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Cífková R, Harazny JM, Bruthans J, Wohlfahrt P, Krajčoviechová AH, Lánská V, Gelžinský J, Mateřánková M, Mareš Š, Filipovský J, Mayer O, Schmieder RE. Early vascular damage in retinal microcirculation in arterial hypertension: the Czech post-MONICA study. J Hypertens 2024; 42:557-563. [PMID: 38088414 PMCID: PMC10842650 DOI: 10.1097/hjh.0000000000003637] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024]
Abstract
Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Joanna M. Harazny
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander- University, Erlangen-Nürnberg, Germany
- Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Jan Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
| | - Alena Hrubeš Krajčoviechová
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Július Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Roland E. Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander- University, Erlangen-Nürnberg, Germany
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Mayer O, Bruthans J, Seidlerová J, Gelžinský J, Kučera R, Karnosová P, Mateřánková M, Wohlfahrt P, Cífková R, Filipovský J. High leptin status indicates an increased risk of mortality and heart failure in stable coronary artery disease. Nutr Metab Cardiovasc Dis 2022; 32:2137-2146. [PMID: 35843790 DOI: 10.1016/j.numecd.2022.06.006] [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: 03/13/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Leptin is an adipocyte-derived peptide involved in energy homeostasis and body weight regulation. The position of leptin in cardiovascular pathophysiology remains controversial. Some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as a neutral or even protective factor. We have explored whether high leptin affects the mortality and morbidity risk in patients with stable coronary heart disease. METHODS AND RESULTS We followed 975 patients ≥6 months after myocardial infarction or coronary revascularization in a prospective study. All-cause or cardiovascular death, non-fatal cardiovascular events (recurrent myocardial infarction, stroke, or any revascularization), and hospitalizations for heart failure (HF) we used as outcomes. High serum leptin concentrations (≥18.9 ng/mL, i.e., 4th quartile) were associated with worse survival, as well as with a higher incidence of fatal vascular events or hospitalizations for HF. Even after full adjustment for potential covariates, high leptin remained to be associated with a significantly increased 5-years risk of all-cause death [Hazard risk ratio (HRR) 2.10 (95%CIs:1.29-3.42), p < 0.003], CV death [HRR 2.65 (95%CIs:1.48-4.74), p < 0.001], and HF hospitalization [HRR 1.95 (95% CIs:1.11-3.44), p < 0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76-2.13), p = 0.359]. CONCLUSIONS High leptin concentration entails an increased risk of mortality, apparently driven by fatal CV events and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radek Kučera
- Laboratory of Immunochemical Diagnostics, University Hospital, Pilsen, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
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Mayer O, Bruthans J, Seidlerová J, Gelžinský J, Kučera R, Karnosová P, Mateřánková M, Rychecká M, Wohlfahrt P, Cífková R, Filipovský J, Vermeer C. Low vitamin K status, high sclerostin and mortality risk of stable coronary heart disease patients. Biomark Med 2021; 15:1465-1477. [PMID: 34668399 DOI: 10.2217/bmm-2021-0168] [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: 01/07/2023] Open
Abstract
Aim: We explored whether matrix Gla protein (MGP, natural calcification inhibitor) and sclerostin (glycoprotein responsible for osteoblast differentiation) interact in terms of mortality risk in coronary patients. Methods: 945 patients after myocardial infarction and/or coronary revascularization were followed in a prospective study. All-cause death, fatal or nonfatal cardiovascular events and heart failure hospitalizations were registered. Results: Either high desphospho-uncarboxylated MGP (dp-ucMGP) or high sclerostin were independently associated with 5-year all-cause/cardiovascular mortality. However, we observed an additional mortality risk in the coincidence of both factors. Concomitantly high dp-ucMGP (≥884 pmol/l) plus sclerostin (≥589 ng/l) were associated with increased all-cause mortality risk compared with 'normal' concentrations of both factors (HRR 3.71 [95% CI: 2.07-6.62, p < 0.0001]), or if only one biomarker has been increased. A similar pattern was observed for fatal, but not for nonfatal cardiovascular events. Conclusion: Concomitantly high MGP and sclerostin indicate increased mortality risk, which probably reflects their role in cardiovascular calcifications.
