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Oksen D, Aslan M. Impact of oxidative stress on myocardial performance in patients with diabetes: a focus on subclinical left ventricular dysfunction. BMJ Open Diabetes Res Care 2024; 12:e004153. [PMID: 38886070 PMCID: PMC11184181 DOI: 10.1136/bmjdrc-2024-004153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Oxidative stress is known to affect left ventricular functions negatively. There is a strong bidirectional connection between diabetes mellitus (DM) and oxidative stress. In parallel, left ventricular dysfunction is observed more frequently, even in patients with DM without other risk factors. In this context, the objective of this study is to comparatively investigate the potential relationship between oxidative stress and subclinical left ventricular dysfunction (SCLVD) assessed by Myocardial Performance Index (MPI) in patients with and without DM. RESEARCH DESIGN AND METHODS The sample of this observational cross-sectional single-center study consisted of 151 patients who were evaluated for oxidative stress and SCLVD by tissue Doppler echocardiography. Patients' total oxidant status (TOS), total antioxidant status (TAS), and Oxidative Stress Index (OSI) values were calculated. The effects of oxidative stress and DM on MPI were analyzed. RESULTS There were 81 patients with DM (mean age: 46.17±10.33 years) and 70 healthy individuals (mean age: 45.72±9.04 years). Mean TOS and OSI values of the DM group were higher than healthy individuals (5.72±0.55 vs 5.31±0.50, p = <0.001; and 4.92±1.93 vs 1.79±0.39, p = <0.001; respectively). The mean TAS value of the DM group was significantly lower than the healthy group (1.21±0.40 vs 3.23±0.51, p = <0.001). There was a significant correlation between OSI and MPI mitral in the DM group (R 0.554, p = <0.001) but not in the healthy group (R -0.069, p=0.249). CONCLUSIONS Both oxidative stress and myocardial dysfunction were found to be more common in patients with DM. The study's findings indicated the negative effect of oxidative stress on myocardial functions. Accordingly, increased oxidative stress caused more significant deterioration in MPI in patients with DM compared with healthy individuals.
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Affiliation(s)
- Dogac Oksen
- Cardiology Department, Altinbas Universitesi, Istanbul, Turkey
| | - Muzaffer Aslan
- Cardiology Department, Siirt University, Siirt, Siirt, Turkey
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Mandani S, Rezaei B, Asghar Ensafi A. Developing a highly-sensitive aptasensor based on surface energy transfer between InP/ZnS quantum dots and Ag-nanoplates for the determination of insulin. J Photochem Photobiol A Chem 2022. [DOI: 10.1016/j.jphotochem.2021.113601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Khalil SA, Megallaa MH, Rohoma KH, Guindy MA, Zaki A, Hassanein M, Malaty AH, Ismael HM, Kharboush IF, El Kafash DNE, Sallam HN, Desouky IA. Prevalence of Chronic Diabetic Complications in Newly Diagnosed versus Known Type 2 Diabetic Subjects in a Sample of Alexandria Population, Egypt. Curr Diabetes Rev 2019; 15:74-83. [PMID: 29366422 DOI: 10.2174/1573399814666180125100917] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND In Egypt, data on the prevalence of chronic diabetic complications, which are essential for the adjustment of policies and practices related to diabetes care, are scarce. Therefore, the aim of this study was to determine the frequency of chronic complications of diabetes; namely neuropathy, Diabetic Kidney Disease (DKD), retinopathy and Peripheral Arterial Disease (PAD) in newly-diagnosed versus known type 2 diabetic patients. SUBJECTS & METHODS This is a cross-sectional study that is based on a previous household survey conducted on a representative sample of the population of Alexandria, Egypt. This study included 506 consecutive subjects with type 2 diabetes; 323 patients with previously known T2DM and 183 patients with newly diagnosed T2DM (discovered during the survey). For each participant, a focused history was taken. Comprehensive clinical examination was done including fundus examination, foot examination and assessment of ankle brachial index. Laboratory tests included HbAlc, lipids profile, serum creatinine and Urinary Albumin Creatinine Ratio (UACR). RESULTS Peripheral neuropathy was detected in 20% of the studied patients; 29.4% of known patients and 3.3% of newly diagnosed patients (p<0.001). Diabetic kidney disease was detected in 33.2% of the studied patients; 46.1% of known patients and 10.4% of newly diagnosed patients (p<0.001). Diabetic retinopathy was detected in 34.6% of the studied patients; 48.3% of known patients and 10.4% of newly diagnosed patients (p<0.001). Peripheral arterial disease was detected in 32.6% of the studied patients; 45.5% of known patients and 9.8% of newly diagnosed patients (p<0.001). In patients with known diabetes, the presence of any of the studied complications (neuropathy, diabetic kidney disease, retinopathy or PAD) was significantly associated with the presence of all other complications (p< 0.001). In patients with newly-diagnosed diabetes, the presence of diabetic kidney disease was significantly associated with the presence of retinopathy (p<0.001), with no significant association with PAD (p=0.357). CONCLUSION The present study confirms that a considerable proportion of people with T2DM have microvascular complications and/or PAD at the time of, and possibly years before, diagnosis. Having shown that, it is strongly recommended to apply appropriate screening strategies for subjects with diabetes at the time of diagnosis. Finally, these results should be considered as a call for action for the health care planners and providers in our region to plan for early screening for diabetes and its complications to reduce the disease burden in our community.
