Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Does changes of dipeptidyl peptidase-4 and IGF binding protein 1 during cardiac rehabilitation can predict recurrent anginal pain – correlation with nitric oxide response – 3 years follow up

Background

Dipeptidyl peptidase 4 (DPP4) is a proteolytic enzyme, and its expression and activity is increased in coronary artery disease (CAD). Insulin-like growth factor binding protein 1 (IGF BP1) can affect prognosis and mortality from cardiovascular diseases.

Purpose

To evaluate the effects of cardiac rehabilitation on DPP4 and circulating IGF BP1 levels, also on circulating blood marker of endothelial function, nitric oxide (NOx); to assess their relationship and prognostic significance on recurrent chest pain.

Methods

51 subjects; 31 pts with stable CAD (CAD group; 58.4±6.8 years) and 20 healthy controls (C group; 57.4±8.1 years) were studied. All patients underwent a supervised 3 weeks exercise training. At baseline and after 3 weeks in all pts values of DPP4, IGF BP1 and NOx were determined and exercise test was performed. Clinical long-term follow-up (3 years) was performed. All medical therapy were documented, and for this analysis, we focused on recurrent anginal chest pain.

Results

After follow-up period there were no cardiovascular (CV) hard end points (CV death, MI, stroke), however 18 pts (58%) had episodes of typical anginal chest pain while 13 pts (42%) were without anginal chest pain. Baseline value of DPP4 and IGF BP1 was significantly higher in CAD than in C group (P<0.01 and P<0.01), while NOx was lower (58.61±7.64 vs 77.28±29.86 μmol/L P=0.024). After 3 weeks of exercise training DPP4 decreased significantly in CAD group (from 762.32±185.76 to 604.88±206.18 μg/L, P<0.001), as well as IGF BP1 (P=0.018) and NOx inreased (P<0.01). Those changes resulted in no significant difference in DPP4, IGF BP1 and NOx after three weeks between CAD and C group. Exercise capacity (METs) at baseline was significantly lower in CAD than in C group (P<0.001), and it significantly increase in CAD group after exercise period (P<0.001).A positive correlation during exercise period was found between IGF BP1 decrease and NOx increase (r=0.790, P<0.001), between IGF BP1 decrease and DPP 4 decrease (r=0.880, P<0.001), between IGF BP1 decrease and METs increase (r=0.866, P<0.001), between DPP 4 decrease and NOx increase (r=0.975, P<0.001), between DPP 4 decrease and METs increase (r=0.718, P<0.001), and between METs increase and NOx increase (r=0.846, P<0.001). Univaried logistic regression analyses were performed and showed that NOx increase (OR 0.842, CI 0.562–0.944, p<0.01), DPP4 decrease (OR 0.718, CI 0.644–0.826, p=0.01), IGF BP1 decrease (OR 0.695, CI 0.475–0.822, p=0.002) and METS increase (OR 0.924, CI 0.788–0.988, p=0.015) significantly predict a 3 years period without anginal chest pain.

Conclusion

Residential cardiovascular rehabilitation, in patients with stable CAD, improved endothelial function. Patients with higher increase of NOx and METs, and greater reduction in DPP4 and IGF BP1 after 3 weeks of specialized cardiac rehabilitation, during 3 years follow up, were without anginal chest pain and without any CV event.

Funding Acknowledgement

Type of funding source: None

Is there a gender difference in endothelial response on exercise training in heart failure patients with preserved ejection fraction?

Purpose

To examine the reaction of endothelium, assess through changes of circulating blood markers of endothelial function: the stable end products of nitric oxide (NOx), S – nitrosothiols (RSNO – reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) that promotes exercise training in female and male patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 78 pts with HFpEF were enrolled in the study: 43 male (M group) and 35 female (F group). In all pts, before and after a short-term supervised 3 weeks exercise training at residential center values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results

After 3 weeks of exercise training NOx increased significantly in both groups: in M group (from 34.4±7.5 to 42.3±9.5 μmol/l, P<0.001), and in F group (from 31.3±6.8 to 41.5±7.2 μmol/l, P<0.001), as well as RSNO: In M group RSNO increased from 3.6±1.7 to 4.6±1.9 μmol/l (P<0.05) and in F group from 3.1±1.5 to 4.2±2.2 μmol/l (P<0,05). Increase in NOX and RSNO after exercise training was higher in F than in M group: NOx 32,6% vs 22,9%; RSNO 35,1% vs 27%. Value of ADMA as well of SDMA decreased in both groups after 3 weeks: ADMA in M group from 0.315±0.09 to 0.278±0.12 μmol/l (by 11.7%; ns), and in F group from 0.342±0.08 to 0.297±0.13 μmol/l (by 13.1%; ns); SDMA in M group from 0.269±0.08 to 0.234±0.09 μmol/l (by 13%; ns), and in F group from 0.285±0.09 to 0.245±0.10 μmol/l (by 14%; ns). After 3 weeks, level and duration of exercise test were significantly higher in M (both P<0,001), as well as, in F group (both P<0.001), compared to baseline values.

Conclusions

There was no gender difference in the way of endothelial response on exercise training in pts with HFpEF. Exercise training induced favorable modification of endothelial function, expressed through significant increased of NOx, RSNO and decreased of ADMA, SDMA in male as well as in female pts. Those positive changes in endothelial function were associated with significant improvement in exercise capacity. Some higher percentage of NOx and RSNO increase in women suggests that they have more pronounced benefit of exercise training than men.

Funding Acknowledgement

Type of funding source: None

The determinants and consequences of forgoing healthcare

Background

Forgoing healthcare is associated with unfavorable health-related outcomes, a higher risk of hospitalization, and a decreased quality of life. Relatively to its neighboring countries, forgoing healthcare for economic reasons is high in Switzerland, primarily because of the high out of pocket expenditures that characterize the Swiss healthcare system. The purpose of this study was to investigate the determinants of forgoing healthcare, and to examine the long term health-related consequences of unmet medical needs.

