Impact of age on cardiovascular risk: implications for cardiovascular disease management

Marine Microalgal Products with Activities against Age-Related Cardiovascular Diseases

Heart disease is one of the leading causes of death worldwide, and it is estimated that 17.9 million people die of it each year. The risk factors for cardiovascular diseases are attributable to an unhealthy and sedentary lifestyle, poor nutrition, stress, genetic predisposition, diabetes, obesity, and aging. Marine microalgae have been the subject of numerous studies for their potential activity against several human diseases. They produce a plethora of primary and secondary metabolites such as essential nutrients, vitamins, pigments, and omega-3 fatty acid. Many of these molecules have antioxidant properties and have been shown to play a role in the prevention of heart diseases. The aim of this review is to summarize recent studies on the discovery of marine microalgal compounds and bioactivities for cardiovascular diseases, including in vitro and in vivo studies, showing and discussing recent discoveries and trends. The most promising results were found for microalgal polysaccharides, peptides and carotenoids. In conclusion, the overall data summarized here show that microalgae-based supplementation has the potential to improve age-related cardiovascular diseases and we expect more clinical studies in the future.

Post-ischemic cardioprotective potential of exogenous ubiquitin in myocardial remodeling late after ischemia/reperfusion injury

AIMS

Pretreatment with ubiquitin (UB) associates with preservation of heart function 3 days post-ischemia/reperfusion (I/R) injury. This study investigated the cardioprotective potential of exogenous UB late after myocardial I/R injury. To enhance the clinical relevance, UB treatment was started at the time of reperfusion and continued for 28 days post-I/R.

MAIN METHODS

Mice underwent ligation of the left anterior descending coronary artery for 45 min. At the time of reperfusion, mice were treated with UB or saline which was continued until 28 days post-I/R. Heart function was measured at 3, 7, 14 and 28 days post-I/R using echocardiography. Biochemical parameters of the heart and serum cytokines/chemokines levels were measured 28 days post-I/R.

KEY FINDINGS

I/R decreased heart function and induced LV dilation at all time points post-I/R. However, I/R + UB exhibited improved heart function throughout the observation period, while LV dilation was lower in I/R + UB group at 3, 14 and 28 days post-I/R. I/R-mediated increase in myocardial fibrosis, hypertrophy and apoptosis were significantly lower in I/R + UB vs. I/R. Collagen-1α1 and MMP-2 expression was lower, while MMP-9 and TIMP-2 expression was higher in I/R + UB vs. I/R. MYH-7B (hypertrophy marker) expression was lower in I/R + UB vs. I/R. GSK3β activation was lower (vs. Sham), while activation of ERK1/2 (vs. I/R) and AKT (vs. Sham) was higher in I/R + UB. Serum levels of IL-6, G-CSF and IL-2 were lower in I/R + UB vs. I/R.

SIGNIFICANCE

Post-ischemic UB treatment improves heart function, and associates with decreased myocardial fibrosis, apoptosis, hypertrophy and serum cytokine/chemokine levels.

Omarigliptin Prevents TNF-α-Induced Cellular Senescence in Rat Aorta Vascular Smooth Muscle Cells

Cellular senescence is one of the most significant factors involved in aging and age-related diseases. Senescence of vascular smooth muscle cells (VSMCs) adversely affects the function of the cardiovascular system and contributes to the development of atherosclerosis, hypertension, and other cardiovascular diseases. Glucagon-like peptide-1 (GLP-1) is an important incretin hormone involved in insulin release and vascular tone. GLP-1 is quickly degraded by the enzyme dipeptidyl peptidase-4 (DPP-4). Omarigliptin is a new DPP-4 inhibitor that has demonstrated anti-inflammatory and antioxidative stress properties. In the present study, we investigated the effects of the selective DPP-4 inhibitor omarigliptin (OMG) on VSMCs exposed to insult from tumor necrosis factor-α (TNF-α), one of the main inflammatory signaling molecules involved in cellular senescence. We found that OMG could suppress TNF-α-induced expression of pro-inflammatory cytokines (interleukin-1β (IL-1β), IL-6, and IL-8) and inhibit oxidative stress by reducing the production of H2O2 and protein carbonyl. OMG ameliorated the increase in senescence-associated β-galactosidase (SA-β-gal) and telomerase activity induced by TNF-α. The plasminogen activator inhibitor-1 (PAI-1)/p53/p21 pathway is a key inducer of cellular senescence. OMG ameliorated the acetylation of p53 at lysine 382 (K382) and subsequent activation of p21 via inhibition of PAI-1. Importantly, our experiments revealed that blockage of silent information-regulator 1 (SIRT1) abolished the inhibitory effects of OMG on p53 acetylation, SA-β-gal activity, and telomerase activity in VSMCs. These results suggest that OMG may have the potential to delay or prevent the progression of age-related cardiovascular diseases by modulating the activity of SIRT1.

