Risk Factor For Vascular Disease Research Articles

Methylenetetrahydrofolate reductase polymorphisms as risk factors for retinal venous occlusive disease: A literature review

The role of polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene in retinal vein occlusion (RVO) is a theme of discussion since the first reports of RVO in patients with MTHFR C677T mutation and without classic acquired risk factors for retinal vascular disease. The association between MTHFR polymorphisms and RVO has been studied over the last 20 years producing conflicting results. This review aims to summarize the literature concerning the role MTHFR polymorphisms as risk factors for RVO.

Specific model for the coordination of primary and hospital care for patients with diabetes mellitus. Evaluation of two-year results (2015–2017)

IntroductionDiabetes mellitus (DM) is one of the most prevalent chronicdiseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease (VD) reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. ObjectiveTo assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). Patients and methodsA quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. ResultsDuring the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level < 8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction (AMI) and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (P = .001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14 ± 1.73%; 95% CI: 0.73–1.55; P = .0001) and cholesterol (11.28 ± 40 mg/dL; 95% CI: 2.07–20.48; P = .012). ConclusionsThis study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

COVID-19 ile İlişkili İskemik İnmenin Görüntüleme Bulguları

Objective: We aimed to present the relationship between ischemic stroke and COVID-19, stroke types, and imaging findings in COVID-19 with stroke. Material Method: From March to November 2020, COVID-19 diagnosed in patients with stroke (n=10) was included in the study retrospectively. To eliminate intracranial hemorrhage, a non-contrast computed tomography (CT) was performed for all patients. Then, magnetic resonance imaging (MRI) and Diffusion-Weighted MRI (DWI) (n=10) were obtained. Magnetic resonance angiography was performed in patients whose CT angiography was contraindicated. Clinical information, stroke risk factors, and case imaging results were recorded. Stroke time, size, location (cortical, deep lacunar, and white matter), and vascular territory area were evaluated. Results: The mean age of the 10 patients included in the study was 62±15.10 years. All patients had an ischemic stroke. In total, 4 cases (40%) did not have any risk factors for cerebral vascular disease. Based on DWI results, seven cases were assessed as acute strokes (70%) and three cases as sub-acute strokes (30%). The size of the stroke was 21.80±15.83mm. In 4 cases, the size was extended cortical areas. 3 cases were cortical, 5 cases had a lacunar infarction, 2 cases had cortical and lacunar infarctions. 6 cases were in the posterior cerebral artery territory and 4 cases were in the anterior territory. Conclusion: The presentation of patients with stroke during COVID-19 therapy or after therapy might be considered the hypothesis that the virus led to a stroke, especially in cases accompanied by risk factors.

Clinical impact of estradiol/testosterone ratio in patients with acute ischemic stroke

BackgroundSex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS).MethodsBetween January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.ResultsThe E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).ConclusionsThese findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

Is Periodontitis a Predictor for an Adverse Outcome in Patients Undergoing Coronary Artery Bypass Grafting? A Pilot Study.

Periodontitis is a risk factor for atherosclerosis and coronary vascular disease (CVD). This research evaluated the relationship between periodontal conditions and postoperative outcome in patients who underwent coronary artery bypass grafting (CABG). A total of 101 patients with CVD (age 69 years, 88.1% males) and the necessity of CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the Centers for Disease Control and Prevention (CDC, 2007). Additionally, periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) were determined. Multivariate survival analyses were carried out after a one-year follow-up period with Cox regression. All study subjects suffered from periodontitis (28.7% moderate, 71.3% severe). During the follow-up period, 14 patients (13.9%) experienced a new cardiovascular event (11 with angina pectoris, 2 with cardiac decompensation, and 1 with cardiac death). Severe periodontitis was not significant associated with the incidence of new events (adjusted hazard ratio, HR = 2.6; p = 0.199). Other risk factors for new events were pre-existing peripheral arterial disease (adjusted HR = 4.8, p = 0.030) and a history of myocardial infarction (HR = 6.1, p = 0.002). Periodontitis was not found to be an independent risk factor for the incidence of new cardiovascular events after CABG surgery.