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Affiliation(s)
- Otto Mayer
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Jan Bruthans
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Jitka Seidlerová
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Julius Gelžinský
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Radek Kučera
- Department of Immunochemistry Diagnostics, University Hospital, Pilsen, 301 00, Czech Republic
| | - Petra Karnosová
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Markéta Mateřánková
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Martina Rychecká
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Jan Filipovský
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, Maastricht, 6200, The Netherlands
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Mayer O, Bruthans J, Seidlerová J, Karnosová P, Mateřánková M, Gelžinský J, Rychecká M, Opatrný J, Wohlfahrt P, Kučera R, Trefil L, Cífková R, Filipovský J, Vermeer C. The coincidence of low vitamin K status and high expression of growth differentiation factor 15 may indicate increased mortality risk in stable coronary heart disease patients. Nutr Metab Cardiovasc Dis 2021; 31:540-551. [PMID: 33257192 DOI: 10.1016/j.numecd.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/24/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Matrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). METHODS AND RESULTS 894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status. Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with "normal" concentrations of both biomarkers [HR 5.51 (95% CI 2.91-10.44), p < 0.0001 and 6.79 (95% CI 3.06-15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. CONCLUSIONS The individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Jan Opatrný
- Department of Cardiology, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Radek Kučera
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, the Netherlands
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Mayer O, Seidlerová J, Bruthans J, Gelžinský J, Rychecká M, Mateřánková M, Karnosová P, Wohlfahrt P, Cífková R, Filipovský J. Is There Really an Association of High Circulating Adiponectin Concentration and Mortality or Morbidity Risk in Stable Coronary Artery Disease? Horm Metab Res 2020; 52:861-868. [PMID: 32746485 DOI: 10.1055/a-1212-8759] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adiponectin has several beneficial properties, namely, on the level of glucose metabolism, but paradoxically, its high concentrations were associated with increased mortality. We aimed to clarify the impact of high serum adiponectin on mortality and morbidity in patients with stable coronary artery heart disease (CAD). A total of 973 patients after myocardial infarction and/or coronary revascularization were followed in a prospective cohort study. All-cause and cardiovascular (CV) death, non-fatal cardiovascular events, and hospitalizations for heart failure (HF) were registered as outcomes. High serum adiponectin levels (≥8.58 ng/ml, i. e., above median) were independently associated with increased risk of 5-year all-cause, CV mortality or HF [with HRR 1.57 (95% CI: 1.07-2.30), 1.74 (95% CI: 1.08-2.81) or 1.94 (95% CI: 1.20-3.12), respectively] when adjusted just for conventional risk factors. However, its significance disappeared if brain natriuretic peptide (BNP) was included in a regression model. In line with this, we observed strong collinearity of adiponectin and BNP. Additionally, major adverse cardiovascular event (i. e., CV death, non-fatal myocardial infarction or stroke, coronary revascularization) incidence risk was not associated with high adiponectin. In conclusion, the observed inverse association between adiponectin concentrations and mortality risk seems to be attributable to concomitantly increased BNP, rather than high adiponectin being a causal factor.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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Cífková R, Harazny JM, Bruthans J, Wohlfahrt P, Krajčoviechová A, Lánská V, Gelžinský J, Mateřánková M, Mareš Š, Filipovský J, Mayer O, Schmieder RE. Reference values of retinal microcirculation parameters derived from a population random sample. Microvasc Res 2020; 134:104117. [PMID: 33245956 DOI: 10.1016/j.mvr.2020.104117] [Citation(s) in RCA: 3] [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: 08/20/2020] [Revised: 11/21/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022]
