Total Cardiovascular Risk Research Articles

10-YEAR RISK ESTIMATION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN HYPERTENSIVE PATIENTS

Arterial hypertension is one of the most common causes of atherosclerotic cardiovascular disease, which is still the reason of mortality for a lot of persons. Assessment of 10-year risk of atherosclerotic cardiovascular disease in hypertensive patients is very important for further treatment improvement. The aim is the absolute 10-year risk assessment of atherosclerotic cardiovascular disease in hypertensive patients for further correction of treatment. We included 61 patients with stage 1 to 2 arterial hypertension into our study. Most of them are women (70%). The patients were (56.84 ± 8.1) years old. The total cholesterol was (4.32 ± 1.0) mmol/l, high and low density lipoprotein cholesterol – (1.35 ± 0.2) mmol/l and (2.44 ± 0.7) mmol/l, respectively. Online calculator «ASCVD Risk Estimator Plus» was used. It included the assessment of age, sex, race, systolic and diastolic blood pressure, total cholesterol, high and low density lipoprotein cholesterol, presence of diabetes, smoking status, hypertension treatment, consumption of statins or aspirin. The risk was classified as low (< 5%), borderline (5% to < 7.5%), intermediate (≥ 7.5% to < 20%), or high (≥ 20%). The results were analyzed statistically using Microsoft Excel. For five persons it was not possible to calculate this risk using the online calculator because of too low values of total cholesterol and low density lipoprotein cholesterol. Low 10-year risk of atherosclerotic cardiovascular disease was confirmed in 30 (53.6%) people, borderline – in 2 (3.6 %), intermediate – in 11 (19.6%), high – in 13 (23.2%). Low absolute 10-year risk of atherosclerotic cardiovascular disease was determined in more than half (53.6%) of patients, high – in about quarter (23.2%), intermediate – in the fifth part (19.6%) of patients with arterial hypertension. For patients with borderline and intermediate risks, it is reasonable to continue therapy with moderate-intensity statins. For hypertensive patients with high risk, high-intensity statin therapy can be recommended and low-dose aspirin might be considered if bleeding risk is not increased. If the absolute 10-year risk of atherosclerotic cardiovascular disease is low, it is reasonable to assess additionally total cardiovascular risk categories and continue moderate-intensity statin therapy in the case of absence of low-density lipoprotein cholesterol goal levels with the next lipid profile assessment in 8 (± 4) weeks.

Novel approaches to management of hypertension.

Of the roughly 1.4 billion people with hypertension worldwide, only about one in seven has their blood pressure (BP) successfully treated and adequately controlled. This review will focus on new therapeutic approaches of hypertension. Several recent clinical studies and guidelines have favoured the assessment of target organ damage and cardiovascular risk scores for the diagnosis and treatment approach of hypertension. Paradigm shifts recommended in the guidelines are the initiation of antihypertensive treatment with combination (not mono) therapy and the recommendation of single-pill combinations (SPC), which improve adherence and result in rapid and effective BP control. In clinical trials with optimized design and renal denervation (RDN) technology, the biological proof of concept has been established. Consistent, durable ambulatory and office BP reductions without procedure associated serious adverse events have been documented. The challenges are now to identify patients who respond best to interventional treatment. Major key points in the treatment strategy for hypertension are: individualization of the therapy according to total cardiovascular risk, combination therapy as initial step, recommendation of SPC and RDN as promising interventional therapy.

European Society of Cardiology / European Atherosclerosis Society 2019 Dyslipidemia Treatment Guideline: What Has Changed?

After 3 years, European Society of Cardiology and the European Atherosclerosis Society published the new guideline for the management of dyslipidemias on August 2019. Comparing with the 2016 version, based on the latest prospective studies, randomized trials and Mendelian randomization studies, there are major changes in the recommendations; especially in the areas of total cardiovascular risk estimation, treatment targets and management of treatment, focusing on the combination therapy. Aforementioned studies indicated that it is possible to prevent atherosclerotic cardiovascular diseases by reducing low density lipoprotein cholesterol as early as and as much as possible since there is a correlation between the concentration of low density lipoprotein cholesterol in the blood and the risk of atherosclerotic cardiovascular diseases. In the light of those information the recommendation for patients at very high risk was changed as a low density lipoprotein cholesterol goal of Keywords: dyslipidemia, guidelines, risk assessment, LDL cholesterol

Primary care physicians' awareness and perceptions on adherence to primary cardiovascular disease prevention guidelines in Lebanon: A cross-sectional study.

