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Yang Y, Li Z, Guo X, Zhou Y, Chang Y, Yang H, Yu S, Ouyang N, Chen S, Sun G, Hua Y, Sun Y. Interventricular Septum Thickness for the Prediction of Coronary Heart Disease and Myocardial Infarction in Hypertension Population: A Prospective Study. J Clin Med 2022; 11:jcm11237152. [PMID: 36498725 PMCID: PMC9738248 DOI: 10.3390/jcm11237152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
The aim of the present study was to evaluate the prognostic value of interventricular septum thickness (IVSd) on the incidence of cardiovascular diseases. Based on the general population in Northeast China, 10,349 participants were successfully followed up for echocardiography over a median follow-up time of 4.66 years, among which 4801 were hypertensive. Coronary heart disease (CHD) and myocardial infarction (MI) incidence were followed up. Cox proportional hazards models were used to estimate the association of the baseline IVSd with adverse outcomes. IVS hypertrophy increased incident rates of CHD and MI compared with normal IVSd in the overall population and in the female sex-stratification group. In males, IVS hypertrophy had parallel increase rates of CHD (all p < 0.05). Kaplan−Meier analysis showed that IVS hypertrophy could predict CHD and MI incidence and CHD-free and MI-free survival. Multivariable Cox analysis revealed that IVS hypertrophy was correlated with CHD incidence (HR = 1.155, 95% CI = 1.155−2.861, p = 0.01) and MI incidence (HR = 2.410, 95% CI = 1.303−4.458, p = 0.005). In women, IVS hypertrophy was independently associated with CHD and MI incidence (all p < 0.05). Our prospective cohort study illustrated that IVS hypertrophy detected by echocardiography has a prognostic significance for CHD and MI. Therefore, the early detection of IVSd should be conducted to avoid adverse outcomes in further clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yu Hua
- Correspondence: (Y.H.); (Y.S.); Tel.: +86-24-83282688 (Y.S.)
| | - Yingxian Sun
- Correspondence: (Y.H.); (Y.S.); Tel.: +86-24-83282688 (Y.S.)
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Abstract
AIM Advanced age is associated with vascular endothelial dysfunction, characterized by reductions in the endothelium-dependent vasodilation of the conduit and resistance arteries, in part, from decreased nitric oxide bioavailability. Although vascular smooth muscle function (SMF), assessed by responsiveness to an exogenous nitric oxide donor, is typically reported to be intact, many of these studies are limited by a small sample size. Therefore, the purpose of this meta-analysis is to systematically review and determine whether vascular SMF is different between older versus young healthy individuals. DESIGN We conducted a systematic search of MEDLINE, Cochrane and Scopus, since their inceptions until January 2014, for articles evaluating SMF in the brachial artery and/or resistance arteries (BASMF and RASMF, respectively), as assessed by the endothelium-independent vasodilator response to exogenous nitric oxide donors in older (≥60 years) and young (<30 years) groups of healthy individuals. Meta-analyses were performed to compare the mean difference in BASMF and the standardized mean difference in RASMF between older and young groups. Subgroup analyses were performed to identify sources of heterogeneity. RESULTS Fifteen studies assessing BASMF and 20 studies assessing RASMF were included, comprising 550 older and 516 young healthy individuals. After data pooling, BASMF and RASMF were lower in older compared with the young groups (mean difference = -1.89%, P = 0.04; standardized mean difference = -0.46, P = 0.0008, respectively). Significant heterogeneity was observed in the BASMF (I2 = 74%, P < 0.00001) and the RASMF (I2 = 57%, P = 0.0008) meta-analyses. Subgroup analyses revealed that studies with (predominantly) men showed similar SMF responses between the older and the young groups. CONCLUSION On the basis of the current published studies, vascular SMF is reduced in conduit and resistance arteries of otherwise healthy older individuals, particularly in women.