Abstract
Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Our objective has been to establish reference values for major functional and structural parameters of retinal microcirculation in a randomly selected urban population sample. A total of 398 randomly selected individuals from an urban population aged 25 to 65 years, resident in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry (SLDF), with data evaluable in 343 patients. Of this number, complete data were available for 256 individuals free from manifest cardiovascular disease, diabetes and drug treatment for hypertension and/or dyslipidemia, constituting the reference value population. Juxtapapillary retinal capillary blood flow has increased significantly with age whereas vessel and luminal diameters have decreased. No sex differences in retinal microcirculation parameters have been found. Therefore, reference values for retinal microcirculation parameters have been established by age groups. Unattended automated office systolic BP, after adjusting for age, correlated significantly with wall-to-lumen ratio (WLR) and wall thickness (WT). Moreover, after adjusting for age and mean BP, a positive relationship has been found between carotid femoral pulse wave velocity and WT, WLR and wall cross-sectional area, indicating the interaction between micro- and macro-vasculature. In conclusion, our study is the first to provide reference values of retinal microcirculation parameters in a random Caucasian population sample. Our results have shown that, at the population level, the first structural changes in retinal microcirculation are those in lumen diameters. Of note, a close relationship between BP and vascular remodeling of retinal arterioles and between aortic stiffness and WLR of retinal arterioles suggests an interaction between micro- and macro-vasculature.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
| | - Joanna M Harazny
- Department of Nephrology and Hypertension, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Jan Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - Alena Krajčoviechová
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Július Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
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König P, Mayer O, Bruthans J, Seidlerová J, Mateřánková M, Gelžinský J, Rychecká M, Karnosová P, Wohlfahrt P, Cífková R, Filipovský J. The prognostic importance of subclinical heart failure in stable coronary heart disease patients. Acta Cardiol 2020; 75:329-336. [PMID: 30942129 DOI: 10.1080/00015385.2019.1590958] [Citation(s) in RCA: 3] [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] [Indexed: 12/20/2022]
Abstract
Background: In stable coronary heart disease (CHD) patients we aimed to assess the predictive potential of only mild increase of brain natriuretic peptide (BNP) in subjects free from symptoms or diagnostic criteria of heart failure (HF).Methods: We examined 967 patients, at least 6 months after myocardial infarction or coronary revascularization and divided them into three categories: 'overt HF' (NYHA II-IV, objective signs of HF, chronic treatment with furosemide and/or spironolactone or history of hospitalisation for HF), 'subclinical HF (BNP over 150 ng/mL, but no criterion of overt HF)' and 'no HF' (no above mentioned criterion present). Follow-up was done to assess 5-years all-cause mortality.Results: Overt and subclinical HF (by definition) had 38.8% and 9.6% of patients, respectively. In analyses adjusted for classical risk factors and other possible covariates, both overt and subclinical HF were independently associated with increased mortality compared to no HF subjects [hazard risk ratio 1.99 (95%CI:1.02-3.91) and 3.01 (95%CI:1.90-4.78), respectively. The risk of total mortality was similar in overt and subclinical HF patients [HRR 1.30 (95%CI: 0.72-2.36)]. Within overt HF group, those with BNP >150 ng/mL had also higher mortality risk than those with low BNP levels [HRR 2.79 (95%CI: 1.67-4.68)]. The addition of left ventricle ejection fraction into definition of HF groups did not affect main results.Conclusions: Mild increase of BNP in generally stable and asymptomatic CHD patients identifies high individual mortality risk in the same extend that presence of clinically manifest HF.
