Risk Factor For Cardiovascular Mortality Research Articles

Asymmetric dimethylarginine: predictor of cardiovascular diseases?

Cardiovascular diseases are the most common diseases worldwide. They are responsible for one third of global deaths and they are the leading cause of disability, too. The usage of different levels of prevention in combination with effective risk assessment improved these statistical data. Risk assessment based on classic risk factors has recently been supported with several new markers, such as asymmetric dimethylarginine, which is an endogenous competitive inhibitor of nitric oxide synthase. Elevated levels of asymmetric dimethylarginine have been reported in obese, smoker, hypercholesterolemic, hypertensive and diabetic patients. According to previous studies, asymmetric dimethylarginine is a suitable indicator of endothelial dysfunction, which is held to be the preceding condition before atherosclerosis. Several researches found positive correlation between higher levels of asymmetric dimethylarginine and coronary artery disease onset, or progression of existing coronary disease. According to a study involving 3000 patients, asymmetric dimethylarginine is an independent risk factor of cardiovascular mortality in patients with coronary artery disease. This article summarizes the role of asymmetric dimethylarginine in prediction of cardiovascular diseases, and underlines its importance in cardiovascular prevention.

Urinary alpha-1 antitrypsin and CD59 glycoprotein predict albuminuria development in hypertensive patients under chronic renin-angiotensin system suppression.

BackgroundHypertension is a multi-factorial disease of increasing prevalence and a major risk factor for cardiovascular mortality even in the presence of adequate treatment. Progression of cardiovascular disease (CVD) occurs frequently during chronic renin-angiotensin-system (RAS) suppression, and albuminuria is a marker of CV risk. High prevalence of albuminuria in treated hypertensive patients has been demonstrated, but there are no available markers able to predict evolution. The aim of this study was the identification of novel indicators of albuminuria progression measurable in urine of diabetic and non-diabetic patients.Methods1143 hypertensive patients under chronic treatment were followed for a minimum period of 3 years. Among them, 105 diabetic and non-diabetic patients were selected and classified in three groups according to albuminuria development during follow-up: (a) patients with persistent normoalbuminuria; (b) patients developing de novo albuminuria; (c) patients with maintained albuminuria. Differential urine analysis was performed by 2D gel electrophoresis (2D-DIGE) and further confirmed by liquid chromatography-mass spectrometry. Non-parametric statistical tests were applied.ResultsCD59 glycoprotein and alpha-1 antitrypsin (AAT) resulted already altered in patients developing albuminuria de novo, with a similar response in those with maintained albuminuria. A prospective study in a sub-group of normoalbuminuric patients who were clinically followed up for at least 1 year from urine sampling, revealed CD59 and AAT proteins significantly varied in the urine collected from normoalbuminurics who will negatively progress, serving as predictors of future albuminuria development.ConclusionsCD59 and AAT proteins are significantly altered in hypertensive patients developing albuminuria. Interestingly, CD59 and AAT are able to predict, in normoalbuminuric individuals, who will develop albuminuria in the future, being potential predictors of vascular damage and CV risk. These findings contribute to early identify patients at risk of developing albuminuria even when this classical predictor is still in the normal range, constituting a novel strategy towards a prompt and more efficient therapeutic intervention with better outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0331-7) contains supplementary material, which is available to authorized users.

Prevalence and correlates of hypertension in the rural community of Dakshina Kannada, Karnataka, India

Background: Hypertension is considered a chronic disorder of interest owing to its involvement in the generation of coronary heart disease, stroke, and other vascular complications. It is one of the major risk factors for cardiovascular mortality, which accounts for 20%–50% of all deaths and will be the prime cause of morbidity by 2020 in India. Objective: To assess the prevalence of hypertension among adults aged 18–59 years residing at rural community of Dakshina Kannada and study the correlates of hypertension among adults. Materials and Methods: A community-based cross-sectional study was carried out in the age group of 18–59 years to estimate the prevalence of hypertension and its risk factors among the residents of the rural community. A total of 710 study subjects were selected. A pretested questionnaire was used to collect data on sociodemographic profiles and dietary patterns. Anthropometric measurements were taken using the standard methodology. The blood pressure was assessed and classified using JNC 7 criteria Result: The overall prevalence of hypertension among adults was 43.6%, and it was higher in female subjects. The maximum prevalence of hypertension was found among the age group of 50–59 years (male subjects, 60.2%, and female subjects, 65.4%). The study participants with diabetes showed 1.59 times higher risk than nondiabetic participants. Conclusion: The rates of hypertension in the rural community under study are similar to those seen in high-income countries and in urban India. Hence, there is a need for primordial prevention efforts on large scale.

