1
|
Belch JJF, Lowe GDO, Pollock JG, Prentice CRM. Low Dose Heparin in the Prevention of Deep-Vein Thrombosis after Aortic Bifurcation Graft Surgery. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAn optimal inhibition of tissue fibrinolysis, studied by a histochemical fibrin slide technique in the rat stomach, was obtained by administration of tranexamic acid in a dose of 60 mg/100 g body weight. A significant fibrinolysis inhibition was found within 5 min, when tranexamic acid in this dose was given either intravenously or intragastrically. A prolonged duration of fibrinolysis inhibition was observed after intragastric administration. After 4 hr no inhibitory effect of tranexamic acid could be recorded, irrespective of the route of administration.
Collapse
Affiliation(s)
- J J F Belch
- The Departments ofMedicine and Vascular Surgery, Royal Infirmary, Glasgow. G4 OSF
| | - G D O Lowe
- The Departments ofMedicine and Vascular Surgery, Royal Infirmary, Glasgow. G4 OSF
| | - J G Pollock
- The Departments ofMedicine and Vascular Surgery, Royal Infirmary, Glasgow. G4 OSF
| | - C R M Prentice
- The Departments ofMedicine and Vascular Surgery, Royal Infirmary, Glasgow. G4 OSF
| |
Collapse
|
2
|
Prowse CV, Farrugia A, Boulton FE, Tucker J, Ludlam CA, McLaren M, Belch JJF, Prentice CRM, Dawes J, MacGregor IR. A Comparative Study Using Immunological and Biological Assays of the Haemostatic Responses to DDAVP Infusion Venous Occlusion and Exercise in Normal Men. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661034] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a group of six normal male volunteers, infusion of DDAVP, venous occlusion and exercise were shown to increase plasma levels of factor VIII and plasminogen activator, activity and antigen, to different extents and at differing rates. Any mechanisms suggested to explain release of these proteins by various stimuli should account for such differences.All three stimuli could also increase plasma levels of prostacyclin metabolites, although this was only significant for high doses of DDAVP. Other potential endothelial markers, such as fibronectin and thrombospondin, showed no specific increase after any of the stimuli.
Collapse
Affiliation(s)
- C V Prowse
- The Edinburgh and South-East Scotland Blood Transfusion Service Edinburgh, Great Britain
| | - A Farrugia
- The Edinburgh and South-East Scotland Blood Transfusion Service Edinburgh, Great Britain
| | - F E Boulton
- The Edinburgh and South-East Scotland Blood Transfusion Service Edinburgh, Great Britain
| | - J Tucker
- The Department of Haematology, Royal Infirmary, Edinburgh, Great Britain
| | - C A Ludlam
- The Department of Haematology, Royal Infirmary, Edinburgh, Great Britain
| | - M McLaren
- The Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - J J F Belch
- The Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - C R M Prentice
- The Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - J Dawes
- The MRC/SNBTS Blood Components Assay Group, Forrest Road, Edinburgh, Great Britain
| | - I R MacGregor
- The Scottish National Blood Transfusion Service, Headquarters Laboratory, Forrest Road, Edinburgh, Great Britain
| |
Collapse
|
3
|
Belch JJF, McArdle BM, Burns P, Lowe GDO, Forbes CD. The Effects of Acute Smoking on Platelet Behaviour, Fibrinolysis and Haemorheology in Habitual Smokers. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1660996] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThere is an increased frequency of arterial thrombosis in cigarette smokers. The changes in blood coagulation seen in these subjects have been studied by many workers but results have not always been in agreement. We wished to study the effects of acute .smoking on platelet behaviour, fibrinolysis and haemorheology in ten habitual smokers, and to compare these results with nonsmoking controls. Results show that the smoking group had higher plasma fibrinogen (p <0.04), lower plasminogen (p <0.02) and plasminogen activator (p <0.05), and higher plasma viscosity (p <0.003). The changes seen in cigarette smokers after smoking three cigarettes were an increase in the rate of platelet aggregation to ADP (p <0.02), an increase in α2M, (p <0.02), and factor VIII RAG (p <0.05). Plasma viscosity was decreased (p <0.02) as was red cell deformability (p >0.02).We confirm an increased tendency to hypercoagulability in smokers compared to controls which becomes more pronounced immediately after smoking three cigarettes.
Collapse
Affiliation(s)
- J J F Belch
- The University Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - B M McArdle
- The University Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - P Burns
- The University Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - G D O Lowe
- The University Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| | - C D Forbes
- The University Department of Medicine, Royal Infirmary, Glasgow, Great Britain
| |
Collapse
|
4
|
Belch JJF, McLaren M, Lowe GDO, McIntyre DE, Forbes CD, Prentice CRM. Effect of Des-Amino-D-Arginine Vasopressin (DDAVP) on Plasma Levels of Platelet and Endothelial Cell Release Products – Reply. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J J F Belch
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| | - M McLaren
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| | - G D O Lowe
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| | - D E McIntyre
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| | - C D Forbes
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| | - C R M Prentice
- Depts of Medicine and Vascular Surgery, Royal Infirmary, Glasgow G4 OSF, U.K
| |
Collapse
|
5
|
Affiliation(s)
- I A Greer
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - J H Winter
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - D Gaffney
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - K McLoughlin
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - J J F Belch
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - G Boyd
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - C D Forbes
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| |
Collapse
|
6
|
Saniabadi AR, Lowe GDO, Belch JJF, Forbes CD, Prentice CRM, Barbenel JC. The Novel Effect of a New Prostacyclin Analogue ZK36374 on the Aggregation of Human Platelets in Whole Blood. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1665294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPlatelet aggregation was studied at 37° C in citrated whole human blood, using the Ultra Flo 100 Whole Blood Platelet Counter. Aggregation was measured as a fall in the number of single platelets following addition of an aggregating agent. At peak aggregation, the fall in the number of platelets induced by ADP (10 μM), collagen (1 μg/ml) or thrombin (0.2 U/ml) was about 90%. When blood was incubated with the prostacyclin- analogue ZK36374, the aggregation responses to ADP, collagen and thrombin were reduced with IC50’S = 0.5, 1.5 and 3 nM respectively and the corresponding IC100’S were: 1, 3 and 12 nM. When ZK36374 was added at peak aggregation, the number of single platelets increased significantly due to disaggregation of preformed platelet aggregates. It is concluded that the present technique represents a rapid, sensitive and more physiological approach for investigating the effects of pharmacological agents on platelet aggregation.
Collapse
Affiliation(s)
- A R Saniabadi
- The University Department of Medicine, Royal Infirmary, Glasgow, U. K
| | - G D O Lowe
- The University Department of Medicine, Royal Infirmary, Glasgow, U. K
| | - J J F Belch
- The University Department of Medicine, Royal Infirmary, Glasgow, U. K
| | - C D Forbes
- The University Department of Medicine, Royal Infirmary, Glasgow, U. K
| | - C R M Prentice
- The University Department of Medicine, Royal Infirmary, Glasgow, U. K
| | - J C Barbenel
- The Bioengineering Unit, University of Strathclyde, Glasgow, U. K
| |
Collapse
|
7
|
Belch JJF, Shaw B, O’Dowd A, Saniabadi A, Leiberman P, Sturrock RD, Forbes CD. Evening Primrose Oil (Efamol) in the Treatment of Raynaud’s Phenomenon: A Double Blind Study. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657880] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryProstaglandin E1 (PGE1) and prostacyclin have been used in Raynaud’s phenomenon (RP) but are unstable and require intravenous administration. An alternative approach is to stimulate the body’s own PGE1 production via administration of the precursor essential fatty acid. We studied the effect of 12 capsules/day of evening primrose oil (EPO) on the manifestations of RP. 21 patients received a two week course of placebo, thereafter 11 received EPO for 8 weeks and 10 patients received placebo. As the weather worsened the placebo group experienced significantly more attacks than the EPO group. Visual analogue scales assessing the severity of attacks and coldness of hands improved in the EPO group. No changes were seen in either group in hand temperatures and cold challenge plethysmography. Blood tests showed some antiplatelet effects of the drug. In conclusion patients receiving EPO benefited symptomatically. This was not matched however by any change in objective assessment of blood flow, although changes in platelet behaviour and blood prostanoids were observed.