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Affiliation(s)
- Petr König
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Otto Mayer
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Bruthans
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer’s Hospital, Prague, Czech Republic
| | - Jitka Seidlerová
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Julius Gelžinský
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martina Rychecká
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Petra Karnosová
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer’s Hospital, Prague, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer’s Hospital, Prague, Czech Republic
| | - Jan Filipovský
- Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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Mayer O, Seidlerová J, Kučera R, Kučerová A, Černá V, Gelžinský J, Mateřánková M, Mareš Š, Kordíková V, Pešta M, Topolčan O, Cífková R, Filipovský J. Synergistic effect of sclerostin and angiotensin II receptor 1 polymorphism on arterial stiffening. Biomark Med 2020; 14:173-184. [PMID: 32057249 DOI: 10.2217/bmm-2019-0249] [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: 01/21/2023] Open
Abstract
Aim: We aimed to establish the association between sclerostin (a glycoprotein involved in bone metabolism) and development of pulse wave velocity (PWV) in the general population. Methods: A prospective cohort study with a total of 522 subjects. Aortic PWV was measured twice (at baseline and after approximately 8 years of follow-up) and intraindividual change in PWV per year (ΔPWV/year) was calculated. Results: ΔPWV/year increased across the sclerostin quintiles, but generally in a strong age-dependent manner. However, a significant independent positive association between sclerostin and ΔPWV/year was observed exclusively in C allele carriers of rs5186 polymorphism for the angiotensin II receptor 1 (n = 246). Conclusion: Sclerostin concentrations were associated with an accelerated natural course of arterial stiffening, but only in interaction with renin-angiotension system.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radek Kučera
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Alena Kučerová
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Václava Černá
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Július Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Veronika Kordíková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martin Pešta
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Ondřej Topolčan
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
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Mayer O, Bruthans J, Gelžinský J, Mateřánková M, Mareš Š, Svobodová V, Seidlerová J, Cífková R, Filipovský J. Adherence to cardiovascular prevention principles in subjects at high risk. Vnitr Lek 2020; 66:53-60. [PMID: 32972166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Asymptomatic high-risk individuals represent one of the highest priorities of cardiovascular prevention, in clinical practice frequently overlooked. We analyzed the real adherence to recommended principles of cardiovascular prevention in primary care subjects. METHODS Our analysis is based on random general population sample, examined in the frame of post-MONICA survey in 2016/17. Each subject was categorized with regard to its individual cardiovascular risk (based on Sixth Joint European Guidelines) and the real adherence to recommended targets was ascertained. RESULTS In total 898 subjects aged 25-75 years (47% males) were analyzed. Of them, 16.7% were classified into “very high risk“ and 36.8% into “high risk“ subgroup; remaining 46.5% were only at moderate or low risk. Regarding adherence to recommended principles, in “very high risk“ category only 58.7% abstain from any form of tobacco, 38% reported appropriate physical activity (150 minutes of at least moderate activity weekly), 16.7% had recommended body constitution (BMI 20-25 kg/m2 ), 39.3% appropriate blood pressure (.
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10
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Karnosová P, Mateřánková M, Seidlerová J, Mayer O, Filipovský J, Karnos V. Soluble RAGEs and cardiovascular risk factors in adult offspring of patients with premature coronary heart disease. Blood Press 2019; 29:87-94. [PMID: 31691578 DOI: 10.1080/08037051.2019.1685372] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Advanced glycation end products (AGEs) are a heterogeneous group of highly oxidant compounds which can potentiate microvascular and macrovascular complications through the formation of irreversible cross-links between molecules in the basal membrane and also by engaging the receptor for AGEs (RAGE). Soluble receptor for AGEs (sRAGE) is suggested to have a protective role neutralizing the toxic action of AGEs. We aimed to investigate differences in plasma levels of sRAGE alongside with classic cardiovascular risk factors between offspring of patients with early onset of coronary heart disease (CHD) and healthy controls.Materials and methods: In a cross-sectional design, we examined 114 adult offspring of patients with premature CHD and 194 controls. Concentrations of soluble RAGE were quantified by ELISA methods. Aortic PWV was measured using Sphygmocor device. Multivariate logistic regressions were used to compare differences between the offspring and controls.Results: In the offspring group there were more men (p = 0.023), both groups had similar age (28.5 vs. 28.9 years; p = 0.51). After adjustment for covariates, we observed significantly higher aPWV (6.17 vs. 5.82 m s-1; p = 0.001) and lower sRAGE (1308.11 vs. 1475.59; p = 0.009) in the offspring group compared to controls. The significant determinants of the intergroup difference were sRAGE (p = 0.0017), aPWV (p = 0.011) and current smoking (p = 0.0053).Conclusion: Offspring of patients with early onset of CHD compared to age-matched healthy controls had significantly lower sRAGE levels suggesting a shift in the oxidative balance between stressors and defence mechanisms that may influence a higher cardiovascular risk in the future. The measurement of sRAGE might be a valuable predictor for more precise stratification of cardiovascular risk.