Methods

We used data from “Bus Santé”, a cross-sectional study conducted in the city of Geneva (CH). Socioeconomic factors were self-reported by participants at baseline (N = 5032, 2007-2011), including income, education, receiving subsidies, and insurance deductibles (mandatory out of pocket expenditures). Forgoing healthcare for economic reasons was self-reported by study participants, including details about the frequency and the type of forgone care. Prospectively, a subset of participants came for a follow-up visit (2014-2015) in order to assess objective (glycemia, blood pressure, plasma lipids) and subjective health-outcomes (self-reported physical and mental health) resulting from forgone healthcare at baseline.

Results

At baseline, adverse socioeconomic circumstances (lower income, education, receiving subsidies, and high deductibles) were associated with a higher risk of forgoing healthcare (OR range 1.51-5.49, p < 0.015). Four years later, participants who reported forgoing healthcare at baseline were at a higher risk of having lower HDL-cholesterol (β=-0.08 [-0.14;-0.03]), and adverse physical and mental self-reported health outcomes when compared to controls (p < 0.017).

Conclusions

Forgoing healthcare is driven by adverse socioeconomic circumstances, subsequently leading to adverse lipid profiles and poor self-reported health outcomes. Unmet medical needs may constitute a pathway through which socioeconomic status affects health.

Key messages

Adverse socioeconomic circumstances lead to unmet medical needs, even in wealthy countries. Unmet medical needs lead to poor objective and subjective health-related outcomes.

Exploring the relation between methylxanthines and plasma lipids in two population-based studies

Background

Chronic intake of caffeinated beverages might be associated with plasma lipids via disturbed lipid metabolism. Previous investigations have been limited by the use of self-reported caffeine intake instead of measured caffeine, whereas the associations between plasma lipids and other methylxanthines (paraxanthine, theobromine, theophylline) are unknown. Here, we investigated the associations of plasma lipids with caffeine and its metabolites in plasma and urine in two European populations.

Methods

Individuals were selected from the general population of North Belgium (FLEMENGHO) and Switzerland (SKIPOGH). Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured in plasma using standard enzymatic methods. Plasma and 24h urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured using ultra-high performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of methylxanthines with plasma lipids while adjusting for major confounders.

Results

Overall, 1946 FLEMENGHO participants (911 men, age 45.9±15.2 years) and 990 SKIPOGH participants (467 men, age 47.1±17.3 years) were included. Mean plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in FLEMENGHO/SKIPOGH were 5.37/5.06, 3.12/3.12, 1.43/1.50, and 2.4/1.02 mmol/L. In both cohorts, adjusted mean total cholesterol, LDL cholesterol, and HDL cholesterol, increased with quartile of plasma caffeine, with stronger associations in men. Similar positive associations were observed for paraxanthine and theophylline. Similar associations were observed using 24h urine excretions in SKIPOGH.

Conclusions

Plasma and urinary caffeine, paraxanthine, and theophylline were positively associated with plasma lipids in men, whereas there were fewer meaningful associations in women. The increase in plasma lipids might mitigate the overall beneficial impact of caffeinated beverages on health.

Key messages

Caffeine constitutes one of the most widely consumed biological active substances. Plasma concentration and urinary excretion of caffeine and its derived metabolites is positively associated with plasma lipids.

Exploring the relation between socioeconomic position and DNA methylation in a European population

Background

Previous investigations have reported that adverse socioeconomic circumstances across the life-course lead to the alteration of major biological processes, eventually resulting in a higher disease risk and premature death. In particular, a low life-course socioeconomic position (SEP) has been associated with a modified epigenetic signature of loci involved in inflammation, the physiological response to stress, and other regulatory processes.

Methods

In this study, we investigated the association between nine indicators of SEP across the life-course and the differential methylation of 451'000 genome-wide CpG markers, using data from 690 adults included in a Swiss population-based study. We further examined the interrelations between the SEP-related CpGs, and the biological pathways in which the identified markers are involved.

Results

Three SEP indicators in adulthood were associated the differential methylation of 161 genome-wide CpG markers, whereby 156 CpGs were less methylated in people with low versus high SEP. Among the identified CpGs, a substantial proportion of markers were no longer associated with SEP upon accounting for health behaviors and cardiometabolic disorders. In addition, the identified CpGs were found to be involved in immune, inflammatory, and cancer-related processes.

Conclusions

Our results support the hypothesis that adverse socioeconomic circumstances may lead to the dysregulation of inflammatory processes, eventually resulting in the occurrence of serious chronic conditions such as atherosclerosis, diabetes, or cancer.

Key messages

Socioeconomic position is a major determinant of health-related outcomes. Epigenetic modifications may constitute a biological mechanism through which socioeconomic circumstances affect health.

Forgoing health care is associated with insurance deductibles in a consumer-driven health care system

Background

The Swiss health care system is consumer-driven with universal coverage and good population outcomes. Deductibles of mandatory insurance plans are self-selected, regulated, and unrelated to pre-existing conditions. In a Swiss population, we aimed to determine if forgoing health care was associated with insurance plan deductibles and if the association was dependent on socioeconomic status.

Methods

We used data from the Bus Santé Study; a cross-sectional survey study ongoing in Geneva (Switzerland) since 1993. We included adult participants in the study between 2007 and 2016. We divided participants according to insurance plan deductibles (low, medium, or high). Forgoing health care information was obtained from the study questionnaire. Forgoing dental health care was considered separately as mandatory insurance plans do not cover dental care. Inequalities were quantified using the regression-based relative index of inequality (RII) adjusted for potential confounders (age, gender, income, educational attainment, known comorbidities, cardiovascular risk factors, additional health insurance plans or subsidized premiums)

Results

We included 9081 participants, with 8.9% reporting forgoing non-dental healthcare. Those with a high-deductible insurance plan were younger, more often Swiss and male, with higher income and educational attainment, less known cardiovascular risk factors and comorbidities. Participants with high-deductible plans had a higher probability of forgoing non-dental health care (RII=2.2, p < 0.001) independently of socioeconomic status and known comorbidities or cardiovascular risk factors. As expected, we did not observe inequalities related to insurance plan deductibles in forgoing dental health care (RII=1.0, p = 0.8).

