Clinical and Biochemical Markers of Cardiovascular Structure and Function in Women With the Metabolic Syndrome

Blood Pressure in Patients with Arterial Hypertension and Overweight or Obesity During Office Measurement and Daily Monitoring

Arterial hypertension (AH) is one of the most common chronic diseases in the world. More than 1.5 billion people suffer from hypertension. According to official statistics, in Ukraine in 2021 more than 13 million patients with AH were registered, and annually this disease is detected in 1 million Ukrainians. The objective: to determine the levels of blood pressure (BP) in overweighted or obese patients with AH who use antihypertensive drugs during office measurement and 24-hours monitoring of BP. Materials and methods. The study analyzed the results of treatment of 395 overweighted or obese patients (139 women and 236 men) with essential AH. All patients received antihypertensive treatment for at least 3 months before study start. Patients were divided into five groups depending on blood pressure. The control group included 33 age-matched individuals. During the study BP was measured in physician’s office with use of mechanical tonometer with a shoulder cuff and ambulatory 24-hours blood pressure monitoring (ABPM) was performed for all patients. Results. The results of office blood pressure measurement and ABPM were analyzed. Normal BP was detected in 34.7% of patients with AH and high BMI. In 10.9% of patients systolic blood pressure (SBP) remains above 139 mm Hg despite of drug use, in 16.3% of patients the grade 1 AH was diagnosed, in 23.2% – grade 2, and in 14.9% – grade 3 AH was deter mined during office blood pressure measurement. It was found that men are 1.7 times more likely had uncontrolled AH comparing to women. The further analyze of the BP data showed that office BP levels were higher then home. Target blood pressure levels were found in 87% of patients during ABPM, although in the office measurement this figure was 54%, 5% of patients could not withstand the BP monitoring during the day with an automatic device due to pain. No difference in heart rate was determined in study patients by different types of measurement. Conclusions. In patients with AH and high body mass index, office measurement reveals insufficient reduction of blood pressure (BP) in 35% of patients despite of antihypertensive drugs use. At the same time ABPM found target BP achievement in 87% of patients. Thus, ABPM should be performed in overweighted or obese patients with AH before making the decision to increase the antihypertensive drug dose to avoid possible undesirable BP decrease.

Effect of atorvastatin on lipogenic, inflammatory and thrombogenic markers in women with the metabolic syndrome

BACKGROUND AND AIM

Specific drug therapy to target the underlying proinflammatory and prothrombotic state in patients with metabolic syndrome (MS) is lacking. We sought to study the effect of high-intensity atorvastatin on markers of lipogenesis, inflammation and thrombogenesis, in women with MS in the absence of cardiovascular disease or diabetes.

METHODS AND RESULTS

This randomized double-blinded controlled trial included 88 women with MS (according to National Cholesterol Education Panel Adult Treatment Panel III criteria) and low atherosclerotic cardiovascular risk. Participants were randomized to receive atorvastatin 80 mg or matching placebo. Thrombogenic, lipogenic and inflammatory markers were collected at the time of enrollment, after a 6-week dietary run-in phase (time of randomization), and at 6- and 12-weeks after randomization. At 6 weeks post-randomization, there was significant reduction in total cholesterol, low density lipoprotein cholesterol, triglycerides, apolipoprotein-B (Apo-B) and Apo-B/Apo-A1 ratio in the atorvastatin arm compared to placebo. This difference persisted at 12-weeks post randomization. There was no significant difference in fasting blood glucose, high-density lipoprotein cholesterol, high sensitivity C-reactive protein, serum leptin, Apo-A1, intercellular adhesion molecule 1 and platelet activity. A significant increase in vascular adhesion molecule 1 at 6 and 12 weeks was seen within the atorvastatin arm. No difference was observed in blood pressure and waist circumference.

CONCLUSIONS

In conclusion, high-intensity atorvastatin has an early and significant impact on lipoproteins and apolipoproteins but did not lower inflammatory, thrombogenic or biomarkers of platelet activity and aggregation in women with MS. The use of statins for primary prevention in these patients should be further explored.

Linking myeloperoxidase with subclinical atherosclerosis in adults with metabolic syndrome

BACKROUND

Myeloperoxidase (MPO) is a leukocyte-derived enzyme that has been associated with cardiovascular diseases in many studies. Together with hydrogen peroxide and a halogen, MPO forms a very strong antimicrobial system and there is evidence of links between MPO and inflammation in cardiovascular diseases. Brachial flow-mediated dilation (FMD) refers to a physiologic measure, and carotid intima-media thickness (IMT) is an anatomic structural measure of subclinical atherosclerosis. This research aimed to assess the correlation of MPO serum levels with subclinical atherosclerosis in patients with metabolic syndrome (MS) using the parameters FMD and IMT.

METHODS

A total of 88 patients with metabolic syndrome defined according to the International Diabetes Criteria (IDF) criteria were recruited in the study. Doppler ultrasound was used to determine the left and right common carotid artery thickness (left and right CCA IMT) and FMD of brachial artery. The MPO concentrations were measured using the Immundiagnostik MPO ELISA kit.

RESULTS

A significant inverse correlation between MPO and brachial FMD (r = -0.354, p < 0.001), a significant positive correlation between MPO and right CCA IMT (r = 0.327, p < 0.001), and a significant positive correlation between MPO and left CCA IMT (r = 0.301, p < 0.001) in patients with MS were obtained in this research study.

CONCLUSION

Serum MPO concentration is correlated with subclinical atherosclerosis in patients with MS. The MPO may be a potential therapeutic goal in patients with MS. This finding suggests that new biological markers for MS and subclinical atherosclerosis are helpful for understanding the mechanisms of the risk factors and their role as a considerable burden on the population.