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Revisiting the cutaneous impact of oral hormone replacement therapy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:971760. [PMID: 24455744 PMCID: PMC3881660 DOI: 10.1155/2013/971760] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/09/2013] [Indexed: 01/20/2023]
Abstract
Menopause is a key point moment in the specific aging process of women. It represents a universal evolution in life. Its initiation is defined by a 12-month amenorrhea following the ultimate menstrual period. It encompasses a series of different biologic and physiologic characteristics. This period of life appears to spot a decline in a series of skin functional performances initiating tissue atrophy, withering, and slackness. Any part of the skin is possibly altered, including the epidermis, dermis, hypodermis, and hair follicles. Hormone replacement therapy (oral and nonoral) and transdermal estrogen therapy represent possible specific managements for women engaged in the climacteric phase. All the current reports indicate that chronologic aging, climacteric estrogen deficiency, and adequate hormone therapy exert profound effects on various parts of the skin.
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Montero D, Walther G, Pérez-Martin A, Vicente-Salar N, Roche E, Vinet A. Vascular smooth muscle function in type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetologia 2013; 56:2122-33. [PMID: 23864267 DOI: 10.1007/s00125-013-2974-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/05/2013] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS In type 2 diabetes, in contrast to the well-documented endothelial dysfunction, studies assessing vascular smooth muscle (VSM) function have yielded discrepant results over the last two decades. We therefore sought to determine whether or not VSM function is impaired in individuals with type 2 diabetes. METHODS We conducted a systematic search of MEDLINE, Cochrane, Scopus and Web of Science databases, from their respective inceptions until December 2012, for articles evaluating VSM function in individuals with type 2 diabetes. A meta-analysis was performed to compare the standardised mean difference (SMD) in VSM function between individuals with type 2 diabetes and age-matched controls. Subgroup analyses and meta-regression were used to identify sources of heterogeneity. RESULTS Twenty-seven articles (1,042 individuals with type 2 diabetes and 601 control subjects) were included in this analysis. VSM function was significantly impaired in diabetic compared with control subjects (SMD -0.68, 95% CI -0.84, -0.52; p < 0.001). Although moderate heterogeneity among studies was found (I (2) = 52%), no significant publication bias was detected. Subgroup analyses showed a further decline in VSM function assessed in the microcirculation compared with the macrocirculation of individuals with type 2 diabetes (p = 0.009). In meta-regression, VSM function in the microcirculation was inversely associated with BMI and triacylglycerols and was positively associated with HDL-cholesterol. CONCLUSIONS/INTERPRETATION In addition to the endothelium, the VSM is a source of vascular dysfunction in type 2 diabetes. An exacerbation of VSM function in the microcirculation may be a distinctive feature in type 2 diabetes.
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Affiliation(s)
- David Montero
- LAPEC EA4278, Avignon University, 33 rue Louis Pasteur, F-84000, Avignon, France.
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Abstract
BACKGROUND Diabetes is a major cause of morbidity and mortality in the United States, with much of the economic and social costs related to macrovascular and microvascular complications, such as myocardial infarctions, renal failure, and lower extremity amputations. While racial/ethnic differences in diabetes are well documented, less attention has been given to differences in diabetes outcomes by gender. QUESTIONS/PURPOSES Does gender influence the rate of diabetes-related lower extremity amputations and/or the rate of mortality after amputation? METHODS I reviewed the literature utilizing peer-reviewed publications found through MEDLINE searches. WHERE ARE WE NOW?: Major complex gender differences exist in diabetes-related lower extremity amputations: men are more likely to undergo lower extremity amputations, but women apparently have higher mortality related to these procedures. The reasons for such differences are not entirely clear, but it appears biologic factors may play important roles (increased rates of peripheral vascular disease and peripheral neuropathy in men, interaction between gender and cardiac mortality in women). WHERE DO WE NEED TO GO?: More research is warranted to confirm gender differences in diabetes-related lower extremity amputation mortality and explore underlying mechanisms for the gender differences in lower extremity amputations and its associated mortality. HOW DO WE GET THERE?: Exploring gender disparities in diabetes-related outcomes, such as lower extremity amputations, will need to become a national priority from a research (eg, National Institutes of Health) and policy (eg, Centers for Medicare and Medicaid Services) perspective. Only when we have a better understanding of the causes of such differences can we begin to make strides in addressing them.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue MC 2007, Chicago, IL 60637, USA.