Collapse
Affiliation(s)
- J J F Belch
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - B Shaw
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - A O’Dowd
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - A Saniabadi
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - P Leiberman
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - R D Sturrock
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| | - C D Forbes
- The Centre for Rheumatic Diseases, Department of Medicine and Vascular Surgery, Royal Infirmary, Glasgow, UK
| |
Collapse
|
8
|
Abstract
SummaryDes-amino-D-arginine vasopressin (DDAVP) stimulates the release of factor VIII and plasminogen activator from the vascular endothelium. An infusion of exogenous factor VIII given to haemophiliacs causes an increase in platelet activation. This activation does not occur after stimulating a rise in the patient's own factor VIII level caused by DDAVP infusion. We hypothesised therefore that DDAVP could also cause the endothelial release of prostacyclin (PGI2), a potent anti-platelet agent which would counteract the aggregating effect of factor VIII. To examine this possibility we studied the effect of DDAVP on prostacyclin release, as measured by its stable metabolite 6-oxo-PGFla, in vitro and in vivo. Rabbit aortic rings were incubated with different concentrations of DDAVP using saline as control. The supernatant was assayed for 6-oxo-PGFlct by radioimmunoassay. All concentrations of DDAVP gave a significant release of 6-oxo-PGF1α. Vasopressin was much less potent. When DDAVP was infused into haemophilic patients there was a significant increase in circulating 6-oxo-PGF1α levels immediately after the infusion. The facial flushing observed as a side-effect of DDAVP could therefore be prostacyclin-mediated. We confirmed this by abolishing the DDAVP induced flushing seen in normal subjects by prior treatment with aspirin which inhibits PGI2 formation.
Collapse
Affiliation(s)
- J J F Belch
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - M Small
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - F McKenzie
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - P A Hill
- The Department of Pharmacology, Glasgow University, Glasgow, U. K
| | - G D O Lowe
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - D E McIntyre
- The Department of Pharmacology, Glasgow University, Glasgow, U. K
| | - C D Forbes
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - C R.M Prentice
- The Department of Medicine, Glasgow Royal Infirmary, Glasgow
| |
Collapse
|
9
|
Douglas JT, Shah M, Lowe GDO, Belch JJF, Forbes CD, Prentice CRM. Plasma Fibrinopeptide A and Beta-Thromboglobulin in Pre-Eclampsia and Pregnancy Hypertension. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657124] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIncreased plasma levels of β-thromboglobulin (βTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in normal women, women taking oral contraceptives, normal pregnancy and pregnant women with hypertension or pre-eclampsia. No significant increases in βTG or FPA were found in women taking oral contraceptives. Significantly increased concentrations of βTG, but not FPA, were found in normal pregnant women in the second and third trimester of pregnancy when compared with nonpregnant age-matched controls. In eleven women with pregnancy hypertension and thirteen women with pre-eclampsia significantly elevated levels of both βTG and FPA were found when compared with age, parity and gestation-matched pregnant controls. Although the mean value for both βTG and FPA in the group with pre-eclampsia was higher than the group with pregnancy hypertension, the difference was not statistically significant. These findings provide additional evidence that pre-eclampsia and pregnancy hypertension are associated with activation of the coagulation system and the platelet release reaction.
Collapse
Affiliation(s)
- J T Douglas
- The University Department of Medicine, Royal Infirmary, Glasgow, U.K
| | - M Shah
- The University Department of Obstetrics, Royal Maternity Hospital, Glasgow, U.K
| | - G D O Lowe
- The University Department of Medicine, Royal Infirmary, Glasgow, U.K
| | - J J F Belch
- The University Department of Medicine, Royal Infirmary, Glasgow, U.K
| | - C D Forbes
- The University Department of Medicine, Royal Infirmary, Glasgow, U.K
| | - C R M Prentice
- The University Department of Medicine, Royal Infirmary, Glasgow, U.K
| |
Collapse
|
10
|
Belch JJF, Douglas JT, Lowe GDO, Forbes CD, Prentice CRM. Platelet Aggregation after Elevation of Factor VIII Following DDAVP Infusion in Haemophilia A Patients. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J J F Belch
- University Dept of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 0SF
| | - J T Douglas
- University Dept of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 0SF
| | - G D O Lowe
- University Dept of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 0SF
| | - C D Forbes
- University Dept of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 0SF
| | - C R M Prentice
- University Dept of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 0SF
| |
Collapse
|
11
|
Belch JJF, Newman P, Drury JK, Capell H, Leiberman P, James WB, Forbes CD, Prentice CRM. Successful Treatment of Raynaud's Syndrome with Prostacyclin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650182] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThere is evidence to suggest that platelet activation occurs in Raynaud’s syndrome. We evaluated the effect of prostacyclin (PGI2) a potent antiplatelet and vasodilator agent in 5 female patients with Raynaud’s syndrome. Outpatient visits were made at weekly intervals for 4 weeks. At the first visit buffer solution (Wellcome Laboratories) was infused intravenously for 5 hrs, thereafter three five hr infusions of PGI2 at a peak dose of 10 ng/ Kg/min were given. Six weeks after the infusions patients were reviewed. Symptomatic improvement, including healing of ischaemic ulcers, occurred in 4 out of 5 patients. Thermography confirmed an increase in hand temperature after PCI2. Subjective and objective improvement has persisted for at least 6 weeks after the last treatment.