Correlation of the Homeostasis Model Assessment Index and Adiponectin, Leptin and Insulin Levels to Body Mass Index-Associated Gene Polymorphisms in Adolescents

Objectives

This study aimed to describe correlations between glucose, insulin and adipokine levels and the homeostasis model assessment (HOMA) index with regards to the presence/absence of fat mass and obesity-associated (FTO) rs9939609 and peroxisome proliferator-activated receptor (PPAR)-y rs1801282 single nucleotide polymorphisms (SNPs) as indicators of body mass index in adolescents.

Methods

This cross-sectional study was conducted between September and December 2016 in Toluca, Mexico. A total of 71 students between 14-18 years old were included. Various anthropometric and laboratory measurements were collected, including lipid profile, glucose, insulin and adipokine levels and HOMA index. The degree of association between variables was evaluated with regards to the presence/absence of the SNPs.

Results

Leptin levels were significantly higher among female students (P = 0.001), although adiponectin levels did not differ significantly (P = 0.060). There were significant positive correlations between insulin levels and HOMA index with FTO (r = 0.391; P = 0.007 and r = 0.413; P = 0.005, respectively) and PPARγ (r = 0.529; P = 0.007 and r = 0.537; P = 0.007, respectively) SNPs. Leptin showed a significant positive correlation in the presence of PPARγ (r = 0.483; P = 0.007) or in the absence of both SNPs (r = 0.627; P = 0.039). However, adiponectin was significantly negatively correlated in the presence of FTO, either alone (r = -0.333; P = 0.024) or in combination with PPARγ (r = -0.616; P = 0.043).

Conclusion

The presence of FTO and/or PPARγ SNPs might be related to a genetic predisposition to metabolic syndrome.

Effect of Agraz (Vaccinium meridionale Swartz) on High-Density Lipoprotein Function and Inflammation in Women with Metabolic Syndrome

Metabolic syndrome (MetS) is associated with low-grade inflammation and high-density lipoprotein (HDL) dysfunction. Polyphenol-rich foods may improve these alterations. Agraz is a fruit rich in polyphenols (mainly anthocyanins); however, there is limited information about its effects on human health. We evaluated the effects of agraz consumption as compared to placebo on HDL function and inflammation in women with MetS. Forty volunteers (25–60 years) were included in this double-blind crossover study. Women consumed agraz or placebo over 4 weeks; separated by a 4-week washout period. HDL function (apoliprotein-A1; paraoxonase 1 (PON1) activity; cholesterol efflux capacity), oxidative stress (myeloperoxidase (MPO), advanced oxidation protein products) and inflammatory markers (serum cytokines/chemokines and peripheral blood mononuclear cell nuclear factor-kB) were measured after each period. Compared to placebo, agraz consumption did not significantly change any of the biomarkers measured. Interestingly, only after agraz period there were significant positive correlations between PON1 activities and cholesterol efflux. Additionally, there were significant inverse correlations between changes in inflammatory markers and HDL function markers and positive correlations with oxidative markers. Although polyphenol-rich foods have been shown to be beneficial for certain conditions; polyphenol-rich agraz fruit consumption did not impact inflammation and HDL function in the current study of women with MetS.

Is oxidative stress of adipocytes a cause or a consequence of the metabolic syndrome?

Metabolic syndrome is accompanied by oxidative stress in animals and humans. The main source of ROS in experimental metabolic syndrome is NADPH oxidase and possibly adipocyte mitochondria. It is now documented that oxidative stress induces insulin resistance of adipocytes and increases secretion of leptin, MCP-1, IL-6, and TNF-α by adipocytes. It was established that oxidative stress induces a decrease in adiponectin production by adipocytes. It has also been shown that obesity itself can induce oxidative stress. Oxidative stress can cause an alteration of intracellular signaling in adipocytes that apparently leads to the formation of insulin resistance of adipocytes. Chronic stress, glucocorticoids, mineralocorticoids, angiotensin-II, TNF-α also play an important role in the pathogenesis of oxidative stress of adipocytes. Oxidative stress is not only a consequence of metabolic syndrome, but also a reason and a foundational link in the pathogenesis of the metabolic syndrome.

Reproductive Endocrinology in Recurrent Pregnancy Loss

Endocrine disruptions may be important in patients experiencing recurrent pregnancy loss (RPL). This review focuses on data available on RPL and the endocrine system to investigate relevant, and perhaps modifiable, endocrine factors of importance for the disorder. Evidence indicates that some hormones may be important as immune modulators and a better understanding of this interplay has potential for improving pregnancy outcome in RPL. To date there is a lack of consensus on the effect of endocrine treatment options in RPL and there is a strong need for large randomized-controlled trials.

Challenges and opportunities in treating inflammation associated with pulmonary hypertension

INTRODUCTION

Inflammatory cells are present in the lungs from patients with many, if not all, forms of severe pulmonary hypertension.

AREAS COVERED

Historically the first inflammatory cell identified in the pulmonary vascular lesions was the mast cell. T and B lymphocytes, as well as macrophages, are present in and around the pulmonary arterioles and many patients have elevated blood levels of interleukin 1 and 6; some patients show elevated levels of leukotriene B4. An overlap between collagen-vascular disease-associated pulmonary arterial hypertension (PAH) and idiopathic PAH exists, yet only a few studies have been designed that evaluate the effect of anti-inflammatory treatments. Here we review the pertinent data that connect PAH and inflammation/autoimmune dysregulation and evaluate experimental models of severe PAH with an emphasis on the Sugen/athymic rat model of severe PAH. Expert commentary: We postulate that there are several inflammatory phenotypes and predict that there will be several anti-inflammatory treatment strategies for severe PAH.