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Dixon A, Corinne CW, Singh S, Babayan R, Maric C. Renoprotective effects of a selective estrogen receptor modulator, raloxifene, in an animal model of diabetic nephropathy. Am J Nephrol 2007; 27:120-8. [PMID: 17308373 PMCID: PMC3179626 DOI: 10.1159/000099837] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 01/19/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Our previous studies have shown that supplementation with 17beta-estradiol (E2) from the onset of diabetes attenuates diabetic nephropathy. However, E2 is accompanied by feminizing effects as well as adverse side effects on other organs. The current study examined the renoprotective effects of a selective estrogen receptor modulator, raloxifene (RAL), in an experimental model of diabetic nephropathy. RAL activates estrogen receptors and estrogen-receptor-mediated cellular events without the side effects of E2. METHODS The study was performed in Sprague-Dawley nondiabetic (ND), streptozotocin-induced diabetic (D) and streptozotocin-induced D + RAL rats (n = 6/group). RESULTS After 12 weeks of treatment, D was associated with increased urine albumin excretion (ND: 4.2 +/- 0.4; D: 41.3 +/- 9.0 mg/day), glomerulosclerosis [glomerulosclerotic index; ND: 0.26 +/- 0.04; D: 1.86 +/- 0.80 arbitrary units (AU)], tubulointerstitial fibrosis (tubulointerstitial fibrosis index; ND: 0.37 +/- 0.05; D: 2.12 +/- 0.50 AU), increased collagen type I [ND: 1.31 +/- 0.07; D: 4.65 +/- 0.09 relative optical density (ROD)], collagen type IV (ND: 0.64 +/- 0.03; D: 1.37 +/- 0.11 ROD) and transforming growth factor beta (TGF-beta) protein expression (ND: 0.65 +/- 0.08; D: 1.25 +/- 0.10 ROD), increased density of CD68-positive cells (ND: 1.37 +/- 3.02; D: 29.2 +/- 1.74 cells/mm2) and increased plasma levels of interleukin-6 (ND: 14.8 +/- 5.0; D: 51.3 +/- 14.0 pg/ml). Treatment with RAL partially or fully attenuated these processes (urine albumin excretion: 21.0 +/- 5.0 mg/day; glomerulosclerotic index: 0.40 +/- 0.06 AU; tubulointerstitial fibrosis index: 0.20 +/- 0.04 AU; collagen type I: 2.55 +/- 0.49 ROD; collagen type IV: 0.70 +/- 0.09 ROD; TGF-beta: 0.91 +/- 0.08 ROD; CD68: 6.03 +/- 2.38 cells/mm2; interleukin-6: 31.2 +/- 5.0 pg/ml). CONCLUSIONS Our data indicate that treatment with RAL attenuates albuminuria and renal structural changes associated with diabetes.
