Depression, antidepressants, and plasma amyloid beta (Beta) peptides in those elderly who do not have cardiovascular disease

BACKGROUND

Low plasma amyloid-beta peptide 42 (Abeta42) is associated with depressive symptoms independently of cardiovascular disease (CVD) in the elderly. It is critical to investigate whether antidepressants modify this relationship.

METHODS

We evaluated 324 elders without CVD in a cross-sectional study. Depression was evaluated with the Center for Epidemiological Studies Depression (CES-D) scale. Antidepressants were documented. Plasma Abeta40 and Abeta42 were measured.

RESULTS

In the absence of CVD, those with depression had lower plasma Abeta42 (median: 13.7 vs. 18.8 pg/mL, p = .003) than those without. Depressed subjects on antidepressant treatment had a lower concentration of plasma Abeta40 (median: 97.8 vs. 133.5 pg/mL, p = .008), but not Abeta42, than those without the treatment. Multivariate logistic regression showed that antidepressant use did not influence the relationship between depression and low plasma Abeta42 (odds ratio = .55; 95% CI = .33, .90; p = .02) after adjusting for confounders, but its use interacted with plasma Abeta40 in the model.

CONCLUSIONS

Lower concentration of plasma Abeta42 is associated with depression in the absence of CVD that is not related to the antidepressant use by those subjects. Prospective studies are needed to determine whether depression associated with low plasma Abeta42 predicts the onset of Alzheimer's disease.

[The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children]

OBJECTIVE

The aim of this study was to establish the reference values of the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check (QUICKI) indexes, as well as those of insulin and C-peptide levels in healthy children and adolescents with a view to determining reference percentiles to detect those at cardiovascular risk.

MATERIAL AND METHODS

A total of 372 children boys and girls of different ages and at distinct pubertal stages with normal body mass index participated in the study. Fasting glucose, insulin and C-peptide values were measured by chemiluminescence and the HOMA and QUICKI indexes were calculated.

RESULTS

Fasting glucose levels were normal in all children. The mean values obtained for each variable were (mean (SD)): fasting glucose 87(7.75) mg/dL, insulin 7.74 (5.35) microU/mL, C-peptide: 1.76 (0.79) ng/mL, HOMA index 1.72 (1.27) and QUICKI index 0.72 (0.29). All the variables progressively increased with age, with statistically significant differences between prepubertal and pubertal children. The QUICKI index showed an inverse relationship. In addition, significant differences were found between sexes. The 90th percentile for all the variables was as follows: insulin 15.05 microU/mL, C-peptide: 2.85 ng/mL, HOMA index 3.43 and QUICKI index 1.10.

CONCLUSIONS

Values of fasting glucose, insulin, C-peptide and the HOMA index significantly increased with age and pubertal stage, while the QUICKI index decreased. We defined the 90th percentile for all the parameters studied as the cut-off point to identify children at cardiovascular risk in our population.

Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease

OBJECTIVES

In this study, we explore the associations of decreased thyroid hormone levels with inflammation, wasting and survival in biochemically euthyroid patients with end-stage renal disease (ESRD).

DESIGN

After exclusion of 23 patients with thyroid-stimulating hormone (TSH) values outside the normal range (0.1-4.5 mIU L(-1)), 187 clinically and biochemically euthyroid incident ESRD stage 5 patients starting dialysis were followed for a median of 20 (range 1-60) months. Measurements of total and free forms of thyroid hormones, s-albumin, hs-CRP, interleukin (IL)-6, vascular adhesion molecule (VCAM)-1 and insulin-like growth factor 1 (IGF-1) were performed at baseline.

RESULTS

In this population, 17 out of 210 patients (8%) were defined as subclinically hypothyroid. Multivariate analysis, according to receiver operating characteristic (ROC) curves, showed that mortality was best predicted by total triiodothyronine (T3). When using the cut-off levels derived from ROC, low T3 levels were associated with increased inflammation (higher hs-CRP, IL-6 and VCAM-1) and lower concentration of both s-albumin and IGF-1. Finally, low T3 but not low free triiodothyronine was associated with worse all-cause (Likelihood ratio = 45.4; P < 0.0001) and cardiovascular mortality (Likelihood ratio = 47.8; P < 0.0001) after adjustment for confounding factors.

CONCLUSION

This study showed that low T3 levels are independent predictors of all-cause and also cardiovascular disease mortality in biochemically euthyroid patients, perhaps due to an intimate association with inflammation. Based on these results, the use of T3 levels in studies assessing the relationship between thyroid dysfunction and mortality risk is recommended.

