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Waldron C, Zafar MA, Ziganshin BA, Weininger G, Grewal N, Elefteriades JA. Evidence Accumulates: Patients with Ascending Aneurysms Are Strongly Protected from Atherosclerotic Disease. Int J Mol Sci 2023; 24:15640. [PMID: 37958625 PMCID: PMC10650782 DOI: 10.3390/ijms242115640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ascending thoracic aortic aneurysms may be fatal upon rupture or dissection and remain a leading cause of death in the developed world. Understanding the pathophysiology of the development of ascending thoracic aortic aneurysms may help reduce the morbidity and mortality of this disease. In this review, we will discuss our current understanding of the protective relationship between ascending thoracic aortic aneurysms and the development of atherosclerosis, including decreased carotid intima-media thickness, low-density lipoprotein levels, coronary and aortic calcification, and incidence of myocardial infarction. We also propose several possible mechanisms driving this relationship, including matrix metalloproteinase proteins and transforming growth factor-β.
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Affiliation(s)
- Christina Waldron
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Mohammad A. Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
- Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, 420012 Kazan, Russia
| | - Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
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Rigi S, Mousavi SM, Shakeri F, Keshteli AH, Benisi-Kohansal S, Saadatnia M, Esmaillzadeh A. Dietary phytochemical index in relation to risk of stroke: a case-control study. Nutr Neurosci 2021; 25:2239-2246. [PMID: 34311680 DOI: 10.1080/1028415x.2021.1954291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIM No study explores the association of dietary phytochemical index (DPI) with stroke. This study was undertaken to obtain the required insight in this regard in Iranian adults. METHODS This hospital-based case-control study was carried out on 195 stroke patients (diagnosed based on clinical and brained CT findings) and 195 control subjects with no history of cerebrovascular diseases or neurologic disorders). Data collection on dietary intakes was done using a 168-item validated FFQ. DPI was calculated using the McCarty equation. Logistic regression model in different models was used to evaluate the association between DPI and stroke. RESULTS Mean age of study participants was 64.8 years, and 53.4% of them were male. Individuals in the highest tertile of DPI were younger (63 ± 11 vs. 67.4 ± 13 y, P = 0.01) and less likely to be physically active (2804 ± 5714 vs. 4772 ± 11912 M, P = 0.03). After adjustment for potential confounders, no significant relationship was observed between DPI and stroke risk (OR: 0.76; 95% CI: 0.39-1.49). However, when we considered the effect of dietary intakes, subjects in the top tertile of DPI were 61% less likely to have a stroke than those in the bottom tertile (OR: 0.39; 95% CI: 0.16-0.95). When BMI was controlled, the association between DPI and stroke became strengthened (OR: 0.32; 95% CI: 0.12-0.86). CONCLUSION We found evidence indicating a significant inverse association between DPI and odds of stroke in adults. Further prospective studies are warranted to confirm this association.
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Affiliation(s)
- Somaye Rigi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Shakeri
- Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Sanaz Benisi-Kohansal
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadatnia
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Dziegielewska-Gesiak S. Metabolic Syndrome in an Aging Society - Role of Oxidant-Antioxidant Imbalance and Inflammation Markers in Disentangling Atherosclerosis. Clin Interv Aging 2021; 16:1057-1070. [PMID: 34135578 PMCID: PMC8200137 DOI: 10.2147/cia.s306982] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The prevalence of metabolic syndrome among the elderly population is growing. The elements of metabolic syndrome in an aging society are currently being researched. Atherosclerosis is a slow process in which the first symptoms may be observed after many years. The mechanisms underlying the progression of atherosclerosis are oxidative stress and inflammation. Inflammation and oxidative stress are associated with the increased incidence of metabolic syndrome. Taking the above into consideration, metabolic syndrome is thought to be a clinical equivalent of atherosclerosis. AIM The aim of this paper is to review the impact of the interplay of oxidant-antioxidant and inflammation markers in metabolic syndrome in general as well as its components in the pathophysiology which underlies development of atherosclerosis in elderly individuals. METHODS A systematic scan of online resources designed for elderly (≥65 years) published from 2005 to the end of 2020 were reviewed. This was supplemented with grey literature and then all resources were narratively analyzed. The analysis included the following terms: "atherosclerosis or metabolic syndrome" and "oxidative stress or inflammation" and "elderly" to find reports of atherosclerotic disease from asymptomatic to life-threatening among the elderly population with metabolic syndrome . RESULTS The work summarizes articles that were applicable to this study, including systematic reviews, qualitative studies and opinion pieces. Current knowledge focuses on monitoring the inflammation and oxidant-antioxidant imbalance in disentangling atherosclerosis in patients diagnosed with metabolic syndrome. The population-based studies described inflammation, increased oxidative stress and weak antioxidant defense systems as the mechanisms underlying atherosclerosis development. Moreover, there are discussions that these targets could potentially be a point of intervention to reduce the development of atherosclerosis in the elderly, especially those with altered glucose and lipid metabolism. Specific markers may be used as an approach for the prevention and lifestyle modification of atherosclerotic disease in such population. CONCLUSION Metabolic syndrome and its components are important contributors in the progression of atherosclerotic disease in the elderly population but constant efforts should be made to broaden our knowledge of elderly groups who are the most susceptible for the development of atherosclerosis complications.