To assess the awareness and have an insight on practice patterns of primary care physicians (PCPs) with respect to several professional primary cardiovascular diseases (CVDs) preventive guidelines. This is a cross-sectional study, questionnaire-based using a non-probability convenience sampling. Data collection occurred at the annual conferences of the Lebanese Societies of General Practice, Family Medicine, and Internal Medicine in Lebanon. 104 PCPs were recruited. Awareness and practices of CVDs preventive guidelines. The response rate was 37%. Awareness of the various CVD preventive guidelines was high among PCPs (>81%). Around 69% of PCPs reported that they always calculate the total cardiovascular risk assessment score. Gaps in managing patients according to guidelines' recommendations were higher in statin initiation compared to antihypertensive initiation. There is over prescription of statin in low risk patients and underutilization in high risk patients. Around 20% of PCPs would initiate aspirin for a low risk patient. Around 17% of physicians do not perform abdominal aortic aneurysm screening. Although PCPs demonstrated high level of awareness regarding CVD preventive guidelines, gaps remain present in managing patients according to guidelines' recommendations. Less adherence to guidelines will increase mortality and affect patient care.

A Multicenter Prospective Hospital-based Cohort Study on the Efficacy and Safety of Pitavastatin.

We aim to investigate the efficacy and safety of pitavastatin 4 mg in a population of people living in the United Arab Emirates (UAE). Pitavastatin is a member of the HMG-CoA reductase inhibitors family which was approved for use in adult subjects with primary hyperlipidemia or mixed dyslipidemia. To date, no published studies have assessed the efficacy and safety of pitavastatin in the United Arab Emirates. The main objective of the current study was to investigate the efficacy and safety of pitavastatin in subjects with dyslipidemia for the primary prevention of cardiovascular diseases based on total cardiovascular risk. This was a multicentre (four private hospitals) prospective cohort study to analyze data on the use of pitavastatin for dyslipidemia in adult outpatients in Abu Dhabi and Dubai, United Arab Emirates. We have followed up the clinical profiles of subjects in four hospitals for six-weeks during the period from June 2015 to June 2017. Efficacy was based on the evaluation of the mean (± standard deviation) change in low-density lipoprotein cholesterol between baseline and week six after the initiation of pitavastatin therapy. Safety was reported with respect to the incidence of adverse events occurring with the use of pitavastatin and the development of new-onset diabetes. A total of 400 subjects who were receiving pitavastatin 4 mg were included. The mean age of subjects was 50.7 ±10.8 years; of these, 79.0% were males. At the baseline, the mean level of total cholesterol was 185.4 ±41.5 mg/dL, low density lipoprotein was 154.9 ±48.55 mg/dL, high- -density lipoprotein cholesterol was 40.5 ±11.23 mg/dL and fasting blood glucose was 115.0 (±16.63) mg/dl. At the end of six weeks, low density lipoprotein levels significantly decreased to 112.09 ±41.90 mg/dl (standard mean difference (SMD) (-42.8%), 95% CI: -42.88 [-49.17 to -36.58] mg/dl, P <0.001), while high density lipoprotein levels improved (SMD, 95% CI: 1.77% [0.25 to 3.28] mg/dl, P <0.022). There were 55 subjects (13.7%) who reported various adverse events such as myalgia (7.5%), sleep disorders (2.5%), and myopathy (2.2%). Furthermore, 4 (1.0%) have had developed new-onset diabetes post-six-weeks of initiation of pitavastatin therapy. Pitavastatin 4 mg showed robust efficacy in reducing LDL-C levels and improving HDL-C levels in subjects with dyslipidemia. The use of pitavastatin was associated with a low discontinuation rate, fewer adverse events, and very limited cases of new-onset diabetes.