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Affiliation(s)
- Samir Assaad Khalil
- Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Magdy Helmy Megallaa
- Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kamel Hemida Rohoma
- Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Adel Zaki
- Department of Biostatistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed Hassanein
- Dubai Hospital, Dubai Health Authority, UAE and Cardiff University, Cardiff, United Kingdom
| | - Amin Helmy Malaty
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanaa Mohamed Ismael
- Department of Nutrition, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ibrahim Fahmy Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | - Hassan Nooman Sallam
- Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
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Wu PY, Huang JC, Chen SC, Chen LI. Type 2 diabetes mellitus-related changes in left ventricular structure and function in patients with chronic kidney disease. Oncotarget 2018; 9:14661-14668. [PMID: 29581872 PMCID: PMC5865698 DOI: 10.18632/oncotarget.24482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/16/2017] [Indexed: 01/20/2023] Open
Abstract
Type 2 Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide, and is associated with an increased risk of left ventricular (LV) hypertrophy, LV systolic and diastolic dysfunctions. The aim of this study was to investigate abnormal echocardiographic findings in patients with CKD with and without DM, and identify the factors associated with these abnormalities. We enrolled 356 pre-dialysis patients with CKD (stages 3-5), including 208 with DM and 148 without DM. The structure and systolic and diastolic functions of the left ventricle were assessed using echocardiography, and the clinical and echocardiographic parameters were analyzed. The patients with DM had higher rates of observed/predicted left ventricular mass > 128% (69.5% vs. 56.7%, p = 0.015), midwall fractional shortening < 14% (22.6% vs. 8.8%, p = 0.001), and ratio of peak early transmitral filling wave velocity to early diastolic velocity of lateral mitral annulus > 12 (32.7% vs. 16.2%, p < 0.001) than those without DM. Multivariate analysis showed that male sex, a history of smoking, high systolic blood pressure, high body mass index, high levels of fasting glucose and total cholesterol, low levels of albumin and hemoglobin, and a low estimated glomerular filtration rate were associated with abnormal echocardiographic findings. The rates of inappropriate left ventricular mass, systolic and diastolic dysfunction were higher in our patients with CKD and DM than in those without DM.
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Affiliation(s)
- Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-I Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Gori M, Canova P, Calabrese A, Cioffi G, Trevisan R, De Maria R, Grosu A, Iacovoni A, Fontana A, Ferrari P, Greene SJ, Gheorghiade M, Parati G, Gavazzi A, Senni M. Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The DAVID-Berg study. Int J Cardiol 2017; 248:414-420. [PMID: 28709699 DOI: 10.1016/j.ijcard.2017.06.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the burden of pre-clinical heart failure (HF) among diabetes mellitus (DM) patients, routine screening echocardiography is not currently recommended. We prospectively assessed risk prediction for HF/death of a screening strategy combining clinical data, electrocardiogram, NTproBNP, and echocardiogram, aiming to identify DM patients more suitable for selective echocardiography. METHODS Among 4047 screened subjects aged≥55/≤80years, the DAVID-Berg Study prospectively enrolled 623 outpatients with DM, or hypertension, or known cardiovascular disease but with no HF history/symptoms. The present analysis focuses on data obtained during a longitudinal follow-up of the 219 patients with DM. RESULTS Mean age was 68years, 61% were men, and median DM duration was 4.9years. During a median follow-up of 5.2years, 50 subjects developed HF or died. A predictive model using clinical data demonstrated moderate predictive power, which significantly improved by adding electrocardiogram (C-statistic 0.75 versus 0.70; p<0.05), but not NTproBNP (C-statistic 0.72, p=0.20). Subjects with normal clinical variables or abnormal clinical variables but normal electrocardiogram had low events rate (1.3 versus 2.4events/100-person-years, p=NS). Conversely, subjects with both clinical and electrocardiogram abnormalities (47%) carried higher risk (9.0events/100-person-years, p<0.001). The predictive power for mortality/HF development increased when echocardiography was added (13.6events/100-person-years, C-statistic 0.80, p<0.05). CONCLUSIONS Our prospective study found that a selective echocardiographic screening strategy guided by abnormal clinical/electrocardiogram data can reliably identify DM subjects at higher risk for incident HF and death. This screening approach may hold promise in guiding HF prevention efforts among DM patients.