The prevalence of hypertension and its associated risk factors among adults in rural Mandya, Karnataka, India

Background: Hypertension is the commonest cardiovascular disorder due to its role in the causation of coronary heart disease, stroke and other vascular complications. In India, hypertension is one of major risk factors for cardiovascular mortality and is attributed for 10% of all deaths. Increasing prevalence in hypertension is expected due to economic transition, increased population growth, ageing, behavioural risk factors such as, unhealthy diet and excessive alcohol consumption. Awareness of hypertension and risk factors for hypertension is less among rural population. Proposed study addresses the risk factors and awareness of the rural community. Methods: Cross sectional study was conducted over a period of one year from June 2013 to May 2014 among adults from randomly selected villages in the Keragodu primary health centre area. House to house survey was conducted among adults in each village and was examined for hypertension and interviewed regarding the risk factors of hypertension using a pre tested, semi structured questionnaire. Results: Among 1786 study subjects, 38.6% were males and 61.4% were females. The prevalence of hypertension was observed to be 25.9%. Prevalence increased as the age increased. The prevalence of hypertension was high among obese, those who had history of diabetes mellitus. Among the study subjects 24.1% (112) were aware of their hypertensive status, of these 56.3% were on regular treatment . Conclusions: The prevalence of hypertension was 25.9%. Various factors like increase in age, obesity, history of diabetes are implicated in the occurrence of hypertension.

Prevalence of Hypertension and Determination of Its Risk Factors in Rural Delhi.

Introduction. Hypertension is an important public health challenge in both economically developing and developed countries. It is one of the risk factors for cardiovascular mortality. Data is available on hypertension in urban population but few studies are reported in rural areas. Materials and Methods. It was a community based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects selected using systematic random sampling method. WHO STEPS approach was used to collect data. Blood pressure, body mass index, and blood sugar were measured. Data analysis was done using SPSS version 16. Odds of hypertension among subjects with risk factors were calculated. p value less than 0.05 was considered significant. Results. The prevalence of hypertension was 14.1% among study subjects. Hypertension was significantly higher in individuals more than 35 years than those less than 35 years. Hypertension was significantly higher in those who take alcohol and in subjects with raised total cholesterol level but in multivariate analysis only age, education, and cholesterol levels were independently associated with hypertension. Conclusion. There is significant burden of hypertension in rural areas in Delhi. Age, education, and cholesterol levels were independent risk factors of hypertension.

Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review.

Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

The Impact of Red Blood Cell Distribution Width and Neutrophil/Lymphocyte Ratio on the Diagnosis of Major Depressive Disorder.

IntroductionMajor depressive disorder (MDD) is an important risk factor for cardiovascular mortality and morbidity. Red blood cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) can be obtained with a basic hemogram test. These parameters have been found as a predictor of mortality in the general population and in several diseases such as cardiovascular disease.MethodsOur study included 100 patients with newly diagnosed MDD and 100 healthy control patients (who had no depressive symptoms and without heart disease) admitted to our outpatient clinics. Patients with MDD were started on selective serotonin reuptake inhibitor (SSRI) treatment and followed up for 3 months. Both MDD and control patients’ laboratory tests and physical, neurological, and psychiatric examinations were performed both at diagnosis and after 3 months of treatment.ResultsIn total, 100 patients with MDD were evaluated and 80 were included in our study. The control group consisted of 91 healthy individuals. The mean age was 44 ± 10.6 years for patients with MDD and 39.8 ± 11.4 years for the control group. There was no significant difference between the age for groups (P = 0.13); 55% of patients with MDD and 33% of the control group was male. NLR levels were found to be 2.55 ± 0.7 and RDW levels were found to be 14.3 ± 2.6 in patients with MDD; NLR levels were found to be 1.41 ± 0.8 and RDW levels were found to be 13.4 ± 1.8 in the control group. RDW and NLR levels were significantly higher in patients with MDD compared to the control group. The significant difference between the levels of RDW and NLR in patients with MDD and the control group was dissolved after SSRI treatment (P < 0.001). RDW [median 14.3, interquartile range (IQR) 2.8 vs. median 13.25, IQR 2.45; P < 0.001] and NLR (median 2.3, IQR 1.1 vs. median 2.0, IQR 1.15; P < 0.001) levels were significantly higher in patients with MDD compared to the control group.ConclusionOur study showed that hematological inflammatory markers might be useful parameters that can be used in patients with MDD for coronary artery disease risk. Specifically, RDW and NLR seem to be more hopeful. Advanced, detailed, and larger studies are needed.