Assessment of cardiovascular risk in Kyrgyz Republic

Objective: An analysis of the current situation in the Kyrgyz Republic demonstrates that the areas of concern in care system for patients with cardiovascular diseases (CVD) are the insufficient and untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete implementation of existing risk stratification guidelines and decision-making. This study assesses distribution of total cardiovascular risk among the population of the Kyrgyz Republic using the WHO/ISH risk scale. In addition, the distribution of the main risk factors separately is calculated, as well as the frequency of some additional CVD risk factors that are not included into the WHO/ISH evaluation scale is estimated. Methods: This research was carried out within the framework of the international project "STEPS". The survey used a questionnaire developed by WHO and adapted to the Kyrgyz Republic. Overall, 2417 people were selected at the age of 25 to 65 years, of which 59.0% are women and 41.0% are men. The mean age in general was 43.9 (11.5) years. Of these, mean age for men was 44.0 (11.2) years and for women - 43.8 (11.7) years (p˃0.05). Results: According to the WHO / ISH chart, the proportion of low, medium, high and very high risk for age group of 40-65 years was 73.9%, 4.6% and 21.4%, respectively. According to the results of the study, among respondents aged 40 to 65 years, a high prevalence of the main risk factors for CVD was revealed (arterial hypertension - 61.5%, hypercholesterolemia - 31.6%, smoking - 19.0%, diabetes mellitus 11.1%) and other additional risk factors for CVD (insufficient intake of fruits and vegetables - 75.4%, obesity - 36.5%, physical inactivity - 29.3% and excessive salt intake - 14.0%). Conclusion: Thus, very high-risk of CVD in our population was presented in 21.4% of individuals, while low risk prevailed – 73.9%. The most frequent risk factors were arterial hypertension, hypercholesterolemia, obesity and physical inactivity, insufficient consumption of fruit and vegetables followed by smokin, diabetes and excessive salt consumption.

Determination of Inflammatory Markers, Hormonal Disturbances, and Sleepiness Associated with Sleep Bruxism Among Adults.

PurposeSleep bruxism (SB) is characterized by repetitive phasic, tonic, or mixed masticatory muscle activity during sleep with multifactorial etiology. Previous studies have shown that the complex origin of SB can be related to the psychological features of the affected individual, consumption of caffeine and alcohol, smoking, obstructive sleep apnea, diabetes, increased body mass index, hypertension, thyroid diseases, and probable genetic vulnerability. This study aimed to investigate the inflammatory markers, hormonal disturbances, and sleepiness associated with SB, which have a potential effect on the total cardiovascular (CV) risk among relatively young and healthy patients.Patients and MethodsA total of 74 individuals with probable SB were subjected to single-night polysomnography, followed by blood panel and 24-h urinary excretion tests. The level of daytime sleepiness was assessed in the participants using the Epworth Sleepiness Scale.ResultsSB was found in 78.4% of participants. The bruxism episode index (BEI) positively correlated with the concentrations of 17-hydroxycorticosteroids, C-reactive protein, and fibrinogen in the collected urine samples. A positive correlation was also found between phasic BEI and glucose concentration 2 h after the consumption of glucose solution. Sleep bruxers showed significantly increased sleepiness compared to nonbruxers (p = 0.02). The scores on sleepiness were positively correlated with mixed BEI, minimal oxygen saturation, and mean heart rate.ConclusionThe results of this study revealed that participants with SB had metabolic and hormonal disturbances, probably due to stress and sympathetic activity. Moreover, it was found that young sleep bruxers potentially have a high CV risk due to the increased level of inflammatory and stress markers.

Lipoprotein(a) lowering by alirocumab reduces the total burden of cardiovascular events independent of low-density lipoprotein cholesterol lowering: ODYSSEY OUTCOMES trial.

AimsLipoprotein(a) concentration is associated with first cardiovascular events in clinical trials. It is unknown if this relationship holds for total (first and subsequent) events. In the ODYSSEY OUTCOMES trial in patients with recent acute coronary syndrome (ACS), the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab reduced lipoprotein(a), low-density lipoprotein cholesterol (LDL-C), and cardiovascular events compared with placebo. This post hoc analysis determined whether baseline levels and alirocumab-induced changes in lipoprotein(a) and LDL-C [corrected for lipoprotein(a) cholesterol] independently predicted total cardiovascular events.Methods and resultsCardiovascular events included cardiovascular death, non-fatal myocardial infarction, stroke, hospitalization for unstable angina or heart failure, ischaemia-driven coronary revascularization, peripheral artery disease events, and venous thromboembolism. Proportional hazards models estimated relationships between baseline lipoprotein(a) and total cardiovascular events in the placebo group, effects of alirocumab treatment on total cardiovascular events by baseline lipoprotein(a), and relationships between lipoprotein(a) reduction with alirocumab and subsequent risk of total cardiovascular events. Baseline lipoprotein(a) predicted total cardiovascular events with placebo, while higher baseline lipoprotein(a) levels were associated with greater reduction in total cardiovascular events with alirocumab (hazard ratio Ptrend = 0.045). Alirocumab-induced reductions in lipoprotein(a) (median −5.0 [−13.6, 0] mg/dL) and corrected LDL-C (median −51.3 [−67.1, −34.0] mg/dL) independently predicted lower risk of total cardiovascular events. Each 5-mg/dL reduction in lipoprotein(a) predicted a 2.5% relative reduction in cardiovascular events.ConclusionBaseline lipoprotein(a) predicted the risk of total cardiovascular events and risk reduction by alirocumab. Lipoprotein(a) lowering contributed independently to cardiovascular event reduction, supporting the concept of lipoprotein(a) as a treatment target after ACS.

