Plasminogen Activator Inhibitor 1 Activity and Other Coronary Risk Factors

Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial

Introduction. Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term. Methods. After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months. Results. Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec, p < 0.05). Conclusions. Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.

A consideration of biomarkers to be used for evaluation of inflammation in human nutritional studies

To monitor inflammation in a meaningful way, the markers used must be valid: they must reflect the inflammatory process under study and they must be predictive of future health status. In 2009, the Nutrition and Immunity Task Force of the International Life Sciences Institute, European Branch, organized an expert group to attempt to identify robust and predictive markers, or patterns or clusters of markers, which can be used to assess inflammation in human nutrition studies in the general population. Inflammation is a normal process and there are a number of cells and mediators involved. These markers are involved in, or are produced as a result of, the inflammatory process irrespective of its trigger and its location and are common to all inflammatory situations. Currently, there is no consensus as to which markers of inflammation best represent low-grade inflammation or differentiate between acute and chronic inflammation or between the various phases of inflammatory responses. There are a number of modifying factors that affect the concentration of an inflammatory marker at a given time, including age, diet and body fatness, among others. Measuring the concentration of inflammatory markers in the bloodstream under basal conditions is probably less informative compared with data related to the concentration change in response to a challenge. A number of inflammatory challenges have been described. However, many of these challenges are poorly standardised. Patterns and clusters may be important as robust biomarkers of inflammation. Therefore, it is likely that a combination of multiple inflammatory markers and integrated readouts based upon kinetic analysis following defined challenges will be the most informative biomarker of inflammation.

Age-related short-term effect of ramipril on N-terminal pro-brain natriuretic peptide and markers of hemostasis in patients after acute myocardial infarction

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (MI) prevent heart failure and recurrent ischemic events. Our aim was to evaluate the effect of ramipril on N-terminal pro-brain natriuretic peptide (NT-proBNP) and on markers of hemostasis, including plasminogen-activator-inhibitor-1 (PAI-1), von Willebrand factor (vWF), factor VIII (FVIII) and fibrinogen, in patients after acute MI, with emphasis on those over 55 years of age.

METHODS

In this prospective, single-center, observational study 38 patients were treated with ramipril after the first Q-wave MI. Markers of hemostasis and NT-proBNP were estimated before and two weeks after ramipril treatment.

RESULTS

Significant differences were observed in PAI-1 and NT-proBNP levels in patients over 55 years. In this age group the mean PAI-1 level decreased significantly after ramipril therapy (3.6 +/- 1.25 U/ml vs. 2.65 +/- 1.4 U/ml, P = 0.011) and was significantly lower than in younger (<55 years) patients (2.65 +/- 1.4 U/ml vs. 4.39 +/- 1.7 U/ml, P = 0.002). In addition, in the older patients the mean baseline NT-proBNP level was significantly higher than in the younger age group (258.35 +/- 347.6 pmol/l vs. 17.1 +/- 22 pmol/l, P = 0.028) and was also higher after ramipril therapy (240.5 +/- 254.3 pmol/l vs. 67.3 +/- 75.2 pmol/l, P = 0.034). In the younger patients, mean NT-proBNP after short-term ramipril therapy increased significantly in comparison with baseline (67.3 +/- 75.2 pmol/l vs. 17.15 +/- 22.0 pmol/l, P = 0.046).

CONCLUSION

In acute Q-wave MI, increased PAI-1 levels, but not increased NT-proBNP, respond rapidly to early ACE inhibition by ramipril in patients over 55 years of age but not in younger patients.

Computed tomography scans of intra-abdominal fat, anthropometric measurements, and 3 nonobese metabolic risk factors

The present cross-sectional study of 46 adult Danish white men and women aimed to evaluate association between intra-abdominal obesity, 4 anthropometric measurements of obesity, and combinations of 3 nonobese metabolic risk factors: systolic blood pressure of 130 mm Hg or higher, serum triglyceride concentration of more than 1.7 mmol/L, and fasting capillary blood glucose concentration of 5.6 mmol/L or more. For 80% of the subjects, intra-abdominal fat on a computed tomography scan of the abdomen using a cutoff limit of more than 144 cm(2) gave a correct classification of combinations of at least 2 of the 3 metabolic risk factors. Body mass index and waist circumference were better markers of intra-abdominal obesity than waist-to-hip ratio in receiver operating characteristic analyses (P = .0035). Body mass index of more than 26 kg/m(2) and waist circumference of more than 0.92 m classified 76% and 74% of the subjects correctly regarding combinations of the 3 nonobese metabolic risk factors. Intra-abdominal obesity was significantly stronger associated with the combinations than a raised waist-to-hip ratio (P = .016). Both body mass index and waist circumference may be used as markers of intra-abdominal obesity, whereas waist-to-hip ratio was significantly inferior. Correspondingly, both body mass index and waist circumference were better than waist-to-hip ratio to indicate combinations of the 3 nonobese metabolic risk factors.