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Rajkov B, Zdravković M, Ninić A, Brajković M, Klašnja S, Gardijan V, Memon L, Munjas J, Mihajlović M, Spasojević-Kalimanovska V, Radosavljević V, Sopić M. Upregulation of peripheral blood mononuclear cells resistin gene expression in severe obstructive sleep apnea and obstructive sleep apnea with coexisting type 2 diabetes mellitus. Sleep Breath 2023; 27:2031-2039. [PMID: 36917442 DOI: 10.1007/s11325-023-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is characterised by increased systemic inflammation, and is often accompanied with type 2 diabetes mellitus (T2DM) and cardiovascular disease. The aim of this investigation was to evaluate gene expression of resistin, its receptor CAP1 and CD36 as the indicators of the inflammatory changes in PBMCs in relation to the severity of OSA, and the presence of type 2 diabetes mellitus (T2DM) in OSA. METHODS Severity of OSA was defined by the apnea/hypopnea index (AHI): AHI < 30: mild to moderate OSA (MM-OSA), AHI ≥ 30: severe OSA (S-OSA). Presence of T2DM was captured: OSA with T2DM (OSA + T2DM), OSA without T2DM (OSA-T2DM). PBMC resistin, CAP1, and CD36 mRNA were determined by real-time PCR. RESULTS Resistin mRNA was significantly upregulated in S-OSA (N = 54) compared to the MM-OSA (N = 52, P = 0.043); CAP1 and CD36 mRNA levels did not differ between the groups (P = 0.302; P = 0.166, respectively). Resistin mRNA was significantly upregulated in OSA + T2DM (N = 29) compared to the OSA-T2DM (N = 77, P = 0.029); CAP1 and CD36 mRNA levels did not differ between the groups (P = 0.662; P = 0.108, respectively). AHI and T2DM were independent predictors of resistin mRNA above the 75th percentile (OR = 3.717 [1.152-11.991]; OR = 3.261 [1.000-10.630], P = 0.042 respectively). CONCLUSION Resistin gene upregulation in S-OSA indicates its possible contribution to increased inflammation in S-OSA and makes it a possible marker of the disease severity. Resistin gene upregulation in OSA + T2DM suggests that a joint effect of these two comorbidities may have a major contribution to increased inflammation and complications that arise from this state.
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Affiliation(s)
- Branislava Rajkov
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Marija Zdravković
- Department of Cardiology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Ninić
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
| | - Milica Brajković
- Department of Pulmology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Slobodan Klašnja
- Department of Cardiology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Vera Gardijan
- Department of Pulmology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Lidija Memon
- Department of Laboratory Diagnostics, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Jelena Munjas
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
| | - Marija Mihajlović
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | | | | | - Miron Sopić
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
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Zeljković A, Milojević A, Vladimirov S, Zdravković M, Memon L, Brajković M, Gardijan V, Gojković T, Stefanović A, Miljković-Trailović M, Spasojević-Kalimanovska V, Ninić A. Alterations of cholesterol synthesis and absorption in obstructive sleep apnea: Influence of obesity and disease severity. Nutr Metab Cardiovasc Dis 2022; 32:2848-2857. [PMID: 36323608 DOI: 10.1016/j.numecd.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/09/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnea (OSA) is closely linked to obesity and related adverse metabolic changes, including dyslipidemia. However, it is not clear whether OSA is an independent contributing factor to dyslipidemia, or the observed association is a reflection of a concomitant presence of obesity. Additionally, dyslipidemia is usually evaluated through measurement of parameters of routine lipid status, while more precise evaluation of lipid homeostasis is rarely performed in OSA. In this study, we analyzed markers of cholesterol synthesis and absorption in patients with OSA with respect to the presence of obesity and the disease severity. METHODS AND RESULTS This study enrolled 116 OSA patients. Concentrations of non-cholesterol sterols (NCS), measured by LC-MS/MS, were used as markers of cholesterol synthesis and absorption. Apnea-hypopnea index (AHI) and oxygen saturation (SaO2) were utilized as markers of OSA severity. Serum lipid status parameters were determined by routine enzymatic methods. Markers of cholesterol synthesis were increased (P = 0.005), whilst markers of cholesterol absorption decreased (P = 0.001) in obese OSA patients. Cholesterol synthesis/absorption ratio was elevated in obese subjects (P < 0.001). Concentration of cholesterol synthesis marker lathosterol was significantly higher in subjects with severe OSA (P = 0.014) and we observed a trend of decreased cholesterol absorption in these patients. AHI was revealed as an independent determinant of lathosterol concentration (P = 0.022). CONCLUSIONS Our results suggest that the presence of obesity and severe forms of OSA is characterized by elevated endogenous cholesterol synthesis. AHI was singled out as an independent determinant of the serum level of cholesterol synthesis marker lathosterol.