Endothelin-1 mediates intermittent hypoxia-induced inflammatory vascular remodeling through HIF-1 activation.

Obstructive sleep apnea (OSA) is a major risk factor for cardiovascular mortality, and apnea-induced intermittent hypoxia (IH) is known to promote various cardiovascular alterations such as vascular remodeling. However, the mechanisms that underlie IH remain incompletely investigated. We previously demonstrated that the hypoxia-inducible factor-1 (HIF-1) and endothelin-1 (ET-1) are involved in arterial hypertension and myocardial susceptibility to infarction induced by IH. Thus the objective of the present study was to investigate whether both ET-1 and HIF-1 were also involved in the vascular inflammatory remodeling induced by IH. Mice partially deficient for the Hif1α gene (HIF-1α(+/-)) and their wild-type equivalents, as well as C57BL/6J mice, treated or not with bosentan, a dual endothelin receptor antagonist, were exposed to IH or normoxia for 2 wk, 8 h/day. Splenocyte proliferative and secretory capacities, aortic nuclear factor-κB (NF-κB) and HIF-1 activities, and expression of cytokines and intima-media thickness (IMT) were measured. IH induced a systemic and aortic inflammation characterized by an increase in splenocyte proliferative and secretory capacities, aortic NF-κB activity, and cytokine expression in the aortic wall. This was accompanied by an increase in IMT. These modifications were prevented in HIF-1α(+/-) and bosentan-treated mice. The results of this study suggest that ET-1 is a major contributor to the vascular inflammatory remodeling induced by OSA-related IH, probably through HIF-1-dependent activation of NF-κB.

Acute increase in blood pressure during inhalation of coarse particulate matter air pollution from an urban location

Particulate matter (PM) air pollution is a leading global risk factor for cardiovascular mortality. Although exposure to fine PM <2.5 μm raises arterial blood pressure (BP), few studies have evaluated the impact of coarse PM which differs in size (2.5–10 μm), sources, and chemistry. Twenty-nine healthy adults (30.4 ± 8.2 years) underwent a randomized double-blind crossover study involving 2-hour exposures to concentrated ambient coarse PM (164.2 ± 80.4 μg/m3) at an urban location (Dearborn, Michigan) versus filtered air. Cardiovascular outcomes were measured during, immediately, and 2 hours after exposures. Both systolic (1.9 mm Hg; 95% confidence interval: 0.96, 2.8; P < .001) and diastolic (1.9 mm Hg; 95% confidence interval: 1.1, 2.7; P < .001) BP levels were higher throughout coarse PM compared with filtered air exposures by mixed-model analyses. Heart rate variability, endothelial function, and arterial compliance were not significantly affected. Brief exposure to coarse PM in an urban environment raises arterial BP. These findings add mechanistic support to the contention that coarse PM may be capable of promoting cardiovascular events.

Where is the link between mineral bone markers and cardiovascular disease in CKD?

Where is the link between mineral bone markers and cardiovascular disease in CKD?

Long-Term Prognostic Role oftheDiagnostic Criteria for Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.

