The impact of legs fat mass and legs lean fat mass on thigh circumference according cardiovascular risk: a population-based study

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Bialystok, Poland

Introduction A low thigh circumference is associated with an increased risk of high blood pressure, diabetes, cardiovascular diseases, and total mortality.

Objectives The aim of the study was to investigate the relationship between the thigh circumference and cardiovascular (CV) risk classes, and to assess what type of tissue, adipose tissue or muscle tissue affects the thigh circumference.

Methods The longitudinal, population-based, Polish study was conducted in 2017-2020. A total of 931 individuals aged 20-79 were analyzed. Pol-SCORE system was used to assess the 10-year risk of fatal CV based on the following risk factors: age, gender, smoking, systolic blood pressure, and total cholesterol for individuals aged 40-70.  Then, CV risk classes were assessed using the 2019 ESC/EAS guidelines. The measurement of thigh circumference were performed directly below the gluteal fold of the thigh. Both thighs were measured and the mean value was calculated as the final thigh circumference. Body composition was assessed using Dual Energy X-ray Absorptiometry (DEXA).

Results The mean age was 49.1 ± 15.5 years and 43.2% male. The mean thigh circumference was 58.2 ± 5.9 cm, the mean legs fat mass was 7.7 ± 2.8kg, and the mean legs lean mass was 16.9 ± 4.0kg. Lower thigh circumference was associated with higher CV risk classes in univariate linear regression analysis (β -0.516, p = 0.002), as well adjusted by age and sex (β -0.839, p = 0.008), adjusted by age, sex, BMI (β -0.886, p <0.001), and age, sex, WHR (β -0.988, p <0.001). In linear regression analysis legs adipose tissue and muscle tissue were related to the thigh circumference independently of CV risk classes (Model 1) and Pol-SCORE value (Model 2). However, fatty tissue (Model 1: β 0.746, p < 0.001; Model 2: β 0.749, p < 0.001) affects the thigh circumference more than the muscle tissue (Model 1: β 0.479, p < 0.001; Model 2: β 0.442, p < 0.001) (Fig. 1).

Conclusion Smaller thigh circumference was associated with higher CV risk classes. Thigh circumference was more influenced by adipose tissue than by muscle tissue, regardless of the Pol-SCORE  or CV risk classes.

Table 1. Variable Model 1 Model 2 Beta p R2 Beta p R2 Legs fat mass 0.746 <0.001 0.785 0.749 <0.001 0.760 Legs lean mass 0.479 <0.001 0.785 0.442 <0.001 0.760 Model 1: adjusted for Cardiovascular risk classesModel 2: adjusted for Pol-SCOREResults of the linear regression analysis thigh circumference in the general population

Abstract Figure 1.

Very similar cardiometabolic profile in the moderate and high cardiovascular risk classes: a population-based study

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Bialystok, Poland

Background

Cardiovascular disease (CVD) is a major, worldwide problem and remain the dominant cause of premature mortality in the word. Simultaneously the metabolic syndrome is a growing problem. The aim of this study was to investigate the cardiometabolic profile among cardiovascular risk classes, and to estimate CV risk using various calculators.

Methods

The longitudinal, population-based study, was conducted in 2017-2020. A total of 931 individuals aged 20-79 were included. Anthropometric and biochemical profiles were measured according to a standardized protocols. The study population was divided into CV risk classes according to the latest recommendation. Comparisons variables between subgroups were conducted using Dwass-Steele-Critchlow-Fligner test. To estimate CV risk were used: the  Systematic Coronary Risk Estimation system, Framingham Risk Score and LIFEtime-perspective model for individualizing CardioVascular Disease prevention strategies in apparently healthy people (LIFE-CVD).

Results

The mean age was 49.1± 15.5 years, 43.2% were male. Percentages of low-risk, moderate-risk, high-risk and very-high CV risk were 46.1%, 22.8%, 13.5%, 17.6%, respectively. Most of the analyzed anthropometric, body composition and laboratory parameters did not differ between the moderate and high CV risk participants, whereas the low risk group differed significantly. In the moderate and high-risk groups, abdominal distribution of adipose tissue dominated with significantly elevated parameters of insulin resistance. Interestingly, estimating lifetime risk of myocardial infarction, stroke or CV death using LIFE-CVD calculator yielded similar results in moderate and high CV risk classes.

Conclusion

The participants belonging to moderate and high CV risk classes have a very similar unfavorable cardiometabolic profile which may result in the similar lifetime CV risk. This may imply the need for more aggressive pharmacological and non-pharmacological management of CV risk factors in the moderate CV risk population. It would be advisable to consider combining the moderate and high risk classes into one high CV risk class, or it may be worth adding one of the parameters of abdominal fat distribution to the CV risk calculators as an expression of increased insulin resistance.

Abstract Figure 1.

Clinical variables improve efficacy of ECG scores to diagnose the left ventricular hypertrophy in general population

 

Left ventricular hypertrophy (LVH) is an important risk factor of various cardiovascular (CV) diseases and sudden death. Electrocardiography (ECG) is commonly used to detect LVH, but it has poor sensitivity, especially in high cardiovascular risk patients. Although echocardiography (ECHO) is a better, it is less available, and more expensive. Aim: To improve ECG scores to diagnose LVH in a general population.