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Affiliation(s)
- Aleksandra Zeljković
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
| | - Ana Milojević
- Department of Laboratory Diagnostics, University Medical Center "Bežanijska kosa", Belgrade, Serbia
| | - Sandra Vladimirov
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Marija Zdravković
- Department of Cardiology, University Medical Center "Bežanijska kosa" and University of Belgrade-Faculty of Medicine, Belgrade, Serbia
| | - Lidija Memon
- Department of Laboratory Diagnostics, University Medical Center "Bežanijska kosa", Belgrade, Serbia
| | - Milica Brajković
- Department of Pulmonology, University Medical Center "Bežanijska kosa", Belgrade, Serbia
| | - Vera Gardijan
- Department of Pulmonology, University Medical Center "Bežanijska kosa", Belgrade, Serbia
| | - Tamara Gojković
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Aleksandra Stefanović
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | | | | | - Ana Ninić
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
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Popadic V, Brajkovic M, Klasnja S, Milic N, Rajovic N, Lisulov DP, Divac A, Ivankovic T, Manojlovic A, Nikolic N, Memon L, Brankovic M, Popovic M, Sekulic A, Macut JB, Markovic O, Djurasevic S, Stojkovic M, Todorovic Z, Zdravkovic M. Correlation of Dyslipidemia and Inflammation With Obstructive Sleep Apnea Severity. Front Pharmacol 2022; 13:897279. [PMID: 35694268 PMCID: PMC9179947 DOI: 10.3389/fphar.2022.897279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) is a serious condition linked with various metabolic disorders and associated with increased all-cause and cardiovascular mortality. Although the potential mechanisms of pathophysiological processes related to OSA are relatively well known, the data regarding the correlation between obstructive sleep apnea, dyslipidemia, and systemic inflammation are still inconclusive. Methods: The study was conducted as a retrospective cohort study including 328 patients with newly diagnosed obstructive sleep apnea during the period between April 2018, and May 2020, in University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. Polysomnography was performed in all patients according to the protocol. Numerous demographic, antropometric, laboratory, and clinical data were correlated to Apnea-Hypopnea Index (AHI) as a dependent variable, with a particular review on the relation between lipid abnormalities, inflammatory parameters, and obstructive sleep apnea severity. Multivariate logistic regression model was used to assess predictors of severe OSA (AHI ≥30 per hour). Results: A total of 328 patients were included in the study. The mean age of the patients was 54.0 ± 12.5 years and more than two-thirds were male (68.8%). The majority of the patients had an AHI of at least 30 events per hour. Patients with severe OSA were more frequently male, obese, hypertensive and hyperlipidemic, and had increased neck circumference (both male and female patients). One hundred and thirty-two patients had metabolic syndrome. Patients with severe OSA more frequently had metabolic syndrome and significantly higher levels of glucose, creatinine, uric acid, AST, ALT, CK, microalbumine/creatinine ratio, triglyceride, total cholesterol, HDL, total cholеsterol to HDL‐C ratio, CRP, and ESR. In the multivariate linear regression model with AHI (≥30 per hour) as a dependent variable, of demographic and clinical data, triglycerides ≥1.7 mmol/L and CRP >5 mg/L were significantly associated with AHI≥30 per hour. Conclusion: The present study on 328 patients with newly diagnosed obstructive sleep apnea revealed significant relation of lipid abnormalities, inflammatory markers, and other clinically important data with obstructive sleep apnea severity. These results can lead to a better understanding of the underlying pathophysiological processes and open the door to a new world of potentially useful therapeutic modalities.
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Affiliation(s)
- Viseslav Popadic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- *Correspondence: Viseslav Popadic,
| | - Milica Brajkovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Slobodan Klasnja
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Internal Medicine,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MI, United States
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | | | - Anica Divac
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Tatjana Ivankovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Andrea Manojlovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Novica Nikolic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Lidija Memon
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Marija Brankovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maja Popovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Ana Sekulic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelica Bjekic Macut
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivera Markovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Maja Stojkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran Todorovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Milovančev A, Petrović M, Popadić V, Miljković T, Klašnja S, Djuran P, Ilić A, Kovačević M, Stojšić Milosavljević A, Brajković M, Crnokrak B, Memon L, Milojević A, Todorović Z, Čanković M, Lukić Šarkanović M, Bjelić S, Tadić S, Redžek A, Zdravković M. Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19. J Clin Med 2022; 11:jcm11071791. [PMID: 35407403 PMCID: PMC9000139 DOI: 10.3390/jcm11071791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/28/2022] Open
Abstract
Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p < 0.01) and higher rates of major complications, 33.7% vs. 16.8%, p < 0.01, and intrahospital 30-day mortality, 6.7% vs. 26.5%, p < 0.01. The strongest predictors of mortality were aortic regurgitation, HR 9.98, 95% CI 1.88; 52.98, p < 0.01, serum creatinine levels, HR 1.03, 95% CI 1.01; 1.04, p < 0.01, and respiratory failure therapy, HR 13.05, 95% CI 3.62; 47.01, p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients.
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Affiliation(s)
- Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
- Correspondence:
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Višeslav Popadić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Slobodan Klašnja
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Predrag Djuran
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Aleksandra Ilić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Mila Kovačević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Milica Brajković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Bogdan Crnokrak
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lidija Memon
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Ana Milojević
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
| | - Zoran Todorović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Mirka Lukić Šarkanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
| | - Snežana Bjelić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Snežana Tadić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Aleksandar Redžek
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.P.); (T.M.); (A.I.); (M.K.); (A.S.M.); (M.Č.); (M.L.Š.); (S.B.); (S.T.); (A.R.)
- Institute of Cardiovascular Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia
| | - Marija Zdravković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (V.P.); (S.K.); (P.D.); (M.B.); (B.C.); (L.M.); (A.M.); (Z.T.); (M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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5
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Milojević A, Zdravković M, Brajković M, Memon L, Gardijan V, Vekić J, Zeljković A, Stefanović A, Mihajlović M, Ivanišević J, Bogavac-Stanojević N, Radosavljević V, Spasojević-Kalimanovska V, Ninić A. Effects of Apnea, Obesity, and Statin Therapy on Proprotein Convertase Subtilisin/Kexin 9 Levels in Patients with Obstructive Sleep Apnea. Med Princ Pract 2022; 31:293-300. [PMID: 35292607 PMCID: PMC9274940 DOI: 10.1159/000524087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a common condition closely related to obesity, insulin resistance, dyslipidemia, and cardiovascular disease. The aim of this study was to explore the possible relationship between OSA and proprotein convertase subtilisin/kexin type 9 (PCSK9). METHODS Full-night polysomnography was performed on 150 participants who were divided into three groups: controls, OSA patients on statin therapy, and OSA patients not on statin therapy. Biochemical markers, plasma low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, and PCSK9 were determined. RESULTS PCSK9 was highest in OSA patients on statins compared to the control group and to OSA patients not on statins (p = 0.036 and p = 0.039, respectively), after adjustment for body mass index (BMI). LDL diameter was greater in OSA patients not on statins compared to OSA patients on statins (p = 0.032). PCSK9 was highest in the group of patients with all three risk factors (diagnosed OSA, statins, BMI ≥25 kg/m2) compared to groups with no, one, and two risk factors (p = 0.031, p = 0.001, and p = 0.029, respectively). Presence of OSA, statin therapy, and BMI ≥25 kg/m2 when combined were independently associated with higher levels of PCSK9 when adjusted for antihypertensive therapy, small dense LDL, and HDL 3c subclass (odds ratio = 2.849; interquartile range [1.026-7.912], p = 0.044). CONCLUSION Statin therapy was closely related to PCSK9. OSA along with obesity and statin use induces elevation of PCSK9.