Conclusions

In a population with universal coverage and good health outcomes, insurance plan deductibles are associated with inequities in forgoing health care independently of socioeconomic status and pre-existing conditions.

Key messages

In a highly performant health system, high insurance plan deductibles are associated with inequities in care independent of individual sociodemographic characteristics, risk factors and comorbidities. Uncovering associations between health system design features and inequities in care could inform decision-makers that seek to curtail inequities through improving their current health system design.

Safety and immunogenicity of a seasonal trivalent inactivated split influenza vaccine: a double blind, phase III randomized clinical trial in healthy Serbian adults

This study was a phase III, multicenter, double-blind, randomized, placebo-controlled trial to evaluate the safety and immunogenicity of a seasonal trivalent split, inactivated influenza vaccine (TIV) in healthy Serbian adults between the ages of 18 and 65 years. This egg-based vaccine was manufactured by the Institute of Virology, Vaccines and Sera, Torlak, Belgrade, Serbia. A total of 480 participants were assigned randomly in a ratio of 2:1 to receive a single intramuscular dose (0.5 ml) of the vaccine (15 µg of hemagglutinin per strain) or placebo (phosphate-buffered saline). Participants were monitored for safety, including solicited and unsolicited adverse events (AEs) and serious adverse events (SAEs). No SAEs related to vaccination were reported. Injection site pain (51.3%), injection site tenderness (40.4%), tiredness (17.0%), and headache (15.1%) were the most commonly reported solicited events in the vaccine group. Incidence of related unsolicited AEs was low (1.3%) among vaccinees. Hemagglutinin inhibition (HAI) titers were measured before and 21 days after vaccination in 151 participants. Overall, HAI seroconversion rates to H1 and H3 were observed in 90.1% and 76.2% of vaccinees, respectively. For B antigen, it was 51.5%, likely due to high pre-vaccination titers. Post-vaccination seroprotection rates were in the range of 78.2-95.0% for the three antigens. Post-vaccination geometric mean titers (GMT) were at least 3.8 times higher than baseline levels for all the three strains among vaccinees. Overall, the study showed that the vaccine was safe and well tolerated, and induced a robust immune response against all three vaccine strains. ClinicalTrials.gov identifier: NCT02935192, October 17, 2016.

Adiponectin resistance parameter as a marker for high normal blood pres-sure and hypertension in patients with metabolic syndrome

INTRODUCTION

The different degrees of adiponectin/insulin sensitivity and dysfunctional adipose tissue lead to the development of hypertension (HT). This study aimed to determine adiponectin (AD) concentration in patients with metabolic syndrome (MetS) and high-normal blood pressure or hypertension and to investigate the importance of Homeostatic Model Assessment-AD (HOMA-AD) index in assessing adiponectin/insulin resistance in hypertension.

METHODS

This cross-sectional study involved 150 subjects divided into two groups: with MetS (and high-normal blood pressure, n =50; and HT, n =50), and controls without MetS (n =50). In all subjects, serum adiponectin concentration was measured by enzyme-linked immunosorbent assay method. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and HOMA-AD index were calculated.

RESULTS

The results showed that, compared to the control group, serum AD concentrations were significantly lower in patients with MetS and high-normal blood pressure (p =0.008), and the lowest in group MetS and HT (p =0.001). High AD levels and low HOMA-AD were significantly associated with decreased blood pressure values. In patients with MetS, the value of HOMA-AD≥1.13 was associated with a higher risk of developing high-normal blood pressure. Furthermore, the value of HOMA-AD≥2.63 was associated with a higher risk of developing hypertension.

CONCLUSIONS

Hypoadiponectinemia is associated with hypertension, especially in the early stages of the disease. The serum AD levels and HOMA-AD index may be useful markers for identifying patients at risk for high-normal blood pressure and hypertension. HIPPOKRATIA 2020, 24(1): 3-7.

Parental socioeconomic position and chronic inflammation during adolescence

Background

Early life adversity has been associated with increased risk of inflammation and inflammation-related diseases in adulthood. This study aimed to examine the association of parental socioeconomic position with chronic inflammation over adolescence.

Methods

We used information on 2942 members (1507 girls and 1435 boys) of the EPITeen cohort that was established in 2003 in Porto, Portugal, and included 13 years old adolescents that were further evaluated at 17 and 21 years. Mother’ and father’s education and occupation were used as indicators of parental socioeconomic position. High-sensitivity C-reactive protein (CRP) was measured at three points in time (13, 17 and 21 years). CRP levels were categorized in tertiles separately for each wave; chronic inflammation in adolescence was defined as having CRP levels in the highest tertile in at least 2 waves and never in the lowest tertile.

Results

Over adolescence, the prevalence of chronic inflammation was significantly higher among participants with low parental socioeconomic position. Low parental socioeconomic position was associated with chronic inflammation in adolescence, after adjustment for sex, perinatal and physical environment factors, health-related behaviours and health status in adolescence OR = 1.63; 95%CI: 1.11, 2.40 for lowest vs. highest mother’s education and OR = 1.61; 95%CI: 1.12, 2.30 for lowest vs. highest father’s education.

Conclusions

Low parental socioeconomic position is associated with chronic inflammation during adolescence. Our results suggest that the early life socioeconomic environment has an impact on inflammatory processes over adolescence.

P638High intensity interval exercise training improves endothelial function in patients with heart failure with preserved ejection fraction

Background

Cardiac rehabilitation has traditionally invoved low-to moderate intensity continuous exercise training (MICT). There is growing evidence that high intensity interval exercise training (HIIT) shows similar or greater efficacy compared with MICT. However, the relationship between the training modality and its effects on endothelial function still remains to be elucidated.