Effect of nebivolol and metoprolol treatments on serum asymmetric dimethylarginine levels in hypertensive patients with type 2 diabetes mellitus

OBJECTIVE

Elevated asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric oxide synthase, are an important cardiovascular risk factor. In patients with diabetes, increased ADMA levels have been reported, which may be associated with endothelial dysfunction. In this study, effect of nebivolol on serum ADMA levels in hypertensive patients with type 2 diabetes have been compared with metoprolol, an another beta-blocker.

METHODS

A total of 54 patients (27 female, 27 male; mean age: 53.0+/-8.7 years) with type 2 diabetes and hypertension were included in this randomized, open-label, prospective study. Patients were randomized to receive either nebivolol 5 mg/day (n=28) or metoprolol 100 mg/day (n=26) for 12 weeks. When the patients could not reach target blood pressure levels at the end of week 4, indapamide (2.5 mg/day) was added. Enzyme Linked Immunosorbent Assay was used for serum ADMA measurements.

RESULTS

Similar reductions in blood pressure values were observed in both groups (p>0.05). In nebivolol group, there were no significant changes in serum ADMA levels compared to baseline (0.6+/-0.2 micromol/l vs 0.6+/-0.1 micromol/l, p>0.05), whereas in metoprolol group a 35.6% increase in serum ADMA levels was observed (0.6+/-0.1 micromol/l vs 0.7+/-0.2 micromol/l, p<0.01).

CONCLUSION

We observed a significant increase in ADMA levels, a marker of endothelial dysfunction, during metoprolol treatment, whereas nebivolol had neutral effects on ADMA levels in patients with type 2 diabetes mellitus and hypertension.

Cardiovascular risk factors in obese women and their first-degree relatives

OBJECTIVE

Evidence for a connection between obesity and cardiovascular disease is derived from epidemiological studies. The aim of this study was to evaluate the cardiovascular risk factors in obese women and their first-degree relatives.

METHODS

Fifty-five obese women and their 154 first-degree relatives (daughter, son, sister, brother), 60 non-obese women and their 100 first-degree relatives were enrolled in this cross-sectional controlled study. Blood pressure, heart rate, body mass index (BMI), waist-to-hip ratio (WHpR), waist circumference (WC) and lipid levels were measured in all participants. Serum concentrations of insulin were measured by chemiluminescence method, plasma levels of high sensitive C-reactive protein (hs CRP) by immunoturbimetric assay and fibrinogen by coagulation method. Measurement of insulin resistance (IR) was calculated using homeostasis model assessment (HOMA). Statistical analysis was preformed using Chi-square, Student's t and Mann-Whitney U tests. The relationship between obesity indices and cardiovascular risk factors were studied using linear regression analysis.

RESULTS

Mean values of BMI in female and male relatives were found as 25.10+/-2.5 kg/m2 and 23.5+/-4.98 kg/m2, respectively. In relatives, the frequencies of obesity, overweight and normal weight were found to be 8.9%, 25.8% and 65.1%, respectively. Central obesity was found higher in males than in females in the first-degree relatives, using WC (28.5% vs. 14.3%, p=0.001) or WHpR (30.9% vs. 24.5%, p=0.002). Elevated blood pressure (>or=140/90 mmHg) was recorded in 23.6% of obese women and in 8.4% of their relatives. Mean HOMA-IR levels of obese women and their relatives were found as 3.26+/-0.7 and 2.07+/-1.1, respectively. Mean hs CRP levels of obese women and their relatives were 0.98+/-0.08 mg/dl and 0.23+/-0.03 mg/dl, respectively (p=0.002). Mean fibrinogen levels of obese women and their relatives were 443.21+/-45.9 mg/dl and 321.10+/-38.23 mg/dl, respectively.

CONCLUSION

In obese women and their relatives, body mass index and waist circumferences are related with blood pressure, total cholesterol, fibrinogen and insulin resistance. If there are obese women in family, first-degree relatives have 1.8 fold increased obesity frequency. Body mass index increases together with cardiovascular risk factors. In early term, prevention of obesity may decrease developing of cardiovascular risk.