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Affiliation(s)
- Ana Milojević
- Department of Laboratory Diagnostics, University Medical Center “Bežanijska Kosa,”, Belgrade, Serbia
| | - Marija Zdravković
- Department of Cardiology, University Medical Center “Bežanijska Kosa” and University of Belgrade-Faculty of Medicine, Belgrade, Serbia
| | - Milica Brajković
- Department of Pulmology, University Medical Center “Bežanijska Kosa,”, Belgrade, Serbia
| | - Lidija Memon
- Department of Laboratory Diagnostics, University Medical Center “Bežanijska Kosa,”, Belgrade, Serbia
| | - Vera Gardijan
- Department of Pulmology, University Medical Center “Bežanijska Kosa,”, Belgrade, Serbia
| | - Jelena Vekić
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
| | - Aleksandra Zeljković
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
| | - Aleksandra Stefanović
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
| | - Marija Mihajlović
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
| | - Jasmina Ivanišević
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
| | | | | | | | - Ana Ninić
- Department of Medical Biochemistry, University of Belgrade–Faculty of Pharmacy, Belgrade, Serbia
- *Ana Ninić,
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6
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Dejanović VV, Stevuljević JK, Vukašinović A, Miljković M, Kafedzic S, Zdravković M, Ilić I, Hinić S, Cerović M, Stefanović M, Spasojević-Kalimanovska V, Memon L, Nešković AN, Bogavac-Stanojević N. Oxidative Stress and Inflammatory Markers PTX3, CypA, and HB-EGF: How Are They Linked in Patients With STEMI? Angiology 2020; 71:713-720. [PMID: 32372694 DOI: 10.1177/0003319720921724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated circulating levels of inflammatory biomarkers pentraxin-3 (PTX3), cyclophilin A (CypA), and heparin-binding epidermal growth factor-like growth factor (HB-EGF); oxidative stress; and antioxidant status markers in the patients with ST-segment elevation acute myocardial infarction (STEMI) to better understand a relationship between inflammation and oxidative stress. We examined the impact of oxidative stress on high values of inflammatory parameters. The study included 87 patients with STEMI and 193 controls. We observed a positive correlation between PTX3 and HB-EGF (ρ = 0.24, P = .027), CyPA, and sulfhydryl (SH) groups (ρ = 0.25, P = .026), and a negative correlation between PTX3 and SH groups (ρ = -0.35, P = .001) in patients with STEMI. To better understand the effect of the examined parameters on the occurrence of high concentrations of inflammatory parameters, we grouped them using principal component analysis. This analysis identified the 4 most contributing factors. Optimal cutoff values for discrimination of patients with STEMI from controls were calculated for PTX3 and HB-EGF. An independent predictor for PTX3 above the cutoff value was a "metabolic-oxidative stress factor" comprised of glucose and oxidative stress marker prooxidant-antioxidant balance (odds ratio = 4.449, P = .030). The results show that higher PTX3 values will occur in patients having STEMI with greater metabolic and oxidative stress status values.
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Affiliation(s)
| | - Jelena Kotur Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Vukašinović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Milica Miljković
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Srdjan Kafedzic
- Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Ivan Ilić
- Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Saša Hinić
- Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | | | | | | | - Lidija Memon
- Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Aleksandar N Nešković
- Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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7
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Đurašević S, Nikolić G, Zaletel I, Grigorov I, Memon L, Mitić-Ćulafić D, Vujović P, Đorđević J, Todorović Z. Distinct effects of virgin coconut oil supplementation on the glucose and lipid homeostasis in non-diabetic and alloxan-induced diabetic rats. J Funct Foods 2020. [DOI: 10.1016/j.jff.2019.103601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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8
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Ninić A, Zdravković M, Radosavljević V, Gardijan V, Memon L, Vekić J, Spasojević-Kalimanovska V. Non-alcoholic fatty liver disease as metabolic consequence of obstructive sleep apnea. Arhiv za farmaciju 2020. [DOI: 10.5937/arhfarm70-27586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Obstructive sleep apnea (OSA) as a worldwide prevalent condition carries risk for cardiovascular and metabolic diseases, ultimately increasing overall mortality rates. Non-alcoholic fatty liver disease (NAFLD) can be considered as the primary metabolic disease, but also as a coexisting OSA comorbidity. Although prevalence of NAFLD covers quarter of world population, it increases with OSA presence. It can be speculated that chronic intermittent hypoxia (CIH) and sympathetic nervous system overactivity are involved in NAFLD pathogenesis and progression from simple steatosis through steatohepatitis to fibrosis. CIH provides the environment for liver oxidative stress, inflammation and increases the expression of genes involved in cholesterol and fatty acids synthesis. Catecholamines increase b-oxidation in liver and release free fatty acids from adipose tissue in plasma which inhibit insulin effects. Obesity and insulin resistance as key players in NAFLD development and advancement, deepen vicious circle of oxidative stress, inflammation and dyslipidemia. If not treated, OSA in NAFLD patients has been associated with inflammation, hepatocytes' necrosis, and fibrosis. Continuous positive airway pressure (CPAP) represents gold standard for OSA therapy, allowing the unimpeded air passage through upper parts of respiratory system. However, it has been demonstrated that CPAP therapy have beneficial effects on cardiometabolic outcomes and slow liver degeneration.