The aim of this study was to evaluate the long-term prognostic role of the 2010 task force criteria (TFC)-based scoring in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Categories of the 2010 TFC include the risk factors for cardiovascular mortality and sudden cardiac death in patients with ARVC/D. Ninety patients with ARVC/D who met the definitive diagnosis of the 2010 TFC were retrospectively studied. ARVC/D risk score was calculated as the sum of major (2 points) and minor (1 point) criteria in all 6 subdivided categories of the TFC and was divided into tertile groups of scores; group A (4 to 6 points), group B (7 to 9 points), and group C (10to 12 points). The primary endpoints were major adverse cardiovascular events: cardiovascular death, heart failure hospitalization, and sustained ventricular tachycardia or ventricular fibrillation. During the follow-up period of 10.2 ± 7.1 years, 19 patients died because of cardiovascular causes, 28 patients were admitted because of worsened heart failure, and 47 patients experienced sustained ventricular tachycardia or ventricular fibrillation. Patients in groups B and C were at increased risk for major adverse cardiovascular events compared with those in group A (hazard ratio [HR]: 4.80; 95% confidence interval [CI]: 1.87 to 12.33; p= 0.001; and HR:6.15; 95% CI: 2.20 to 17.21; p= 0.001, respectively). Patients in groups B and C were at increased risk for sustained ventricular tachycardia or ventricular fibrillation compared with those in group A (HR: 6.64; 95% CI: 2.00 to 22.03; p=0.002; and HR: 9.18; 95% CI: 2.60 to 32.40; p= 0.001, respectively). Our study suggests that risk scoring based on the 2010 TFC is useful to predict major adverse cardiovascular events in patients with ARVC/D.

Mammalian target of rapamycin signaling inhibition ameliorates vascular calcification via Klotho upregulation

Vascular calcification (VC) is a major risk factor for cardiovascular mortality in chronic renal failure (CRF) patients, but the pathogenesis remains partially unknown and effective therapeutic targets should be urgently explored. Here we pursued the therapeutic role of rapamycin in CRF-related VC. Mammalian target of rapamycin (mTOR) signal was activated in the aortic wall of CRF rats. As expected, oral rapamycin administration significantly reduced VC by inhibiting mTOR in rats with CRF. Further in vitro results showed that activation of mTOR by both pharmacological agent and genetic method promoted, while inhibition of mTOR reduced, inorganic phosphate-induced vascular smooth muscle cell (VSMC) calcification and chondrogenic/osteogenic gene expression, which were independent of autophagy and apoptosis. Interestingly, the expression of Klotho, an antiaging gene that suppresses VC, was reduced in calcified vasculature, whereas rapamycin reversed membrane and secreted Klotho decline through mTOR inhibition. When mTOR signaling was enhanced by either mTOR overexpression or deletion of tuberous sclerosis 1, Klotho mRNA was further decreased in phosphate-treated VSMCs, suggesting a vital association between mTOR signaling and Klotho expression. More importantly, rapamycin failed to reduce VC in the absence of Klotho by using either siRNA knockdown of Klotho or Klotho knockout mice. Thus, Klotho has a critical role in mediating the observed decrease in calcification by rapamycin in vitro and in vivo.

Postdialysis Hypertension: Associated Factors, Patient Profiles, and Cardiovascular Mortality.

A postdialytic increase in blood pressure (BP) is a recognized but often an overlooked complication. The epidemiology and predisposing factors are still not well defined. We studied a large sample of Italian dialysis patients to assess the prevalence of postdialysis hypertension (PDHYPER), defined as any increase of systolic BP (SBP) >10mm, Hg above the predialysis value, the associated factors and its role in cardiovascular (CV) mortality. In this observational study, we assessed dialysis associated changes in BP in 4,292 hemodialysis (HD) patients over 1 month (51,504 sessions). We compared the clinical characteristics of the patients with stable BP values during the HD session with those with PDHYPER. We also assessed the impact of PDHYPER on CV mortality. A total of 994 (23.1%) patients had PDHYPER. Patients with PDHYPER were more likely to be hypertesive, older, have a shorter dialysis vintage, be male, have lower SBP, lower changes in weight during HD, and receive more antihypertensive medications. These predictive factors were shown to be associated with an interaction between weight loss and dialysis, suggesting a volume-related mechanism in its pathogenesis. PDHYPER was also associated with CV mortality. In our study on a large Italian cohort of dialysis patients, the prevalence of PDHYPER was higher than what was previously reported and is a significant risk factor for CV mortality in dialysis patients. The pathogenesis is multifactorial but hypertensive state, antihypertensive medications, and extracellular volume expansion appear to play a major role.

Impact of chronic inflammatory airway disease on stroke severity and long-term survival after ischemic stroke--a retrospective analysis.