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Novel Therapeutical Approaches to Managing Atherosclerotic Risk. Int J Mol Sci 2021; 22:ijms22094633. [PMID: 33924893 PMCID: PMC8125277 DOI: 10.3390/ijms22094633] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is a multifactorial vascular disease that leads to inflammation and stiffening of the arteries and decreases their elasticity due to the accumulation of calcium, small dense Low Density Lipoproteins (sdLDL), inflammatory cells, and fibrotic material. A review of studies pertaining to cardiometabolic risk factors, lipids alterations, hypolipidemic agents, nutraceuticals, hypoglycaemic drugs, atherosclerosis, endothelial dysfunction, and inflammation was performed. There are several therapeutic strategies including Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) inhibitors, inclisiran, bempedoic acid, Glucagon-Like Peptide-1 Receptor agonists (GLP-1 RAs), and nutraceuticals that promise improvement in the atheromatous plaque from a molecular point of view, because have actions on the exposure of the LDL-Receptor (LDL-R), on endothelial dysfunction, activation of macrophages, on lipid oxidation, formations on foam cells, and deposition extracellular lipids. Atheroma plaque reduction both as a result of LDL-Cholesterol (LDL-C) intensive lowering and reducing inflammation and other residual risk factors is an integral part of the management of atherosclerotic disease, and the use of valid therapeutic alternatives appear to be appealing avenues to solving the problem.
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Triantafyllidi H, Benas D, Schoinas A, Varoudi M, Thymis J, Kostelli G, Birmpa D, Ikonomidis I. Sex-related associations of high-density lipoprotein cholesterol with aortic stiffness and endothelial glycocalyx integrity in treated hypertensive patients. J Clin Hypertens (Greenwich) 2020; 22:1827-1834. [PMID: 32790102 PMCID: PMC8029813 DOI: 10.1111/jch.14002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/01/2020] [Accepted: 06/27/2020] [Indexed: 12/27/2022]
Abstract
Smoking, a well-recognized major cardiovascular (CV) risk factor, impairs endothelial function and increases aortic stiffness which indicates subclinical organ damage in hypertensive patients. Loss of endothelial glycocalyx (EG) integrity, as part of the endothelium, represents endothelial dysfunction. The authors aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against CV disease, in aortic stiffness and endothelial integrity in middle-aged treated hypertensive patients regarding smoking habit. The authors studied 193 treated hypertensive patients ≥40 years (mean age = 61±11 years, 58% females), divided in four groups regarding sex and smoking. Increased perfusion boundary region of the 5-9 μm diameter sublingual arterial microvessels (PBR5-9 ) was measured as a noninvasive accurate index of reduced EG thickness. Aortic stiffness was estimated by carotid-femoral pulse wave velocity (PWV). In the whole population, an inverse weak relationship was found between HDL-C and PWV (r = -.15, P = .03) and PBR5-9 (ρ = -.15, P = .03). Moreover, HDL-C was negatively related to PBR5-9 in males (r = -.29, P = .008) either smokers (r = -.35, P < .05) or non-smokers (r = -.27, P < .05) and PWV in female non-smokers (r = -.28, P = .009). In a multiple linear regression analysis, using age, weight, smoking, HDL-C, and LDL-C as independent variables, we found that HDL-C independently predicts PWV in the whole population (β = -.14, P = .02) and PBR5-9 in male hypertensive patients (β = -.28, P = .01). Higher HDL-C levels are associated with reduced aortic stiffness in hypertensive patients, while they protect EG and subsequently endothelial function in middle-aged, treated hypertensive male patients (either smokers or not).
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Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Dimitris Benas
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Antonios Schoinas
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Mary Varoudi
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - John Thymis
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Gavriela Kostelli
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Dionysia Birmpa
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Ignatios Ikonomidis
- 2nd Department of CardiologyMedical SchoolATTIKON HospitalNational and Kapodistrian University of AthensAthensGreece
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Oi K, Haas S. Cardiometabolic Risk and Cognitive Decline: The Role of Socioeconomic Status in Childhood and Adulthood. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:326-343. [PMID: 31526019 DOI: 10.1177/0022146519867924] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Socioeconomic conditions in childhood predict cognitive functioning in later life. It is unclear whether poor childhood socioeconomic status (SES) also predicts the acceleration of cognitive decline. One proposed pathway is via cardiometabolic risk, which has been linked to both childhood SES and earlier onset of cognitive impairment. Using data from the Health and Retirement Study, we examine the impact of childhood SES on cognitive trajectories over six years and test whether it operates through increased cardiometabolic risk and adult SES. We find that higher childhood SES leads to slower cognitive decline, partially due to lower levels of cardiometabolic risk. However, these pathways operate entirely through adult socioeconomic attainment. The results have important implications for future trends in cognitive population health within the context of growing social inequality and reduced social mobility.