Application of L-arginine in patients with hypertension in combination with COPD in aspect of effect on platelet activity

Objective. To investigate the relationship between platelet (Pl) adhesive activity and total cardiovascular risk (CVR) and the effect of L-arginine (Tivortin®, “Yuria-Pharm”) on morpho-functional parameters of Pl activity in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).&#x0D; Materials and methods. The study included 44 patients with AH stage II in combination with COPD clinical categories A-D in the stable phase of diseases (group I) and 15 healthy individuals (group II). The calculation of the CVR by SCORE, the study of the degree of adhesion (Adh) Pl (optical turbidometry, analyzer AP 2110, Belarus). 20 patients (IA group) in addition to standard therapy of AH and COPD for 4 weeks received 4 g of L-arginine (Tivortin®, “Yuria-Pharm”), 10 patients (IB group) received only standard therapy. Before and at the end of therapy, the study was performed Pl Adh, in 10 patients of IA – transmission electron microscopy (TEM) Pl (electron microscope PEM-100-01 (SELMP, Ukraine). Statistical processing of the obtained results was performed using the program Statistica 6.1.&#x0D; Results and discussion. In group I the average age was 56.0±6.7, men – 35 (79.5 %), body mass index (BMI) – 26.3 [24.0; 30.3] kg/m2, active smokers – 25 (57 %). In group II the average age was 52.7±4.9, men – 10 (66.7 %), BMI – 25.4 [24.3; 26.2] kg/m2, active smokers were not detected. The degree of Pl Adh in group I was higher than in group II (42.0 [36.0; 52.0] %) vs 29.0 [26.0; 34.0] %; p=0.005). In patients of group I the degree of Pl Adh had a direct correlation with the CVR by SCORE (R=0.50; p=0.001). Against the background of therapy in the IA group, the degree of Pl Adh decreased from 42.0 [34.0; 52.0] % to 30.0 [26.0; 39.0] % (p=0.004), in the IB group – from 38.5 [36.0; 47.0] % to 36.0 [33.5; 43.0] % (p=0.18). According to the results of TEM of Pl in patients of IA group, the number of activated forms of Pl decreased from 45.0 [43.0; 48.0] % to 37.0 [33.0; 41.0] % (p=0.028), aggregated Pl – from 11.5 [10.0; 9.5] % to 9.5 [8.0; 12.0] % (p=0.043), degranulated Pl – from 16.5 [16.0; 20.0] % to 11.0 [9.0; 13.0] % (p=0.028). No adverse effects were identified during L-arginine therapy.&#x0D; Conclusions. Increased adhesive activity of Pl in stable patients with AH in combination with COPD is associated with the total CVR by SCORE. The use of L-arginine (Tivortin®, “Yuria-Pharm”) effectively and safely helps to reduce the functional activity of Pl in this category of patients.

High-normal blood pressure and related cardiovascular risk factors prevalence in the Romanian adult population: insights from the SEPHAR III study.