BackgroundChronic inflammatory airway disease (CIAD) has emerged as independent risk factor for cardiovascular mortality and ischemic stroke but the impact of co-existing CIAD in patients with ischemic stroke is less clear.MethodsWe retrospectively analyzed 1013 patients with acute ischemic stroke who were consecutively admitted to the Department of Neurology, Charité - Universitätsmedizin Berlin, Germany within one year. Mean follow-up was 80 months (IQR 32–85 months). Using multivariable regression models we analyzed the impact of CIAD (defined as chronic obstructive pulmonary disease or asthma bronchiale) on stroke severity and outcome.ResultsCo-existing CIAD was evident in 7.1 % (n = 72) of all patients with acute ischemic stroke. Baseline characteristics of stroke patients with CIAD did not differ significantly from ischemic stroke patients without CIAD. Age (OR 1.17 [95 % CI 1.03-1.37] per decade), atrial fibrillation (OR 3.43 [95 % CI 2.47-4.78]) and coronary artery disease (OR 1.51 [95 % CI 1.07–2.14]) but not a history of CIAD (p = 0.30) were associated with severe stroke (NIHSS≥11) on hospital admission. Age (HR 1.70 [95 % CI 1.53-1.87] per decade), peripheral artery disease (HR 1.91 [95 % CI 1.35-2.7]), stroke severity at hospital admission (NIHSS per point HR 1.08 [95 % CI 1.06-1.10]), and history of CIAD (HR 1.43 [95 % CI 1.02-2.00]) were independently associated with mortality during long-term follow-up. However, CIAD was not significantly associated with short-term mortality after stroke.ConclusionCo-existing CIAD showed no significant association with stroke severity at hospital admission and early mortality after ischemic stroke. CIAD was negatively associated with long-term survival after ischemic stroke.

Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy.

Background:End-stage hypertrophic cardiomyopathy (HCM) is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM.Methods:End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality.Results:End-stage HCM was identified in 99 (5.4%) patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA) III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05–3.80; P = 0.036), left bundle branch block (LBBB) (HR: 2.80; 95% CI: 1.47–5.31; P = 0.002), and an abnormal Q wave (HR: 2.21; 95% CI: 1.16–4.23; P = 0.016) as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death.Conclusions:LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

4D.11

Objective:Arterial stiffness (AS) is an independent risk factor of cardiovascular mortality in general and haemodialysis (HD) population. Endemic (Balkan) nephropathy (EN) is a chronic tubulointerstitial salt wasting nephropathy characterized with later onset of arterial hypertension (AH) which coul

1C.01

Objective: Elevated inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are well-known risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all-cause mortality. We determined whether suPAR, CRP and IL-6 are predictive of both all-cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection. Design and method: We included 1 425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levels were determined, while all-cause and cardiovascular mortality were used as endpoints. Results: At baseline suPAR, CRP and IL-6 were higher in non-survivors than in survivors (P < 0.001). SuPAR (HR 1.27, 95% CI 1.09–1.48), IL-6 (HR 1.49, 95% CI 1.24–1.78) and CRP (HR 1.39, 95% CI 1.17–1.65) predicted all-cause mortality, while only suPAR (HR 1.40, 95% CI 1.04–1.87) and IL-6 (HR 1.61, 95% CI 1.10–2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL-6 and CRP (P<=0.015).Conclusions: SuPAR predicted both all-cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population.