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Affiliation(s)
- Katsuya Oi
- Northern Arizona University, Flagstaff, AZ, USA
| | - Steven Haas
- Pennsylvania State University, Tempe, AZ, USA
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Triantafyllidi H, Benas D, Vlachos S, Vlastos D, Pavlidis G, Schoinas A, Varoudi M, Birmpa D, Moutsatsou P, Lekakis J, Ikonomidis I. HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients. J Clin Hypertens (Greenwich) 2018; 20:1615-1623. [PMID: 30315671 PMCID: PMC8030954 DOI: 10.1111/jch.13404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 07/30/2023]
Abstract
Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL-C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50 years were divided regarding HDL-C tertiles in group HDLH (HDL-C ≥ 71 mg/dL, upper HDL-C tertile) and group HDLL (HDL-C < 71 mg/dL, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9 µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. PBR 5-9 was significantly decreased in group HDLH (P = 0.04). In the whole population, HDL-C was inversely but moderately related to PBR 5-9 (r = -0.22, P = 0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C, and office SBP, as independent variables, the authors found that BMI (β = 0.25, P = 0.006) independently predicted PBR 5-9 in the whole population. In older hypertensive patients, HDL-C ranging between 71 and 101 mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low- or high-risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.
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Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Dimitris Benas
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Stefanos Vlachos
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Dimitris Vlastos
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - George Pavlidis
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Antonios Schoinas
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Mary Varoudi
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Dionysia Birmpa
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - John Lekakis
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Attikon HospitalAthensGreece
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Left ventricular geometry and periodontitis in patients with the metabolic syndrome. Clin Oral Investig 2018; 23:2695-2703. [PMID: 30350134 DOI: 10.1007/s00784-018-2667-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/25/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The presence of periodontal disease (PD) in subjects affected by the metabolic syndrome (MetS) may affect their risk of developing cardiovascular disease. The aim of this cross-sectional study was to investigate the systemic impact of PD in MetS, by assessing measures of sub-clinical atherosclerosis and left ventricular mass and geometry. MATERIALS AND METHODS A total of 103 patients undergoing treatment for MetS were examined for confirmation of diagnosis, blood sampling, and measures of pulse wave velocity (PWV), carotid intima-media thickness (c-IMT), left ventricular mass index (LVM), and relative wall thickness (RWT). All subjects underwent a detailed dental assessment, including measurements of DMFT (decayed-missing-filled teeth) and periodontal parameters. RESULTS Ten patients (10%) were diagnosed with healthy-mild periodontitis, 38 patients (37%) were diagnosed in the moderate periodontitis group, and 55 (53%) had severe periodontitis. A total of 37% of subjects were affected by dental caries. Linear regression analysis revealed that patients with severe PD had increased average ventricular RWT (adjusted p = 0.032). Average full mouth probing pocket depth (PPD) was also associated with RWT (adjusted p = 0.006). No associations between PD and c-IMT, PWV, and LVM were detected after adjusted analyses. CONCLUSION This study suggests that periodontitis may be associated with concentric left ventricular remodeling, a predictive index of cardiovascular events. CLINICAL RELEVANCE The presence of periodontitis in patients with MetS might have an effect on left ventricular geometry. These findings stress the importance of prevention, diagnosis, and management of periodontitis in patients with MetS. TRAIL REGISTRATION NCT03297749.
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Generoso G, Bensenor IM, Santos RD, Santos IS, Goulart AC, Jones SR, Kulkarni KR, Blaha MJ, Toth PP, Lotufo PA, Bittencourt MS. Association between high-density lipoprotein subfractions and low-grade inflammation, insulin resistance, and metabolic syndrome components: The ELSA-Brasil study. J Clin Lipidol 2018; 12:1290-1297.e1. [PMID: 29941395 DOI: 10.1016/j.jacl.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-density lipoprotein cholesterol (HDL-C) can be divided into subfractions, which may have variable effects in atherogenesis. The results about the association between HDL-C subfractions and risk factors for cardiovascular disease are mixed. OBJECTIVE The objective of this study was to analyze the association between HDL-C subfractions and each metabolic syndrome component, homeostasis model assessment-estimated insulin resistance (HOMA-IR) and C-reactive protein (CRP). METHODS Four thousand five hundred thirty-two individuals between 35 and 74 years old without previous manifest cardiovascular disease not using fibrates were enrolled. HDL-C subfractions were separated by vertical ultracentrifugation (vertical auto profile-in mg/dL) into HDL2-C and HDL3-C. HDL2-C/HDL3-C ratio, HOMA-IR, and high-sensitivity CRP were also included in the analysis. RESULTS Mean age of participants was 51 ± 9 years, and 54.8% were women. In univariate analysis, HDL-C, HDL2-C, and HDL3-C were all inversely associated with each of the metabolic syndrome defining factors, HOMA-IR values, and serum CRP. We also observed a negative association between HDL2-C/HDL3-C ratio with the variables aforementioned even after adjusting for smoking, alcohol use, physical activity, and HDL-C levels (P < .01). CONCLUSION HDL-C and its subfractions (HDL2-C and HDL3-C) are inversely associated with the defining features of metabolic syndrome, insulin resistance, and systemic inflammation. In addition, the HDL2-C/HDL3-C ratio measured by vertical auto profile is significantly associated with the former factors even after comprehensive adjustment for HDL-C and other confounding variables.