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9
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Vuković Dejanović V, Bogavac-Stanojević N, Kotur Stevuljević J, Vukašinović A, Stefanović A, Kafedzic S, Zdravković M, Ilić I, Hinić S, Cerović M, Stefanović M, Spasojević-Kalimanovska V, Memon L, Nešković AN. Circulating levels of inflammatory parameters pentraxin-3, cyclophilin and heparin-binding epidermal growth factor-like growth factor in patients with ST-elevation myocardial infarction. Scand J Clin Lab Invest 2019; 80:66-72. [PMID: 31799884 DOI: 10.1080/00365513.2019.1698058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Inflammatory biomarkers - pentraxin-3 (PTX3), cyclophilin A (CypA) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) were examined in patients with ST-segment elevation myocardial infarction (STEMI) undergoing revascularization with primary percutaneous coronary intervention (pPCI) and stent implanting. Investigated parameters were compared between patients with and without obstructive coronary artery disease (CAD). In addition, their changes were tested in circulation before and immediately after pPCI. The study group consisted of 81 STEMI patients. Patients were classified in the STEMI-CAD group if they had significant obstructive CAD or in MINOCA group if they had no significant stenosis. In STEMI-CAD patients inflammatory parameters were determined prior to and after pPCI intervention. Immediately after pPCI, in STEMI-CAD patients levels of PTX3 were significantly lower (1.52 vs. 2.17 μg/L, p < .001), while the levels of HB-EGF (14.61 vs. 12.03 pg/L, p < .001) and CyPA (15.95 vs. 8.62 μg/L, p < .001) were significantly higher compared to levels before pPCI. STEMI-CAD patients had lower PTX3 values 2.17 μg/L (1.55-5.10 μg/L) than MINOCA patients 5.06 μg/L (2.77-6.7 μg/L), p = .046. Diagnostic accuracy of PTX3 for discrimination MINOCA from STEMI-CAD patients was low (area under receiver operating characteristic curve = 0.770). Evaluation of PTX3 values may be helpful in the understanding of MINOCA aetiology but they couldn't distinguish stenosis severity in STEMI patients. Inflammatory biomarkers significantly changed after pPCI but the possibility of clinical use of these biomarkers needs to be evaluated in a larger prospective study.
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Affiliation(s)
| | | | - Jelena Kotur Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Vukašinović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Stefanović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Ivan Ilić
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Saša Hinić
- Department of Cardiology, Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Milivoje Cerović
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Milica Stefanović
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia
| | | | - Lidija Memon
- Clinical Hospital Center Bezanijska kosa, Clinical Chemistry Laboratory, Belgrade, Serbia
| | - Aleksandar N Nešković
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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10
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Stanisavljevic N, Stojanovich L, Marisavljevic D, Djokovic A, Dopsaj V, Kotur-Stevuljevic J, Martinovic J, Memon L, Radovanovic S, Todic B, Lisulov D. Lipid peroxidation as risk factor for endothelial dysfunction in antiphospholipid syndrome patients. Clin Rheumatol 2016; 35:2485-93. [PMID: 27562033 DOI: 10.1007/s10067-016-3369-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/06/2016] [Accepted: 07/25/2016] [Indexed: 01/22/2023]
Abstract
The aim of this study was to evaluate oxidative stress markers and it relations to endothelial damage as risk factor for thrombosis in patients with primary (PAPS) and secondary (SAPS) antiphospholipid syndrome (APS) in correlation to traditional risk factors. Flow-mediated (FMD) and nitroglycerine (NMD)-induced dilation of the brachial artery were studied in 140 APS patients (90 PAPS, 50 SAPS) and 40 controls matched by age, sex, and conventional risk factors for atherosclerosis. Markers of oxidative stress, lipid hydroperoxydes (LOOH), advanced oxidation protein products (AOPP), total sulfhydryl groups (tSHG), and paraoxonase 1 activity (PON1) were determined by spectrophotometric method. Oxidative stress dominates in APS patients. LOOH and AOPP correlate to lipid fractions (p < 0.05), unlike PON1, tSHG that correlated to antiphospholipid antibody positivity (p < 0.05). FMD was lower in APS patients comparing to controls (p < 0.001). Cholesterol is independent variable for FMD impairment in control group (p = 0.011); LOOH in PAPS (p = 0.004); LOOH, aCL, and triglycerides in SAPS patients (p = 0.009, p = 0.049, and p = 0.012, respectively). Combined predictive of aCL and LOOH is better for FMD impairment than LOOH alone in both PAPS and SAPS patients (AUC 0.727, p = 0.001, 95 % CI 0.616-0.837 and AUC 0.824, p˂0.001, 95 % CI 0.690-0.957, respectively). Lipid peroxidation is independent predictor for endothelial dysfunction in APS patients. We demonstrated synergistic effect of aCL and LOOH as risk for endothelial impairment in both PAPS and SAPS patients.
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Affiliation(s)
- Natasa Stanisavljevic
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia.
| | - L Stojanovich
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia
| | - D Marisavljevic
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Djokovic
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Dopsaj
- Clinical Center of Serbia, Faculty of Pharmacy Belgrade, University of Belgrade, Belgrade, Serbia
| | - J Kotur-Stevuljevic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - J Martinovic
- Rakovica Community Health Center, Belgrade, Serbia
| | - L Memon
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia
| | - S Radovanovic
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia
| | - B Todic
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia
| | - D Lisulov
- University Clinical Center "Bezanijska kosa", Bezanijska kosa bb, Belgrade, 11070, Serbia
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11
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Bojic S, Kotur-Stevuljevic J, Kalezic N, Stevanovic P, Jelic-Ivanovic Z, Bilanovic D, Memon L, Damnjanovic M, Kalaba Z, Simic-Ogrizovic S. Diagnostic Value of Matrix Metalloproteinase-9 and Tissue Inhibitor of Matrix Metalloproteinase-1 in Sepsis-Associated Acute Kidney Injury. TOHOKU J EXP MED 2016; 237:103-9. [PMID: 26399271 DOI: 10.1620/tjem.237.103] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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
Sepsis-associated acute kidney injury (SA-AKI) severely impacts morbidity and mortality in surgical patients with sepsis. Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) have an important role in pathophysiology of sepsis but they have been unexplored in SA-AKI. We aimed to investigate the role of MMP-9 and TIMP-1 in septic surgical patients with SA-AKI and to evaluate them as diagnostic biomarkers of SA-AKI. This prospective observational study compared 53 major abdominal surgery patients with sepsis divided into SA-AKI (n = 37) and non-SA-AKI (n =16) group to 50 controls without sepsis matched by age, gender, comorbidities and type of surgery. Blood and urine samples from septic patients were collected on admission to ICU and 24, 48, 72 and 96 h later and once from the controls. The levels of MMP-9, TIMP-1, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1, urea and creatinine were measured. MMP-9/TIMP-1 ratio and disease severity scores, such as Sequential Organ Failure Assessment (SOFA), were calculated. Septic patients with SA-AKI had higher serum TIMP-1 levels and lower serum MMP-9 levels and lower MMP-9/TIMP ratio, compared to septic patients without SA-AKI and controls. The levels of these biomarkers did not change significantly over time. MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio correlated with urea, creatinine, NGAL, and SOFA scores. Moreover, using the area under ROC curve, we showed that TIMP-1 and MMP-9/TIMP-1 ratio, but not MMP-9, were good diagnostic biomarkers of SA-AKI. We report for the first time the potential diagnostic value of TIMP-1 and MMP-9/TIMP-1 ratio in SA-AKI.