High normal blood pressure (HNBP) is associated with an increased risk of incident high blood pressure (HBP) and of cardiovascular diseases (CVD). To estimate the prevalence of HNBP and related cardiovascular risk factors, a representative sample of 1970 Romanian adults was enrolled in SEPHAR III survey (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania). All were evaluated for blood pressure values and by a 71-item questionnaire, anthropometric measurements, together with extensive evaluation for target organ damage, blood, and urine sample collection. Prevalence of HNBP was 11% [45.1% had HBP, 43.9% normal BP (NBP)]. HNBP individuals were older (51.14 ± 17.13 years) than subjects with NBP (40.5 ± 15.96 years) but younger than those with HBP (55.79 ± 15.68 years), p < 0.0001 (95% CI 18-85, respectively 18-91). Values of weight, waist circumference, body mass index, total and LDL cholesterol, triglycerides, fasting blood glucose, glycosylated hemoglobin (HbA1c), uric acid, serum creatinine, glomerular filtration rate estimate by CKD-EPI equation, urinary albumin to creatinine ratio, intimae-media thickness, arterial stiffness measurements and diastolic dysfunction, indexed left ventricular mass, interventricular septum and posterior left ventricle wall thickness, left atrial volume, and LA dilatation were significantly higher in HNBP subjects than in NBP. Our study showed that individuals with HNBP represent ~11% and most of them had an elevated total cardiovascular risk. It is essential to educate the public and health care providers to be aware of these individuals and of steps that should be taken to treat modifiable cardiovascular risk factors.

Распространенность субклинического атеросклероза при ревматоидном артрите

Objective. To study the parameters of the morpho-functional state of the vascular wall in patients with rheumatoid arthritis (RA) with different levels of total cardiovascular risk (CVR). Materials and methods. 181 patients with active RA (mean age 40.4 [31.8; 49.6] years) were examined, and 2 groups were formed: 1) patients with the seronegative subtype (n=87); 2) those with the seropositive subtype (n=94). CVR was determined using the modified Systematic COronary Risk Evaluation (SCORE) scale; the intima-media complex thickness (IMCT) and the stiffness index (SI) of common carotid arteries (CCA) were assessed with specific methods. Results. Low CVR was determined in 86 (48%), moderate risk - in 47%, and high risk - in 5% patients with RA. 176 (97%) patients with RA had signs of subclinical atherosclerosis, with simultaneous IMCT increase above the 75th percentile and SI increase over 10 m/s in 21% patients. Mean IMCT values and SI in the 2nd group were higher than in the 1st group (р=0.018 and р=0.048, respectively). The lower risk was more commonly accompanied by the IMCT increase; as the CVR increased, the proportion of RA patients with SI over 10 m/s increased (р&lt;0.01). A correlation was detected between the age and SI (r=0.58, p=0.035), IMCT parameters (r=0.64, p=0.002). SI correlated with the body mass index (BMI) (r=0.64, p=0.04), and IMTC correlated with the С-reactive protein level (r=0.61, p&lt;0.01). Direct correlation was detected between SI, IMTC, and the Disease Activity Score 28 (DAS28) (r=0.51, p=0.02; r=0.45, p=0.008), RA duration (r=0.42, p=0.04; r=0.58, p=0.04), rheumatoid factor (RF) (r=0.68, p=0.04; r=0.49, р=0.04) and anti-citrullinated peptide antibody (ACPA) levels (r=0.62, p=0.018; r=0.45, р=0.003), respectively. Conclusion. It is feasible to perform an advanced examination for the diagnosis of subclinical atherosclerosis along with the routine evaluation of total CVR using the SCORE scale in patients with active RA.

Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis.

Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AIS patients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P<0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P=0.011) and 90-day mortality (P<0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52-0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23-2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36h after IVT administration. Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AIS patients treated with IVT.

High consumption of ultra-processed food may double the risk of subclinical coronary atherosclerosis: the Aragon Workers\u2019 Health Study (AWHS)