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Affiliation(s)
- Giuliano Generoso
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Raul D Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Steven R Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
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Esenwa CC, Elkind MS. Inflammatory risk factors, biomarkers and associated therapy in ischaemic stroke. Nat Rev Neurol 2016; 12:594-604. [DOI: 10.1038/nrneurol.2016.125] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Triantafyllidi H, Pavlidis G, Trivilou P, Ikonomidis I, Tzortzis S, Xenogiannis I, Schoinas A, Lekakis J. The Association of Elevated HDL Levels With Carotid Atherosclerosis in Middle-Aged Women With Untreated Essential Hypertension. Angiology 2015; 66:904-10. [DOI: 10.1177/0003319715572679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima–media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group (HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = −.42, P < .05). Using receiver –operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P = .02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning.
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Affiliation(s)
- Helen Triantafyllidi
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - George Pavlidis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Stavros Tzortzis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Iosif Xenogiannis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Antonios Schoinas
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - John Lekakis
- Second Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
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12
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Farias JM, Tinetti M, Khoury M, Umpierrez GE. Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. J Clin Endocrinol Metab 2014; 99:4698-703. [PMID: 25322269 PMCID: PMC4255118 DOI: 10.1210/jc.2014-2585] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low total T is associated with an increased risk of atherosclerotic complications. However, the magnitude of this association in middle-aged patients with type 2 diabetes (T2D) has not been determined. MATERIALS AND METHODS This cross-sectional study evaluated atherosclerotic disease markers in T2D patients with normal and low plasma total T. A total of 115 male patients, aged younger than 70 years, without a history of cardiovascular events, and with normal [≥ 3.5 ng/mL (≥ 12.1 nmol/L), n = 79] or low [< 3.5 ng/mL (≤ 12.1 nmol/L), n = 36] total T underwent the measurement of highly sensitive C-reactive protein, carotid artery carotid intima-media thickness (IMT), and atherosclerotic plaque by high-resolution B-mode ultrasound and to asses endothelial function by brachial artery flow-mediated dilation. RESULTS Carotid IMT was negatively correlated with total T concentration (r = -0.39, P < .0001). Compared with subjects with normal T, a higher proportion of patients with low total T had carotid IMT of 0.1 cm or greater [80% vs 39%, odds ratio (OR) 6.41; 95% CI 2.5-16.4, P < .0001], atherosclerotic plaques (68.5% vs 44.8%, OR 2.60, 95% CI 1.12-6.03, P < .0001); endothelial dysfunction (80.5% vs 42.3%, OR 5.77, 95% CI 2.77-14.77, P < .003), and higher highly sensitive C-reactive protein levels (2.74 ± 5.82 vs 0.89 ± 0.88 mg/L, P < .0001). Similar results were found when free T was considered. Multiple logistic regression analyses adjusted for age, diabetes mellitus duration, hemoglobin A1c, lipids, treatment effect, and body mass index reported that a low total T level was independently associated with greater IMT [OR 8.43 (95% CI 2.5-25.8)] and endothelial dysfunction [OR 5.21 (95% CI 1.73-15.66)] but not with the presence of atherosclerotic plaques (OR 1.77, 95% CI 0.66-4.74). CONCLUSIONS Low T is associated with more advanced atherosclerotic disease markers in middle-aged patients with T2D.
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Affiliation(s)
- Javier M Farias
- Endocrinology Service (J.M.F.), Research and Statistics Service (M.K.), Sanatorio Guemes, Ciudad Autonoma de Buenos Aires, C1188AAX Argentina; Cardiologic Image (M.T.), Sanatorio Trinidad Palermo, Ciudad Autonoma de Buenos Aires, C1425AIC Argentina; and Department of Medicine (G.E.U.), Emory University, Atlanta, Georgia 30322
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Novo G, Sansone A, Rizzo M, Guarneri FP, Pernice C, Novo S. High plasma levels of endothelin-1 enhance the predictive value of preclinical atherosclerosis for future cerebrovascular and cardiovascular events. J Cardiovasc Med (Hagerstown) 2014; 15:696-701. [DOI: 10.2459/jcm.0000000000000121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Novo S, Peritore A, Trovato RL, Guarneri FP, Di Lisi D, Muratori I, Novo G. Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up. Cardiovasc Diabetol 2013; 12:155. [PMID: 24152423 PMCID: PMC4016285 DOI: 10.1186/1475-2840-12-155] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events. PATIENTS We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS). METHODS All patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up. RESULTS There were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P < 0.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P < 0.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P = 0.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904). CONCLUSIONS Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS.
