0,753; p&amp;lt;0.05). Positive correlation was also revealed between TGF-β1 and vascular age in UAH group (r=0,657) and CAH (r=0,649) p&amp;lt;0,05. Conclusion An increase in the concentration of TGF-β1, vascular age and an increase of arterial stiffness were revealed in patients of the UAH group in comparison with the other groups. The relationship between TGF-β1, vascular age and arterial stiffness was also found in patients with arterial hypertension. Funding Acknowledgement Type of funding sources: None.

Pacjent z nadciśnieniem tętniczym, zaburzeniami metabolicznymi i łagodnym przerostem stercza w gabinecie lekarza POZ – rola doksazosyny

In recent years, the therapy for patients with metabolic syndrome, which is a risk factor for cardiovascular complications, has become a challenge. Doxazosin – a selective α-adrenergic receptor antagonist, has emerged as a promising research target in the context of metabolic syndrome. It is pleiotropic action contributes to the reduction of metabolic syndrome indices. The results of clinical trials allow the construction of a promising, highly effective, and above all safe therapy in this group of patients.

Evaluation of cardiovascular comorbidity in cancer patients and analysis of potential risk factors for cardiovascular complications of checkpoint inhibitor therapy

Aim. To analyze the spectrum of cancer types and baseline cardiovascular comorbidity in patients receiving checkpoint inhibitor therapy.Material and methods. We performed retrospective analysis of case records of 112 cancer patients (55 men and 57 women) who received checkpoint inhibitor therapy in St. Petersburg hospitals. We analyzed primary tumor localizations, received immunotherapy and the initial comorbid conditions in patients.Results. The mean age of patients at the time of anticancer therapy initiation was 59,7±12,1 years for men, 57,7±14,1 years for women (p=0,249). The most common indications for immunotherapy were the following localizations: melanoma (34,8%), lungs (21,4%) and urinary system (12,5%). Among women who received checkpoint inhibitors, the lung and gynecologic cancer had the same prevalence (17,5%). The vast majority of patients (85,7%) received antiPD-1 agents, while the anti-CTLA4+anti-PD-1 combination was received by only 8,6% of patients, anti-PD-L1 monotherapy — 5,7%. Before anticancer therapy initiation, 69,6% of patients had prior CVD and/or risk factors. There were following most common comorbid conditions: hypertension — 58,9%, coronary artery disease — 36,6%, heart failure — 24,1%. At the same time, men in comparison with women were more likely to have prior stroke (12,7% vs 1,75%, respectively, p=0,024). There were no other significant sex differences between the incidence of cardiovascular diseases.Conclusion. Based on current publications describing potential risk factors for cardiovascular complications of cancer immunotherapy with checkpoint inhibitors, among the patients included in this study, 87,5% of patients can be attributed to the high-risk group.