Collapse
Affiliation(s)
- J J F Belch
- The Department of Medicine, Southern General Hospital, Glasgow, U. K
| | - P Newman
- The Department of Clinical Physics and Bioengineering, West of Scotland Health Board, U. K
| | - J K Drury
- The Department of Vascular Surgery, Glasgow Royal Infirmary, Southern General Hospital, Glasgow, U. K
| | - H Capell
- The Department of Medicine, Southern General Hospital, Glasgow, U. K
| | - P Leiberman
- The Department of Vascular Surgery, Glasgow Royal Infirmary, Southern General Hospital, Glasgow, U. K
| | - W B James
- The Department of Radiology, Southern General Hospital, Glasgow, U. K
| | - C D Forbes
- The Department of Medicine, Southern General Hospital, Glasgow, U. K
| | - C R M Prentice
- The Department of Medicine, Southern General Hospital, Glasgow, U. K
| |
Collapse
|
12
|
Affiliation(s)
- J J F Belch
- University Department of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 OSF, Scotland, U. K
| | - G D O Lowe
- University Department of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 OSF, Scotland, U. K
| | - M M Drummond
- University Department of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 OSF, Scotland, U. K
| | - C D Forbes
- University Department of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 OSF, Scotland, U. K
| | - C R M Prentice
- University Department of Medicine, Royal Infirmary, 86 Castle Street, Glasgow G4 OSF, Scotland, U. K
| |
Collapse
|
13
|
Casanova F, Adingupu DD, Adams F, Gooding KM, Looker HC, Aizawa K, Dove F, Elyas S, Belch JJF, Gates PE, Littleford RC, Gilchrist M, Colhoun HM, Shore AC, Khan F, Strain WD. The impact of cardiovascular co-morbidities and duration of diabetes on the association between microvascular function and glycaemic control. Cardiovasc Diabetol 2017; 16:114. [PMID: 28915818 PMCID: PMC5603035 DOI: 10.1186/s12933-017-0594-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/04/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Good glycaemic control in type 2 diabetes (T2DM) protects the microcirculation. Current guidelines suggest glycaemic targets be relaxed in advanced diabetes. We explored whether disease duration or pre-existing macrovascular complications attenuated the association between hyperglycaemia and microvascular function. METHODS 743 participants with T2DM (n = 222), cardiovascular disease (CVD = 183), both (n = 177) or neither (controls = 161) from two centres in the UK, underwent standard clinical measures and endothelial dependent (ACh) and independent (SNP) microvascular function assessment using laser Doppler imaging. RESULTS People with T2DM and CVD had attenuated ACh and SNP responses compared to controls. This was additive in those with both (ANOVA p < 0.001). In regression models, cardiovascular risk factors accounted for attenuated ACh and SNP responses in CVD, whereas HbA1c accounted for the effects of T2DM. HbA1c was associated with ACh and SNP response after adjustment for cardiovascular risk factors (adjusted standardised beta (β) -0.096, p = <0.008 and -0.135, p < 0.001, respectively). Pre-existing CVD did not modify this association (β -0.099; p = 0.006 and -0.138; p < 0.001, respectively). Duration of diabetes accounted for the association between HbA1c and ACh (β -0.043; p = 0.3), but not between HbA1c and SNP (β -0.105; p = 0.02). CONCLUSIONS In those with T2DM and CVD, good glycaemic control is still associated with better microvascular function, whereas in those with prolonged disease this association is lost. This suggests duration of diabetes may be a better surrogate for "advanced disease" than concomitant CVD, although this requires prospective validation.
Collapse
Affiliation(s)
- F Casanova
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - D D Adingupu
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Adams
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - K M Gooding
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - H C Looker
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - K Aizawa
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Dove
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - S Elyas
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - J J F Belch
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - P E Gates
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - R C Littleford
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - M Gilchrist
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - H M Colhoun
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - A C Shore
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Khan
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
| | - W D Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK.
| |
Collapse
|
14
|
Lambert M, Belch JJF, Khan F, Vermeer C, Kennedy G, Hill A, Witham M. 49VITAMIN K STATUS AND MARKERS OF VASCULAR FUNCTION IN OLDER PEOPLE WITH ORTHOSTATIC HYPOTENSION. Age Ageing 2015. [DOI: 10.1093/ageing/afv109.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Weir-McCall JR, White RD, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Houston JG. 30 Whole body contrast enhanced MRA can quantify and monitor atherosclerosis progression. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Witham MD, Adams F, McSwiggan S, Kennedy G, Kabir G, Belch JJF, Khan F. Effect of intermittent vitamin D3 on vascular function and symptoms in chronic fatigue syndrome--a randomised controlled trial. Nutr Metab Cardiovasc Dis 2015; 25:287-294. [PMID: 25455721 DOI: 10.1016/j.numecd.2014.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Low 25-hydroxyvitamin D levels are common in patients with chronic fatigue syndrome; such patients also manifest impaired vascular health. We tested whether high-dose intermittent oral vitamin D therapy improved markers of vascular health and fatigue in patients with chronic fatigue syndrome. METHODS AND RESULTS Parallel-group, double-blind, randomised placebo-controlled trial. Patients with chronic fatigue syndrome according to the Fukuda (1994) and Canadian (2003) criteria were randomised to receive 100,000 units oral vitamin D3 or matching placebo every 2 months for 6 months. The primary outcome was arterial stiffness measured using carotid-femoral pulse wave velocity at 6 months. Secondary outcomes included flow-mediated dilatation of the brachial artery, blood pressure, cholesterol, insulin resistance, markers of inflammation and oxidative stress, and the Piper Fatigue scale. As many as 50 participants were randomised; mean age 49 (SD 13) years, mean baseline pulse wave velocity 7.8 m/s (SD 2.3), mean baseline office blood pressure 128/78 (18/12) mmHg and mean baseline 25-hydroxyvitamin D level 46 (18) nmol/L. 25-hydroxyvitamin D levels increased by 22 nmol/L at 6 months in the treatment group relative to placebo. There was no effect of treatment on pulse wave velocity at 6 months (adjusted treatment effect 0.0 m/s; 95% CI -0.6 to 0.6; p = 0.93). No improvement was seen in other vascular and metabolic outcomes, or in the Piper Fatigue scale at 6 months (adjusted treatment effect 0.2 points; 95% CI -0.8 to 1.2; p = 0.73). CONCLUSION High-dose oral vitamin D3 did not improve markers of vascular health or fatigue in patients with chronic fatigue syndrome. TRIAL REGISTRATION www.controlled-trials.com, ISRCTN59927814.
Collapse
Affiliation(s)
- M D Witham
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK.
| | - F Adams
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - S McSwiggan
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - G Kennedy
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - G Kabir
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - J J F Belch
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - F Khan
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| |
Collapse
|
17
|
Abstract
Critical limb ischaemia (CLI) is a severe form of peripheral arterial disease (PAD). CLI often causes disabling symptoms of pain and can lead to loss of the affected limb. It is also associated with increased risk of myocardial infarction, stroke and death from cardiovascular disease. The aims of management in patients with CLI are to relieve ischaemic pain, heal ulcers, prevent limb loss, improve function and quality of life and prolong survival. Here, current evidence regarding the medical management of CLI is reviewed. Cardiovascular risk factors should be assessed in all patients with CLI; smoking cessation and treatment of hypertension, hyperlipidaemia and diabetes all reduce the mortality rate in those with PAD. Antiplatelet agents (either aspirin or clopidogrel) are recommended to reduce both the incidence of cardiovascular events and risk of arterial occlusion. By contrast, routine use of anticoagulation (either warfarin or heparin) is not recommended. Treatment of the limbs themselves is often more challenging. Prostanoids may have some efficacy for treating rest pain and for ulcer healing, and iloprost shows favourable results in reducing the risk of major amputations, but long-term follow-up data regarding disease progression are lacking. There is insufficient evidence to support the use of naftidrofuryl or cilostazol, and pentoxifylline is not beneficial. Furthermore, there is no evidence of proven benefit of hyperbaric oxygen. A number of angiogenic growth factors have been studied in Phase I studies and randomized controlled trials (RCTs). They appear to be safe, but efficacy results have been mixed. Treatment with stem cells also shows some potential from early trials, but further larger RCTs are needed to demonstrate clear benefit. Thrombolysis may be an alternative for patients who develop acute limb ischaemia and are unsuitable for surgical intervention. However, newer endovascular techniques are likely to have a greater role in the future.