Purpose

To evaluate the impact of high intensity interval exercise training versus low-to moderate intensity continuous exercise training on circulating blood markers of endothelial function: the stable end product of nitric oxide (NOx), S–nitrosothiols (RSNO–reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 43 pts with HFpEF (mean age 57.5±6.8y) admitted at residential rehabilitation center were enrolled in the study. Patients were randomized to HIIT, (HIIT group, n=20) and MICT, (MICTgroup, n=23). At baseline and 3 weeks later, in all pts values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results

After 3 weeks NOx increased significantly in both groups: in HIITgroup (from 34.7±7.5 to 48.5±8.3 μmol/l, P<0.0001), in MICTgroup (from 35.0±9.5 to 42.5±10.0 μmol/l, P<0.05), and value of NOx after 3 weeks was higher in HIIT than in MICT group (P<0.05). Value of ADMA as well of SDMA decreased in both groups after 3 weeks, and this decrease was significant in HIIT group: ADMA in HIIT group (from 0.305±0.055 to 0.250±0.077 μmol/l, P<0.005) and in MICT group (from 0.325±0.069 to 0.280±0.140 μmol/l, ns); SDMA in HIIT group (from 0.285±0.050 to 0.240±0.060 μmol/l, P<0,005) and in MICT group (from 0.270±0.080 to 0.247±0.063 μmol/l, ns). Value of RSNO significantly increased in both groups, with higher increase in HIIT group: in HIIT group (from 3.0±1.5 to 5.1±1.7 μmol/l, P<0.001), in MICTgroup (from 3.2±1.7 to 4.5±2.3 μmol/l, P<0.05). Compared to the baseline, at the end of the study, exercise capacity (METs) was significantly higher in both groups (P<0.0001). Higher increase in METs in HIIT group during exercise training (by 39.8%), compared to increase in MICT group (by 27.2%), resulted in significantly higher exercise tolerance in HIIT than in MICT group at the end of the study (P<0.02). In both groups, adverse events during or after exercise training, were not occurred.

Conclusions

In pts with HFpEF high intensity interval exercise training as well as low-to moderate intensity continuous exercise training induced favorable modification of endothelial function, expressed through increase of NOx and RSNO, and decrease of ADMA and SDMA. More significant increase of NOx and RSNO, and significant decrease of ADMA and SDMA gives an advantage to HIIT over MICT exercise training in patients with HFpEF.

ADIPONECTIN AS A POTENTIAL BIOMARKER OF LOW BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH METABOLIC SYNDROME

CONTEXT

Adiponectin is an abundant adipokine, which has antiinflammatory, anti-atherosclerotic and vasoprotective actions, and potential antiresorptive effects on bone metabolism. It seems to be directly involved in the improvement and control of energy homeostasis, protecting bone health and predicting osteoporotic fracture risk.

OBJECTIVE

To examine the relationship between adiponectin level and bone mineral density (BMD) in post-menopausal women with metabolic syndrome (MetS) and low BMD, and to estimate the prognostic significance of adiponectin in osteoporosis.

DESIGN

Clinical-laboratory cross-sectional study including 120 middle-aged and elder women (average 69.18±7.56 years).

SUBJECTS AND METHODS

The anthropometric parameters were measured for all examinees. Lumbar spine and hip BMD, as well as body fat percentage, were measured using a Hologic DEXA scanner. In all subjects serum adiponectin concentration was measured by ELISA method.

RESULTS

The level of adiponectin was significantly positively correlated with BMD-total, BMD of the lumbar spine and BMD of the femoral neck (r=0.618, r=0.521, r=0.567; p<0.01). Levels of adiponectin and BMD are significantly lower in post-menopausal women with MetS and osteoporosis compared to patients with osteopenia (856.87±453.43 vs. 1287.32±405.21 pg/mL, p<0.01; BMD, p<0.05), and the highest values in healthy examinees. A cut-off value of adiponectin level for osteoporosis/osteopenia was 1076.22/1392.74 pg/mL.

CONCLUSIONS

Post-menopausal women with MetS have significantly lower adiponectin level and low BMD compared to healthy examinees. Adiponectin may be an early, significant and independent predictor of developing osteoporosis in women with MetS, especially in post-menopausal period.

Ventricular and Vascular Remodelling – Effects of the Angiotensin II Receptor Blocker Telmisartan and/or the Angiotensin-Converting Enzyme Inhibitor Ramipril in Hypertensive Patients

Angiotensin II induces inflammatory activation of vascular smooth muscle cells and can cause left ventricular hypertrophy (LVH). Telmisartan is an angiotensin II receptor blocker with demonstrated beneficial effects on cardiac and vascular structure and function in animal models. The angiotensin-converting enzyme inhibitor ramipril also reduces ventricular and vascular remodelling. The open-label study observed 75 treatment-naïve, moderately or severely hypertensive (systolic blood pressure 160-190 mmHg, diastolic blood pressure 90-110 mmHg) patients (age range, 42-58 years) treated with once-daily telmisartan 40 mg force-titrated to 80 mg after 1 month (n = 25), once-daily ramipril 2.5 mg force-titrated to 5 mg after 1 month (n = 25), or once-daily telmisartan 40 mg plus ramipril 2.5 mg (n = 25); the total duration of treatment was 6 months. At baseline, blood pressure, left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and carotid cross-sectional intima-media area (CSA) were measured. Measurements were repeated 1, 3 and 6 months after initiation of treatment. After 6 months, comparable blood pressure reductions were achieved with the three treatments. Reductions in LVMI after 6 months' treatment were 11.4%, 9.9% and 15.6% with telmisartan, ramipril, and telmisartan plus ramipril, respectively. Respective reductions in IMT were 14.6%, 12.0% and 18.2%, and for CSA were 7.8%, 4.3% and 11.5%. In conclusion, treatment with telmisartan or ramipril for 6 months resulted in regression of LVH and vascular remodelling. When a combination of telmisartan and ramipril was administered, additional regression and remodelling occurred.

The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism

OBJECTIVE

Subclinical hypothyroidism (SH) is associated with a moderately elevated risk of heart failure events among older adults. The objective of our prospective study was to assess the impact of thyroid hormone replacement therapy (HRT) with low doses of L-thyroxine (6.25-25 µg/day) on left ventricular diastolic function in patients with SH.

MATERIALS AND METHODS

33 patients with SH and 25 healthy controls were involved. All participants underwent standard echocardiography and Doppler imaging at baseline and, the patient group, also after a course of HRT.