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Affiliation(s)
- Petra Karnosová
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Jitka Seidlerová
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Otto Mayer
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Filipovský
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Václav Karnos
- Department of Surgery, University Hospital in Pilsen, Pilsen, Czech Republic
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11
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Mayer O, Seidlerová J, Mateřánková M, Gelžinský J, Mareš Š, Rychecká M, Svobodová V, Bruthans J, Filipovský J. To what extent can the chosen blood pressure measurement technique affect the outcomes of an observational survey? J Comp Eff Res 2019; 8:841-852. [PMID: 31475585 DOI: 10.2217/cer-2018-0149] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We analyzed to what extent measurement protocol influenced individual blood pressure (BP) and achievement of treatment target in patients with coronary heart disease. Methods: In a subsample of Czech EUROASPIRE III-V survey participants (n = 913), we compared the per-protocol BP measurement (by automated oscillometric device OMRON at the beginning of survey procedure) with control auscultatory measurement (by physician during interview). Results: Per-protocol approach produced significantly (p < 0.0001) higher BP values (by 9/6 mmHg in median) than auscultatory measurements and led to markedly higher proportion of patients over target BP (less than 140/90 mmHg; 59.3 vs 34.9% [p < 0.0001], per-protocol vs auscultatory technique, respectively). Conclusion: Per-protocol oscillometric technique was not equivalent to conventional auscultatory measurement and seriously over-rated the real nonachievement of BP target in observational surveys.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic.,Department of Cardiology, University Hospital, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic
| | - Veronika Svobodová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic.,Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University & Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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12
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Mayer O, Bruthans J, Seidlerová J, Karnosová P, Mateřánková M, Gelžinský J, Rychecká M, Cífková R, Filipovský J. Mood disorders impaired quality of life but not the mortality or morbidity risk in stable coronary heart disease patients. Acta Cardiol 2019; 75:667-675. [PMID: 31442189 DOI: 10.1080/00015385.2019.1653568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/26/2022]
Abstract
Background: It was suggested that depression and anxiety might be associated with increased cardiovascular risk in both primary and secondary prevention. In stable coronary heart disease (CHD) patients, we aimed to assess prevalence of depression and anxiety, its relations to conventional risk profile and mortality or morbidity and to quality of life (QoL). Methods: We examined 969 patients, at least 6 months after myocardial infarction or coronary revascularisation. Depression or anxiety was assessed using a standard HADS (Hospital Anxiety and Depression Scale), while QoL by SF-36 (Short-Form-36 Questions) questionnaires. Follow-up was done to assess mortality in incidence of non-fatal cardiovascular event. Results: Both mood disorders were rather frequent; borderline depression or anxiety (HADS score 8-10) had 14.8 or 10.9% of patients, respectively; moderate-to-severe depression or anxiety (HADS score ≥11) had another 8.2 or 6.7% of patients. After adjustment for potential covariates impaired QoL (SF-36 score <40) was independently associated with depressive mood [odds ratio (OR) 6.08 (95%CI: 2.92-12.7) or anxiety [OR 8.66 (95%CI: 3.77-19.89)], as well as with combination of both disorders [OR 33.58 (95%CI: 15.5-72.6)]. Conventional risk characteristics remained virtually unrelated to mood disorders (with exception of angina pectoris). We found significantly higher incidence of major cardiovascular events in patients with anxious mood and marginally significant inferior survival in patients with depression, but any cardiovascular risk disappeared if adjusted for potential covariates (conventional risk factors, natriuretic peptides, angina pectoris.) Conclusions: Mood disorders severely affected QoL of stable CHD patients, but not their global cardiovascular risk.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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Seidlerová J, Ceral J, Mateřánková M, König P, Řiháček I, Vysočanová P, Souček M, Filipovský J. Long-term relationship between unattended automated blood pressure and auscultatory BP measurements in hypertensive patients. Blood Press 2018; 28:34-39. [PMID: 30474412 DOI: 10.1080/08037051.2018.1540260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/27/2022]