Olive leaf extract supplementation improves the vascular and metabolic alterations associated with aging in Wistar rats

Olive leaves are rich in bioactive substances which exert anti-inflammatory, antioxidant, insulin-sensitizing and antihypertensive effects. The aim of this study was to analyze the possible beneficial effects of an olive leaf extract (OLE) rich in secoiridoids and phenolic compounds on the aging-induced metabolic and vascular alterations. Three experimental groups of rats were used: 3-month-old rats, 24-month-old rats and 24-month-old rats supplemented 21 days with OLE (100 mg/kg). Administration of OLE to aged rats decreased the weight of adrenal glands and prevented the aging-induced loss of body weight and muscle mass. In the serum, OLE reduced the circulating levels of LDL-cholesterol and IL-6 and increased the concentrations of leptin and adiponectin. In the liver OLE attenuated the decreased gene expression of SOD-1, GSR, GCK and GSK-3β and reduced the aging-induced overexpression of NOX-4, Alox-5, iNOS and TNF-α. In aorta segments, OLE prevented endothelial dysfunction and vascular insulin resistance and improved vasoconstriction in response to KCl and NA. Improvement in vascular function was associated with the attenuation of the alterations in the gene expression of COX-2, IL-6, GPx, NOX-1 and IL-10. In conclusion, OLE exerts anti-inflammatory and antioxidant effects in aged rats and attenuates the alterations in vascular function associated with aging.

Regulation of cellular senescence by extracellular matrix during chronic fibrotic diseases

The extracellular matrix (ECM) is a complex network of macromolecules surrounding cells providing structural support and stability to tissues. The understanding of the ECM and the diverse roles it plays in development, homoeostasis and injury have greatly advanced in the last three decades. The ECM is crucial for maintaining tissue homoeostasis but also many pathological conditions arise from aberrant matrix remodelling during ageing. Ageing is characterised as functional decline of tissue over time ultimately leading to tissue dysfunction, and is a risk factor in many diseases including cardiovascular disease, diabetes, cancer, dementia, glaucoma, chronic obstructive pulmonary disease (COPD) and fibrosis. ECM changes are recognised as a major driver of aberrant cell responses. Mesenchymal cells in aged tissue show signs of growth arrest and resistance to apoptosis, which are indicative of cellular senescence. It was recently postulated that cellular senescence contributes to the pathogenesis of chronic fibrotic diseases in the heart, kidney, liver and lung. Senescent cells negatively impact tissue regeneration while creating a pro-inflammatory environment as part of the senescence-associated secretory phenotype (SASP) favouring disease progression. In this review, we explore and summarise the current knowledge around how aberrant ECM potentially influences the senescent phenotype in chronic fibrotic diseases. Lastly, we will explore the possibility for interventions in the ECM-senescence regulatory pathways for therapeutic potential in chronic fibrotic diseases.

Occupational Assessments of Risk Factors for Cardiovascular Diseases in Labors: An Application of Metabolic Syndrome Scoring Index

Unlike a traditional diagnosis of metabolic syndrome (MS), a numerical MS index can present individual fluctuations of health status over time. This study aimed to explore its value in the application of occupational health. Using a database of physiological and biochemical tests and questionnaires, data were collected from 7232 participants aged 20 to 64 years who received occupational health screenings at a health screening institution in 2018. Using confirmatory factor analysis, five components of MS were used to design an MS severity scoring index, which was then used to evaluate the risks of occupation factors. Waist circumference was the largest loading factor compared with the other MS components. Participants who worked in the traditional industrial, food processing, or electronic technology industries had higher MS severity than those in the logistics industry. Those who worked as a manager or over five years had a relatively high severity. The research showed that assessments based on an MS severity score are applicable when the risk factors of suboptimal health are involved. By monitoring the scores over time, healthcare professionals can propose preventive strategies in time, thus enhancing the effectiveness of occupational health examination services.