The effects of metformin on metabolic and cardiovascular risk factors in nonobese women with polycystic ovary syndrome

OBJECTIVE

There are conflicting data regarding the effects of metformin in lean women with polycystic ovary syndrome (PCOS). Thus, our aim was to evaluate the effects of 6 months of metformin therapy on various metabolic and cardiovascular risk factors in lean women with PCOS.

DESIGN

This was a prospective clinical study performed in a University hospital.

PATIENTS

Twenty nonobese PCOS women and 20 age- and BMI-matched healthy women were included in the study. Metformin (2550 mg/day) was administered for 6 months in women with PCOS. The hormonal and metabolic parameters were evaluated before and after metformin treatment.

MEASUREMENTS

The main outcome measures were serum androgens, FSH, LH, oestradiol, 17-hydroxyprogesterone, glucose, insulin, lipid profile, lipoprotein(a) [Lp(a)] and homocysteine levels. In addition 24-h ambulatory blood pressure monitoring (ABPM) and carotid intima-media thickness (IMT) were taken.

RESULTS

After 6 months of metformin therapy, women with PCOS had decreased LH, total testosterone, free androgen index and slightly increased SHBG levels. Metformin treatment resulted in resumption of regular menses in 12 (60%) patients, and in 8 (40%) of them serum progesterone level was compatible with ovulation. Glucose and insulin responses to oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR) did not improve after the metformin therapy. There were no significant changes in terms of cardiovascular risk factors such as lipids and homocysteine, IMT and ABPM.

CONCLUSION

Metformin may have beneficial effects in lean PCOS women in terms of resumption of menses without any remarkable effect on metabolic and cardiovascular risk factors.

Antioxidant intake, oxidative stress and inflammation among immigrant women from the Middle East living in Sweden: associations with cardiovascular risk factors

BACKGROUND AND AIMS

Immigrant women from the Middle East have higher cardiovascular risk compared to native women. Whether low antioxidant intake, oxidative stress or inflammation contributes to risk is unknown. In a cross-sectional study of 157 randomly selected foreign-born women (Iranian and Turkish) and native women living in Sweden, we investigated antioxidant status, oxidative stress (F(2)-isoprostanes) and systemic inflammation (plasma high sensitive C-reactive protein; CRP) markers. We also investigated relationships between F(2)-isoprostanes, CRP and cardiovascular risk factors.

METHODS AND RESULT

Dietary intake was assessed using 24-h dietary recalls repeated four times. Micronutrient intake was not consistently different between groups. Serum alpha-tocopherol, but not gamma-tocopherol levels, was lower in Turkish vs. Swedish women (P<0.05). Turkish women had the highest F(2)-isoprostane levels (P<0.05 vs. Iranian women) and CRP levels (P<0.01 vs. Swedish women and P=0.05 vs. Iranian women). In immigrants (n=97), F(2)-isoprostanes correlated positively to insulin levels (r=0.31, P<0.01), and CRP was correlated to obesity and several cardiovascular risk factors (r-values >0.21, P values <0.05).

CONCLUSION

The role of antioxidant status is unclear, whereas signs of oxidative stress and inflammation are evident in immigrant women from Middle East, especially Turkish women. Oxidative stress and low-grade inflammation might contribute to the higher cardiovascular risk previously observed in immigrant women. Further larger studies adjusting for more potential confounders are motivated to confirm these results.

Mental disorders, treatment response, mortality and serum cholesterol: a new holistic look at old data

BACKGROUND

The importance of cholesterol for physical and psychological well-being has been recognized for several decades. Changes in serum cholesterol levels may have a direct impact on mental performance, behavior, treatment response, survival and expected lifetime duration.

OBJECTIVES

To examine the association between various mental disorders (schizophrenia, bipolar disorder, depression, generalized anxiety disorder, panic disorders, post-traumatic stress disorder and other mental disorders) and cholesterol levels, and to discuss the possible treatment implications.

METHOD

A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals.

RESULTS

Clinical investigations of cholesterolemia in patients with major mental disorders have produced very conflicting results. Hypercholesterolemia has been reported in patients with schizophrenia, obsessive-compulsive disorders, panic disorder, generalized anxiety disorder, PTSD. Low cholesterol level has been reported in patients with major depression, dissociative disorder, antisocial personality disorder, borderline personality disorder. It seems that both high and low serum total cholesterol may be associated with a higher risk of the premature death.

CONCLUSION

Our current knowledge on the relation between cholesterolemia and mental disorders is poor and controversial. No definite or reliable insight into a pathophysiological link between cholesterol levels and mental disorders, treatment response and mortality rate is available. The lipoprotein profile, rather than total cholesterol levels, seems to be important.