Collapse
Affiliation(s)
- M A Lambert
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | |
Collapse
|
18
|
Newton DJ, Davies J, Belch JJF, Khan F. Role of endothelium-derived hyperpolarising factor in acetylcholine-mediated vasodilatation in skin. INT ANGIOL 2013; 32:312-318. [PMID: 23711683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Acetylcholine (ACh) is an endothelium-dependent vasodilator used to investigate endothelial function in the microcirculation. The mediators of its vasodilatory effects are not clear, but endothelium-derived hyperpolarising factor (EDHF) is thought to contribute, and appears to have particular importance in smaller peripheral vessels. The aim of this study was to investigate the role of EDHF in ACh-mediated vasodilator responses in human forearm skin. METHODS Laser Doppler imaging was used to measure forearm skin blood flow responses to iontophoretic administration of ACh in 7 healthy men. ACh in a 10-mg/mL solution was administered in accumulating doses using increasing delivery currents of 10, 15, 20, 50 and 100 µA. The measurements were repeated on subsequent visits when the effects of EDHF were blocked using intra-arterial sulphaphenazole at 2 mg/min (a cytochrome P-450 inhibitor), nitric oxide (NO) was blocked using intra-arterial administration of the NO synthetase inhibitor l-NG-monomethyl arginine (l-NMMA) at 4 µmol/min, and prostanoids were blocked with oral aspirin 1 g. RESULTS The microvascular response to ACh was significantly attenuated by sulphaphenazole alone (P=0.018), l-NMMA alone (P<0.001) and the combination of sulphaphenazole plus l-NMMA (P<0.001), and aspirin had no additional effect. CONCLUSION EDHF is a significant contributor to the vasodilatory effects of ACh in the human dermal microcirculation. Information about abnormalities in specific pathways of endothelial function in patient groups may help in the targeting of appropriate drug therapies.
Collapse
Affiliation(s)
- D J Newton
- Vascular and Inflammatory Diseases Research Unit, The Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | |
Collapse
|
19
|
Kumar P, Kennedy G, Khan F, Pullar T, Belch JJF. Rosuvastatin might have an effect on C-reactive protein but not on rheumatoid disease activity: Tayside randomized controlled study. Scott Med J 2012; 57:80-3. [DOI: 10.1258/smj.2012.012004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to study the effects of rosuvastatin in patients with rheumatoid arthritis (RA) looking at the C-reactive protein (CRP), interleukin-6 (IL-6) and joint disease activity. Fifty RA patients were randomized in a double-blind placebo-controlled trial to receive either 10 mg of rosuvastatin or placebo as an adjunct to existing disease-modifying antirheumatic therapy. Patients were followed up for a six-month period. Measurements were done at baseline and six months. CRP and IL-6 were measured in the blood. RA disease activity was measured using disease activity score based on 28 joint counts (DAS 28). When analysing from baseline to six months there was no difference between the rosuvastatin and placebo groups in rheumatoid disease activity (–0.01; standard deviation [SD], 1.08; and +0.18; SD, 0.95; respectively; P value 0.509). There was a trend towards improvement in CRP in the rosuvastatin group (–3.23; SD, 18.18) compared with the placebo group (+17.43; SD, 38.03); P value, 0.161. IL-6 showed a trend towards worsening in the rosuvastatin group (+0.15; SD, 1.09) compared with placebo (–0.73; SD, 1.4); P value, 0.054. These data show that rosuvastatin with might decrease the CRP independent to IL-6 in patients with RA but does not improve the overall rheumatoid disease activity.
Collapse
Affiliation(s)
- P Kumar
- Vascular and Inflammatory Diseases Research Unit, Division of Medicine, University of Dundee, Dundee, Scotland, UK
| | - G Kennedy
- Vascular and Inflammatory Diseases Research Unit, Division of Medicine, University of Dundee, Dundee, Scotland, UK
| | - F Khan
- Vascular and Inflammatory Diseases Research Unit, Division of Medicine, University of Dundee, Dundee, Scotland, UK
| | - T Pullar
- Ninewells University Hospital, Dundee, Scotland, UK
| | - J J F Belch
- Vascular and Inflammatory Diseases Research Unit, Division of Medicine, University of Dundee, Dundee, Scotland, UK
| |
Collapse
|
20
|
Green FC, Levison R, Newton DJ, Littleford R, Stonebridge PA, Belch JJF. Detecting diabetes and impaired glucose tolerance in patients with atherosclerotic peripheral arterial disease. INT ANGIOL 2012; 31:125-128. [PMID: 22466976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM In patients with peripheral arterial disease (PAD), diabetes mellitus is associated with increased mortality rates. The aim of this study was to estimate the prevalence of undiagnosed diabetes in PAD patients, and to assess whether a glucose tolerance test is more sensitive than a simple fasting glucose measurement for diagnosis in this group. METHODS A standard glucose tolerance test and fasting glucose measurements were performed in 53 patients with PAD, who were then categorised into diagnostic groups according to each test result. RESULTS Using the glucose tolerance test results, 11.5% of patients were diagnosed with diabetes mellitus and 28.8% had either impaired fasting glucose or impaired glucose tolerance. Using fasting glucose levels only, 7.7% received a diagnosis of diabetes mellitus and 17.3% had impaired fasting glucose. The glucose tolerance data and the fasting glucose data were in agreement in 82.7% of cases, but the glucose tolerance test identified an additional 3.8% of cases with diabetes and an additional 13.5% of cases with impaired glucose tolerance. CONCLUSION Undiagnosed diabetes and impaired glucose homeostasis are common in patients with PAD. Routine screening using a simple glucose tolerance test should be considered in the clinical assessment of this group.
Collapse
Affiliation(s)
- F C Green
- Vascular Laboratory, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | | | | | |
Collapse
|
21
|
Belch JJF, Ray S, Rajput-Ray M, Engeset J, Fagrell B, Lepäntalo M, McKay A, Mackay IR, Ostergren J, Ruckley CV, Salenius J. The Scottish-Finnish-Swedish PARTNER study of taprostene versus placebo treatment in patients with critical limb ischemia. INT ANGIOL 2011; 30:150-155. [PMID: 21427652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Atherosclerotic peripheral arterial disease is a major health problem in the western world, often manifested as intermittent claudication, affecting 10-20% males above 60 years. Ischemic complications can lead to rest pain, ulceration and gangrene. The treatment of choice for critical limb ischemia (CLI) is vascular reconstruction or endovascular interventions. Medical management with vasodilator antiplatelet prostaglandins, could be considered in patients unsuitable for surgery. Long term follow-up on previous prostaglandin studies has been insufficient to evaluate amputation rates. Hence this study evaluated safety and longer term efficacy of taprostene sodium, a prostacyclin (PGI2) analogue in CLI. The aim of this study was to determine whether Taprostene sodium, a PGI2 analogue, was a safe and effective treatment for CLI. METHODS This paper reports the data from the Scottish-Finnish-Swedish PARTNER Study Group which consisted of a double-blind placebo controlled multi-centre study evaluating Taprostene compared to placebo. The primary endpoints were pain relief and early ulcer healing response at the end of the four week infusion phase and amputation at six months follow-up. The patients were randomly allocated to receive taprostene or placebo in a two to one randomization of active versus placebo. A total of 111 patients with CLI were recruited. Taprostene was given twice a day over two 2 hour periods for four weeks. The early response was evaluated at the end of the four week infusion phase. In patients with rest pain without ulceration, a positive response was complete pain relief without any requirement for analgesic therapy. However in patients with ulceration, a positive response was defined as a decrease in the ulcer size by >30%. Amputation scores were compared at the end of the 6 months follow-up period for all participants. RESULTS Seventy-four patients received taprostene and 37 placebo. Overall, 61 male patients were enrolled in the study along with 50 females with 11% more women in the taprostene (active) group. For both patients with and without ulcers there was no statistically significant difference noted in the early response between those receiving taprostene and those receiving placebo infusion. The percentage of patients without any amputations was 43% in the taprostene group compared to 38% in the control group at the end of six months; however, these results were not statistically significant. CONCLUSION Although a reasonable number of patients enrolled in the study it has not been possible to demonstrate any statistically significant benefit of taprostene over placebo. This may be due to more patients with risk factors for peripheral artery disease (PAD) such as hypertension, diabetes mellitus and cigarette smoking in the actively treated group and also due the increased number of women in the active group who are known to generally respond less favourably to antiplatelet agents.