An Application of Metabolic Syndrome Severity Scores in the Lifestyle Risk Assessment of Taiwanese Adults

A metabolic syndrome (MS) diagnosis was made when the criteria for three or more of five MS components were met. Due to some limitations in the traditional MS criteria, however, different health care societies have sought to develop applicable MS scoring systems instead. Continuous MS scores can be of meaningful value in the prevention, diagnosis, and treatment of MS at different life stages. Relatedly, this study used a database for 27,748 subjects aged 20 to 64 years who received health checks at a health screening institution in Taiwan from 2010 to 2015 to a similar end. Five components of MS (waist circumference, fasting plasma glucose, blood pressure, fasting triglycerides, and high-density lipoprotein) were used to formulate an MS severity score in different gender and age stratums, which was then used to evaluate the risks of various lifestyle habits. Those estimates were then compared with the results for traditional MS diagnosis. The MS severity scores for some behaviors relating to smoking, drinking, physical activity, and sweetened beverage consumption were found to have changed from 0.03 to 0.2; however, a logistic regression analysis with dichotomous diagnosis did not indicate significant links between these behaviors and MS. The models established by the MS severity scores can identify the risk factors for MS in a more sensitive manner than the traditional MS diagnosis can, especially with respect to specific lifestyle habits. MS severity score can serve as an indicator to explore the potential risk factors for subclinical conditions in the early stages of MS.

Age-Dependent Disparities in the Prevalence of Single and Clustering Cardiovascular Risk Factors: A Cross-Sectional Cohort Study in Middle-Aged and Older Adults

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide; with age acknowledged as an independent cardiovascular risk factor (CRF) in adults. Appreciating the association between age and classic CRFs is believed to boost all potential benefits of prevention.

Purpose

Assessment of the prevalence of single and clustered CRFs and their association with age.

Patients and Methods

The survey involved 4735 people (33.6% men) who were PONS project attendees aged 45-64. The study protocol comprised the Health Status Questionnaire, general medical examination, anthropometric measurements, and blood and urine sampling. The prevalence of single and clustered CRFs (hypertension, dyslipidemia, diabetes mellitus, and obesity) in the incrementally split age groups was calculated. The incidence rate of CRFs, against their absence, was determined by Poisson regression models with robust standard errors.

Results

The prevalence of CRFs was established in 90% of the respondents. Except dyslipidemia and ≥1 CRFs, prevalence of risk factors increased with age, although this trend was the weakest in men. In the total group, and in women, prevalence of dyslipidemia and ≥1 CRFs was unrelated to age, whereas in men, it was on the rise in the younger age groups. The incidence rate of CRFs was strongly related to age, and, with the exception of dyslipidemia, was higher in the older age groups.

Conclusion

Cardiovascular risk factors are common in the adult population, while their prevalence and clustering are more prevalent in seniors. Apart from dyslipidemia, the risk of CRFs is appreciably age-related, and higher in seniors.

Caloric restriction attenuates aging-induced cardiac insulin resistance in male Wistar rats through activation of PI3K/Akt pathway

BACKGROUND AND AIM

Caloric restriction (CR) improves insulin sensitivity and is one of the dietetic strategies most commonly used to enlarge life and to prevent aging-induced cardiovascular alterations. The aim of this study was to analyze the possible beneficial effects of caloric restriction (CR) preventing the aging-induced insulin resistance in the heart of male Wistar rats.

METHODS AND RESULTS

Three experimental groups were used: 3 months old rats (3m), 24 months old rats (24m) and 24 months old rats subjected to 20% CR during their three last months of life (24m-CR). After sacrifice hearts were mounted in a perfusion system (Langendorff) and heart function in basal conditions and in response to accumulative doses of insulin (10^-9-10^-7 M), in the presence or absence of Wortmannin (10^-6 M), was recorded. CR did not attenuate the aging-induced decrease in coronary artery vasodilation in response to insulin administration, but it prevented the aging-induced downregulation of cardiac contractility (dp/dt) through activation of the PI3K/Akt intracellular pathway. Insulin stimulated in a greater extent the PI3K/Akt pathway vs the activation of the MAPK pathway and increased the protein expression of IR, GLUT-4 and eNOS in the hearts of 3m and 24m-CR rats, but not in the hearts of 24m rats. Furthermore, CR prevented the aging induced increase in endothelin-1 protein expression in myocardial tissue.