Cardiovascular risk in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that has received an immense amount of attention in the recent years due to the possible associated risk of cardiovascular disease. Women with PCOS demonstrate an adverse cardiovascular profile characteristic of the cardiometabolic syndrome and an established risk of progression to type 2 diabetes. Despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease, it is unclear if they develop accelerated atherosclerosis. This article summarized the recent development and findings of cardiovascular risk in women with PCOS, and finally the therapeutic options will be discussed.

European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

Other experts who contributed to parts of the guidelines: Edmond Walma, Schoonhoven (The Netherlands), Tony Fitzgerald, Dublin (Ireland), Marie Therese Cooney, Dublin (Ireland), Alexandra Dudina, Dublin (Ireland) European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG):, Alec Vahanian (Chairperson) (France), John Camm (UK), Raffaele De Caterina (Italy), Veronica Dean (France), Kenneth Dickstein (Norway), Christian Funck-Brentano (France), Gerasimos Filippatos (Greece), Irene Hellemans (The Netherlands), Steen Dalby Kristensen (Denmark), Keith McGregor (France), Udo Sechtem (Germany), Sigmund Silber (Germany), Michal Tendera (Poland), Petr Widimsky (Czech Republic), José Luis Zamorano (Spain)

Document reviewers: Irene Hellemans (CPG Review Coordinator) (The Netherlands), Attila Altiner (Germany), Enzo Bonora (Italy), Paul N. Durrington (UK), Robert Fagard (Belgium), Simona Giampaoli(Italy), Harry Hemingway (UK), Jan Hakansson (Sweden), Sverre Erik Kjeldsen (Norway), Mogens Lytken Larsen (Denmark), Giuseppe Mancia (Italy), Athanasios J. Manolis (Greece), Kristina Orth-Gomer (Sweden), Terje Pedersen (Norway), Mike Rayner (UK), Lars Ryden (Sweden), Mario Sammut (Malta), Neil Schneiderman (USA), Anton F. Stalenhoef (The Netherlands), Lale Tokgözoglu (Turkey), Olov Wiklund (Sweden), Antonis Zampelas (Greece)

Coenzyme Q 10 and cardiovascular risk factors in idiopathic sudden sensorineural hearing loss patients

OBJECTIVES

We investigated the association of idiopathic sudden sensorineural hearing loss (ISSNHL) with coenzyme Q (CoQ) and cardiovascular risk factors.

STUDY DESIGN

A prospective study.

SETTING

Hospital center.

PATIENTS

Thirty Italian patients with ISSNHL and 60 healthy Italian subjects.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURES

Evaluation of serum CoQ levels and cardiovascular risk factors (total cholesterol, low-density lipoprotein [LDL], homocysteine [HCY]). The results were compared with variance analysis and Student's t test. Univariate and multivariate analysis were used to evaluate the association between ISSNHL and CoQ, total cholesterol, LDL, and HCY levels.

RESULTS

In our series, we found a significant association between ISSNHL and high total cholesterol (p < 0.05), high LDL (p = 0.021), and low CoQ (p < 0.05) levels. We did not find a significant association between ISSNHL and HCY levels. In the univariate analysis, low levels of CoQ, high levels of total cholesterol, and LDL were found to be significantly associated with ISSNHL. In the multivariate analysis, only high levels of total cholesterol and low levels of CoQ remained significantly associated with a high risk of sudden sensorineural hearing loss.

CONCLUSION

The studies regarding the role of cardiovascular risk factors in ISSNHL are not conclusive. This is the first report regarding the association of ISSNHL and low serum levels of the antioxidant CoQ. Further studies are needed to investigate the role of antioxidants, including CoQ, in ISSNHL.