Abstract
AIMS Unattended automated office blood pressure (uAutoOBP) has attracted more attention since SPRINT trial had been published. However, its long-term relationship to attended office blood pressure (AuscOBP) is not known. MATERIAL AND METHODS Stable treated hypertensive subjects were examined in four Czech academic hypertension centers. All subjects attended four clinical visits three months apart. uAutoOBP was measured with the BP Tru device; AuscOBP was measured three times with auscultatory method by the physician. 24-hour ambulatory blood pressure monitoring (ABPM) was performed within one week from the second clinical visit. RESULTS Data on 112 subjects aged 65.6 ± 10.8 years with mean AuscOBP 128.2 ± 12.2/78.5 ± 10.3 mm Hg are reported. Across the four clinical visits, the uAutoOBP was by 10.1/3.7 mm Hg lower than AuscOBP and the mean difference was similar during all four visits (P≥.061). Both uAutoOBP and AuscOBP had similar intra-individual variability during study follow-up as demonstrated by similar intraclass correlation coefficients (ICC, for systolic ICC = 0.50, for diastolic ICC = 0.72). However, the intra-individual variability of the systolic AuscOBP and uAutoOBP difference was high as demonstrated by low ICCs for absolute (ICC = 0.17 [95%CI, 0.09 - 0.25]) and low κ coefficients for categorized differences (κ ≤ 0.16). The main determinant of AuscOBP-uAutoOBP difference was AuscOBP level. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM. CONCLUSIONS Although mean AuscOBP-uAutoOBP differences were relatively similar across the four clinical visits, intra-individual variability of this difference was high. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM. Therefore, uAutoOBP cannot be used as a replacement for ABPM.
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Affiliation(s)
- Jitka Seidlerová
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic
| | - Jiří Ceral
- c Department of Cardiology , Faculty Hospital Hradec Králové , Hradec Králové , Czech Republic
| | - Markéta Mateřánková
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic
| | - Petr König
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic
| | - Ivan Řiháček
- d Faculty of Medicine, 2nd Department of Internal Medicine , St. Anne's University Hospital Brno, Masaryk University , Brno , Czech Republic
| | - Petra Vysočanová
- e Department of Cardiology , Faculty Hospital Bohunice , Brno , Czech Republic
| | - Miroslav Souček
- d Faculty of Medicine, 2nd Department of Internal Medicine , St. Anne's University Hospital Brno, Masaryk University , Brno , Czech Republic
| | - Jan Filipovský
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Prague , Czech Republic
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14
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Slezák D, Mayer O, Bruthans J, Seidlerová J, Rychecká M, Gelžinský J, Mateřánková M, Karnosová P, Wohlfahrt P, Cífková R, Filipovský J. The Prognostic Importance of Impaired Fasting Glycemia in Chronic Coronary Heart Disease Patients. Exp Clin Endocrinol Diabetes 2018; 129:29-35. [PMID: 30157533 DOI: 10.1055/a-0684-9601] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Impaired glucose metabolism represents one the most important cardiovascular risk factors, with steeply raising prevalence in overall population. We aimed to compare mortality risk of impaired fasting glycaemia (IFG) and overt diabetes mellitus (DM) in patients with coronary heart disease (CHD). STUDY DESIGN prospective cohort study METHODS: A total of 1685 patients, 6-24 months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. Overt DM was defined as fasting glucose ≥ 7 mmol/L and/or use of antidiabetic treatment, while IFG as fasting glucose 5.6-6.99 mmol/L, but no antidiabetic medication. The main outcomes were total and cardiovascular mortality during 5 years of follow-up. RESULTS During follow-up of 1826 days, 172 patients (10.2%) deceased, and of them 122 (7.2%) from a cardiovascular cause. Both exposures, overt DM (n=623, 37.0% of the whole sample) and IFG (n=436, 25.9%) were associated with an independent increase of 5-year total mortality, compared to normoglycemic subjects [fully adjusted hazard risk ratio (HRR) 1.63 (95%CI: 1.01-2.61)]; p=0.043 and 2.25 (95%CI: 1.45-3.50); p<0.0001, respectively]. In contrast, comparing both glucose disorders one with each other, no significant differences were found for total mortality [HRR 0.82 (0.53-1.28); p=0.33]. Taking 5-years cardiovascular mortality as outcome, similar pattern was observed [HRR 1.96 (95%CI: 1.06-3.63) and 3.84 (95%CI: 2.19-6.73) for overt DM and IFG, respectively, with HRR 0.63 (95%CI: 0.37-1.07) for comparison of both disorders]. CONCLUSIONS Impaired fasting glycaemia adversely increases mortality of CHD patients in the same extent as overt DM.