BackgroundUltra-processed food (UPF) consumption, which is increasing worldwide, has recently been associated with an increased risk of death and cardiovascular disease. We aimed to assess whether consumption of UPF is directly associated with subclinical coronary atherosclerosis in middle-aged men.MethodsA computed tomography scan was performed on 1876 men from the Aragon Workers’ Health Study, recruited from January 2011 to December 2014, to assess coronary calcium. All participants were free of coronary heart disease. Dietary intake was collected by a validated 136-item semi-quantitative food frequency questionnaire. UPF was defined according to the NOVA classification. Associations between consumption of total energy-adjusted UPF and Coronary Calcium Agatston Score (CACS)—categorized into CACS of 0, > 0 and < 100, and ≥ 100—were cross-sectionally assessed by generalized ordered logistic regression adjusted for main confounders.ResultsNo coronary calcium was detected in 60.2% of the participants, whereas 10.2% had a CACS ≥ 100. A significant dose-response association was observed between energy-adjusted UPF consumption and the risk of having a CACS ≥ 100, when compared with those in the lowest CACS categories (CACS of 0 together with CACS > 0 and < 100). The fully adjusted ORs (95% CI) of having a CACS ≥ 100 across quartiles of energy-adjusted UPF consumption (approximately 100 g/day in the lowest quartile (ref.) and 500 g/day in the highest) were 1.00 (ref.), 1.50 (0.93, 2.42), 1.56 (0.96, 2.52), and 2.00 (1.26, 3.16), p trend .005.ConclusionIn this middle-aged worker’s sample, approximately 500 g/day of UPF consumption was associated with a 2-fold greater prevalence of subclinical coronary atherosclerosis than consuming only 100 g/day, independently of total energy intake and other well-established cardiovascular risk factors.

Polyherbal mixture ameliorates hyperglycemia, hyperlipidemia and histopathological changes of pancreas, kidney and liver in a rat model of type 1 diabetes

Ethnopharmacological relevanceOne of the commonly prescribed ‘anti-diabetic’ polyherbal mixtures by European herbalists is made of Rubus fruticosus and Vaccinium myrtillus leaves, Potentilla erecta roots, Geum urbanum aerial parts and Phaseolus vulgaris pods. Aim of the studyThis study aimed to evaluate the phytochemical composition, antioxidant capacity, potential toxicity, hypoglycemic, hypolipidemic, nephroprotective and hepatoprotective activities of this polyherbal mixture decoction. Materials and methodsThe phytochemical composition was evaluated using HPLC-UV. The antioxidant activity was assessed using the DPPH test. Potential toxicity was evaluated using the acute and sub-chronic oral toxicity method. Diabetes was induced in Wistar female rats with a single intraperitoneal injection of alloxan monohydrate (150 mg/kg). The animals whose blood glucose was >20 mmol/L for 14 consecutive days were considered diabetic. For the next 14 days, D-10 and D-20 groups were treated with the polyherbal mixture (10 and 20 g of dry plant material/kg, respectively). I and M were control groups treated with insulin glargine (13 IU/kg) and metformin (150 mg/kg), respectively. Healthy control (HC) and diabetic control (DC) groups were treated with water. The blood glucose level was measured on days 14, 21 and 28. Lipid profile analysis was done on day 28. Pancreas, kidney and liver histopathology was evaluated using the H&E and Masson’s trichrome staining. The liver tissue was additionally tested for PAS-positive cells. ResultsThe HPLC-UV analysis revealed the presence of quinic, gallic and caftaric acid, arbutin, rutin, trifolin, astragalin, hyperoside, isoquercetin and quercitrin. The antioxidant activity of the extract was higher than the reference's one (p < 0.01). Treatment with the polyherbal mixture (10 and 20 g/kg) has shown no toxic effects. No major decline in blood sugar was recorded in I and M groups compared to the DC one (22.86 ± 2.58, 28.5 ± 0.42 and 27.82 ± 0.9 mmol/L, respectively). The polyherbal mixture lowered the blood glucose level to the normal value (8.64 ± 4.09, 5.26 ± 1.3 and 6.76 ± 1.54 mmol/L in D-10, D-20 and HC groups, respectively). Furthermore, it decreased the levels of total cholesterol, triglycerides, VLDL, LDL, atherogenic and cardiovascular risk indices (p < 0.001) compared to the DC group. In addition, the extract restored histopathological changes of the pancreas, kidneys and liver to the healthy animal level. ConclusionTreatment with the polyherbal mixture extract was more effective than the standard drugs (insulin and metformin) in the amelioration of hyperglycemia, hyperlipidemia, and histopathological changes of the pancreas, kidney and liver tissue.