Collapse
Affiliation(s)
- J J F Belch
- C1Peripheral Vascular Diseases Research Unit, Institute of Cardiovascular Research, Ninewells Hospital, Dundee, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Galarraga B, McSwiggan S, Caswell FR, Brodie RC, Sharma P, Abel EW, Newton DJ, Belch JJF. A novel approach to measuring skin elasticity in systemic sclerosis: results from a pilot study. Scand J Rheumatol 2011; 40:211-6. [PMID: 21231806 DOI: 10.3109/03009742.2010.530610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is characterized by progressive fibrosis of various organs, and causes hard, tethered, and inelastic skin. The modified Rodnan score is used to quantify skin involvement, but this method is subjective and user dependent. The aim of this study was to test the ability of a new skin torsion device to measure skin elasticity in patients with SSc. METHODS The study included 16 female SSc patients and 58 healthy controls. Skin elasticity was assessed on the forearms and backs of the hands using a new hand-held device that gently rotates the skin for 15 s to a maximum of 40 deg, and measures the speed of rotation and the angle of rotation at 15 s. Total and localized modified Rodnan scores were also documented. RESULTS Measurements produced by the skin torsion device had good intra-subject reproducibility, particularly in the control group. The SSc patients had significantly lower skin elasticity than an age-matched subgroup of control subjects, as determined by the median speed of rotation of the device in the hands (1.91 vs. 2.60 deg/s, p < 0.0001) and forearms (1.84 vs. 2.46 deg/s, p < 0.0001), and the rotation at 15 s in the hands (28.6 vs. 39.0 deg, p < 0.0001) and forearms (27.6 vs. 36.9 deg, p < 0.0001). The presence of SSc disease was the only independent predictor of skin elasticity. CONCLUSIONS This pilot study has shown the potential value of a new skin torsion device to assess skin involvement in patients with SSc.
Collapse
Affiliation(s)
- B Galarraga
- Vascular and Inflammatory Diseases Research Unit, The Institute of Cardiovascular Research, Dundee, UK
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Galarraga B, Khan F, Kumar P, Pullar T, Belch JJF. Etanercept improves inflammation-associated arterial stiffness in rheumatoid arthritis. Rheumatology (Oxford) 2009; 48:1418-23. [DOI: 10.1093/rheumatology/kep251] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
|
25
|
|
26
|
|
27
|
|
28
|
Kirk G, Maple C, McLaren M, Belch JJF. Short Communication: A Circadian Rhythm may Exist in Healthy Controls for Soluble P-Selectin and Platelet Count. Platelets 2009; 6:414-5. [DOI: 10.3109/09537109509078482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Belch JJF, Inorburn J, Greer IA, Sarfo S, Prentice CRM. Intravenous Prostacyclin in the Management of Pregnancies Complicated by Severe Hypertension. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/10641958509031657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
30
|
McLaren M, Bancroft A, Alexander W, Belch JJF. Short Communication: Platelet Aggregation in Whole Blood: Comparison Between Clay Adams Ultra-FLO 100 and Coulter Haematology Analyser T-540. Platelets 2009; 1:95-6. [DOI: 10.3109/09537109009005470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Abstract
This mini review evaluates mortality in SSc and provides a literature review concluding that premature death does occur in this population. However, there has been a changing spectrum of cause of death over the past three decades, with interstitial lung disease now being the commonest cause of SSc-related mortality. Cardiovascular (CV) mortality and events also contribute to the premature mortality seen in these patients, and this contention is supported by epidemiological studies, and further underpinned by a plethora of increased biomarkers for CV disease and events. Thus, macrovascular disease does occur in these patients, and is likely to contribute to mortality. It remains to be seen whether addressing conventional risk factors will attenuate CV disease in this population.
Collapse
Affiliation(s)
- J J F Belch
- Vascular and Inflammatory Diseases Research Unit, Ninewells Hospital, Tayside, Scotland, UK.
| | | | | |
Collapse
|
32
|
Robinson M, Gray SR, Watson MS, Kennedy G, Hill A, Belch JJF, Nimmo MA. Plasma IL-6, its soluble receptors and F2-isoprostanes at rest and during exercise in chronic fatigue syndrome. Scand J Med Sci Sports 2009; 20:282-90. [PMID: 19422646 DOI: 10.1111/j.1600-0838.2009.00895.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of the current study was to investigate the levels of interleukin-6 (IL-6), its soluble receptors (sIL-6R and sgp130) and F(2)-isoprostanes, at rest and during exercise, in patients with chronic fatigue syndrome (CFS). Six male CFS patients and six healthy controls performed an incremental exercise test to exhaustion and a submaximal exercise bout to exhaustion. Blood samples taken in the submaximal test at rest, immediately post-exercise and 24 h post-exercise were analyzed for IL-6, sIL-6R, sgp130 and F(2)-isoprostanes. A further 33 CFS and 33 healthy control participants gave a resting blood sample for IL-6 and sIL-6R measurement. During the incremental exercise test only power output at the lactate threshold was lower (P<0.05) in the CFS group. F(2)-isoprostanes were higher (P<0.05) in CFS patients at rest and this difference persisted immediately and 24 h post-exercise. The exercise study found no differences in IL-6, sIL-6R or sgp130 at any time point between groups. In the larger resting group, there were no differences in IL-6 and sIL-6R between CFS and control groups. This investigation has demonstrated that patients with CFS do not have altered plasma levels of IL-6, sIL-6R or sgp130 either at rest or following exercise. F(2)-isoprostanes, however, were consistently higher in CFS patients.
Collapse
Affiliation(s)
- M Robinson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | | | | | | | | | | |
Collapse
|
33
|
Libby G, McEwan SR, Morris AD, Belch JJF. No difference in the association between birth weight and total cholesterol for males and females. A SHARP (Scottish Heart and Arterial Disease Risk Prevention) study. Vasc Med 2009; 13:271-4. [PMID: 18940903 DOI: 10.1177/1358863x08093465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We carried out a cohort study in a relatively young healthy working population to assess any difference between males and females in the association between birth weight and adult total cholesterol. Perinatal data came from the Walker database of babies born between 1952 and 1966 in Dundee, Scotland. This was record-linked to information from the SHARP (Scottish Heart and Arterial Risk Prevention) cohort who had undergone a cardiovascular risk screening between 1991 and 1993. There were 1158 individuals (56% male, mean age 32.1 years). For both males and females there was no association between birth weight and cholesterol either unadjusted or after adjustment for BMI and other potential confounders: B = -0.11 (95% CI -0.03, 0.04) for males, B = -0.15 (95% CI -0.31, 0.01) for females. All individuals together showed a slight decrease in cholesterol for 1 kg increase in birth weight but only after adjustment for BMI: B = -0.13 (95% CI -0.24, -0.01). These results suggest no difference in the relationship between birth weight and total cholesterol for males and females.