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Affiliation(s)
- Mauro Gori
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Canova
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alice Calabrese
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital, Trento, Italy
| | - Roberto Trevisan
- Diabetology Unit, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Renata De Maria
- CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Aurelia Grosu
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Attilio Iacovoni
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandra Fontana
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Ferrari
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Istituto Auxologico Italiano, Milan and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonello Gavazzi
- FROM Research Foundation, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Senni
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy.
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The role of natriuretic peptides in diabetes and its complications. Biomed Pharmacother 2016; 84:1826-1832. [PMID: 27832993 DOI: 10.1016/j.biopha.2016.10.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/06/2016] [Accepted: 10/30/2016] [Indexed: 12/15/2022] Open
Abstract
This review aimed to summarize recent findings on the role of natriuretic peptides (NPs) in diabetes and its important complications. Although the treatment of diabetes mellitus has benefited from recent advances, aggressive glycemic control can increase the risk of hypoglycemia and weight gain. Therefore, innovative therapies are required to address this issue. Natriuretic peptides (NPs) may have such novel therapeutic potential. NPs comprise a family of structurally related peptides, including atrial, brain, C-type, and dendroaspis. Each of these NPs has a wide range of specific functions to regulate and maintain cardiovascular, renal, and endocrine homeostasis. NPs exert their effects by interacting with three receptor subtypes including NPR-A, NPR-B, and NPR-C. The coronary NP system has been suggested to be involved in regulating water and salt balance, as well as vascular remodeling. In this review, we provide evidence that NPs play an important role in diabetes mellitus and its related complications including macrovascular and microvascular disorders. NPs hold promise as markers for early diagnosis, risk assessment, and intervention guidance in diabetes and its complications and may thus improve diabetes care.
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Muddu M, Mutebi E, Mondo C. Prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago Hospital. Afr Health Sci 2016; 16:183-93. [PMID: 27358631 PMCID: PMC4915408 DOI: 10.4314/ahs.v16i1.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The prevalence of Diabetes mellitus (DM) is on a rise in sub-Saharan Africa and will more than double by 2025. Cardiovascular disease (CVD) accounts for up to 2/3 of all deaths in the diabetic population. Of all the CVD deaths in DM, 3/4 occur in sub Saharan Africa (SSA). Non invasive identification of cardiac abnormalities, such as Left Ventricular Hypertrophy (LVH), diastolic and systolic dysfunction, is not part of diabetes complications surveillance programs in Uganda and there is limited data on this problem. This study sought to determine the prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago National referral hospital in Uganda. METHODS In this cross sectional study conducted between June 2014 and December 2014, we recruited 202 newly diagnosed adult diabetic patients. Information on patients' socio-demographics, bio-physical profile, biochemical testing and echocardiographic findings was obtained for all the participants using a pre-tested questionnaire. An abnormal echocardiogram in this study was defined as the presence of LVH, diastolic and/or systolic dysfunction and wall motion abnormality. Bivariate and multivariate logistic regression analyses were used to investigate the association of several parameters with echocardiographic abnormalities. RESULTS Of the 202 patients recruited, males were 102(50.5%) and the mean age was 46±15 years. Majority of patients had type 2 DM, 156(77.2%) and type 1 DM, 41(20.3%) with mean HbA1C of 13.9±5.3%. Mean duration of diabetes was 2 months. The prevalence of an abnormal echocardiogram was 67.8 % (95% CI 60%-74%). Diastolic dysfunction, systolic dysfunction, LVH and wall motion abnormalities were present in 55.0%, 21.8%, 19.3% and 4.0% of all the participants respectively. In bivariate logistic regression analysis, the factors associated with an abnormal echocardiogram were age (OR 1.09 [95% CI 1.06-1.12], P <0.0001), type 2 DM (OR 5.8[95% CI 2.77-12.07], P<0.0001), hypertension (OR 2.64[95% CI 1.44-4.85], P=0.002), obesity (OR 3.51[955 CI 1.25-9.84], P=0.017 and increased waist circumference (OR 1.02[95% CI 1.00-1.04], P=0.024. On Multiple logistic regression analysis, age was the only factor associated with an abnormal echocardiogram (OR 1.09[95%CI 1.05-1.15], P<0.0001). CONCLUSION Echocardiographic abnormalities were common among newly diagnosed adults with DM. Traditional CVD risk factors were associated with an abnormal echocardiogram in this patient population. Due to a high prevalence of echocardiographic abnormalities among newly diagnosed diabetics, we recommend screening for cardiac disease especially in patients who present with traditional CVD risk factors. This will facilitate early diagnosis, management and hence better patient outcomes.