Cardiovascular Risk Distribution in Argentina in 2018

Background: Cardiovascular diseases are the main cause of disability and death globally. Total cardiovascular risk (CR) is the probabilityof having a cardiovascular event in a defined period and is determined by the combined effect of risk factors.Objectives: The aim of this study was to estimate CR and describe its distribution in Argentina in 2018.Methods: Cardiovascular risk was analyzed in 11,450 individuals over 30 years of age from the 4th National Risk Factor Survey(NRFS). The Framingham risk equations used to estimate and calibrate global CR classified the individuals into the following threegroups: optimum CR ( 20%). Bayesian prevalence and credibility intervals (BCI)were estimated under the non-informative beta prior distribution.Results: Nationally, 60.6% of the individuals presented moderate/high CR. Moderate CR by region was distributed homogeneously.When analyzing extreme CRs, the metropolitan (47.6%) and Pampean (28.6%) regions presented the greatest incidence of high CR.The highest prevalence of optimum CR was found in the Patagonian region, followed by the Northwest, Northeast and Cuyo, allabove 40%. The analysis by province showed that the greatest incidence of high CR was found in Buenos Aires (49.9%) and CABA(45.7%). At all levels, the prevalence of moderate/high CR is much higher in men, with the exception of the metropolitan region.Conclusions: Geographical differences position the metropolitan region as the one with maximum CR due to the great incidence ofhigh and moderate CR. Prevalence of high CR in men is almost 4 times greater than that registered in women.

Changes in Lipid Profile, Body Weight Variables and Cardiovascular Risk in Obese Patients Undergoing One-Anastomosis Gastric Bypass

Morbid obesity has a direct impact on the development of cardiovascular disease. One-anastomosis gastric bypass (OAGB) is an effective surgical technique for the control of body weight and the reduction of cardiovascular risk. This work examines the change in weight loss, lipid profile and cardiovascular risk in 100 patients (71 women, 29 men), mean age 42.61 ± 11.33 years at 3, 6, 9, 12, 18 and 24 months after OAGB. At 24 months post-surgery, mean body weight was significantly reduced compared to pre-operative values (116.75 ± 22.19 kg vs. 69.66 ± 13.07 kg), as were mean total cholesterol (201.86 ± 44.60 mg/dL vs. 172.99 ± 32.26 mg/dL), LDL (Low-Density Lipoprotein) cholesterol (126.90 ± 39.81 mg/dL vs. 96.28 ± 26.99 mg/dL), triglycerides (138.05 ± 78.45 mg/dL vs. 76.04 ± 30.34 mg/dL) and cardiovascular risk (total cholesterol/HDL (High-Density Lipoprotein) cholesterol: 4.32 ± 1.24 vs. 2.93 ± 0.71), while the mean HDL cholesterol concentration was significantly higher (49.09 ± 14.16 mg/dL vs. 61.98 ± 14.86 mg/dL) (all p < 0.001). In conclusion, OAGB surgery led to significant reductions in body weight, a significant improvement in the lipid profile, and a reduction in cardiovascular risk.

Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease.

eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.

The Influence of Non-Alc oholic Fatty Liver Disease on Indicators of Arterial Stiffness and Risk of Cardiovascular Complications in Patients with Arterial Hypertension

Aim. To determine the value of concomitant non-alcoholic fatty liver disease in patients with arterial hypertension in the progression of rigidity of the main arteries and in increase of risk of cardiovascular complications. Material and methods. A cross-sectional comparative study was conducted. Group 1 (n=50, 35(70%) women, average age 57,4±6,9 years) included patients with arterial hypertension and non-alcoholic fatty liver disease, group 2 (n=50, 40(80%) women, average age 56,5±7,0 years) included patients with arterial hypertension only. The groups were comparable in the main clinical and demographic indicators (p&gt;0,05). A comparative analysis of pulse wave velocity, central aortic pressure, vascular age and a 10-year risk of developing cardiovascular complications in both groups was performed.Results. There is a statistically larger number of patients with metabolic index&gt;7,0 (58,0% vs 28,0%, p=0,0019). It was also established that systolic (121,9±10,9 mm Hg vs 115,9±8,9 mm Hg) and diastolic (82,5±9,3 mm Hg vs 77,4±8,9 mm Hg) aortic pressure, as well as the augmentation index (26,5±8,5% vs 18,6±4,2%), were significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension. In the 1st group, a statistically significant increased pulse wave velocity was found both in muscular (12,0±3,1 m/s vs 10,6±1,8 m/s) and elastic (10,4±2,8 m/s vs 9,1±1,7 m/s) vessels, which indicates an increase in arterial stiffness. In addition, there was an increase in post-occlusal pulse wave velocity in this category of patients (11,0±3,3 m/s vs 9,4±1,9 m/s, p=0,0037). A significant increase in vascular age in relation to the passport age (60,4 [56,0:68,0] years vs 58,0 [53,0:60,0] years) and an increase in the 10-year fatal risk was detected (2,15 [1,42: 4,63] and 1,05 [0,52: 2,82] %, p = 0,0043 ) were also revealed in patients with arterial hypertension and non-alcoholic fatty liver disease compared to patients with isolated arterial hypertension. Significantly more patients with a high (13 (26,0%) vs 5 (10,0%), p = 0,0332) total cardiovascular risk were observed in group 1 than in group 2.Conclusions. Arterial stiffness was significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension, which is confirmed by a statistically significant increase in pulse wave velocity and central aortic pressure. Comorbid patients have pronounced endothelial dysfunction, which is confirmed by a significant increase in the post-occlusion rate of the pulse wave. An increase in vascular age in relation to the passport age indicates earlier aging of blood vessels in the 1st group compared with the 2nd group. Patients in the main group have a higher incidence of a high 10-year risk of developing cardiovascular events compared with patients in the control group.