Collapse
Affiliation(s)
- G Libby
- Division of Community Health Sciences, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | | | |
Collapse
|
34
|
Galarraga B, Khan F, Kumar P, Pullar T, Belch JJF. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:1780-4. [DOI: 10.1093/rheumatology/ken386] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
35
|
Newton DJ, Khan F, Kennedy G, Belch JJF. Improvement in systemic endothelial condition following amputation in patients with critical limb ischemia. INT ANGIOL 2008; 27:408-412. [PMID: 18974704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Most patients with critical limb ischemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality. Peripheral ischemic tissue produces circulating toxic molecules, which may worsen endothelial function systemically and contribute to the general atherosclerotic process within the body. We looked at whether markers of endothelial function improve after amputation of the ischemic limb, when this potential source of toxins has been removed. METHODS We measured blood levels of vascular endothelial growth factor (VEGF), homocysteine, endothelin-1, vascular cell adhesion molecule-1, E-selectin, thrombomodulin and von Willebrand factor (vWF) in 40 patients with CLI. We also assessed peripheral microvascular function in forearm skin by measuring responses to iontophoresis of acetylcholine and sodium nitroprusside. The measurements were repeated 6 months after amputation. RESULTS We found abnormally high levels of endothelial products in the patients, and 6 months later VEGF and vWF had both reduced significantly from previous values (by 70% and 40%, respectively; P<0.01 in both cases). CONCLUSION Improvements in these two markers after amputation are consistent with the hypothesis that peripheral ischemic tissue has a systemic effect on the vascular endothelium and may contribute to the progression of coronary heart disease in patients with CLI.
Collapse
Affiliation(s)
- D J Newton
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | |
Collapse
|
36
|
Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C, Ogston S, Nuki G, Belch JJF. Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:665-9. [PMID: 18362100 DOI: 10.1093/rheumatology/ken024] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA. METHODS Dual-centre, double-blind placebo-controlled randomized study of 9 months' duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure. RESULTS Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P = 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed. CONCLUSIONS This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.
Collapse
Affiliation(s)
- B Galarraga
- Vascular and Inflammatory Diseases Research Unit, University Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Franklin VL, Khan F, Kennedy G, Belch JJF, Greene SA. Intensive insulin therapy improves endothelial function and microvascular reactivity in young people with type 1 diabetes. Diabetologia 2008; 51:353-60. [PMID: 18040663 DOI: 10.1007/s00125-007-0870-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 07/19/2007] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Macrovascular disease is an important cause of the increased morbidity and mortality rates associated with type 1 diabetes, and this vascular impairment begins in childhood. The aim of this study was to determine whether introducing intensive diabetes management [intensive insulin therapy (IIT) and 'Sweet Talk' text-messaging support] produces measurable improvements in endothelial function. METHODS One hundred and twenty-six patients fulfilled the eligibility criteria (type 1 diabetes for >1 year; on conventional insulin therapy (CIT); aged between 8 and 18 years), of whom 92 enrolled. Patients were randomised to group 1, CIT only (n=28); group 2, CIT and Sweet Talk (n=33); or group 3, IIT and Sweet Talk (n=31). Vascular assessments (including measures of endothelial damage, activation, dysfunction and oxidative stress) and HbA1c were performed at baseline and repeated after 12 months of the study. RESULTS Glycaemic control deteriorated in patients on CIT, but improved significantly in patients allocated to IIT (p=0.007). IIT was associated with significantly greater improvements in E-selectin (p<0.0001) than CIT (group 1, p=0.026 and group 2, p=0.053). Vascular responses to acetylcholine improved in patients on IIT (p=0.017), but not in patients receiving CIT. These changes were all independent of HbA1c level. CONCLUSIONS/INTERPRETATION IIT appears to be associated with improvements in vascular markers, independently of changes in HbA1c, suggesting that IIT may confer vascular protection in addition to improving glycaemic control.
Collapse
Affiliation(s)
- V L Franklin
- Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | | | |
Collapse
|
38
|
Dias MP, Newton DJ, McLeod GA, Khan F, Belch JJF. The inhibitory effects of local anaesthetics on the vascular flare responses to bradykinin and substance P in human skin*. Anaesthesia 2008; 63:151-5. [DOI: 10.1111/j.1365-2044.2007.05324.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Abstract
The vasodilator properties of lidocaine are believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. However, mechanisms involving the vascular endothelium may also play a role, and in this study we investigated the potential influences of nitric oxide release, the cyclo-oxygenase pathway and the beta-adrenoceptors of vascular smooth muscle. Laser Doppler imaging was used to measure microvascular blood flow responses to intradermal injection of lidocaine 2%, with or without the addition of preservatives, in eight healthy, male volunteers. Co-injection of the nitric-oxide-synthase inhibitor Nomega-nitro-L-arginine methyl ester caused a 60% reduction in the response after about 20 min, and this reduction was enhanced with the lidocaine solution containing the preservatives methylhydroxybenzoate and propylhydroxybenzoate. No reduction in response was seen after blocking the cyclo-oxygenase or beta-adrenoceptor pathways. Nitric oxide release contributes to the vasoactivity of lidocaine in human skin.
Collapse
Affiliation(s)
- D J Newton
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University Department of Anaesthesia, Dundee DD1 9SY, UK.
| | | | | | | |
Collapse
|
40
|
George J, Carr E, Davies J, Belch JJF, Struthers A. High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation 2006; 114:2508-16. [PMID: 17130343 DOI: 10.1161/circulationaha.106.651117] [Citation(s) in RCA: 405] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Allopurinol has been shown to improve endothelial function in chronic heart failure. This study aimed to establish its mechanism of action and to construct a dose-response curve for the effect of allopurinol. METHODS AND RESULTS Two randomized, placebo-controlled, double-blind, crossover studies were performed for 1 month on patients with New York Heart Association Class II-III chronic heart failure, comparing 300 mg allopurinol, 600 mg allopurinol, and placebo for the first study and 1000 mg probenecid versus placebo in the second study. Endothelial function was assessed by standard forearm venous occlusion plethysmography. Allopurinol 600 mg/d significantly increased forearm blood flow response to acetylcholine compared with both allopurinol 300 mg/d and placebo (% change in forearm blood flow [mean+/-SEM]: 240.31+/-38.19% versus 152.10+/-18.21% versus 73.96+/-10.29%, P<0.001). For similar levels of urate lowering, the uricosuric agent probenecid had no effect on endothelial function. Sodium nitroprusside response was unchanged by all treatments. Vitamin C and acetylcholine coinfusion data showed that 600 mg/d allopurinol completely abolished the oxidative stress that was sensitive to high-dose vitamin C. CONCLUSIONS For the first time, we have shown that a steep dose-response relationship exists between allopurinol and its effect on endothelial function. We also showed that the mechanism of improvement in endothelial function with allopurinol lies in its ability to reduce vascular oxidative stress and not in urate reduction. The reduction in vascular oxidative stress was profound because high-dose allopurinol totally abolished the oxidative stress that was sensitive to the high-dose vitamin C that was used in this study.