European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

Other experts who contributed to parts of the guidelines: Edmond Walma, Tony Fitzgerald, Marie Therese Cooney, Alexandra Dudina

European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG): Alec Vahanian (Chairperson), John Camm, Raffaele De Caterina, Veronica Dean, Kenneth Dickstein, Christian Funck-Brentano, Gerasimos Filippatos, Irene Hellemans, Steen Dalby Kristensen, Keith McGregor, Udo Sechtem, Sigmund Silber, Michal Tendera, Petr Widimsky, Jose Luis Zamorano

Document reviewers: Irene Hellemans (CPG Review Co-ordinator), Attila Altiner, Enzo Bonora, Paul N. Durrington, Robert Fagard, Simona Giampaoli, Harry Hemingway, Jan Hakansson, Sverre Erik Kjeldsen, Mogens Lytken Larsen, Giuseppe Mancia, Athanasios J. Manolis, Kristina Orth-Gomer, Terje Pedersen, Mike Rayner, Lars Ryden, Mario Sammut, Neil Schneiderman, Anton F. Stalenhoef, Lale Tokgözoglu, Olov Wiklund, Antonis Zampelas

Reliability of S100B in predicting severity of central nervous system injury

S100B is a protein biomarker that reflects CNS injury. It can be measured in the CSF or serum with readily available immunoassay kits. The excellent sensitivity of S100B has enabled it to confirm the existence of subtle brain injury in patients with mild head trauma, strokes, and after successful resuscitation from cardiopulmonary arrest. The extent of S100B elevation has been found to be useful in predicting clinical outcome after brain injury. Elevations of S100B above certain threshold levels might be able to reliably predict brain death or mortality. A normal S100B level reliably predicts the absence of significant CNS injury. The specificity of S100B levels as a reflection of CNS injury is compromised by the findings that extra-cranial injuries can lead to elevations in the absence of brain injury. This potential problem can most likely be avoided by measuring serial S100B levels along with other biomarkers and carefully noting peripheral injuries. Serum markers GFAP and NSE are both more specific for CNS injury and have little to no extra-cranial sources. Sustained elevations of S100B over 24 h along with elevations of GFAP and NSE can more reliably predict the extent of brain injury and clinical outcomes. In the future, S100B measurements might reliably predict secondary brain injury and enable physicians to initiate therapeutic interventions in a timelier manner. S100B levels have been shown to rise hours to days before changes in ICP, neurological examinations, and neuroimaging tests. S100B levels may also be used to monitor the efficacy of treatments.

Finding drug targets through analysis of the platelet transcriptome

Recent studies of the platelet transcriptome have shown it to be complex and readily analysed by modern techniques. Among the thousands of distinct transcripts are many not previously described in platelets. Differences in message abundance between groups are apparent, and these are reflected at the protein level. Platelets are enriched in messages for receptors, signal transduction proteins and cytokines. Categories of potential drug targets include novel receptors mediating platelet activation and proteins involved in signal transduction. In addition, proteins released or secreted by activated platelets, or specifically translated from mRNA following platelet activation represent a new category of potential drug target for the treatment and prevention of thrombosis and atherogenesis. Transcriptional studies provides a means for the identification and characterisation of novel platelet drug targets in all these categories.

The effect of low dose omega-3 on plasma lipids in hemodialysis patients

Hemodialysis (HD) patients have a high incidence of cardiovascular disease and increased premature mortality. N-3 polyunsaturated fatty acids (PUFAs) are known to decrease plasma triglyceride (TG) levels and have a cardio-protective effect in subjects with normal renal function. The aim of this study was to investigate the effect of Omega-3 on plasma lipid levels in patients on HD. We included 33 patients on HD with serum TG higher than 200 mg/dl and total cholesterol higher than 220 mg/dl, in the study and randomly assigned them to treatment with 2 gm pearls of Omega-3 per day, given in two equal doses or a control group who did not receive this drug. The study was conducted for a period of 12 weeks. Patients were evaluated by measurement of fasting plasma lipid levels before and after the use of Omega-3. There was a significant (28%) increase in high-density lipoprotein levels (P %) decrease in serum TG levels (P < 0.02) in the group that received Omega-3 supplement. There were no changes in total cholesterol or low-density lipoprotein levels in either group. Our study suggests that supplementation with low-dose Omega-3 has a favorable effect on plasma lipid levels in patients on HD.

The association of interleukin-18 genotype and serum levels with metabolic risk factors for cardiovascular disease

OBJECTIVE

Circulating levels of interleukin (IL)-18 are associated with the metabolic syndrome and risk for the development of cardiovascular disease (CVD). This study investigated the association between the circulating IL-18 levels and the -137 G/C polymorphism within the IL-18 gene with metabolic risk factors for CVD in normal-weight and obese black South African women.

METHODS

Blood pressure (BP), body composition (dual-energy X-ray absorptiometer), visceral adiposity (computerized tomography), as well as fasting glucose, insulin, lipid profile, IL-18 levels, and IL-18 genotype were measured in 104 normal-weight (body mass index (BMI) < or = 25 kg/m2) and 124 obese (BMI > or = 30 kg/m2) black South African women.