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Affiliation(s)
- Salvatore Novo
- Chair of Cardiovascular Disease and Centre for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for Secondary Prevention, Department of Internal Medicine and Specialties (DIBIMIS), University of Palermo, Via del Vespro n, 139-90127, Palermo, Italy.
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15
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Lim HJ, Choue R. Association between poor nutritional status and severe depression in Korean cerebral infarction patients. Nutr Neurosci 2013; 15:25-30. [DOI: 10.1179/1476830511y.0000000023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lim H, Choue R. Impact of nutritional status and dietary quality on stroke: do we need specific recommendations? Eur J Clin Nutr 2013; 67:548-54. [PMID: 23443833 DOI: 10.1038/ejcn.2013.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stroke, one of the most prevalent geriatric diseases, is a leading cause of death worldwide that often results in permanent physical disability and decreased quality of life, and can have a negative impact on families both financially and emotionally. Although many previous studies have shown relationships between the risk of stroke and nutritional factors, clear dietary recommendations for the prevention and reduction of stroke recurrence have not been established. Several factors should be considered to control and manage stroke. For example, a considerable number of patients with stroke are poorly nourished, have several comorbidities and undesirable health-related behaviors may be present. Stroke patients are less likely to consume beneficial foods, have poorer eating habits and have impoverished dietary quality. In addition, psychological factors such as depression must also be considered in stroke management. Given these factors, dietary recommendations for stroke patients should be established. In this article, we summarized the nutritional status and dietary quality of stroke patients. We also suggested some nutritional guidelines for stroke patients and for those who are at risk for stroke.
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Affiliation(s)
- H Lim
- Department of Medical Nutrition, Research Institute of Clinical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin-si, Gyeonggi-do Seoul, Republic of Korea
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Bosevski M, Bosevska G, Stojanovska L. Influence of fibrinogen and C-RP on progression of peripheral arterial disease in type 2 diabetes: a preliminary report. Cardiovasc Diabetol 2013; 12:29. [PMID: 23375154 PMCID: PMC3598335 DOI: 10.1186/1475-2840-12-29] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/27/2013] [Indexed: 11/21/2022] Open
Abstract
Background Limited studies have suggested that inflammatory biomarkers play a role in the initiation and progression of atherosclerosis in diabetic patients. This study assesses the effect of inflammatory biomarkers: fibrinogen and C-reactive protein (C-RP) on the progression of peripheral arterial disease (PAD) in type 2 diabetic (T2D) patients. Methods Sixty two patients with T2D and PAD (mean age 60.28 ± 27 years and diabetes duration of 8.58 ± 6.17 years) were enrolled in a cohort prospective study of 36 months. Ankle-brachial index (ABI) was measured in all patients at baseline and after 36 months. Multiple linear regression analysis was used to determine the predictivity of variables for fibrinogen, C-RP, plasma lipid fractions, fasting plasma glucose, Body Mass Index (BMI), duration of diabetes status and the age on changes in ABI value. Results Linear regression analysis defined F as a predictor for endpoint value of ABI (β = 0.469, p = 0.007). Value of C-RP determinates change of minimal value of ABI (β = 0.449, p = 0.037) and change of mean ABI per year (β = 0.442, p = 0.025). Conclusion Our data indicate that plasma determination of fibrinogen and C-RP might have a clinical implication in defining the process of progression of PAD in T2D population.