CONCLUSION

In conclusion CR partially improves cardiac insulin sensitivity and prevents the aging induced decrease in myocardial contractility in response to insulin administration through activation of PI3K/Akt pathway.

Current Trends of Cardiovascular Risk Determinants in Pakistan

We carried out a case control study to determine the prevalence of various cardiovascular risk factors in a Pakistani population. A total of 835 patients (555 males and 280 females) and 794 control subjects (486 males and 308 females) were recruited in this study. Patients with documented history of coronary artery disease (CAD) were included. We assessed major risk factors such as age, body mass index (BMI), hypertension and dyslipidemia, using pre-specified definitions. A comparative analysis of the biochemical and clinical parameters was carried out between controls and patients using student's t test. We observed that the cardiovascular disease (CVD) risk factors were more prominent in the patient group as compared to the controls (P < 0.05). In the whole studied population females had increased levels of total cholesterol (TC) (P = 0.01), triglyceride (TG) (P = 0.02), and very low density lipoprotein cholesterol (vLDL-C) (P = 0.02) as compared to males. Among patients group all the risk factors were significantly higher and more prevalent in females when compared with male patients (P < 0.05). The study population was also analyzed according to the smoking status and BMI to study the effect of these risk factors independently. The smokers and study subjects with raised BMI had significantly raised blood pressure and cholesterol levels. The role of age as a risk factor was also investigated in the current study. The persons with age ≤45 years had the highest levels of lipid profile including TC, TG, low density lipoprotein cholesterol (LDL-C), vLDL-C and high density lipoprotein cholesterol (HDL-C) among the three (≤45, 46-55, ≥56 years) groups (P < 0.05). In conclusion, the present study demonstrates an increased propensity of CVD risk factors at a younger age with female preponderance. Moreover, hypertension and dyslipidemia are the most prominent of the risk factors.

Study of insulin vascular sensitivity in aortic rings and endothelial cells from aged rats subjected to caloric restriction: Role of perivascular adipose tissue

The prevalence of metabolic syndrome is dramatically increasing among elderly population. Metabolic syndrome in aged individuals is associated with hyperinsulinemia and insulin resistance both in metabolic tissues and in the cardiovascular system, with this fact being associated with the cardiometabolic alterations associated to this condition. Caloric restriction (CR) improves insulin sensitivity and is one of the dietetic strategies most commonly used to enlarge life and to prevent aging induced cardiovascular alterations. The aim of this study was to analyze the possible beneficial effects of CR in aging-induced vascular insulin resistance both in aortic rings and in primary culture of endothelial cells. In addition, the inflammatory profile of perivascular adipose tissue (PVAT) and its possible role in the impairment of vascular insulin sensitivity associated with aging was also assessed. Three experimental groups of male Wistar rats were used: 3 (3m), 24 (24m) fed ad libitum and 24months old rats subjected to 20% CR during their three last months of life (24m-CR). Aorta rings surrounded or not by PVAT were mounted in an organ bath and precontracted with phenylephrine (10^-7.5M). Changes in isometric tension were recorded in response to cumulative insulin concentrations (10^-8-10^-5.5M) in the presence or absence of L-NAME (10^-4M). Aortic rings and primary aortic endothelial cells were incubated in presence/absence of insulin (10^-7M) and the activation of the PI3K/Akt and MAPK pathways as well as nitrite and nitrates concentrations and the mRNA levels of eNOS, insulin receptor, and GLUT-4 were assessed. CR prevented the aging-induced decrease in the vasodilator response to insulin and the aging-induced increase in the vasoconstrictor response to high insulin concentrations. Changes between 24m and 24m-CR aorta rings were abolished in the presence of L-NAME. CR induced-improvement in insulin vascular sensitivity was related with activation of the PI3K/Akt both in aortic rings and in aortic endothelial cells in response to insulin. CR attenuated the overexpression of iNOS, TNF-α and IL-1β in the PVAT of aged rats although aortic rings surrounded by PVAT from 24m rats showed and increased vasorelaxation in response to insulin compared to aortic rings from 3m and 24m-CR rats. In conclusion, a moderate protocol of CR improves insulin vascular sensitivity and prevents the aging induced overexpression of pro-inflammatory cytokines in PVAT.