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Affiliation(s)
- David Slezák
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Otto Mayer
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Jan Bruthans
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Jitka Seidlerová
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Martina Rychecká
- Fakultni Nemocnice Plzen, Dept. of Cardiology, Plzen, Czech Republic
| | - Julius Gelžinský
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Markéta Mateřánková
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Petra Karnosová
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Peter Wohlfahrt
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Renata Cífková
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Jan Filipovský
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
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15
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Seidlerová J, Gelžinský J, Mateřánková M, Ceral J, König P, Filipovský J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press 2018; 27:256-261. [PMID: 29566565 DOI: 10.1080/08037051.2018.1454258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/17/2022]
Abstract
AIMS Several papers reported that unattended automated office blood pressure (uAutoOBP) is closely related to daytime ambulatory blood pressure monitoring (ABPM). In the present study, we aim to study uAutoOBP and its relation to 24-hour ABPM and ABPM variability. MATERIAL AND METHODS Stable treated hypertensive subjects were examined in two Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP three times with auscultatory method (AuscOBP) by the physician. ABPM was performed within one week from the clinical visit. RESULTS Data on 98 subjects aged 67.7 ± 9.3 years with 24-hour ABPM 120.3 ± 10.6/72.7 ± 7.9 mm Hg are reported. uAutoOBP was lower than 24-hour (by -5.2 ± 11.3/-0.5 ± 6.9 mm Hg) and daytime (by -6.7 ± 12.82.4 ± 8.0 mm Hg) ABPM and the individual variability of the difference was very large (up to 30 mm Hg). The correlation coefficients between ABPM and uAutoOBP were similar compared to AuscOBP (p ≥ .17). Variability of uAutoOBP, but not AuscOBP, readings during one clinical visit was related to short-term blood pressure variability of ABPM. The difference between AuscOBP and uAutoOBP was larger in patients with white-coat effect compared to other blood pressure control groups (25.1 ± 7.0 vs. 2.2 ± 10.3 mm Hg; p = .0036). CONCLUSIONS Our study shows that uAutoOBP is not good predictor of ambulatory blood pressure monitoring, not even of the daytime values. It might, however, indicate short-term blood pressure variability and, when compared with AuscOBP, also detect patients with white-coat effect.
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Affiliation(s)
- Jitka Seidlerová
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic
| | - Julius Gelžinský
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic
| | - Markéta Mateřánková
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic
| | - Jiří Ceral
- c Department of Cardiology , Faculty hospital Hradec Králové , Hradec Králové , Czech Republic
| | - Petr König
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic
| | - Jan Filipovský
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Hradec Králové , Czech Republic
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16
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Filipovský J, Seidlerová J, Ceral J, Vysočanová P, Špác J, Souček M, Řiháček I, Mateřánková M, König P, Rosolová H. A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients. Blood Press 2018; 27:188-193. [PMID: 29334262 DOI: 10.1080/08037051.2018.1425606] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM). MATERIAL AND METHODS Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit. RESULTS Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher. CONCLUSIONS Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP - uAuscOBP difference, as well of uAutoOBP - ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.