PP.06.36

Objective: PP amplification is an independent risk factor for cardiovascular mortality. The aim of this study was to investigate the relationship between PP amplification and Augmentation Index (AIx) in subjects with a broad spectrum of BP values, from optimal BP to HTN grade III. Design and method: Patients attending the HTN Unit of the Clinical Hospital of Valencia were included. Central BP, AIx and augmentation pressure (AP) were assessed using the SphygmoCor device (Atcor medical, Sydney, Australia). PP amplification was defined as ratio between peripheral and central PP. Study participants were divided in groups according to BP values. ANCOVA, Cuzick's test for trend, partial correlation and multiple linear regression models were used for statistical analysis Data were adjusted for age, gender, HR and height. Results: 741 patients (48% women; mean age 53.2 ± 13.6 years; 343 hypertensives (46%); optimal BP n = 123 (17%), normal BP n = 125 (17%), high normal BP n = 150 (20%), HTN grade I n = 245 (33%), HTN grade II n = 73 (10%), HTN grade III n = 25 (3%)). PP amplification was higher in normotensives than in hypertensives (1.31 y 1.28 respectively, p < 0.001). Likewise, a significant difference in PP amplification among BP groups was found (PP amplification 1.33, 1.3, 1.31, 1.29, 1.27 y 1.25 for optimal BP, normal BP, high normal BP, HTN grade I, HTN grade II, HTN grade III, respectively, p = 0.001). AIx and AP were higher with rising BP values. PP amplification showed significant correlation with AIx, AP and BP (r = -0.77, -0.47 and -0.12, respectively, p < 0.001). Main determinants of PP amplification were female sex, age, HR, systolic BP (beta = -0.35, -0.39, 0.53, -0.09, respectively, p < 0.001) and cholesterol (beta = -0.58, p = 0.022). BMI, BP treatment and presence of DM type 2 were not significant. Main determinants of AIx were female sex, age, HR, systolic BP and cholesterol. Conclusions: PP amplification is related to BP categories, the higher the BP the lower the PP amplification and an inverse relationship were observed with AIx and AP after adjusting for covariates. Female sex, age, systolic BP, HR and cholesterol are the main determinants of PP amplification.

Phenotype of Children with QT Prolongation Identified Using an Institution-Wide QT Alert System.

QT prolongation is an independent risk factor for cardiovascular mortality in adults. However, there is little information available on pediatric patients with QT prolongation and their outcomes. Herein, we evaluated the prevalence of QT prolongation in pediatric patients identified by an institution-wide QT alert system, and the spectrum of their phenotype. Patients with documented QT prolongation on an ECG obtained between November 2010 and June 2011 were included. There were 1303 pediatric ECGs, and 68 children had electrographically isolated QT prolongation. Comprehensive review of medical records was performed with particular attention to QT-prolonging clinical, laboratory, and medication data, which were summarized into a pro-QTc score. Overall, 68 (5 %) pediatric patients had isolated QT prolongation. The mean age of this pediatric cohort was 9 ± 6 years, and the average QTc was 494 ± 42 ms. All children had 1 or more QT-prolonging risk factor(s), most commonly QT-prolonging medications. One patient was identified with congenital long QT syndrome (LQTS), which was not previously diagnosed. In one-year follow-up, only one pediatric death (non-cardiac) occurred (1.5 %). Potentially QT-offending/pro-arrhythmic medications were changed in 80 % of pediatric patients after the physician received the QT alert. Children with QT prolongation had very low mortality and minimal polypharmacy. Still, medications and other modifiable conditions were the most common causes of QT prolongation. Children with a prolonged QTc should be evaluated for modifiable QT-prolonging factors. However, if no risk factors are present or the QTc does not attenuate after risk factor modification/removal, the child should be evaluated for congenital LQTS.

Role of GABAB receptor and L-Arg in GABA-induced vasorelaxation in non-diabetic and streptozotocin-induced diabetic rat vessels.

Background:Hypertension is considered an independent risk factor for cardiovascular mortality in diabetic patients. The present study was designed to determine the role of gamma amino butyric acid B (GABAB) receptor and L-arginine (L-Arg) in GABA-induced vasorelaxation in normal and streptozotocin-induced diabetic rat vessels. Methods: Diabetes was induced by a single i.p. injection of streptozotocin (STZ, 60 mg/kg). Eight weeks later, superior mesenteric arteries of all groups were isolated and perfused according to the McGregor method. Results: Baseline perfusion pressure of STZ diabetic rats was significantly higher than non-diabetic rats in both intact and denuded endothelium. In the presence of faclofen, a selective GABAB receptor blocker, GABA-induced relaxation in intact and denuded endothelium mesenteric beds of STZ diabetic rats was suppressed, but this response in non-diabetic rats was not suppressed. Our results showed that in the presence of L-Arg, a nitric oxide precursor, GABA induced vasorelaxation in both diabetic and non-diabetic vessels. Conclusion:From the results of this study, it may be concluded that the vasorelaxatory effect of GABA in diabetic vessel is mediated by the GABAB receptor and nitric oxide, but it seems that in non-diabetic vessel GABAB receptor does not play any role in GABA-induced vasorelaxation, but nitric oxide induced GABA relaxation in non-diabetic vessel.