Uterine fibroids and cardiovascular risk

STUDY QUESTION

Are uterine fibroids associated with increased cardiovascular risk?

SUMMARY ANSWER

This study reports an association between increased serum lipids and metabolic syndrome with an increased risk of uterine fibroids.

WHAT IS KNOWN ALREADY

Recent studies suggest similarities in biological disease mechanisms and risk factors for fibroids and atherosclerosis: obesity, hypertension and abnormal serum lipids. These findings are awaiting confirmation that a population-based follow-up study could offer with extensive health examination data collection linked with a national hospital discharge register.

STUDY DESIGN, SIZE, DURATION

The Northern Finland Birth Cohort (NFBC1966) is a population-based long-term follow-up study including all children with estimated date of delivery in 1966 in the Northern Finland area. The data were collected from national registries, postal questionnaires and clinical health examinations. The study population for this study comprised all females included in the NFBC1966 that underwent an extensive clinical health examination at age 46 years (n = 3635).

PARTICIPANTS/MATERIALS, SETTING, METHODS

All females included in the NFBC1966 who were alive and traceable (n = 5118) were invited for the 46-year follow-up study; 3268 (63.9%) responded, returned the postal questionnaire and attended the clinical examination. Uterine fibroid cases were identified through the national hospital discharge register that has data on disease diagnoses based on WHO ICD-codes. Uterine fibroid codes, ICD-9: 218 and ICD-10: D25 were used for case identification. Self-reported fibroid cases were identified through the postal questionnaire.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 729 fibroid cases were identified, including 293 based on hospital discharge registries. With adjustment for BMI, parity, education and current use of exogenous hormones the risk of prevalent fibroids rose significantly for every 1 mmol/l increase in LDL (OR = 1.13, 95% CI: 1.02-1.26 for all cases) and triglycerides (OR = 1.27, 95% CI: 1.09-1.49 for all cases). Metabolic syndrome associated with hospital discharge-based fibroid diagnosis (OR = 1.48, 95% CI: 1.09-2.01). Additionally every 1 unit increase in waist-hip ratio associated with fibroids (OR = 1.32, 95% CI: 1.10-1.57).

LIMITATIONS, REASONS FOR CAUTION

The case ascertainment may present some limitations. There was likely an under-identification of cases and misclassification of some cases as controls; this would have diluted the effects of reported associations. The data analysed were cross-sectional and therefore cause and effect for the associations observed cannot be distinguished.

WIDER IMPLICATIONS OF THE FINDINGS

Increased serum lipids and metabolic syndrome are associated with increased risk of uterine fibroids. Along with central obesity these findings add to an increased risk for cardiovascular disease among women with fibroids. These observations may suggest that there are shared predisposing factors underlying both uterine fibroids and adverse metabolic and cardiac disease risk, or that metabolic factors have a role in biological mechanisms underlying fibroid development.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the Academy of Finland, University Hospital Oulu, University of Oulu, Finland, Northern Finland Health Care Foundation, Duodecim Foundation, ERDF European Regional Development Fund-Well-being and health: Research in the Northern Finland Birth Cohort 1966. The authors declare no conflict of interest.

A Global View of the Relationships between the Main Behavioural and Clinical Cardiovascular Risk Factors in the GAZEL Prospective Cohort