Association of High Serum Homocysteine Levels and Severe Chronic Venous Disease

Homocysteine (Hcy) is considered as a modifiable risk factor for vascular disease. This study was aimed to explore the association between serum concentration and the severity of primary chronic venous disease (CVD). Clinical data of 582 patients diagnosed with primary CVD were collected and analyzed retrospectively. The Clinical Etiology Anatomy Pathophysiology classification system was used to grade the severity of chronic venous disease. Patients were divided into 2 groups (group A: C1-C3; group B: C4-C6). The association between serum homocysteine levels and the severity of primary chronic venous disease was investigated using rank sum test and logistic regression. The difference between the level of homocysteine in each grade has statistical significance. Group A has higher median Hcy concentrations than Group B (15.40 μmol/L vs. 14.05 μmol/L, P< 0.01). Further binary logistic regression showed no statistical significance among the level of Hcy (11.00-14.75 μmol/L [OR 0.66, 95% CI 0.40-1.11, P= 0.12], 14.75-20.38μmol/L [OR 0.97, 95% CI 0.59-1.69, P = 0.89], ≥20.38 μmol/L [OR 0.67, 95% CI 0.41-1.10, P = 0.11]), but age (OR 1.03, 95% CI 1.01-1.04, P< 0.01) and female (OR 0.41, 95% CI 0.28-0.59, P< 0.01) are associated with more severe stages of CVD. Higher level of Hcy is associated with more severe stages of CVD, but it not an independent risk factor. However, Advanced age and female are risk factors for CVD development based on logistic regression analysis.

Challenges of Cardio-Kidney Composite Outcomes in Large-Scale Clinical Trials.

Patients with chronic cardiovascular or metabolic diseases, including diabetes, hypertension, obesity, and heart failure, often have comorbid kidney disease. Long-term outcomes are worse in the setting of both cardiac and kidney disease compared with either disease in isolation. In addition, the clinical presentations of certain acute cardiovascular events (such as heart failure) and worsening kidney function overlap and may be challenging to distinguish. Recently, certain novel treatments have demonstrated beneficial effects on both cardiac and kidney outcomes. Sodium-glucose cotransporter-2 inhibitors have exhibited concordant risk reduction and clinically important benefits in chronic kidney disease with and without diabetes, diabetes and established cardiovascular disease or multiple atherosclerotic vascular disease risk factors, and heart failure with reduced ejection fraction with and without diabetes. Primary trial results have revealed that sacubitril-valsartan therapy improves cardiovascular outcomes in patients with chronic heart failure with reduced ejection fraction and post hoc analyses suggest favorable kidney effects. A concordant pattern of kidney benefit with sacubitril-valsartan has also been observed in chronic heart failure with preserved ejection fraction. Given the complex interplay between cardiac and kidney disease and the possibility that treatments may show concordant cardio-kidney benefits, there has been recent interest in formally acknowledging, defining, and using composite cardio-kidney outcomes in future cardiovascular trials. This review describes potential challenges in use of such outcomes that should be considered and addressed before their incorporation into such trials.

A Cardiac cephalalgia attacks provoked by Prinzmetal angina - a case report

A 51-year-old man with no past medical history of headache or risk factors for vascular diseases was diagnosed with supraventricular tachycardia (SVT) in 2005. In 2014 SVT attacks were longer and always followed by severe headache attacks. Accompanying symptoms were dizziness, non-rotational vertigo, confusion, episodes of double vision and tinnitus; these symptoms would last one day, followed by severe tiredness for 2 days. Neurologic and cardiologic evaluation as well as extensive diagnostic test between the attacks was normal. Catheter coronarography showed no stenoses but did show spasms in distal left anterior descending artery. A remarkable effect on SVT and headaches was shown after the introducement of diltiazem. The diagnosis cardiac cephalalgia (CC) was established. As our case report is unique, we hope that our observations will help cardiologists and neurologists to better understand and treat patients with CC. CC should be distinguished from migraine, to avoid prescribing triptans and vasoconstrictors.