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Affiliation(s)
- Jan Filipovský
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic
| | - Jitka Seidlerová
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic.,b Biomedical Centre, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic
| | - Jiří Ceral
- c Department of Cardiology , Faculty Hospital Hradec Králové , Hradec Králové , Czech Republic
| | - Petra Vysočanová
- d Department of Cardiology , Faculty Hospital Bohunice , Brno , Czech Republic
| | - Jiří Špác
- e 2nd Department of Internal Medicine , Faculty of Medicine, Masaryk University, St. Anne's University Hospital Brno , Brno , Czech Republic
| | - Miroslav Souček
- e 2nd Department of Internal Medicine , Faculty of Medicine, Masaryk University, St. Anne's University Hospital Brno , Brno , Czech Republic
| | - Ivan Řiháček
- e 2nd Department of Internal Medicine , Faculty of Medicine, Masaryk University, St. Anne's University Hospital Brno , Brno , Czech Republic
| | - Markéta Mateřánková
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic
| | - Petr König
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic
| | - Hana Rosolová
- a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic
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Mateřánková M, Karnosová P, Mlíková Seidlerová J, Filipovský J, Mayer O. [Risk factors for cardiovascular diseases in the descendants of patients after early myocardial infarction]. Vnitr Lek 2017; 63:398-402. [PMID: 28840735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
GOAL The cardiovascular diseases (CVDs) developing as the result of atherosclerosis are among the most frequent causes of morbidity and mortality within the Czech Republic and elsewhere. Genetic predisposition for cardiovascular diseases is amplified in the presence of routine risk factors which can be influenced. Our aim was to establish whether the level of the risk factors for ICHS already differs in the population of healthy descendants of the patients after early myocardial infarction, as opposed to the control group of examined individuals. METHODOLOGY We approached adult children (n = 127; age 28.7 ± 6.5 years) of the patients with early manifestation of ICHS, who were examined within the study EUROASPIRE IV. The examination of both the descendants and the control group (n = 199; age 28.9 ± 5.3 years) focused on identifying the risk factors for ICHS. RESULTS Descendants presented arterial hypertension more often (18.9 vs 8.0 %, p = 0.003) and there were more smokers among them compared to the control group (37 vs 24.1 %, p = 0.01). The levels of triglycerides (1.13 vs 0.99 mmol/l, p = 0.05) and LDL-cholesterol (2.7 vs 2.45 mmol/l, p = 0.01) were higher in the descendant group, HDL-cholesterol was similar in both groups (1.6 vs 1.67 mmol/l, p = 0.17). Increased fasting glycemia occurred more frequent in the descendant group (5.5 vs 1.5 %, p = 0.05). None of the examined participants met the criteria for the diagnosis of diabetes mellitus. Aortic stiffness was higher in the descendant group as opposed to the control group (6.2 vs 5.8 m/s, p = 0.001). The total calculated cardiovascular risk based on the SCORE system was also higher in the descendant group as compared to the control group - the current risk related to the age of 40 years: 0.35 (0.19-0.64) vs 0.20 (0.13-0.47), p < 0.0001 and the risk related to the age of 60 years: 3.35 (2.23-5.36) vs 2.40 (1.58-4.11), p < 0.0001. CONCLUSION The population of the descendants includes, based on our results, a greater number of smokers and hypertensive patients. They also have higher levels of LDL-cholesterol, triglycerides and impaired fasting glycemia more frequently. Unfavourable genetic predisposition along with unfitting lifestyle contributes to a higher likelihood of accumulation of risk factors, and therefore to a higher risk of a cardiovascular disease manifestation. In practice we should try, with regard to these predisposed individuals, to lower their cardiovascular risk and implement a healthy lifestyle.Key words: atherosclerosis - cardiovascular disease - lifestyle - myocardial infarction - primary prevention - risk factors for CVD.
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