Although it has been recognized for a long time that the predisposition to cardiovascular diseases (CVD) is determined by many risk factors and despite the common use of algorithms incorporating several of these factors to predict the overall risk, there has yet been no global description of the complex way in which CVD risk factors interact with each other. This is the aim of the present study which investigated all existing relationships between the main CVD risk factors in a well-characterized occupational cohort. Prospective associations between 12 behavioural and clinical risk factors (gender, age, parental history of CVD, non-moderate alcohol consumption, smoking, physical inactivity, obesity, hypertension, dyslipidemia, diabetes, sleep disorder, depression) were systematically tested using Cox regression in 10,736 middle-aged individuals free of CVD at baseline and followed over 20 years. In addition to independently predicting CVD risk (HRs from 1.18 to 1.97 in multivariable models), these factors form a vast network of associations where each factor predicts, and/or is predicted by, several other factors (n = 47 with p<0.05, n = 37 with p<0.01, n = 28 with p<0.001, n = 22 with p<0.0001). Both the number of factors associated with a given factor (1 to 9) and the strength of the associations (HRs from 1.10 to 6.12 in multivariable models) are very variable, suggesting that all the factors do not have the same influence within this network. These results show that there is a remarkably extensive network of relationships between the main CVD risk factors which may have not been sufficiently taken into account, notably in preventive strategies aiming to lower CVD risk.

Prevalência de fatores de risco cardiovascular em idosos não institucionalizados

INTRODUÇÃO: Na medida em que mais pessoas vivem até a idade avançada, aumenta a prevalência de doenças em que a idade é fator de risco, como as doenças cardiovasculares. OBJETIVO: Descrever as prevalências de fatores de risco para doenças cardiovasculares em idosos não institucionalizados, conforme sexo e grupo etário. MÉTODO: Estudo transversal com amostra de conveniência composta por idosos não institucionalizados. Foram analisadas as variáveis hipertensão arterial, hipercolesterolemia, excesso de peso e adiposidade abdominal. Utilizou-se o teste Qui-quadrado para a análise das diferenças estatísticas. RESULTADOS: As prevalências de hipertensão arterial, hipercolesterolemia, excesso de peso e adiposidade abdominal foram, respectivamente, de 82,30% para idosas e 76,81% para idosos (p>0,05), 43,64% para idosas e 25,48% para idosos (p<0,05), 47,40% para idosas e 36,12% para idosos (p<0,05) e de 76,16% para idosas e 41,06% para idosos (p<0,05). A respeito das diferenças por grupo etário, identificou-se menor prevalência, somente para o excesso de peso, à medida que a idade avança. CONCLUSÃO: As idosas podem ser consideradas como grupo mais vulnerável para fatores de risco cardiovascular, pois tiveram maior número de medidas com valores acima do recomendado, bem como maior prevalência de hipertensão arterial, hipercolesterolemia, excesso de peso e adiposidade. Com relação ao grupo etário, identificou-se menor prevalência somente para o excesso de peso, à medida que a idade avança.

Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus

Providing effective medical care for older patients with type 2 diabetes mellitus (T2D) that may contribute to their active aging has always been challenging. We examined the independent effect of age ≥ 60 years on disease control and its relationship with diabetes-related complications in patients with T2D in Malaysia. This was a cross-sectional study using secondary data from the electronic diabetes registry database Adult Diabetes Control and Management (ADCM). A total of 303 centers participated and contributed a total of 70,889 patients from May 2008 to the end of 2009. Demographic data, details on diabetes, hypertension, dyslipidemia and their treatment modalities, various risk factors and complications were updated annually. Independent associated risk factors were identified using multivariate regression analyses. Fifty-nine percent were female. Malay comprised 61.9%, Chinese 19% and Indian 18%. There were more Chinese, men, longer duration of diabetes and subjects that were leaner or had lower BMI in the older age group. Patients aged ≥ 60 years achieved glycemic and lipid targets but not the desired blood pressure. After adjusting for duration of diabetes, gender, ethnicity, body mass index, disease control and treatment, a significantly higher proportion of patients ≥ 60 years suffered from reported diabetes-related complications. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors. Our findings caution against the currently recommended control of targets in older T2D patients with more longstanding diseases and complications.

Follow-up of a cardiovascular prevention campaign

The aim of this study was to evaluate the cardiovascular risk (CVR) factors and morbidity in a sample of the population that received a brief intervention on cardiovascular prevention seven years ago. All family physicians who participated in the Cardiovascular Prevention Campaign in five Belgian towns in 2002-2003 received a follow-up questionnaire for each participating patient. The questionnaire included questions about new cardiovascular diagnoses, parameters of the latest physical examination and blood tests. Analyses were based on the 318 questionnaires that included essential information such as the date of the latest contact and the new diagnosis or mortality. The proportion of patients with a low CVR decreased from 75% in 2002-2003 to 40% in 2010. Participants showed a significant increase of the abdominal circumference, triglycerides and fasting glycaemia. Only LDL-cholesterol levels decreased significantly (p = 0.002). Four percent of the patients died, more male (7 ) than female (2%) (p = 0.03). One in ten patients presented with a cardiovascular event. Most of the changes are probably attributable to age. It is clear that the long-term effect of a brief intervention only followed by usual care is not sufficient to attain optimal level of cardiovascular prevention.