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Affiliation(s)
- Martin Muddu
- Department of Medicine, College of Health Sciences, Makerere University
| | - Edrisa Mutebi
- Department of Medicine, College of Health Sciences, Makerere University
| | - Charles Mondo
- Division of Cardiology, Department of Medicine, Mulago Hospital Kampala - Uganda
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Hamano K, Abe M, Komi R, Kobayashi S. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) for predicting silent myocardial ischaemia in type 2 diabetes mellitus independent of microalbuminuria. Diabetes Metab Res Rev 2010; 26:534-9. [PMID: 20812386 DOI: 10.1002/dmrr.1113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the early identification of cardiovascular risk, it is essential to establish a biological marker for cardiac complications that is comparable to albuminuria for nephropathy. We tested the hypothesis that N-terminal pro-brain natriuretic peptide (NT-proBNP) might be a marker for silent myocardial ischaemia in diabetes. METHODS In forty consecutively recruited subjects without evident coronary artery disease, serum NT-proBNP was measured together with multi-slice computed tomography. With patients suspected of having significant coronary artery stenosis by multi-slice computed tomography, coronary angiography was performed. Silent myocardial ischaemia was defined as the presence of significant coronary artery stenosis with more than 50% luminal narrowing by angiography. RESULTS Thirteen patients (32.5%) had silent myocardial ischaemia. NT-proBNP levels were significantly higher in these patients (181.1 ± 43.8 versus 55.2 ± 9.7 pg/mL, p < 0.005) but HbA(1c), lipid profiles, and creatinine were similar in the two groups. Moreover, log NT-proBNP was identified as an independent predictor of silent myocardial ischaemia (R(2) = 0.502, p < 0.05) after adjustment for HbA(1c), creatinine, albuminuria, hypertension, hyperlipidaemia, or smoking. After stratifying patients by NT-proBNP, the upper tertile compared to the lowest tertile was significantly associated with silent myocardial ischaemia (odds ratio: 26.7, p < 0.05). Receiver operation characteristics analysis with a cut-off value of 52 pg/mL showed 92% sensitivity and 75% specificity for predicting silent myocardial ischaemia (positive predictive value 64.7%, negative predictive value 94.3%). CONCLUSIONS The outstandingly high negative predictive value of NT-proBNP enables us to focus on diabetic patients with occult coronary disease, independently of microalbuminuria.
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Affiliation(s)
- Kumiko Hamano
- Department of Diabetes and Endocrinology, Shonan Kamakura General Hospital, Yamazaki, Kanagawa, Japan
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Kékes E. [Combined antihypertensive and antilipemic therapy as one of the pillars in the poly-pharmacologic preventive strategy for patients with high cardiovascular risk]. Orv Hetil 2008; 149:1827-37. [PMID: 18805771 DOI: 10.1556/oh.2008.28457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is a highly prevalent disease and a strong risk factor for cardiovascular disease in industrialized countries in Europe and North America. About 40-50% of hypertensive patients have some other cardiovascular risk factors as smoking, dyslipidemia, glucose intolerance, metabolic syndrome and diabetes. The realization of optimal therapy of these patients is a difficult task, and reaching target blood pressure values is almost impossible by monotherapy. It was realized that the simultaneous normalization of blood pressure and that of abnormal lipid profile with 2-3 or more drugs have great importance for preventing atherosclerotic complications.We started an open-formed study with about 1000 hypertensive patients complicated with dyslipidemia, visceral obesity, metabolic syndrome and diabetes type 2. The base of our therapeutic strategy was a typical poly-pharmacologic treatment with ACE inhibitor (lisinopril), calcium antagonist (amlodipine), statin (atorvastatin) and antiplatelet therapy (if it was necessary).
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