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Affiliation(s)
- Alexis Dixon
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057
| | - C. Wells Corinne
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057
| | - Sandhya Singh
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057
| | - Regina Babayan
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057
| | - Christine Maric
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057
- Center for the Study of Sex Differences: in Health, Aging and Disease, Georgetown University Medical Center, Washington, DC 20057
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Litschauer B, Schaller G, Wolzt M. Naloxone does not influence cardiovascular responses to mild mental stress in postmenopausal women. Am J Physiol Heart Circ Physiol 2005; 289:H2120-5. [PMID: 15994852 DOI: 10.1152/ajpheart.01113.2004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The interaction between central opioid activity, sex hormones, and the cardiovascular reactivity to stress is unknown. Twenty-eight healthy postmenopausal women, 16 without, and 12 with hormone replacement therapy (HRT) participated in this randomized, double-blind, cross-over study. The opioid receptor antagonist naloxone or placebo was administered intravenously on 2 different days and mild mental stress was induced by the Stroop Color-Word Test. Cardiovascular responses were assessed noninvasively by impedance cardiography. Stress significantly increased stroke volume, cardiac output, blood pressure, and heart rate, which was not influenced by opioid receptor blockade. Whereas naloxone increased cortisol plasma concentrations irrespective of HRT status, luteinizing hormone concentrations, which were higher in non-HRT compared with HRT women, were increased by naloxone in women with HRT only. These data suggest that the opioidergic tone of the hypothalamus-pituitary-adrenal axis persists in postmenopausal women, irrespective of HRT use, while the opioidergic tone on the hypothalamus-pituitary-gonadal axis seems to depend on an estrogenic milieu. Naloxone does not alter cardiovascular mental stress reactions in postmenopausal women independent of their hormone substitution status.
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Affiliation(s)
- Brigitte Litschauer
- Medical Univ. Vienna, Center of Phydiology and Pathophysiology, Vienna, Austria
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Caballero AE. Endothelial dysfunction, inflammation, and insulin resistance: a focus on subjects at risk for type 2 diabetes. Curr Diab Rep 2004; 4:237-46. [PMID: 15265464 DOI: 10.1007/s11892-004-0074-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Subjects with obesity, family history of type 2 diabetes, polycystic ovary syndrome, previous gestational diabetes, dyslipidemia, hypertension, impaired glucose tolerance or impaired fasting glucose, and those with metabolic syndrome are at risk for the development of type 2 diabetes. Some of them are also at risk for cardiovascular disease. Some underlying abnormalities such as insulin resistance, endothelial dysfunction, and low-grade chronic inflammation are frequently present and closely associated in all these groups. The flow of substrates, hormones, and cytokines from visceral fat to skeletal muscle and to the endothelial cells, along with some genetic abnormalities that lead to impaired insulin action in the peripheral tissues and to impaired insulin-stimulated nitric oxide production in endothelial cells, may play a role in establishing these shared metabolic and vascular derangements. Weight loss, thiazolidinediones, and metformin improve vascular function in subjects at risk for type 2 diabetes and may prove to reduce cardiovascular events in these individuals.
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Affiliation(s)
- A Enrique Caballero
- Latino Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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Somjen D, Paller CJ, Gayer B, Kohen F, Knoll E, Stern N. High glucose blocks the effects of estradiol on human vascular cell growth: differential interaction with estradiol and raloxifene. J Steroid Biochem Mol Biol 2004; 88:101-10. [PMID: 15026088 PMCID: PMC3638755 DOI: 10.1016/j.jsbmb.2003.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2003] [Indexed: 10/26/2022]
Abstract
Because diabetic women appear not to be protected by estrogen in terms of propensity to cardiovascular disease, we tested the possibility that chronic hyperglycemia modulates the effects of E(2) on vascular cell growth in vitro. Human endothelial cells (E304) and vascular smooth muscle cells (VSMC) were grown in normal glucose (5.5 mmol/l), high glucose (22 mmol/l) or high manitol (22 nmol/l; an osmotic control) for 7 days. In endothelial cells glucose per se stimulated DNA synthesis. However E(2)- (but not RAL-) stimulated [3H] thymidine incorporation was attenuated in the presence of high glucose. In parallel, E(2)-dependent MAP-kinase-kinase activity was blocked in the presence of high glucose. High glucose increased basal creatine kinase (CK) specific activity, but E(2)-stimulated CK was not significantly impaired in the presence of high glucose. In VSMC, high glucose prevented the inhibitory effect of high E(2) (but not of high RAL) concentrations on DNA synthesis. High glucose also prevented E(2)-induced MAP-kinase-kinase activity. In contrast, while high glucose augmented basal CK, the relative E(2)-induced changes were roughly equal in normal and high high glucose media. Hence, high glucose blocks several effects of E(2) on vascular cell growth, which are mediated, in part, via the MAP-kinase system and are likely contributors to E(2)'s anti-atherosclerotic properties. Since RAL's estrogen-mimetic effects on human vascular cell growth were independent of MAP-kinase activation and were not affected by hyperglycemia, the potential use of RAL to circumvent the loss of estrogen function induced by hyperglycemia and diabetes in the human vasculature should be further explored.