[Control of cardiovascular risk in the elderly]

The population aged 65 years or more is set to increase in the next few years, especially in Spain and elsewhere in Europe. Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide as well as in Spain. Most studies on vascular risk factors (VRF) have been performed in younger persons, usually aged less than 70 years and without associated pathologic conditions. Patients with pluripathologies are those with multiple chronic diseases and advanced age (a mean of 78 years) in whom the most significant diseases are cardiovascular, with several VRF, leading to high mortality. Strategies to reduce morbidity and mortality in this age group are required.

Aetiology and management of male erectile dysfunction and female sexual dysfunction in patients with cardiovascular disease

The historical basis for understanding erectile function as a neurovascular phenomenon and the advance from fanciful to effective treatment of erectile dysfunction (ED) are reviewed, with emphasis on patients with cardiovascular disease (CVD). ED occurs in 60% of CVD patients by 40 years of age. Male ED and female sexual dysfunction (FSD) diminish quality of life and often warn of occult CVD. ED is often unrecognised but is readily diagnosed during a 5-minute interview using a truncated International Index of Erectile Function questionnaire. Erection of the penis and clitoral engorgement result from local, arousal-induced release of neuronal and endothelial-derived nitric oxide (NO). Arterial vasodilatation and relaxation of cavernosal smooth muscle cells cause arterial blood to flood trabecular spaces, compressing venous drainage, resulting in tumescence. Cyclic guanosine monophosphate (cGMP)-induced activation of protein kinase G mediates the effects of NO by enhancing calcium sequestration and activating large-conductance, calcium-sensitive K+ channels. Future treatment strategies will likely enhance these pathways. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil and vardenafil) increase cGMP levels in erectile tissue. These agents are effective in 80% of CVD patients with ED and can be used safely, even in the presence of stable coronary disease or congestive heart failure, provided nitrates are avoided and patients do not have hypotension, severe aortic stenosis or evocable myocardial ischaemia. Second-line therapies (vacuum constrictor device and transurethral or intracavernosal prostaglandin E1) can also be used in CVD patients. Treatment of FSD and its relationship to CVD are less well established, but similarities to ED exist. ED can be prevented by reduction of CVD risk factors, exercise, weight loss and abstinence from smoking.

Effects of polyunsaturated/saturated fatty acid ratio and antioxidant supplementation on hepatic TBARS and enzyme activities under the maintenance of dietary peroxidizability index value in young and adult rats

AIMS

To investigate the effects of the polyunsaturated/saturated fatty acid (P/S) ratio and antioxidant supplementation on hepatic lipid peroxidation and enzyme activities under the control of the dietary peroxidizability index (PI) value in young and adult rats.

METHODS

We measured thiobarbituric acid-reactive substance (TBARS) concentration and enzyme activities in liver tissue. Female Sprague-Dawley rats aged 3 and 16 weeks were used. Dietary P/S ratios were 0.38 and 4.81 (LP and HP) when the PI value was 81.22. The diets were supplemented with vitamin E 1,000 mg/kg diet and selenium 2.5 mg/kg diet (LPS and HPS).

RESULTS

The hepatic TBARS concentration was higher in LP and LPS than in HP and HPS. In reducing TBARS concentration, antioxidant supplementation was more effective in adult rats than in young rats. Glutathione peroxidase and glutathione-S-transferase activities were lower in young rats than in adult rats.

CONCLUSION

We conclude that dietary fats and antioxidant supplementation play an important role in the change of hepatic TBARS concentration when the dietary PI value is maintained at the same level. However, with the exception of glutathione reductase, no effects of the P/S ratio and antioxidant supplementation on hepatic enzyme activities were detected. This may be due to the invisible effects of fixed PI value in diets.