RESULTS

At baseline, patients with SH showed significantly lower E (0.79 ± 0.22 vs. 0.93 ± 0.19, p < 0.001), E/A ratio (1.19 ± 0.29 vs. 1.31 ± 0.25, p < 0.003), and higher intraventricular septum thickness (IVST) (0.99 ± 0.14 vs. 0.89 ± 0.18, p < 0.001) in comparison with healthy controls. After 6 months of therapy, the E/A ratio underwent significant increase (1.28 ± 0.21 vs. 1.19 ± 0.29, p < 0.001), while the IVS displayed a robust reduction (0.92 ± 0.16 vs. 0.99 ± 0.14, p < 0.001).

CONCLUSIONS

HRT with low-dosed L-thyroxine may improve left ventricular diastolic function in patients with SH.

The semi-sewer river: hydraulic backwater effects and combined sewer overflow reverse flows in Central Brussels reduce deoxygenation impact further downstream

In 2011 and 2012 the dissolved oxygen content in the low-discharge river Zenne was monitored continuously, every 5 minutes, downstream of Brussels city centre, making it possible to document the complex mechanisms by which combined sewer overflow (CSO) spills affect both the hydraulics and the oxygen balance of the hydrosystem. In addition to oxygen demand impacts, proportions of water volumes are such that the oxygen-devoid sewage water discharged from CSOs contributes significantly to the oxygen deficit observed in the river further downstream. It is shown that ensuing unexpected hydraulic behaviour, such as a full river-flow reversal, can explain the dual nature of oxygen sag following major CSO events. At times the semi-sewer river plays the role of an in-stream stormwater tank, effectively attenuating the environmental impacts of Brussels CSOs.

Craniofacial bone tissue engineering

There are numerous conditions, such as trauma, cancer, congenital malformations, and progressive deforming skeletal diseases, that can compromise the function and architectonics of bones of craniofacial region. The need to develop new approaches for treatment of these disorders arises from the fact that conventional therapeutic strategies face many obstacles and limitations. The use of tissue engineering in regeneration of craniofacial bone structures is a very promising possibility and a great challenge for researchers and practitioners. Developments in stem cell biology and engineering have led to the discovery of different stem cell populations and biodegradable materials with suitable properties. This review summarizes the current achievements in tissue engineering of craniofacial bone, temporomandibular joint, and periodontal ligament.

Association of manganese superoxide dismutase and glutathione S-transferases genotypes with carotid atherosclerosis in patients with diabetes mellitus type 2

AIM

The aim of the present study was to test the association between genetic polymorphisms with functional effects on redox regulation: Ala16Val of manganese superoxide dismutase (MnSOD or SOD2), polymorphic deletions of glutathione S-transferases M1 (GSTM1) and T1 (GSTT1) and Ile105Val of the GSTP1 and carotid atherosclerosis in patients with type 2 diabetes.

METHODS

The study enrolled 287 subjects with type 2 diabetes. Carotid atherosclerosis was quantified by ultrasonography as carotid intima-media thickness (CITM), plaque score from 0 to 6 and plaque type from 1 to 5. Genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).

RESULTS

The highest triglyceride level was observed in patients with MnSOD Val/Val genotype. Other polymorphisms did not show significant association with clinical parameters. We did not observe significant differences in MnSOD, GSTM1 and GSTP1 genotypes distribution according to CIMT, plaque type or plaque score. After adjustment for age, sex, smoking, BMI, lipid parameters and duration of hypertension and diabetes carriers of GSTT1-0 genotype showed an increased risk for higher plaque score (OR=2.29; p=0.012), but no association with CIMT and plaque stability was observed. Carrying of both GSTM1-0 and GSTT1-0 did not influence clinical parameters but increased risk for higher plaque score (OR=2.59; P=0.018).

CONCLUSION

We did not find a significant association between the MnSOD, GSTM1 and GSTP1 polymorphisms and carotid atherosclerosis. The GSTT1-0 genotype and GSTT1-0/GSTM1-0 haplotype might be a potential determinants of susceptibility to advanced atherosclerosis in patients with type 2 diabetes mellitus.

Oral status in patients receiving 5-fluorouracil for colorectal cancer

PURPOSE

Oral complications are frequent and troublesome symptoms for those undergoing chemotherapy for cancer. Several antineoplastic agents are proved to have stomatotoxic potential, among them 5-fluorouracil (5-FU). The aim of the present study was to evaluate the oral status and patient experiences during chemotherapy with 5-FU for colorectal cancer.

METHODS

Twenty-eight patients treated with 5-day 5-FU plus leucovorin entered this study. Positive data about oral symptoms were taken by anamnesis. Mucositis severity index, gingival index, plaque index, probing pocket depth and bleeding on probing have been used to assess oral mucosa and periodontal status of the patients. Patients were examined prior to chemotherapy and 14 days after the start of the chemotherapy cycle.

RESULTS

Mild to moderate subjective complaints concerning oral cavity were reported by 17.9% of patients before and 39.2% of patients after chemotherapy. Clinical examination revealed oral mucosa damage in 10.7% and 35.7% of patients, with mean mucositis score of 0.14 and 0.54 before and after chemotherapy, respectively. Although mean values of all periodontal indices were elevated after chemotherapy, only increase in gingival index was statistically significant (p=0.035). Mucositis was significantly correlated with oral pain (p=0.00), xerostomia (p=0.00), and plaque index (p=0.077), while the correlation between mucositis and the rest of the examined parameters was not significant.

CONCLUSION

Oral complications were not highly expressed in this study. Although 5-FU is considered to exert significant stomatotoxic effect, severe mucositis was far less common in this study compared to studies reported elsewhere.