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Affiliation(s)
- Suzana Bojic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Clinical Hospital Center Bezanijska Kosa
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12
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Memon L, Spasojevic-Kalimanovska V, Stanojevic NB, Kotur-Stevuljevic J, Simic-Ogrizovic S, Giga V, Dopsaj V, Jelic-Ivanovic Z, Spasic S. Are levels of NT-proBNP and SDMA useful to determine diastolic dysfunction in chronic kidney disease and renal transplant patients? J Clin Lab Anal 2014; 27:461-70. [PMID: 24218128 DOI: 10.1002/jcla.21628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine the clinical usefulness of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and symmetric dimethylarginine (SDMA) for detection of renal and left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients and renal transplant (RT) recipients. METHODS We included 98 CKD and 44 RT patients. We assessed LV function using pulsed-wave Doppler ultrasound. Diastolic dysfunction was defined when the E:A ratio was <1. RESULTS Independent predictors of NT-proBNP levels were age, creatinine, and albumin in CKD patients and age and urea in RT patients. Determinants of SDMA in CKD patients were glomerular filtration rate (GFR) and NT-proBNP and creatinine in RT patients. In RT patients with diastolic dysfunction, NT-proBNP and SDMA were significantly higher than in patients without diastolic dysfunction (F = 7.478, P < 0.011; F = 2.631, P < 0.017). After adjustment for GFR, the differences were not seen. In CKD patients adjusted NT-proBNP and SDMA values for GFR were not significantly higher in patients with diastolic dysfunction than in patients without diastolic dysfunction. CONCLUSIONS NT-proBNP is useful for detection of LV diastolic dysfunction in RT recipients. When evaluating both NT-proBNP and SDMA it is necessary to consider GFR as a confounding factor.
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Affiliation(s)
- Lidija Memon
- Clinical Chemistry Laboratory, Clinical Centre Bezanijska Kosa, Belgrade, Serbia
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13
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Spasojevic-Kalimanovska V, Bogavac-Stanojevic N, Kalimanovska-Ostric D, Memon L, Spasic S, Kotur-Stevuljevic J, Jelic-Ivanovic Z. Factor analysis of risk variables associated with iron status in patients with coronary artery disease. Clin Biochem 2014; 47:564-9. [PMID: 24690216 DOI: 10.1016/j.clinbiochem.2014.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/09/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Epidemiological evidence concerning the role of iron, a lipid peroxidation catalyst, in atherosclerosis and coronary artery disease (CAD) is inconsistent. DESIGN AND METHODS Exploratory factor analysis was used to examine the potential clustering of variables known to be associated with CAD using data from 188 patients with angiographically-approved disease. The resulting factors were then tested for their association with serum ferritin and soluble transferrin receptor (sTfR) as indicators of body iron status. RESULTS Factor analysis resulted in a reduction of a variable number from the original 15 to 5 composite clusters. These factors were interpreted as (1) "proatherogenic factor" with positive loadings of TC, LDL-C, apoB and TG; (2) "inflammatory factor" with positive loadings of hsCRP, fibrinogen and MDA; (3) "antiatherogenic factor" with positive loadings of HDL-C and apoA-I; (4) "obesity factor" with positive loadings of weight and waist; and (5) "antioxidative status factor" with positive loadings of SOD and age and negative loading of superoxide anion. "Inflammatory", "obesity" and "antiatherogenic" factors predicted high ferritin values and the "proatherogenic factor" predicted high sTfR values. We compared the ability of the "proatherogenic factor" with that of a multivariable logistic model that included the "proatherogenic factor" and sTfR values in predicting significant stenosis in patients. The area under the ROC curve was 0.692 vs. 0.821, respectively. CONCLUSIONS "Inflammatory", "obesity", "antiatherogenic" and "proatherogenic" factors were associated with increased parameters of body iron status. The measurement of sTfR improves the prediction of CAD based on clustered cardiovascular risk factors.
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Affiliation(s)
| | | | | | - Lidija Memon
- Clinical Chemistry Laboratory, Clinical Center "Bezanijska Kosa", Belgrade, Serbia
| | - Slavica Spasic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Kotur-Stevuljevic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Zorana Jelic-Ivanovic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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14
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Radovanovic S, Savic-Radojevic A, Pekmezovic T, Markovic O, Memon L, Jelic S, Simic D, Radic T, Pljesa-Ercegovac M, Simic T. Uric acid and gamma-glutamyl transferase activity are associated with left ventricular remodeling indices in patients with chronic heart failure. ACTA ACUST UNITED AC 2014; 67:632-42. [PMID: 25037542 DOI: 10.1016/j.rec.2013.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/25/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Uric acid and gamma-glutamyl transferase are prognostic indicators in chronic heart failure. Nevertheless, the mechanism underlying the association between uric acid, gamma-glutamyl transferase, and chronic heart failure progression and prognosis remains largely unknown. METHODS The association of uric acid and gamma-glutamyl transferase with flow-mediated dilation and echocardiographic indices of cardiac remodeling was addressed in 120 patients with chronic ischemic heart failure. To determine the independent contribution of uric acid and gamma-glutamyl transferase to the flow-mediated dilation and echocardiographic indices of remodeling, a series of multiple linear regression models, based on traditional and nontraditional risk factors impacting upon these parameters, were constructed. RESULTS Uric acid, but not gamma-glutamyl transferase, was an independent predictor of flow-mediated dilation. Uric acid was associated with all the echocardiographic indices of left ventricular dysfunction tested in 3 multiple-regression models. Uric acid correlated with left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left ventricular end-systolic volume, and left ventricular end-diastolic volume (r = 0.337; r = 0.340; r = 0.321; r = 0.294; P = .001, respectively). Gamma-glutamyl transferase was an independent predictor of left ventricular end-systolic volume and left ventricular end-diastolic volume, after adjustment for all variables. Gamma-glutamyl transferase correlated with left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left ventricular end-systolic volume, and left ventricular end-diastolic volume (r = 0.238, P = .009; r = 0.219, P = .016; r = 0.359, P < .001; r = 0.369, P = .001, respectively). CONCLUSIONS Serum uric acid and gamma-glutamyl transferase levels are associated with left ventricular remodeling in patients with chronic ischemic heart failure.