Serum Homocysteine Level Might Be a Predictor for Persistence of Abnormal Glucose Tolerance in Gestational Diabetes

Background: Increased plasma homocysteine levels are recognized to exert oxidative damage resulting into risk factors for insulin resistance (IR) and vascular disease. Present study was conducted to observe post-partum persistence of abnormal glucose tolerance (AGT) and level of homocysteine after delivery in patient with GDM. Methods: This observational cross-sectional study encompassed 100 subjects (age: 28.58±4.26 years, BMI: 26.7±2.80 Kg/m2; mean±SD) who were diagnosed as GDM during their index pregnancy by any of the internationally acceptable standard criteria. At 6-12 weeks post-partum, each of them underwent anthropometric measurements, 75 gram 2 sample OGTT and measurement of plasma homocysteine level by utilizing the chemiluminescent Immunoassay method. Results: Of the 100 subjects, 32% converted to having AGT during 6 – 12 week of post-partum follow up. Statistically significant difference was found in between the AGT and normal glucose tolerance (NGT) groups in circulating concentration of homocysteine (AGT vs NGT: 9.19±1.15 vs. 6.29±1.31 mmol/L; p=<0.001). Mean age and BMI were significantly higher in the AGT group (p<0.05 for both). Independent association was found between each of the variables age, history of macrosomia and higher homocysteine level with AGT in multiple regression analysis. Conclusion: Our study identified persistence of AGT and elevation of homocysteine levels are more prominent in women with GDM in post-partum period.

Evaluation of carotid intima-media thickness and serum homocysteine level as markers of subclinical atherosclerosis in lichen planus

Background Lichen planus (LP) is a chronic mucocutaneous inflammatory disease. Its etiology remains unknown and may be caused by a cell-mediated immunological response, where autoreactive cytotoxic T lymphocytes are the effector cells, which cause degeneration and destruction of keratinocytes. Inflammation produces disturbances of lipid metabolism such as serum increase of triglycerides or decrease of high-density lipoprotein. Hyperhomocysteinemia has been regarded as a new modifiable risk factor for atherosclerosis and vascular disease. Homocysteine increases the damage to the cardiovascular system in different ways. It is widely seen now as an independent risk factor of cardiovascular disease in adults. Carotid intima-media thickness (CIMT) is a well-recognized clinical predictor of subclinical atherosclerosis. In several previous studies, patients with psoriasis exhibited greater CIMT than did the controls. In light of these studies, authorities might think that LP would also be associated with the formation of subclinical atherosclerosis, given the similarity between the pathogenesis of psoriasis and that of LP. Aim To assess carotid intima thickness and serum homocysteine level as markers of subclinical atherosclerosis in patients with LP. Patients and methods Abstract Peripheral blood samples were collected from 25 patients with LP and 25 controls to assess serum homocysteine level, blood glucose, cholesterol, and triglycerides. CIMT was measured by B mode ultrasound. Results Both serum homocysteine and CIMT were significantly higher in patients with LP than controls. Conclusion Serum homocysteine and CIMT could be reliable predictors of subclinical atherosclerosis in LP.

Prevalence and factors associated with hypertension among people living with HIV/AIDS on antiretroviral therapy in Uganda.

Introductionantiretroviral therapy (ART) has improved survival of People Living with HIV (PLWH); however, this has resulted in an increasingly high prevalence of non-communicable diseases (NCD) like hypertension. Hypertension is a major risk factor for cardiovascular and cerebral vascular disease, which are both associated with high morbidity and mortality rates. We studied the prevalence and factors associated with hypertension among PLWH on ART.Methodswe conducted a retrospective data analysis of PLWH on ART enrolled between 2011 and 2014 into a randomized double-blinded placebo-controlled trial investigating the safety of discontinuing cotrimoxazole prophylaxis (COSTOP) among PLWH in Central Uganda. We used the mean blood pressure (BP) measurements of the first four monthly clinic visits to define hypertension. Patients were categorised as: having normal BP (≤120/80mmHg), elevated BP (systolic >120-129, and diastolic ≤80), Stage 1 hypertension (systolic 130-139, or diastolic >80-89) and Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Multiple logistic regression was used to evaluate factors associated with hypertension.Resultsdata from 2026 COSTOP trial study participants were analysed, 74.1% were women and 77.2% were aged 35 years and above. The overall prevalence of hypertension was 29%, of whom 19.5% had Stage 1 hypertension and 9.5% had Stage 2 hypertension. About 21.4% were overweight or obese. Factors independently associated with hypertension among PLWH on ART included increasing age (p≤0.001) and high body mass index (p≤0.001). Efavirenz (p≤0.001) and lopinavir/ritonavir (p=0.036) based regimen had lower odds of hypertension than Nevirapine based regimens.ConclusionPLWH on ART have a high prevalence of hypertension, which rises with increasing age and body mass index (BMI) and among those on nevirapine-based ART. Implementation of hypertension prevention measures among PLWH on ART and integration of NCD and HIV care to improve patients’ management outcomes are required.