Collapse
Affiliation(s)
- Jacob George
- Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | | | | | | | | |
Collapse
|
41
|
Khan F, Kerr H, Ross RA, Newton DJ, Belch JJF. Effects of poor glucose handling on arterial stiffness and left ventricular mass in normal children. INT ANGIOL 2006; 25:268-73. [PMID: 16878075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM Cardiovascular risk factors can be present in children and young adults. We previously found abnormal microvascular function in children who had glucose intolerance and insulin resistance. The aim of the present study was to investigate whether they also have abnormalities in left ventricular mass (LVM) and arterial stiffness. METHODS We measured heart dimensions and LVM using echocardiography, and arterial stiffness using pulse wave analysis in 23 children with good glucose handling (postfeeding glucose: 3.9 to 5 mmol/L) and 21 with poor glucose handling (7.7 to 11.4 mmol/L). RESULTS The time to pulse reflection was slightly shorter in the poorer glucose handlers (mean+/-SD: 143+/-10 vs 153+/-20 ms, P=0.04), suggestive of increased arterial stiffness. Also in this group, there were significant relationships between intraventricular septal thickness, blood pressure and body mass index, but not in the normal glucose handlers. CONCLUSIONS We have found that normal children who are in the lowest quintile of glucose tolerance in comparison with their peers are exhibiting the first signs of arterial stiffening. In addition, we have seen the beginnings of a relationship between blood pressure, body mass index and left ventricular enlargement in this group. While these changes may not yet be clinically significant, their emergence might be further evidence of early predisposition to cardiovascular disease.
Collapse
Affiliation(s)
- F Khan
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | | | |
Collapse
|
42
|
McLaren M, Waring A, Galarraga B, Rudd A, Morley K, Belch JJF. Investigation of platelet glycoprotein IIIa polymorphism using flow cytometry in patients with rheumatoid arthritis. Scand J Rheumatol 2006; 34:437-40. [PMID: 16393764 DOI: 10.1080/03009740510026607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Previous work has shown that the human platelet antigen (HPA) 1b polymorphism of platelet glycoprotein IIIa (GPIIIa) is implicated in the development of ischaemic vascular disease. HPA1b positive platelets have a lower threshold for activation and may exert a greater thrombotic tendency than those without the 1b allele. However, platelets heterozygous for the polymorphism are also more sensitive to aspirin than those homozygous for the 1b allele, which have a similar sensitivity to those without the 1b allele. A flow cytometric method has become available to identify this polymorphism. The aim of our study was to evaluate the use of this assay in patients with rheumatoid arthritis (RA) and to determine the incidence of the 1b allele in these patients. We also compared platelet aggregation and platelet/white blood cell interaction in patients with or without this polymorphism. METHODS We enrolled 99 patients and measured platelet aggregation in whole blood and platelet-rich plasma (prp), platelet/white blood cell interaction and C-reactive protein (CRP). RESULTS Thirty-four of the 99 patients were unsuitable for analysis because their baseline expression of GPIIIa was outwith the normal range, making the results outwith the limits of the flow cytometric method. The incidence of the 1b allele in the patients was 29%, with incidence being higher in females, although this failed to reach statistical significance. The number of circulating platelet aggregates and adenosine diphosphate (ADP)-induced aggregation in prp was significantly higher in those patients with the 1b allele. CONCLUSIONS This method may be of use as an initial screening test.
Collapse
Affiliation(s)
- M McLaren
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
| | | | | | | | | | | |
Collapse
|
43
|
Newton DJ, Khan F, McLaren M, Kennedy G, Belch JJF. Endothelin-1 levels predict 3-year survival in patients who have amputation for critical leg ischaemia. Br J Surg 2005; 92:1377-81. [PMID: 16187255 DOI: 10.1002/bjs.5144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients. METHODS In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine. RESULTS Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0.002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality:hazard ratio 3.53 (95 per cent confidence interval (c.i.) 1.29 to 9.70; P = 0.007) and cardiovascular mortality:hazard ratio 4.15 (95 per cent c.i. 1.30 to 13.23); P = 0.014. CONCLUSION ET-1 was an independent predictor of death in these patients with CLI.
Collapse
Affiliation(s)
- D J Newton
- Vascular Diseases Research Unit, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | | | | | | | | |
Collapse
|
44
|
Abstract
AIM The aim of the study was to determine whether areas of the diabetic foot that experience high pressures during normal activity also demonstrate reductions in cutaneous microvascular flow and/or endothelial function. METHODS Sixteen patients with diabetes mellitus and eight healthy, age-matched control subjects were recruited. Maps of dynamic pressure on the plantar aspect of both feet were recorded during a normal gait cycle, and the skin microvascular blood flow response to the endothelium-dependent vasodilator acetylcholine was assessed at the sites of highest and lowest plantar pressure over the metatarsal heads. RESULTS Patients with diabetes had higher plantar pressures than control subjects (P = 0.002), but there were no significant differences in basal skin blood flow or acetylcholine response between the groups. In the patients, baseline flow was increased (P = 0.041) but the acetylcholine response reduced (P = 0.03) at the high-pressure compared with the low-pressure site; this was most apparent in those who were particularly at risk of ulceration due to high plantar pressures. CONCLUSIONS Chronically raised plantar pressure in the diabetic foot is associated with increased basal skin blood flow, compared with lower pressure areas on the same foot. Further work is required to determine whether, and under what conditions, this additional hyperaemia is protective or maladaptive. In addition, high-pressure areas have a reduced responsiveness to an endothelium-dependent vasodilator, although the clinical significance of these changes is not clear.
Collapse
Affiliation(s)
- D J Newton
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Newton DJ, McLeod GA, Khan F, Belch JJF. Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin. Br J Anaesth 2005; 94:662-7. [PMID: 15722384 DOI: 10.1093/bja/aei095] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine. METHODS Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008% to 0.75%, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 microg ml(-1). RESULTS The cumulative responses to the lower subclinical concentrations (0.008-0.0625%) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 microg ml(-1) significantly reduced the responses to clinical doses of both drugs (P<0.001), producing net vasoconstriction. CONCLUSIONS Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 microg ml(-1) decreases these responses markedly.
Collapse
Affiliation(s)
- D J Newton
- Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | | | | | | |
Collapse
|
46
|
Shehab AMA, MacFadyen RJ, McLaren M, Tavendale R, Belch JJF, Struthers AD. Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study. Heart 2004; 90:1263-8. [PMID: 15486117 PMCID: PMC1768533 DOI: 10.1136/hrt.2003.028399] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To see whether sudden unexpected death in chronic heart failure is preceded by intraindividual worsening in inflammation and in ECG criteria. DESIGN AND SETTING Prospective cohort study conducted in the community. PATIENTS 34 patients with chronic heart failure were studied. Their mean (SD) age was 68 (8) years, 29 were men, mean (SD) left ventricular ejection fraction was 29 (9)%, and they were in New York Heart Association functional class II (n = 20), III (n = 11), and IV (n = 3). The patients were examined monthly over 24 months, with sequential measurement of C reactive protein and neutrophil counts and 24 hour ambulatory ECG monitoring measuring heart rate variability, mean heart rate, and arrhythmias. Intraindividual changes in these parameters were related to subsequent cardiac deaths. RESULTS During follow up, nine patients died: five patients had a sudden unexpected death (SUD) and four died of progressive heart failure (PHF). There were significant intraindividual changes in neutrophil counts (p = 0.02), C reactive protein (p = 0.039), and heart rate variability (p < or = 0.018) in those who died of SUD and PHF. In contrast no significant changes were seen in ventricular extrasystoles, ventricular tachycardia episodes, brain natriuretic peptide, or aldosterone in the SUD group, but all of these parameters did increase as expected in those who died of PHF. CONCLUSIONS This is preliminary evidence that SUD may be preceded by intraindividual increases in both inflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not, intraindividual increases in either may be convenient markers to identify patients at high risk of impending SUD. Larger studies are needed to confirm the observation from this pilot study.