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MESH Headings
- Cell Line
- Cells, Cultured
- Creatine Kinase/drug effects
- Creatine Kinase/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/enzymology
- Endothelium, Vascular/growth & development
- Endothelium, Vascular/metabolism
- Enzyme Activation
- Estradiol/metabolism
- Estrogen Antagonists/pharmacology
- Glucose/metabolism
- Glucose/pharmacology
- Humans
- Mannitol/metabolism
- Mitogen-Activated Protein Kinase Kinases/drug effects
- Mitogen-Activated Protein Kinase Kinases/metabolism
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/growth & development
- Muscle, Smooth, Vascular/metabolism
- Raloxifene Hydrochloride/pharmacology
- Thymidine/pharmacokinetics
- Time Factors
- Tritium
- Umbilical Arteries/cytology
- Umbilical Veins/cytology
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Affiliation(s)
- Dalia Somjen
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Rehovot, Israel
| | - Channing J. Paller
- Department of Biological Regulation, The Weizman Institute of Science, Rehovot, Israel
| | - Batya Gayer
- Department of Biological Regulation, The Weizman Institute of Science, Rehovot, Israel
| | - Fortune Kohen
- Department of Biological Regulation, The Weizman Institute of Science, Rehovot, Israel
| | - Esther Knoll
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Rehovot, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Rehovot, Israel
- Corresponding author. Tel.:+972-3-6973732; fax: +972-3-6974578. (N. Stern)
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Hamdy O, Abou-Elenin K, LoGerfo FW, Horton ES, Veves A. Contribution of nerve-axon reflex-related vasodilation to the total skin vasodilation in diabetic patients with and without neuropathy. Diabetes Care 2001; 24:344-9. [PMID: 11213890 DOI: 10.2337/diacare.24.2.344] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the contribution of nerve-axon reflex-related vasodilation to total acetylcholine-induced vasodilation in the skin of normal and diabetic subjects. RESEARCH DESIGN AND METHODS The skin microcirculation was evaluated at the forearm level in 69 healthy subjects and 42 nonneuropathic diabetic patients and at the foot level in 27 healthy subjects and 101 diabetic patients (33 with neuropathy, 23 with Charcot arthropathy, 32 with peripheral vascular disease and neuropathy, and 13 without complications). Two single-point laser probes were used to measure total and neurovascular vasodilation response to the iontophoresis of 1% acetylcholine, 1% sodium nitroprusside, and deionized water. RESULTS The neurovascular response to acetylcholine was significantly higher than the response to sodium nitroprusside and deionized water (P < 0.01). At the forearm level, the contribution of neurovascular response to the total response to acetylcholine was 35% in diabetic patients and 31% in control subjects. At the foot level, the contribution was 29% in diabetic patients without neuropathy and 36% in control subjects, while it was significantly diminished in the three neuropathic groups. A significantly lower nonspecific nerve-axon-related vasodilation was observed during the iontophoresis of sodium nitroprusside, which does not specifically stimulate the C nociceptive fibers. CONCLUSIONS Neurovascular vasodilation accounts for approximately one-third of the total acetylcholine-induced vasodilation at both the forearm and foot levels. The presence of diabetic neuropathy results in reduction of both the total vasodilatory response to acetylcholine and the percentage contribution of neurovascular vasodilation to the total response. Acetylcholine and sodium nitroprusside cause vasodilation in the skin microcirculation through different pathways.
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Affiliation(s)
- O Hamdy
- Clinical Research Center, Department of Surgery, Harvard Medical School, Boston, Massachusetts 02215, USA
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