Prevalence of cardio vascular disease risk factors in suburban of Chennai, South India: A community assessment

Prevalence of cardio vascular disease risk factors in suburban of Chennai, South India: A community assessment

Testosterone aggravates cerebral vascular injury by reducing plasma HDL levels.

Testosterone is often used to improve the physiological function. But increased testosterone levels affect blood lipids and cause inflammation and oxidative stress, which are risk factors for vascular diseases. This study aimed at investigating the effects of testosterone on cerebral vascular injury using an established intracranial aneurysm (IA) model. Sixteen-week-old female C57Bl/6 mice were subcutaneously infused with testosterone propionate (TP; 5 mg/kg day) or plain soybean oil (controls) for 6 weeks. After 2 weeks of treatment, mice were given angiotensin II-elastase for another 4 weeks. The results showed that TP significantly increased cell apoptosis and reactive oxygen species production in cerebral artery, together with increases in plasma tumor necrosis factor-α (TNF-α) levels and in urinary 8-isoprostane levels. Plasma assays showed that 2 weeks after TP or soybean oil administration, the high-density lipoprotein (HDL) level was higher in the TP group than in controls. In vitro studies showed that testosterone increased TNF-α and monocyte chemotactic protein-1 mRNA and protein expression levels in RAW 264.7 macrophages. In summary, by reducing the HDL level, TP aggravates cerebral artery injury by increasing cell apoptosis, inflammation, and oxidative stress.

Does Obesity Influence the Outcome of the Patients Following a Cardiac Arrest?

BackgroundObesity is one of the major risk factors for cardiovascular and peripheral vascular diseases. However, the obesity paradox confers survival benefits in heart failure and cardiac surgery patients. Studies examining the outcomes of obese patients following cardiac arrest provided conflicting results.ObjectiveTo study the association between obesity and outcome in patients following cardiac arrest.Materials and methodsWe conducted a retrospective cohort study at a tertiary intensive care unit (ICU). Data were collected from medical records between January 1, 2018 and December 31, 2018, for all adult ICU patients who were admitted to our ICU following a cardiac arrest. Data collected included demographics, anthropometrics, and details of the cardiac arrest. The primary outcome was survival to hospital discharge. Secondary outcomes were duration of mechanical ventilation, ICU, and hospital length of stay.ResultsA total of 126 patients were admitted to the ICU following a cardiac arrest during the study period, of whom 14 patients were excluded due to missing body mass index (BMI) data. Seventy-six patients were non-obese (BMI <30) and 36 patients were obese (BMI ≥30). There was no difference in survival to hospital discharge between obese and non-obese patients (52.8 vs 59.2%, p = 0.52, OR = 0.77, 95% CI 0.35–1.71). Moreover, there was no difference between obese and non-obese patients in ICU length of stay (81.50 vs 76.0 hours, p = 0.42), hospital length of stay (9 vs 10 days, p = 0.63), and duration of mechanical ventilation (55 vs 43 hours, p = 0.30). In the logistical regression analysis, BMI was not associated with improved survival (OR = 0.97, 95% CI 0.92–1.03, p = 0.23).ConclusionFor patients admitted to ICU following cardiac arrest, we could not show that obesity improves survival, length of stay, or duration of mechanical ventilation.How to cite this articleChavda MP, Pakavakis A, Ernest D. Does Obesity Influence the Outcome of the Patients Following a Cardiac Arrest? Indian J Crit Care Med 2020;24(11):1077–1080.

Plasma Homocysteine and Vascular Disease

Vascular disease is the leading cause of death and disability in the Western World: atherosclerosis is responsible for the majority of deaths in virtually all westernized societies; pulmonary embolism, a complication of deep venous thrombosis, is the leading cause of morbidity and mortality, resulting in approximately 50,000 deaths per year in the United States; approximately 1.5 million acute myocardial infarcts occur each year, each infarction bearing a 30% mortality rate; and strokes represent the third leading cause of death in developed countries (1). While the adverse effects of hypertension, hypercholesterolemia, diabetes, and smoking on the vascular system have received widespread publicity, another important risk factor for vascular disease--less well-known outside the medical community but recently gaining increasing attention in the literature is an elevated plasma level of the amino acid homocysteine. Bolstered by findings of an association between hyperhomocysteinemia and a variety of vascular disorders, theories implicating homocysteine in the pathogenesis of these disorders have inspired researchers to explore novel approaches in the prevention and treatment of vascular disease. With the biochemistry of homocysteine metabolism already well understood, vitamin supplementation has emerged as a promising strategy for reduction of plasma homocysteine levels, with consequent arrest or reversal of the postulated pathogenic mechanisms involved in homocysteine-associated disorders of the vasculature, and, thus, potential prevention and treatment of vascular disease in hyperhomocysteinemic patients.