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Affiliation(s)
- Slavica Radovanovic
- Odeljenje Kardiologije, Klinicko-Bolnicki Centar Bezanijska Kosa, Belgrade, Serbia
| | - Ana Savic-Radojevic
- Institut za Medicinsku i Klinicku Biohemiju, Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institut za Epidemiologiju, Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Olivera Markovic
- Odeljenje Kardiologije, Klinicko-Bolnicki Centar Bezanijska Kosa, Belgrade, Serbia; Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Lidija Memon
- Odeljenje Kardiologije, Klinicko-Bolnicki Centar Bezanijska Kosa, Belgrade, Serbia
| | - Svetlana Jelic
- Odeljenje Kardiologije, Klinicko-Bolnicki Centar Bezanijska Kosa, Belgrade, Serbia; Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Dragan Simic
- Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia; Klinika za Kardiovaskularne Bolesti, Klinicki Centar Srbije, Belgrade, Serbia
| | - Tanja Radic
- Institut za Medicinsku i Klinicku Biohemiju, Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Marija Pljesa-Ercegovac
- Institut za Medicinsku i Klinicku Biohemiju, Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia
| | - Tatjana Simic
- Institut za Medicinsku i Klinicku Biohemiju, Medicinski Fakultet, Univerzitet u Beogradu, Belgrade, Serbia.
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15
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Zeljkovic A, Vekic J, Spasojevic-Kalimanovska V, Jelic-Ivanovic Z, Kalimanovska-Ostric D, Memon L, Bogavac-Stanojevic N, Topic A, Spasic S. Smaller HDL particles are associated with absence of obstructive coronary artery disease in stable angina pectoris patients. Ann Clin Biochem 2013; 51:412-5. [DOI: 10.1177/0004563213499908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background A research on novel cardiovascular risk factors is mainly focused on patients with clinically verified coronary artery disease (CAD), while less is known about their presence in symptomatic patients, but without angiographically proven occlusion of coronary arteries. The aim of this study was to compare plasma low-density lipoprotein (LDL) and high-density lipoprotein (HDL) size and subclasses in stable angina patients with and without significant obstructive CAD. Methods LDL and HDL subclasses were analysed in 100 stable angina patients with ≥50% of obstruction and 40 patients with less than 50% of luminal narrowing, as assessed by coronary angiography. Results Patients with <50% of obstruction had reduced mean HDL size and higher proportion of small HDL particles ( P < 0.05). HDL size and proportion of small HDL particles were significant and independent predictors of obstructive CAD ( P < 0.05, respectively). Conclusions Stable angina patients with <50% of coronary obstruction have more favourable HDL subclasses distribution than patients with significant coronary stenosis.
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Affiliation(s)
- Aleksandra Zeljkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Vekic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Zorana Jelic-Ivanovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Dimitra Kalimanovska-Ostric
- Clinic for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Lidija Memon
- Clinical Chemistry Laboratory, Clinical Centre “Bezanijska Kosa”, Belgrade, Serbia
| | | | - Aleksandra Topic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Slavica Spasic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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16
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Spasojevic-Kalimanovska V, Veljic S, Kotur-Stevuljevic J, Bogavac-Stanojevic N, Memon L, Kalimanovska-Ostric D. MS255 C-REACTIVE PROTEIN BUT NOT SOLUBLE CD40 LIGAND IS ASSOCIATED WITH THE SEVERITY OF ANGIOGRAPHICALLY VERIFIED CORONARY ARTERY DISEASE. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70756-x] [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: 11/29/2022]
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17
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Vekic J, Zeljkovic A, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V, Bogavac-Stanojevic N, Memon L, Spasic S. Small, dense LDL cholesterol and apolipoprotein B: Relationship with serum lipids and LDL size. Atherosclerosis 2009; 207:496-501. [DOI: 10.1016/j.atherosclerosis.2009.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 06/24/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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18
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Kotur-Stevuljevic J, Spasic S, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V, Stefanovic A, Vujovic A, Memon L, Kalimanovska-Ostric D. PON1 status is influenced by oxidative stress and inflammation in coronary heart disease patients. Clin Biochem 2008; 41:1067-73. [DOI: 10.1016/j.clinbiochem.2008.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 06/04/2008] [Accepted: 06/10/2008] [Indexed: 11/26/2022]
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19
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Vekic J, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V, Memon L, Zeljkovic A, Bogavac-Stanojevic N, Spasic S. High serum uric acid and low-grade inflammation are associated with smaller LDL and HDL particles. Atherosclerosis 2008; 203:236-42. [PMID: 18603253 DOI: 10.1016/j.atherosclerosis.2008.05.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/12/2008] [Accepted: 05/13/2008] [Indexed: 12/22/2022]
Abstract
Elevated serum uric acid (UA) is associated with higher risk for cardiovascular disease (CVD). Smaller, denser low density lipoprotein (LDL) and high-density lipoprotein (HDL) particles are the potential risk factors for CVD, while the role and diagnostic value of inflammatory markers are firmly established. This current cross-sectional study investigates interrelationships between UA, high sensitivity C-reactive protein (hsCRP) and fibrinogen concentrations with LDL and HDL sizes in healthy middle-aged subjects. The outcomes-of-interest were smaller, denser LDL and HDL particles (LDL size <or=25.5nm and HDL size <or=8.8nm). Serum UA, hsCRP and plasma fibrinogen concentrations were measured by standard laboratory methods in a sample of 194 healthy volunteers (112 men and 82 women). LDL and HDL particle sizes were determined by gradient gel electrophoresis. The subjects in the highest UA tertile had significantly smaller LDL and HDL particle sizes (P<0.05 and P<0.01, respectively) and higher concentrations of fibrinogen and hsCRP (P<0.05 and P<0.01, respectively). Elevated UA (>or=318micromol/L) was a significant predictor of smaller, denser LDL and HDL particles (OR=3.09; P<0.01; n=19 and OR=4.40; P<0.001; n=23, respectively). The observed relationship with smaller HDL size persisted after adjustment for conventional cardiovascular risk factors. UA strongly correlated with both markers of inflammation. In addition, the higher hsCRP level correlated with smaller LDL size (P<0.05), while fibrinogen concentration was inversely related to HDL size (P<0.05). Multiple regression analysis revealed that HDL size and inflammatory markers remained independent determinants of UA concentration. In conclusion, higher serum UA and low-grade inflammation are closely linked to alterations in lipoprotein metabolism which may represent an early sign of atherosclerosis in asymptomatic subjects.