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Affiliation(s)
- Marijan Bosevski
- Medical Faculty, University Cardiology Clinic, Skopje, Macedonia
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Vistnes M. Macrophage inflammatory protein-1β: a novel prognostic biomarker in atherosclerosis? Cardiology 2012; 121:149-51. [PMID: 22441313 DOI: 10.1159/000336484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Indexed: 01/20/2023]
Affiliation(s)
- Maria Vistnes
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
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Cordero A, Moreno-Arribas J, Bertomeu-González V, Agudo P, Miralles B, Masiá MD, López-Palop R, Bertomeu-Martínez V. Low levels of high-density lipoproteins cholesterol are independently associated with acute coronary heart disease in patients hospitalized for chest pain. Rev Esp Cardiol 2011; 65:319-25. [PMID: 22112390 DOI: 10.1016/j.recesp.2011.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 07/26/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The role of high-density lipoproteins in the context of acute chest pain has not been well characterized. The objective of this study was to determine the relative contribution of lipid profile to the risk of acute coronary syndrome in patients admitted to a cardiology ward for chest pain. METHODS We included all consecutive admissions in a single cardiology department over a period of 10 months and 1-year follow-up was performed. RESULTS In total, 959 patients were included: 457 (47.7%) were diagnosed with non-ischemic chest pain, 355 (37%) with non-ST-elevation acute coronary syndrome, and 147 (15.3%) with ST-elevation acute coronary syndrome. Prevalence of high-density lipoproteins <40 mg/dL was 54.6%, and was higher in patients with acute coronary syndrome (69.4% vs 30.6%; P<.01). The prevalence of acute coronary syndrome increased with reductions in mean high-density lipoproteins. Age, active smoking, diabetes, fasting glucose >100 mg/dL, and high-density lipoproteins <40 mg/dL were independently associated with acute coronary syndrome, and low high-density lipoproteins was the main associated factor (odds ratio, 4.11; 95% confidence interval, 2.87-5.96). Survival analysis determined that, compared with non-ischemic chest pain, the presence of acute coronary syndrome was associated with significantly greater risk of all-cause and cardiovascular mortality. CONCLUSIONS Low levels of high-density lipoproteins cholesterol (≤40 mg/dL) were independently associated with a diagnosis of acute coronary syndrome in patients hospitalized for chest pain, with an inverse relationship between lower levels of high-density lipoproteins and prevalence of acute coronary syndrome.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
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Batista RDM, Zandonade E, Roelke LH, Emmerich AO, Rosetti EP, Molina MDCB, Santos Neto ETD. Associação entre doença periodontal e aterosclerose subclínica: uma revisão sistemática. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A associação entre doença periodontal e o desenvolvimento de aterosclerose tem sido pesquisada. Esta revisão sistemática da literatura se propõe a verificar a associação entre a doença periodontal e a aterosclerose subclínica. A pesquisa utilizou as bases de dados: PubMed, Scopus, LILACS, BBO, Biblioteca Cochrane e Scielo com os termos: "doença periodontal", "periodontite", "carótida" e "aterosclerose". Foram excluídos artigos: que apresentaram resumos escritos em idiomas diferentes do português, inglês e espanhol; com abordagem laboratorial em modelos experimentais; sem descrição ou referência a estimadores de associação entre doença periodontal e aterosclerose subclínica; pesquisas que realizaram a medida da doença periodontal por parâmetros diferentes de exames clínicos; pesquisas que não analisaram a espessura da íntima média da artéria carótida através de exame de ultrassom; e que abordassem grupos específicos. Foram comparados os desenhos de estudo, protocolos de medida e os dados relatados. De um total de 63 referências, apenas 10 artigos contemplavam todos os critérios de inclusão, distribuídos em: 1 estudo longitudinal, 6 transversais e 3 casos controles. Observou-se uma heterogeneidade entre os estudos em relação ao método de mensuração da doença periodontal e os desfechos da aterosclerose. Concluiu-se que infecções periodontais são fortemente associadas ao desenvolvimento da aterosclerose subclínica, entretanto os mecanismos envolvidos no processo patogênico ainda permanecem desconhecidos.
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Novo G, Rizzo M, La Carruba S, Caruso M, Amoroso GR, Balistreri CR, Coppola G, Evola G, Caruso C, Assennato P, Novo S, Mancuso D. The role of macrophage colony-stimulating factor in patients with acute myocardial infarction: a pilot study. Angiology 2011; 63:127-30. [PMID: 21642288 DOI: 10.1177/0003319711409742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed whether macrophage colony-stimulating factor (M-CSF) levels are associated with left ventricular systolic dysfunction (LVSD) in patients with acute myocardial infarction (AMI). We studied 56 patients with AMI (mean age: 67 ± 12 years) and identified those with clinical (Killip class >II) or echocardiographic signs (ejection fraction ≤45%) of LVSD. We evaluated the established cardiovascular risk factors and measured several cardiovascular biomarkers, including M-CSF. Serum M-CSF concentrations (pg/mL) were significantly increased in patients with both clinical and echocardiographic signs of LVSD (460 ± 265 vs 290 ± 210, P = .0103 and 493 ± 299 vs 287 ± 174, P = .0028, respectively). We found a significant inverse association between M-CSF and ejection fraction (r = -.351, P = .0079). Logistic regression analysis revealed that, among all evaluated clinical and biochemical parameters, the stronger predictor of LVSD was M-CSF (odds ratios 2.1, 95% confidence interval 1.1-2.9, P = .0168). This is the first study reporting plasma M-CSF levels as independent determinants of low LV ejection fraction and clinical LV dysfunction in patients with AMI.
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Affiliation(s)
- Giuseppina Novo
- Department of Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, Italy.