Cardiotoxic injury caused by chronic administration of microcystin-YR

Microcystins are cyclic peptide toxins. Chronic intoxication with well-known members of the microcystin family--microcystins-LR--induces liver tumour formation, injury of kidney and heart. Despite worldwide distribution in the environment, the effects of microcystins-YR have not been studied extensively. The aim of the study was to evaluate whether microcystins-YR, in relatively low doses, have a toxic effect on cardiomyocytes of chronically treated rats. Male adult Wistar rats were treated every second day for 8 months with microcystins-YR (10 microg/kg i.p., N = 5). Control groups were treated either with vehicle (ethanol and methanol 4 : 1 v/v; N = 5) or with physiologic saline (N = 4). The heart sections of microcystin-YR-treated rats revealed decreased volume density of cardiac muscle tissue (microcystins- YR = 0.485 mm3/mm3 +/- 0.003; vehicle = 0.493 mm3/mm3 +/- 0.002; saline = 0.492 mm3/mm3 +/- 0.002) due to fibrous proliferation. A few lymphocyte infiltrates were observed. Most of cardiomyocytes were enlarged (microcystins-YR = 20.19 microm +/- 1.34, vehicle = 17.45 microm +/- 0.52, saline = 16.00 microm +/- 1.43), with enlarged and often bizarre-shaped nuclei and decreased myofibril volume fraction (microcystins- YR = 0.416 mm3/mm3 +/- 0.009; vehicle = 0.472 mm3/ mm3 +/- 0.009; saline = 0.479 mm3/mm3 +/- 0.010). No TUNEL-positive cells were found in the heart sections of rats in all groups. The results allow the conclusion that chronic exposure to low doses of microcystins-YR may cause atrophy and fibrosis of the heart muscle.

Peroxisome proliferator-activated receptor gamma/Pro12Ala polymorphism and peroxisome proliferator-activated receptor gamma coactivator-1 alpha/Gly482Ser polymorphism in patients with sarcoidosis

BACKGROUND AND AIM OF THE WORK

Reduced expression and activity of the peroxisome proliferator-activated receptor gamma (PPARG) have been measured in cells of bronchoalveolar lavage fluid in sarcoidosis patients. PPARG, together with its transcriptional coactivator peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PPARGC1A), has important modulating effects on immune response and apoptosis. In the present study, we investigated whether the polymorphisms Pro12Ala (rs1805192) in the PPARG gene and Gly482Ser (rs8192678) in the PPARGC1A gene, which affect transcriptional activities, are associated with sarcoidosis.

METHODS

We performed an integrative "omic" approach and identified the PPARG gene as a suitable candidate. Polymerase chain reaction was performed followed by restriction fragment length polymorphism to determine PPARG/Pro12Ala and PPARGC1A/Gly482Ser genotypes of 104 sarcoidosis patients and 112 healthy control subjects.

RESULTS

A higher frequency of the Ala allele (p=0.0101, OR=1.84, CI 1.18-2.88), as well as a significantly higher frequency of Pro/Ala heterozygotes and Ala/Ala homozygotes at the Pro12Ala/PPARG polymorphism (p=0.0020, OR=2.45, CI 1.42-4.25) were found in patients with sarcoidosis. In addition, a higher frequency of the Ser allele (p=0.013, OR=1.69, CI 1.13-2.53) and Gly/Ser heterozygotes and Ser/Ser homozygotes (p=0.0470, OR=1.80, CI 1.04-3.10) at the Gly482Ser/PPARGC1A polymorphism were found in patients with sarcoidosis as compared to healthy control subjects.

CONCLUSION

Our results indicate that the presence of the Ala allele at the PPARG/Pro12Ala polymorphism and the Ser allele at the PPARGC1A/Gly482Ser polymorphism may be a predisposing factor for sarcoidosis.

Inflammatory changes in small blood vessels in the endomyocardium of cardiac syndrome X in female patients with increased C-reactive protein

The pathogenesis and pathohistological changes of CSX, a syndrome characterized by anginal chest pain and normal coronary arteries on coronary angiography, is poorly understood. The purpose of this study was to analyse morphological changes in small blood vessels of the CSX patients with increased CRP levels (above 5 mg/l). EMB was performed for diagnostic purposes in 31 female patients with CSX, and EMB specimens were histologically and immunohistochemically analysed. Increased CRP was found in 18 (58.1%) female patients with CSX. Signs of inflammation in the walls of small blood vessels were demonstrated in 13 (76%) and TUNEL-positive endothelial cells in 3 (17%) women with increased CRP. Morphological analysis of small blood vessels in EMB in CSX female patients with increased CRP levels revealed signs of inflammation and apoptosis of endothelial cells, indicating the role of inflammation in the pathogenesis of CSX.

Predicting clinical outcomes for newborns using two artificial intelligence approaches

Two different approaches, based on artificial neural networks (ANN) and fuzzy logic, were used to predict a number of outcomes of newborns: How they would be delivered, their 5 minute Apgar score, and neonatal mortality. The goal was to assess whether the methods would be comparable or whether they would perform differently for different outcomes. The results were comparable for Correct Classification Rate (CCR) and Specificity (true negative cases). Sensitivity (true positive cases) was slightly higher for the back-propagation feed-forward ANN than using the Fuzzy-Logic Classifier (FLC). Since this is one single database and a very large one, it is possible that the FLC would perform better than the ANN for very small databases, as shown by some of the co-authors in the past. The next step will be to test a small database with both methods to assess strengths and weaknesses with the intent to use both if needed with some medical data in the future.

M235T polymorphism of the angiotensinogen gene and insertion/deletion polymorphism of the angiotensin-1 converting enzyme gene in essential arterial hypertension in Caucasians

In order to investigate the contribution of candidate genes in the RAAS in pathogenesis of EAH, we analysed the M235T polymorphism of the angiotensinogen gene, and the I/D polymorphism of ACE gene in a group of adult Caucasians (Slovene population) with EAH. Four-hundred and thirteen unrelated subjects with the diagnosis of EAH were included in the association study and they were compared to 414 subjects with normal blood pressure (the control group). The M235T angiotensinogen genotype distribution in patients with EAH (TT = 23.2%, MT = 48.7%, MM = 28.1%) did not differ from genotype distribution in controls (TT = 21.1%, MT = 49.0%, MM = 29.9%), and the TT genotype was not associated with EAH (OR 1.1; 95% CI 0.7-1.7; P = 0.6). Moreover, The I/D ACE genotype distribution in patients with EAH (DD = 32.0%, ID = 48.2%, II = 19.8%) did not differ from genotype distribution in controls (DD = 32.2%, ID = 49.0%, II = 18.8%), and the DD genotype was not associated with EAH (OR 1.0; 95% CI 0.7-1.3; P = 0.9). In conclusion, we failed to demonstrate that the M235T angiotensinogen polymorphism and the ACE I/D polymorphism were genetic markers for EAH in adult Caucasians.