Collapse
Affiliation(s)
- A M A Shehab
- Department of Clinical Pharmacology and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND/AIMS Many patients with chronic fatigue syndrome (CFS) have symptoms that are consistent with an underlying viral or toxic illness. Because increased neutrophil apoptosis occurs in patients with infection, this study examined whether this phenomenon also occurs in patients with CFS. METHODS Apoptosis was assessed in patients with CFS in conjunction with concentrations of the anti-inflammatory cytokine, transforming growth factor beta1 (TGFbeta1). RESULTS The 47 patients with CFS had higher numbers of apoptotic neutrophils, lower numbers of viable neutrophils, increased annexin V binding, and increased expression of the death receptor, tumour necrosis factor receptor-I, on their neutrophils than did the 34 healthy controls. Patients with CFS also had raised concentrations of active TGFbeta1 (p < 0.005). CONCLUSIONS These findings provide new evidence that patients with CFS have an underlying detectable abnormality in their immune cells.
Collapse
Affiliation(s)
- G Kennedy
- Vascular Diseases Research Unit, University Department of Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | | | | | | |
Collapse
|
48
|
Stonebridge PA, Buckley C, Thompson A, Dick J, Hunter G, Chudek JA, Houston JG, Belch JJF. Non spiral and spiral (helical) flow patterns in stenoses. In vitro observations using spin and gradient echo magnetic resonance imaging (MRI) and computational fluid dynamic modeling. INT ANGIOL 2004; 23:276-83. [PMID: 15765044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM Physiological blood flow patterns are themselves poorly understood despite their impact on arterial disease. Stable spiral (helical) laminar flow (SLF) has been observed in normal subjects. The purpose of the present study is to develop a method of magnetic resonance (MR) flow pattern visualization and to analyze spiral and non-spiral flow patterns with and without luminal narrowing in vitro. The flow conditions were then modeled using computational fluid dynamics (Star-CD). METHODS Laminar integrity was examined in a flow-rig using spin and gradient echo magnetic resonance imaging (MRI) in non-stenosed and stenosed conduits in the presence of non-spiral and spiral flow. RESULTS No difference was observed in a non-stenosed conduit between non-spiral and spiral flow. In the presence of a stenosis spiral flow preserves flow velocity coherence whereas non-spiral flow increasingly lost coherence beginning proximal to the stenosis. Computational fluid dynamic modeling of the in vitro experiment showed marked differences between the 2 flow patterns. Non-spiral flow produced greater inwardly directed forces just beyond the stenosis and greater outward pressures at more distal sites. The near wall turbulent energy was up to 700% less with spiral flow over non-spiral flow beyond the stenosis. CONCLUSIONS Spiral flow appears to offer clear flow profile stabilizing advantages over non-spiral flow, by significantly reducing the turbulence caused by a stenosis. Spiral flow also produces lower forces acting on the vessel wall.
Collapse
Affiliation(s)
- P A Stonebridge
- Vascular Diseases Research Unit, Department of Surgery, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Elhadd TA, Kennedy G, Robb R, McLaren M, Jung RT, Belch JJF. Elevated soluble cell adhesion molecules E-selectin and intercellular cell adhesion molecule-1 in type-2 diabetic patients with and without asymptomatic peripheral arterial disease. INT ANGIOL 2004; 23:128-33. [PMID: 15507889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM Cell adhesion molecules may serve as markers of endothelial cell activation, and they may well have a role in the pathogenesis of atherosclerotic vascular disease in diabetes mellitus. METHODS EXPERIMENTAL DESIGN a cross sectional, comparative study. SETTING a teaching University Hospital. Patients and controls. A cohort of diabetic patients with absent peripheral arterial pulses but no history of cardiovascular or cerebrovascular disease i.e. asymptomatic (n=29), median age 68 (36-80) years, (range), diabetes duration 10 (1-43) years and HbA1c 7.7% (4.8-9.6). They were compared to 12 age and sex matched normal non-diabetic controls. INTERVENTION none. MEASURES soluble cell adhesion molecules intercellular cell adhesion molecule-1 (ICAM-1) and E-selectin levels measured by ELISA methods. RESULTS The 29 patients with diabetes, as a whole, were found to have significantly higher median plasma sICAM-1 and sE-selectin of 283 ng/ml (154-1000) (range), and 65.8 ng/ml (20.6-145) vs 237 (147-312.4) and 37.7 (19.8-46.6) respectively, Mann Whitney U test p<0.02, and p<0.002. In the diabetic group, E-selectin correlated with ICAM-1, age and HbA1c: r=0.524 p<0.01, r=0.385 p<0.05 and r=0.393 p<0.05 respectively (Spearman correlation coefficient). CONCLUSION These results confirm that elevated levels of adhesion molecules, E-selectin and ICAM-1 occur in Type-2 diabetes early in the course of asymptomatic peripheral arterial occlusive disease, and this is related to glycemic control. This suggests that adhesion molecules may have a role in the pathogenesis of atherosclerotic vascular disease in diabetes.
Collapse
Affiliation(s)
- T A Elhadd
- Section of Vascular Biology and Medicine, University and Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
| | | | | | | | | | | |
Collapse
|
50
|
Spence VA, Khan F, Kennedy G, Abbot NC, Belch JJF. Acetylcholine mediated vasodilatation in the microcirculation of patients with chronic fatigue syndrome. Prostaglandins Leukot Essent Fatty Acids 2004; 70:403-7. [PMID: 15041034 DOI: 10.1016/j.plefa.2003.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2003] [Indexed: 11/27/2022]
Abstract
The aetiology of chronic fatigue syndrome (CFS) remains controversial and a number of hypotheses have been put forward to explain it. Research into the condition is hindered by the considerable heterogeneity seen across patients but several reports have highlighted disturbances to cholinergic mechanisms in terms of central nervous system activity, neuromuscular function and autoantibodies to muscarinic cholinergic receptors. This paper examines an altogether separate function for acetylcholine and that is its role as an important and generalized vasodilator. Most diseases are accompanied by a blunted response to acetylcholine but the opposite is true for CFS. Such sensitivity is normally associated with physical training so the finding in CFS is anomalous and may well be relevant to vascular symptoms that characterise many patients. There are several mechanisms that might lead to ACh endothelial sensitivity in CFS patients and various experiments have been designed to unravel the enigma. These are reported here.
Collapse
Affiliation(s)
- V A Spence
- Vascular Diseases Research Unit, University Department of Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | | | | | | | | |
Collapse
|