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Novo G, Cappello F, Rizzo M, Fazio G, Zambuto S, Tortorici E, Marino Gammazza A, Corrao S, Zummo G, De Macario EC, Macario AJL, Assennato P, Novo S, Li Volti G, Li Volti G, Volti GL. Hsp60 and heme oxygenase-1 (Hsp32) in acute myocardial infarction. Transl Res 2011; 157:285-92. [PMID: 21497776 DOI: 10.1016/j.trsl.2011.01.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 01/04/2011] [Accepted: 01/07/2011] [Indexed: 11/26/2022]
Abstract
Heat shock proteins (Hsps) are produced in response to various stressors, including ischemia-reperfusion, and they can exit cells and reach the blood. In this pilot study, we determined serum levels of Hsp60 and heme-oxygenase-1 (HO-1; also named Hsp32) in subjects with acute myocardial infarction (AMI) to assess their clinical significance and potential prognostic value. We also performed a bioinformatics analysis of the 2 molecules in search of structural clues on the mechanism of their release from cells. We studied 40 patients consecutively admitted for AMI (male:female patient ratio=20:20, mean age: 64 ± 13 years) and 40 matched controls. A blood sample was drawn for biochemical analyses within 24 h of symptoms onset, and Hsp60 and HO-1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA). All patients were followed up for 6 months to register adverse post-AMI cardiovascular events. A multivariate analysis demonstrated that elevated Hsp60 (P=0.0361), creatine phosphokinase-muscle brain (CK-MB) (P=0.0446), and troponin (P=0.0490) were predictive of post-AMI adverse events. In contrast, increased HO-1 showed a significant association with less severity of coronary artery diseases (P=0.0223). These findings suggest that Hsp60 and HO-1 play distinct roles in the pathogenesis of AMI and subsequent AMI-related pathology. The possibility that these proteins differ in their roles and mechanisms of action in AMI and post-AMI pathology was supported also by the bioinformatics estimates of probability of their localization in various subcellular compartments. The results clear the way for subsequent investigation on the pathogenetic role and clinical significance of Hsp60 and HO-1 in AMI.
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Affiliation(s)
- Giuseppina Novo
- Department of Internal Medicine, Cardiovascular, and Nephrourological Diseases, University of Palermo, Palermo, Italy
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Novo S, Carità P, Corrado E, Muratori I, Pernice C, Tantillo R, Novo G. Preclinical carotid atherosclerosis enhances the global cardiovascular risk and increases the rate of cerebro- and cardiovascular events in a five-year follow-up. Atherosclerosis 2010; 211:287-90. [DOI: 10.1016/j.atherosclerosis.2010.01.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/14/2010] [Accepted: 01/14/2010] [Indexed: 12/11/2022]
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Corrado E, Rizzo M, Coppola G, Fattouch K, Novo G, Marturana I, Ferrara F, Novo S. An Update on the Role of Markers of Inflammation in Atherosclerosis. J Atheroscler Thromb 2010; 17:1-11. [DOI: 10.5551/jat.2600] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fazio G, Giovino M, Gullotti A, Bacarella D, Novo G, Novo S. Atherosclerosis, inflammation and Chlamydia pneumoniae. World J Cardiol 2009; 1:31-40. [PMID: 21160574 PMCID: PMC2999038 DOI: 10.4330/wjc.v1.i1.31] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 12/22/2009] [Accepted: 12/28/2009] [Indexed: 02/06/2023] Open
Abstract
Coronary heart disease is the single most common cause of illness and death in the developed world. Coronary atherosclerosis is by far the most frequent cause of ischemic heart disease, and plaque disruption with superimposed thrombosis is the main cause of the acute coronary syndromes of unstable angina, myocardial infarction, and sudden death. Atherosclerosis is the result of a complex interaction between blood elements, disturbed flow, and vessel wall abnormality, involving several pathological processes: inflammation, with increased endothelial permeability, endothelial activation, and monocyte recruitment; growth, with smooth muscle cell proliferation, migration, and matrix synthesis; degeneration, with lipid accumulation; necrosis, possibly related to the cytotoxic effect of oxidized lipid; calcification/ossification, which may represent an active rather than a dystrophic process; and thrombosis, with platelet recruitment and fibrin formation. In this review we discuss these processes and the possible pathological effects of Chlamydia infection and the ensuing phlogosis.