Microcystin-LR induces alterations in heart muscle

MC-LR belongs to a family of cyanobacterial toxins. MC-LR acts as serine-threonine phosphatase-1 and -2A inhibitor. Chronic intoxication with low doses of this toxin promotes liver tumour formation and induces kidney injury. The aim of the study was to evaluate whether chronic exposure to relatively low doses of MC-LR has toxic effects on hearts of treated animals. Male adult Wistar rats were treated every second day for 8 months with MC-LR (10microg/kg i. p., N = 5). Control groups were treated either with a vehicle (ethanol and methanol 4 : 1 v/v; N = 5) or with physiologic saline (N = 4). We found that MC-LR could induce enlargement of cardiomyocytes (MC-LR = 20.984microm+/-1.351, vehicle=17.454microm +/-0.518, saline = 15.996microm+/-1.430), loss of cell cross-striations, lower myofibril volume fraction (MC-LR = 0.3657mm(3)/mm(3) +/- 0.0337, vehicle=0.4716mm(3)/mm(3) +/-0.0086, saline = 0.4793 mm(3)/mm(3)+/-0.0101), fibrosis (MC-LR = 0.0747mm(3)/mm(3)+/-0.01288, vehicle = 0.0275 mm(3)/mm(3) +/- 0.0076, saline = 0.0309mm(3)/mm(3) +/-0.0074) and mononuclear infiltration in the interstitial tissue. The TUNEL staining of the heart sections of rats in all groups showed no apoptotic cells. We may conclude that long-term exposure to relatively low doses of MC-LR represents a considerable risk of injury of the heart.

The K469E polymorphism of the intracellular adhesion molecule 1 (ICAM-1) gene is not associated with myocardial infarction in Caucasians with type 2 diabetes

Type 2 diabetes is one of the major risk factors for the development of CAD and subsequent MI. Inflammation, whereby ICAM-1 plays an important role, has been implicated in the pathogenesis of MI. The K469E polymorphism of the ICAM-1 gene has recently been associated with ischemic stroke, atherosclerosis of femoral arteries and microvascular complications of type 2 diabetes. We examined the association between the K469E polymorphism of the ICAM-1 gene and MI among the patients with type 2 diabetes in Slovenian population. Genotyping of the K469E polymorphism of the ICAM-1 gene was performed for 367 subjects with type 2 diabetes: 152 patients with MI and 215 with no history of CAD. The K469E ICAM-1 genotype distribution in patients with MI (EE = 21.7 %, EK = 47.4 %, KK = 30.9 %) did not differ from genotype distribution in patients without CAD (EE = 19.1 %, EK = 50.7 %, KK = 30.2 %), and the EE genotype was not associated with MI in subjects with type 2 diabetes (P = 0.5). In conclusion, the K469E polymorphism of the ICAM-1 gene was not associated with MI in patients with type 2 diabetes, and therefore may not be used as a genetic marker for MI in patients with type 2 diabetes.

Familial progressive sinoatrial and atrioventricular conduction disease of adult onset with sudden death, dilated cardiomyopathy, and brachydactyly. A new type of heart-hand syndrome?

We identified a family with 10 affected members in four generations suffering from adult-onset progressive sinoatrial and atrioventricular conduction disease, sudden death due to ventricular tachyarrhythmia, dilated cardiomyopathy, and a unique type of brachydactyly with mild hand involvement (short distal, middle, proximal phalanges and clinodactyly) and more severe foot involvement (short distal, proximal phalanges and metatarsal bones, short or absent middle phalanges, terminal symphalangism, duplication of the bases of the second metatarsals, extra ossicles, and syndactyly). The phenotype differences from other reported genetic abnormalities and linkage exclusion of Holt-Oram syndrome, ulnar-mammary syndrome, brachydactyly type B or Robinow syndrome, and cardiac conduction disease or Brugada syndrome loci suggest that we report on a new hereditary heart-hand syndrome.

Are the T/C polymorphism of the CYP17 gene and the tetranucleotide repeat (TTTA) polymorphism of the CYP19 gene genetic markers for premature coronary artery disease in Caucasians?

Gender differences in CAD have been clearly documented, and sex hormones have been recognized to influence the risk of CAD. The cytochrome P450c17alpha gene (CYP17) and the CYP19 gene influence concentrations of sex hormones. In this cross-sectional association study we tested the hypothesis whether the T/C polymorphism of the CYP17 gene and the tetranucleotide repeat (TTTA) polymorphism of the CYP19 gene are genetic markers for CAD in Caucasians. The TT genotype of the CYP17 gene polymorphism was not associated with premature CAD in men and women combined (OR 0.9; 95% CI = 0.6-1.4; P = 0.7), in men only (OR 1; 95% CI = 0.6-1.8; P = 0.7), and in women only (OR 0.8; 95% CI = 0.5-1.4; P = 0.4). The tetranucleotide repeat (TTTA) CYP19 gene polymorphism was not associated with premature CAD. Moreover, the genotypes containing the longer alleles (A6 or A7) were not associated with a lower incidence of CAD, and the genotypes containing the shorter alleles (A1 or A2) were not over-represented in the CAD patients. We may conclude that in Caucasian subjects neither the T/C CYP17 gene polymorphism nor the tetranucleotide repeat (TTTA) polymorphism of the CYP19 gene contributes to the genetic susceptibility to CAD, therefore they may not be used as genetic markers for CAD risk assessment.