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Affiliation(s)
- Jelena Vekic
- Institute of Medical Biochemistry, Faculty of Pharmacy, Belgrade, Serbia.
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Bogavac-Stanojević N, Ivanova Petrova G, Jelić-Ivanović Z, Memon L, Spasić S. Cost-effectiveness analysis in diagnosis of coronary artery disease: Choice of laboratory markers. Clin Biochem 2007; 40:1180-7. [PMID: 17869234 DOI: 10.1016/j.clinbiochem.2007.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 07/04/2007] [Accepted: 07/07/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of our study was to determine the cost-effectiveness of coronary artery disease (CAD) diagnostic parameters in a clinical laboratory setting. DESIGN AND METHODS The effectiveness of apolipoproteins, lipoproteins and high sensitivity C-reactive protein (hs-CRP) supplementary to Framingham scoring data within a CAD risk assessment procedure was established in 221 CAD patients and 289 controls. The total costs of diagnostic procedures were calculated and incremental cost-effectiveness analysis was applied. RESULTS A diagnostic strategy employing Framingham calculation followed by apolipoprotein A-I (apoA-I) had the lowest cost per additional successfully diagnosed patient than the same strategy followed by hs-CRP in the low (2.63 vs. 24.47 euros) and intermediate-risk groups (2.96 vs. 122.85 euros). In the high-risk group the diagnostic strategy employing apoA-I saved 9.14 euros in comparison to the strategy employing hs-CRP. CONCLUSION Cost-effectiveness analysis of different diagnostic markers results in improved identification of at-risk patients at a lower health cost for society.
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Topic A, Spasojevic-Kalimanovska V, Veselinovic S, Jelic-Ivanovic Z, Spasic S, Memon L. PO3-76 APOLIPOPROTEIN E POLYMORPHISM IN THE SERBIAN GENERAL POPULATION AND EFFECT ON LIPID PARAMETERS IN THE MIDDLE-AGED SUBJECTS. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71086-3] [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: 11/16/2022]
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Jelić-Ivanović Z, Memon L, Spasojević-Kalimanovska V, Bogavac-Stanojević N, Spasić S. Independent association of high serum uric acid concentration with angiographically defined coronary artery disease. TOHOKU J EXP MED 2007; 211:369-77. [PMID: 17409677 DOI: 10.1620/tjem.211.369] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 11/18/2022]
Abstract
Epidemiological studies have shown that a high serum uric acid concentration is a risk factor for coronary artery disease (CAD). However, the issue of whether it is an independent cardiovascular risk factor or simply a marker of co-existing conditions is a matter of controversy. In the present case-controlled study, we explored the association between serum uric acid and angiographically defined CAD in middle-aged subjects (356 CAD patients and 350 healthy individuals). Serum uric acid in CAD patients was significantly higher than that in healthy individuals (359 +/- 88.7 and 289 +/- 79.3 micromol/l, respectively, p < 0.01) and remained significantly higher after adjusting for confounding factors (F = 79.77, p < 0.01). The association between uric acid and CAD was not limited to the hyperuricemic range of values, but was also found in the high-normal range (p < 0.01). An unadjusted odds ratio (OR) of 5.0 was obtained in both genders (p < 0.01). Female patients with > 50% stenosis (clinically significant CAD), regardless of the number of diseased vessels, had higher uric acid concentrations than those with < 50% stenosis even after adjusting for confounders (F = 3.79, p = 0.01). In conclusion, we have demonstrated that high serum uric acid is independently associated with CAD and that uric acid determination could be useful as one of the markers of clinically significant CAD.
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Kotur-Stevuljevic J, Memon L, Stefanovic A, Spasic S, Spasojevic-Kalimanovska V, Bogavac-Stanojevic N, Kalimanovska-Ostric D, Jelić-Ivanovic Z, Zunic G. Correlation of oxidative stress parameters and inflammatory markers in coronary artery disease patients. Clin Biochem 2006; 40:181-7. [PMID: 17070511 DOI: 10.1016/j.clinbiochem.2006.09.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 09/18/2006] [Accepted: 09/19/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVES In addition to many traditional risk factors for coronary artery disease (CAD) development, enhanced oxidative stress and inflammation are serious conditions that may also be classified as novel risk factors. In the present study, we assessed the relationship between several parameters of oxidative stress status [malonaldehyde (MDA), superoxide anion (O(2)(-)) and plasma and erythrocyte superoxide dismutase (SOD) activities] with high sensitivity C-reactive protein (hsCRP) and fibrinogen as inflammation markers. DESIGN AND METHODS Oxidative stress status parameters, inflammation markers and lipid status parameters were measured in 385 subjects [188 coronary heart disease (CHD) patients with angiographically diagnosed coronary artery disease (CAD), 141 patients with occlusion >50% in at least one major coronary artery (CAD+) and 47 patients with occlusion less than 50% (CAD-), and 197 CHD-free middle-aged subjects (the control group)]. RESULTS The plasma MDA concentration and the level of O(2)(-) in plasma were significantly higher in combination with significantly lower SOD activity in the CAD+ group vs. the control group. By using multiple stepwise regression analysis, fibrinogen and hsCRP showed independent correlation with MDA. Binary logistic regression analysis indicated that both MDA and O(2)(-) were significantly associated with CAD development and adjustment for inflammatory markers weakened this association in the case of MDA. CONCLUSIONS The relationship between oxidative stress parameters and inflammatory species suggest their strong mutual involvement in atherosclerosis development that leads to CAD progression.