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Affiliation(s)
- Giovanni Fazio
- Giovanni Fazio, Maria Giovino, Alessandro Gullotti, Daniela Bacarella, Giuseppina Novo, Salvatore Novo, Division of Cardiology, University of Palermo, 90100, Palermo, Italy
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Abstract
Body fat distribution modulates risk for type 2 diabetes mellitus. We evaluated potentially involved metabolic risk factors. In a population of 282 male and 157 female healthy subjects (data from the San Antonio and the European Group of Insulin Resistance (EGIR) study cohorts), we evaluated associations between body fat distribution (assessed by waist and hip circumference) and parameters of lipid- and glucose metabolism, including clamp measurements of insulin sensitivity. After stratification for BMI, fasting triglycerides were lower in the presence of a large hip, and higher in a large waist. Persons with the largest BMI (3rd tertile) showed a difference in triglyceride levels of 1.5 vs. 2.4 mmol/l in large vs. small hip circumference groups (P < 0.038), and a difference of 1.5 vs. 1.2 mmol/l in large vs. small waist circumference groups (P < 0.025). A similar analysis did not reveal a difference in insulin sensitivity. Linear regression analyses confirmed the findings; they revealed negative associations between triglycerides and hip, and (for women borderline statistically significant) positive associations between triglycerides and waist, after adjustment for BMI, mutual confounding, and age (beta +/- s.e.; men: -0.48 +/- 0.005, P < 0.001, and 0.21 +/- 0.005, P < 0.05; women: -0.78 +/- 0.007, P < 0.001, and 0.24 +/- 0.005, P < 0.065), respectively. Linear regression analyses revealed similar opposite associations with high-density lipoprotein (HDL)-cholesterol, though not with glucose, insulin, or insulin sensitivity as measured with the clamp method. In our study population of healthy persons, body fat distribution is associated with fasting triglycerides and HDL-cholesterol, and not with insulin sensitivity. Metabolic risk of unfavorable body fat distribution may be modulated by lower triglyceride storage capacity.
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Affiliation(s)
- Johannes B Ruige
- Ghent University Hospital, Department of Endocrinology, Ghent, Belgium
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Sander D, Kearney MT. Reducing the risk of stroke in type 2 diabetes: pathophysiological and therapeutic perspectives. J Neurol 2009; 256:1603-19. [PMID: 19399381 DOI: 10.1007/s00415-009-5143-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/06/2009] [Accepted: 04/15/2009] [Indexed: 12/18/2022]
Abstract
Reducing the excess cerebrovascular burden in patients with type 2 diabetes remains a major therapeutic challenge, especially with respect to the high risk of recurrent events. Targeting the traditional metabolic risk factors of hypertension, dyslipidemia, and hyperglycemia has failed to remove this excess risk, and agents targeting thrombotic risk (i.e., antiplatelet and anticoagulant drugs) remain poorly studied in the context of stroke in diabetes. This may relate to the accumulation of risk factors in type 2 diabetes as well as to diabetes-specific pathophysiologic factors. Regrettably, there is a lack of prospective evidence to support the efficacy of interventions in the secondary prevention of cerebrovascular events in type 2 diabetes, particularly recurrent stroke events. Overall, there is a need for rigorous evaluations of new therapeutic approaches in both primary and secondary prevention of stroke and management of acute stroke in patients with type 2 diabetes. This systematic review of the published literature summarizes the evidence regarding current therapeutic interventions and their impact on the risk of stroke in people with type 2 diabetes, and highlights potential strategies for improving outcomes.
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Affiliation(s)
- Dirk Sander
- Department of Neurology, Medical Park Hospital, Thanngasse 15, 83483 Bischofswiesen, Germany.
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Herlitz H, Schmidt C, Behre CJ. Albuminuria within the normal range and ultrasound-assessed atherosclerosis in the AIR study: a 9-year follow-up of 58-year-old clinically healthy men. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:512-7. [PMID: 19347741 DOI: 10.1080/00365510902795670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Microalbuminuria, traditionally defined as 30-300 mg urinary albumin/24 h, predicts renal impairment and cardiovascular disease. Studies suggest that also a far lower urinary albumin excretion (UAE) can predict clinical outcome. Intima media thickness (IMT) is an established estimate of atherosclerosis. In this study, we investigated the predictive value of UAE within the normal rate (UAE-n) for the progression of IMT in the carotid and femoral arteries. METHODS We included 325 clinically healthy men with normoalbuminuria. Anthropometrics, urine and blood samples were taken and IMT in the carotid and femoral arteries were assessed by B-mode ultrasound at baseline and after 3 and 9 years. The annual progression rate of IMT (r-IMT) was calculated. RESULTS UAE-n correlated with carotid IMT at baseline and after 3 and 9 years, but not with r-IMT. In a regression analysis, only HDL and baseline IMT remained as statistically significant co-variates to mean IMT at 9 years. IMT in the femoral artery and r-IMT at any time-point did not correlate to baseline UAE. CONCLUSION UAE-n was associated with carotid IMT after 3 and 9 years but not r-IMT or with femoral artery IMT. Carotid IMT after 9 years' follow-up was independently related to baseline IMT and HDL cholesterol. In this cohort of 58-year-old men, our interpretation is that UAE-n is not associated with the increase in carotid and femoral artery IMT observed after 9 years.
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Affiliation(s)
- Hans Herlitz
- Department of Nephrology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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