Hemoglobin glycation index in relationship to the risk of cardiovascular complication in patients with type 2 diabetes: A systematic review and meta-analysis

AimTo estimate the association of hemoglobin glycation index (HGI) level with total mortality and cardiovascular complication risk among patients with T2DM. MethodsLiteratures evaluating the associations of HGI with the risk of cardiovascular outcomes and total mortality in patients with T2DM were systematically searched by using the PubMed and Embase databases from January 2002 to April 2019. Fixed-effects model and random-effects model meta-analyses were used to calculate pooled adjusted hazard ratios (HRs). ResultsSix prospective cohort studies and one nest case-control study (comprising n = 37,280) were included in this systematic review. T2DM patients with high HGI level had significant high HRs (95% confidence interval, 95% CI) for cardiovascular complication [1.25 (1.16, 1.36)] and total mortality [1.26 (1.14, 1.39)] compared to intermediate HGI level. For every 1-unit increment in HGI, the average HR (95% CI) were 1.20 (1.00, 1.41) for cardiovascular complication and 1.13 (1.06, 1.19) for total mortality. ConclusionsThe findings suggested that a rising HGI level was associated with the increased risk for cardiovascular complication and total mortality among patients with T2DM.

Cardiovascular risk in petrochemical workers

Introduction. The high prevalence of diseases of the circulatory system of workers in various sectors of the economy, the lack of data on the effects of harmful production factors on the formation of cardiovascular diseases in petrochemical industry workers justify the importance of conducting special studies on these petrochemical complex plants with the aim of assessing cardiovascular risk with the subsequent development of preventive measures. Material and methods. The objects of the study were workers in the production of monomers (ethylene, propylene, ethylbenzene, isoprene, divinyl) of petrochemical enterprises. Hygienic studies of the working conditions of workers included an assessment of the factors of the working environment and the labor process using generally accepted methods. Comprehensive clinical examination of workers included periodic examinations (n = 2634) with calculation of total and relative cardiovascular risk using the SCORE system, using questionnaire data, a Reeder L questionnaire and an in-depth clinical diagnostic medical examination (n = 101) with the definition total cardiovascular risk. Results. The most significant occupational factors of the labor process for workers in the main profession - panmen were established to include the combination of a chemical factor with the occupational noise and labor intensity, with an overall assessment of working conditions 3.2. The class of working conditions of workers of the comparison group (locksmith in instrumentation and automation corresponds to the permissible). There were revealed a high prevalence of arterial hypertension and other factors of cardiovascular risk. A higher dependence of the arterial hypertension level on age and length of service in the group of panmen was established when compared to the mechanicians of instrumentation and automation. Using mathematical models of multiple regression, the likely dynamics of the level of arterial hypertension and the left ventricular myocardial mass index were calculated under the influence of increasing age and other risk predictors. Conclusion. The results of a clinical study showed workers with severe arterial hypertension, a high and very high risk of death from cardiovascular disease on the SCORE scale, a high and very high overall cardiovascular risk, signs of dyslipidemia, obesity, high stress levels to require close attention. It is important to timely diagnose lesions of target organs, to conduct rational prevention aimed at reducing risk factors. According to the results of the study, there were developed preventive measures aimed at reducing cardiovascular morbidity and cardiovascular risk, prolonging the longevity of workers in petrochemical industries.