RESULTS

Subjects with a GC genotype (23%) had a greater mean arterial pressure (MAP, 90.6+/-11.1 vs 85.5+/-10.3 mmHg, P<0.001) than the subjects with the GG genotype. Serum IL-18 levels were not associated with IL-18 genotype (P=0.985); however, they significantly correlated with percentage of body fat (r=0.25, P<0.001), visceral adiposity (r=0.32, P<0.001), MAP (r=0.22, P=0.001), HOMA-IR (r=0.33, P<0.001), fasting insulin (r=0.25, P<0.001), triglyceride (r=0.16, P<0.05), and high-density lipoprotein-cholesterol (r=-0.14, P<0.05) levels, after adjusting for age and body fatness.

CONCLUSIONS

We show for the first time that the GC genotype of the IL-18 -137 G/C polymorphism and the circulating IL-18 levels are independently associated with raised BP. Moreover, fasting IL-18 levels are associated with the other metabolic risk factors for CVD in normal-weight and obese black South African women.

Effect of low-density lipoprotein apheresis on inflammatory and noninflammatory high-density lipoprotein cholesterol

Low-density lipoprotein (LDL) apheresis, a treatment for familial hypercholesterolemia, significantly decreases LDL cholesterol and inflammatory markers such as C-reactive protein, CD40 ligand, and tissue factor. LDL apheresis also decreases high-density lipoprotein (HDL) cholesterol, which might be considered therapeutically counterproductive because HDL is known to be anti-inflammatory. However, recent studies have shown that HDL also possesses proinflammatory properties, as seen in its ability to alter LDL-induced monocyte chemotactic activity. We examined the acute effects of LDL apheresis on inflammatory HDL activity in 13 patients with familial hypercholesterolemia and cardiovascular disease who had been receiving bi-weekly LDL apheresis treatments. Immediately before and immediately after treatment, each patient's plasma was collected for analysis of inflammatory HDL and full lipid profile. LDL apheresis reduced LDL by 52% (from 208 +/- 89 to 99 +/- 48 mg/dl, p <0.002), and HDL decreased by 16% (49 +/- 15 to 41 +/- 13 mg/dl, p <0.003). At the same time, inflammatory HDL activity (in migrated monocytes per high-power field) decreased from 22 +/- 4 to 14 +/- 2, a 37% acute reduction (p <0.003). Moreover, inflammatory HDL before HDL apheresis was highly correlated with its acute reduction (r(s) = 0.85, p <0.001). In conclusion, our findings indicate that, in addition to decreasing LDL, LDL apheresis also decreases inflammatory HDL. The clinical significance of reducing inflammatory HDL is currently unknown, and further research is needed to examine its potential benefit for cardiovascular disease.

The role of C-reactive protein as a marker for cardiovascular risk associated with antiretroviral therapy in HIV-infected patients

C-reactive protein (CRP) has been associated with prognosis of HIV-infection, but its relationship with cardiovascular disease remains unknown. We aimed to evaluate whether CRP may be a marker of cardiovascular risk in HIV-infected patients, and to determine the influence of antiretroviral therapy (ART) on CRP levels. We conducted a cross-sectional study on 245 consecutive HIV-infected patients during a 2-month period. An extensive workup for cardiovascular risk was performed, including determination of CRP levels measured by an ultrasensitive immunoturbidimetric assay (detection limit, 0.003 mg/dl). Ninety-nine (40.4%) patients had serum CRP concentrations above 0.3 mg/dl, considered to represent individuals at high risk for developing cardiovascular complications. In univariate analysis, CRP levels correlated positively with total cholesterol (p=0.01), LDL cholesterol (p=0.001), triglycerides (p=0.04) and Framingham risk score (p=0.006), and negatively with HDL cholesterol (p=0.004). Concentrations of CRP were higher in males (p=0.05) and smokers (p=0.002). No correlation was found between CRP levels and HIV-viral load or CD4 cell counts. In multivariate analysis, independent factors associated with the highest quartile of serum CRP concentrations (0.49 mg/dl) were LDL-cholesterol (p<0.001), HDL-cholesterol (p=0.001), cigarette smoking (p=0.019) and current ART (p=0.021). Our results show that C-reactive protein is associated with traditional cardiovascular risk factors, and may then be a marker for cardiovascular risk linked to HIV infection and ART.