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Affiliation(s)
- Jelena Kotur-Stevuljevic
- Institute for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, P.O. Box 146, 11000 Belgrade, Serbia.
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Memon L, Spasojevic-Kalimanovska V, Jelic-Ivanovic Z, Bogavac-Stanojevic N, Kalimanovska-Ostric D, Spasic S. Mo-P1:64 Association of plasma uric acid concentrations with the occurrence and the severity of coronary artery disease. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80199-6] [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: 11/15/2022]
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Memon L, Spasojević-Kalimanovska V, Bogavac-Stanojević N, Kalimanovska-Ostrić D, Jelić-Ivanović Z, Spasić S, Topić A. Association of C-Reactive Protein with the Presence and Extent of Angiographically Verified Coronary Artery Disease. TOHOKU J EXP MED 2006; 209:197-206. [PMID: 16778366 DOI: 10.1620/tjem.209.197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/18/2022]
Abstract
Prospective studies have demonstrated that markers of inflammation, such as high-sensitivity C-reactive protein (hsCRP) and fibrinogen, predict future cardiovascular disease risk. However, the association between the hsCRP and fibrinogen levels and the extent of coronary stenosis in patients with coronary artery disease (CAD) remains controversial. The aim of our case-control study was to assess the association of inflammatory markers with the occurrence and extent of CAD. Serum hsCRP and plasma fibrinogen levels were measured in 138 patients with angiographically assessed CAD and in 183 healthy subjects matched according to age and gender. According to the number of significantly stenosed (>or= 50%) vessels, the patients were classified in four groups: those without stenosis (0-vessel disease) and those with 1, 2 or 3-vessel disease. The hsCRP and fibrinogen levels were significantly higher in patients than in controls (p < 0.001). Although the hsCRP and fibrinogen levels tended to increase with the number of stenotic vessels, the differences were only significant for hsCRP (p < 0.01). Regression analysis indicated hsCRP as an independent predictor for the presence (OR = 3.573, p < 0.05) and extent of CAD (beta = 1.095, p < 0.05). In conclusion, the present study is the first report concerning the frequency distribution of hsCRP in Serbian healthy subjects and CAD patients. We have shown that elevated levels of hsCRP are associated with the presence and extent of CAD.
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Affiliation(s)
- Lidija Memon
- Clinical Chemistry Laboratory, Clinical Center Bezanijska Kosa, Belgrade, Serbia and Montenegro
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Stanojević NB, Ivanović ZJ, Djurovic S, Kalimanovska VS, Spasić S, Ostrić DK, Memon L. Lack of Association Between Low HDL-cholesterol and Elevated Circulating Cellular Adhesion Molecules in Normolipidemic CAD Patients and Healthy Subjects. Int Heart J 2005; 46:593-600. [PMID: 16157950 DOI: 10.1536/ihj.46.593] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Abstract
High plasma HDL-cholesterol (HDL-c) is a well-established protective factor in coronary artery disease (CAD). One of its potential protective mechanisms is the inhibition of the cytokine-induced upregulation of expression of cellular adhesion molecules (CAMs). High sCAM levels were found to be associated with low HDL-c in some studies performed mostly in hyperlipidemic subjects, but this association has not yet been investigated in CAD patients. In addition, conflicting results were obtained from in vitro studies that explored the proposed HDL effect on cytokine-induced CAM expression. The aim of the present case-control study was to investigate whether low HDL-c values are associated with CAM overexpression in normolipidemic CAD patients and healthy individuals, matched according to age and gender. Plasma HDL-c, sICAM-1, sVCAM-1, and sE-selectin were measured in 37 normolipidemic patients with angiographically verified coronary artery disease and in 52 healthy normolipidemic subjects. The sCAM values obtained in the subjects (patients or controls) with low HDL-c levels (< 1.03 mmol/L) were compared with the values in the subjects with high HDL-c (>or= 1.03 mmol/L). No significant difference was found between sICAM-1, sVCAM-1, and E-selectin values obtained in subjects with low and high HDL-c, either among the patients or the healthy controls. In conclusion, low HDL-c levels are not associated with CAM overexpression in normolipidemic CAD patients and healthy subjects.
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Graedel TE, van Beers D, Bertram M, Fuse K, Gordon RB, Gritsinin A, Kapur A, Klee RJ, Lifset RJ, Memon L, Rechberger H, Spatari S, Vexler D. Multilevel cycle of anthropogenic copper. Environ Sci Technol 2004; 38:1242-1252. [PMID: 14998044 DOI: 10.1021/es030433c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A comprehensive contemporary cycle for stocks and flows of copper is characterized and presented, incorporating information on extraction, processing, fabrication and manufacturing, use, discard, recycling, final disposal, and dissipation. The analysis is performed on an annual basis, ca. 1994, at three discrete governmental unit levels--56 countries or country groups that together comprise essentially all global anthropogenic copper stocks and flows, nine world regions, and the planet as a whole. Cycles for all of these are presented and discussed, and a "best estimate" global copper cycle is constructed to resolve aggregation discrepancies. Among the most interesting results are (1) transformation rates and recycling rates in apparently similar national economies differ by factors of two or more (country level); (2) the discard flows that have the greatest potential for copper recycling are those with low magnitude flows but high copper concentrations--electronics, electrical equipment, and vehicles (regional level); (3) worldwide, about 53% of the copper that was discarded in various forms was recovered and reused or recycled (global level); (4) the highest rate of transfer of discarded copper to repositories is into landfills, but the annual amount of copper deposited in mine tailings is nearly as high (global level); and (5) nearly 30% of copper mining occurred merely to replace copper that was discarded. The results provide a framework for similar studies of other anthropogenic resource cycles as well as a basis for supplementary studies in resource stocks, industrial resource utilization, waste management, industrial economics, and environmental impacts.
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Affiliation(s)
- T E Graedel
- Center for Industrial Ecology, School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut 06511, USA.
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