Presence of Chlamydia pneumoniae DNA in the artery wall--biomarker of coronary artery disease

Many authors have shown an association between Chlamydia pneumoniae (CPn) infection and coronary artery disease (CAD). However, whether CPn infection demonstrated by CPn DNA presence in the artery wall plays an important role in pathogenesis of CAD and acute coronary events (i.e. unstable angina) remains to be elucidated. One hundred and fifteen consecutive patients with CAD (51 with unstable angina and 64 with stable angina) were compared with 52 control subjects with aortic valve disease without angiographic evidence of CAD. The presence of CPn DNA in the aortic wall was assessed with nested polymerase chain reaction (PCR), and the IgM, IgG and IgA anti-CPn titres were assessed with microimmunofluorescence test. CPn DNA presence in the artery (i.e. aortic) wall was associated with 3.7-fold increased risk of CAD (95% CI 1.2-11.3, P < 0.01); however, no statistically significant difference in CPn DNA presence was demonstrated between unstable and stable angina (17.6% vs. 25%). In the CPn DNA positive group more often than in the CPn DNA negative group, serological signs of chronic infection (55.2% vs. 27%, P = 0.004) were demonstrated, whereas no statistically significant differences were demonstrated in prevalence of either acute infection (9.3% vs. 0%) or reinfection (0% vs. 0%). In conclusion, CPn DNA presence in the artery (i.e. aortic) wall was associated with CAD, therefore may be used as a biomarker for CAD. Moreover, no statistically significant differences in CPn DNA presence in the artery wall and in serology were present between unstable and stable angina; therefore, CPn infection does not seem implicated in triggering an acute coronary event.

A Gly482Ser polymorphism of the peroxisome proliferator-activated receptor-gamma coactivator-1 (PGC-1) gene is associated with type 2 diabetes in Caucasians

The PGC-1 gene has been implicated in the regulation of several genes controlling energy metabolism. The prevalent Gly482Ser polymorphism of the PGC-1 gene has been shown to be associated with type 2 diabetes in some but not all studies. The aim of this study was to analyse whether the Gly482Ser variant is a risk factor for development of type 2 diabetes in Slovene population (Caucasians). Genotyping of the Gly482Ser polymorphism was performed for 545 subjects: 305 patients with type 2 diabetes and 240 non-diabetic controls. The Gly482Ser genotype distribution in patients with type 2 diabetes (AA = 11.5%, AG = 42.3%, GG = 46.2%) differed from genotype distribution in non-diabetic controls (AA = 6.3%, AG = 46.3%, GG = 47.5%), and the AA genotype was associated with 1.9-times increased risk of type 2 diabetes (95% confidence interval 1.0-3.6; P = 0.036). In conclusion, we suggest that the AA genotype of the Gly482Ser polymorphism of the PGC-1 gene should be considered as a risk factor for the development of type 2 diabetes in Caucasians.

Cytopathological basis of heart failure--cardiomyocyte apoptosis, interstitial fibrosis and inflammatory cell response

A characteristic feature of heart failure is progressive deterioration of the left ventricular function. The mechanisms responsible for progression of heart failure are not known, but may be related to progressive loss of cardiomyocytes due to apoptosis or programmed cell death. Apoptosis of cardiomyocytes can cause scattered loss of cardiomyocytes and, when sufficiently widespread, this might cause heart failure. Beside cardiomyocyte apoptosis, progressive accumulation of interstitial collagen fibres in the heart occurs in the failing heart that may lead to ventricular diastolic or systolic dysfunction. Pathological processes in the failing heart (cardiomyocyte apoptosis, changes in interstitial tissue of the heart) are accompanied by an inflammatory cell response. In this paper cardiomyocyte apoptosis, inflammatory cell response and changes in interstitial tissue of the heart are reviewed as potential factors responsible for progression of the left ventricular dysfunction in heart failure.

Haemochromatosis-causing mutations C282Y and H63D are not risk factors for coronary artery disease in Caucasians with type 2 diabetes

Iron metabolism might be involved in the pathogenesis of CAD, and C282Y and H63D mutations in the HFE gene are associated with increased serum iron levels and net iron accumulation. The aim of this study was to look for a relationship between the C282Y and H63D gene mutations of the HFE gene and coronary artery disease (CAD) in a group of patients with type 2 diabetes lasting more than 10 years. The C282Y and H63D gene mutations were tested in 338 Caucasians with type 2 diabetes: 156 cases with CAD and 182 subjects with no history of CAD. The C282Y and the H63D HFE gene distributions in patients with CAD (C282Y: YY 0.6%, CY 9.0%, CC 90.4%; H63D: DD 3.8%, HD 21.8%, HH 74.4%) were not significantly different from those of diabetic subjects without CAD (C282Y: YY 0%, CY 8.2%, CC 91.8%; H63D: DD 2.2%, HD 20.3%, HH 77.5%). In conclusion, we failed to demonstrate that the C282Y and H63D HFE gene mutations were risk factors for CAD in Caucasians with type 2 diabetes lasting longer than 10 years.

Prothrombotic gene polymorphisms and atherothrombotic cerebral infarction

OBJECTIVES

To test the hypothesis whether risk genotypes of the prothrombotic gene polymorphisms (I/D 4G5G PAI-1, G1691A factor V point mutation, factor VII Arg/Gln353) are risk factors for ACI in the Slovene population. The study sought an association between the insertion/deletion 4G/5G-plasminogen activator inhibitor 1 (PAI-1) gene polymorphism, the 1691G-A factor V point mutation or the arg353-to-gln factor VII gene polymorphism and atherothrombotic cerebral infarction (ACI).

MATERIAL AND METHODS

Ninety-six Slovene patients who suffered ACI were compared with 115 control subjects clinically free of cerebrovascular disease. Insertion/deletion 4G/5G PAI-1 gene polymorphism, 1691G-A factor V point mutation and arg353-to-gln polymorphism in the factor VII were determined using polymerase chain reaction.

RESULTS

The 4G4G genotype of 4G5G PAI-1 gene polymorphism was less frequent in cases (21.9%) than in controls (35.6%; OR = 0.5, 95% CI = 0.3-1; P = 0.033). No association was found either between the factor V point mutation (1691G-A) or the RR genotype of the factor VII Arg/Gln353 gene polymorphism and the risk of ACI using univariate analysis.

CONCLUSION

The 4G/4G-PAI-1 genotype might be a protective factor against ACI, whereas the factor V point mutation (1691G-A) and the factor VII Arg/Gln353 gene polymorphism have not proved to be risk factors for ACI.