Guidance for the management of patients with vascular disease or cardiovascular risk factors and Covid-19 Position paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Guidance for the management of patients with vascular disease or cardiovascular risk factors and Covid-19 Position paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Association of Food and Alcohol Consumption with Peripheral Atherosclerotic Plaque Volume as Measured by 3D-Ultrasound.

Background: Food patterns and alcohol consumption influence the risk for cardiovascular diseases (CVD) and a healthy nutrition is essential for the prevention of CVD. The aim of this study was to determine the influence of nutrition and alcohol consumption on peripheral atherosclerotic plaque volume (PV) using an innovative 3D ultrasound approach. Methods: In this prospective, single centre study we included 342 patients with at least one cardiovascular risk factor or established CVD. PV in the carotid and femoral artery was measured using a semi-automatic software. Information on food and alcohol consumption of the participants was collected using an internationally acknowledged standardized questionnaire (DEGS1). Results: Patients with low total PV consumed significantly more vegetables (p = 0.004) and vegetable juice (p = 0.019) per week compared to patients with high total PV. In contrast, patients with high total PV reported a higher alcohol consumption compared to patients with low total PV (p = 0.026). Patients without vascular disease, in particular cerebrovascular disease (p = 0.001) and peripheral arterial disease (p = 0.012), reported a significantly higher fish consumption per week. In the multivariate model, we found a significant negative association for vegetable consumption (p = 0.034) and female gender (p = 0.018) but a significant positive association for alcohol (p = 0.001), age (p < 0.001) the presence of vascular disease (p < 0.001) and cardiovascular risk factors (p < 0.001) with total PV. Conclusion: In this study we were able to show an association of food and alcohol consumption with peripheral atherosclerotic PV measured by 3D-ultrasonography. Following a healthy nutritional lifestyle (vegetable consumption, no excessive alcohol consumption) and regular fish consumption appears to be associated with less peripheral atherosclerosis and decreased prevalence of vascular diseases, respectively.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Is long-bout sedentary behaviour associated with long-term glucose levels 3 months after acute ischaemic stroke? A prospective observational cohort study

Background and purposeSedentary behaviour is a risk factor for vascular disease and stroke patients are more sedentary than their age-matched peers. The association with glucose levels, as a potential mediator,...

Secreted Factors from Stem Cells of Human Exfoliated Deciduous Teeth Directly Activate Endothelial Cells to Promote All Processes of Angiogenesis.

Diabetes is a major risk factor for atherosclerosis and ischemic vascular diseases. Recently, regenerative medicine is expected to be a novel therapy for ischemic diseases. Our previous studies have reported that transplantation of stem cells promoted therapeutic angiogenesis for diabetic neuropathy and ischemic vascular disease in a paracrine manner, but the precise mechanism is unclear. Therefore, we examined whether secreted factors from stem cells had direct beneficial effects on endothelial cells to promote angiogenesis. The soluble factors were collected as conditioned medium (CM) 48 h after culturing stem cells from human exfoliated deciduous teeth (SHED) in serum-free DMEM. SHED-CM significantly increased cell viability of human umbilical vein endothelial cells (HUVECs) in MTT assays and accelerated HUVECs migration in wound healing and Boyden chamber assays. In a Matrigel plug assay of mice, the migrated number of primary endothelial cells was markedly increased in the plug containing SHED-CM or SHED suspension. SHED-CM induced complex tubular structures of HUVECs in a tube formation assay. Furthermore, SHED-CM significantly increased neovascularization from the primary rat aorta, indicating that SHED-CM stimulated primary endothelial cells to promote comprehensive angiogenesis processes. The angiogenic effects of SHED-CM were the same or greater than the effective concentration of VEGF. In conclusion, SHED-CM directly stimulates vascular endothelial cells to promote angiogenesis and is promising for future clinical application.