Methods

The study was conducted in 2017–2019 in a representative sample of area residents. 717 volunteers randomly chosen from the local population were examined. Due to incomplete data, QRS complex duration ≥120ms, fascicular blocks, bundle branch blocks, paced rhythm, 216 people were excluded. Physical examination, ECG, ECHO and laboratory assessment were performed. In ECG LVH defined as >28mm for men, >20mm for women using Cornell index; >17mm for both sexes using Lewis index. In ECHO LV mass was calculated using the Devereux Formula and indexed by body surface area (left ventricular mass index – LVMI). The LVH was defined as LVMI ≥115 g/m2 for man and ≥95 g/m2 for women. Cardiovascular risk was calculated based on the ESC SCORE and additional risk categories published in the latest ESC guidelines. We analyzed 4 models to predict the probability of LVH at ECHO: Model 1: Cornell index; Model 2: Lewis index; Model 3: Cornel index + clinical parameters (age, sex, BMI, office BPs, QRS time, hs-TnT, and HbA1c); Model 4: Lewis index + clinical parameters (age, sex, BMI, office BPs, QRS time, hs-TnT, and HbA1c). Associations between LVH and clinical and biochemical variables were earlier analyzed using multiple linear regression models, these parameters were independently associated with LVH.

Results

A total of 501 patients were included. The average age of patients was 49.0±15.35 years, and 203 probants (40.5%) were male. We developed a novel score to assess the probability of LVH at ECHO in general population based on nine items (age, sex, body mass index, office BPs, Cornell index or Lewis index, QRS time, hs-TnT, and HbA1c). Additional clinical parameters improved sensitivity of Cornell index up to 86.0% (AUC:0.8011; 95% CI:0.748–0.854) from 64.9% (AUC:0.6450; 95% CI:0.573–0.716) in general population, to 92.9% (AUC:0.8423; 95% CI:0.760–0.924) from 64.3% (AUC:0.6481; 95% CI:0.518–0.779) in low CV risk patients, to 69.2% (AUC:0.6767; 95% CI:0.544–0.809) from 38.5% (AUC:0.5284; 95% CI:0.352–0.705) in moderate CV risk, and to 73.3% (AUC:0.7151; 95% CI: 0.609–0.821) of Lewis index from 50.0% (AUC: 0.5630; 95% CI:0.448–0.678) in high and very-high CV risk class.

Conclusions

Addition of clinical parameters to ECG indices in the diagnosis of LVH markedly improves their diagnostic efficacy both in general population and in higher risk groups. The new score may be useful in guiding the appropriateness of ECHO study in general population, and especially in moderate and high CV risk patients, who are not always aware of the increased CV risk.

ROC curves for recognize LVH.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Medical University of Bialystok for Bialystok PLUS study

The effect of temperature, acidification, and alkalization changes as well as ethanol on salivary cathepsin D activity

The activity of salivary cathepsin D undergoes inactivation at the temperature of 50-60 degrees C and at pH of 2.0 and pH of 8.0-10.0. The enzyme activity is also decreased by high concentrations of ethanol and high-proof alcoholic beverages. The factors should be taken into consideration in the evaluation of salivary cathepsin D activity.

The choice of conditions for cathepsin D activity determination in human saliva

The aim of the study was the demonstration and choice of conditions for the determination of cathepsin D activity in human mixed saliva. The 6% solution of hemoglobin, denatured with hydrochloric acid, was used as the substrate. The ratio of saliva volume to hemoglobin was 4:1 w/v. The reaction was interrupted by adding 10% trichloroacetic acid, after 6 hours of incubation at 37 degrees C. The increase in degradation products was determined with the use of Folina and Ciocalteau method with copper modification.

[Cancer procoagulant and cathepsin D activity in blood serum in patients with bladder cancer]

The increasing morbidity and mortality rates of bladder cancer forced the scientists to search for new unfailing diagnostic and therapeutic methods that will improve treatment effects. There are biochemical cancer markers as cancer procoagulant (CP) and cathepsin D which may be used to this end. The aim of the study was to evaluate the activity of the cancer procoagulant and cathepsin D in the blood serum in patients with superficial bladder cancer. The venous blood samples were from 15 patients with microscopically proved superficial bladder carcinoma (i.e. study group) and 15 normal volunteers as a control group. The serum blood CP activity was determined by the Gordon-Benson's coagulation method and expressed by the clotting time in seconds (s) while the cathepsin D activity was determined by the Folin-Ciocalteau's method and expressed by a quantity of released tyrosine in nmol/ml per 4 hours. The CP activity in serum of patients with superficial bladder cancer was increased in statistically way as compared to the non-cancer controls (p<0.0001). The cathepsin D activity in blood serum of the study group was also enhanced as compared to the control group and the said values differed statistically (p<0.0351). It appears to be justifiable to apply the determination of the CP and cathepsin D activity in blood serum for the diagnostics of superficial bladder cancer.

Effects of cathepsin D inhibitor from Vicia sativa L. seed hulls on human skin fibroblasts and breast cancer cells (in vitro studies)

Cathepsin D is a lysosomal protease which plays an important role in cancer invasion and metastasis. There are known inhibitors of that enzyme, such as pepstatin and potato inhibitor. In this study, we examined effects of the cathepsin D inhibitor from Vicia sativa L. seed hulls on cell cultures of human skin fibroblasts and breast cancer cells. There is no effect of the D-cathepsin inhibitor from Vicia sativa L. seed hulls on the proliferative activity of either human skin fibroblasts or breast cancer cells, measured by the [3H] thymidine incorporation assay.

[Proteolytic activity of placenta with EPH-gestosis determined by casein and azocasein]

Total proteolytic activity, activity of cathepsin B, activity of cysteine cathepsins and contents of protein degradation products were determined in placentas of pregnancies complicated with mild, moderate and severe EPH-gestosis and in placentas from normal pregnancies. The highest activity of all the determined proteases was observed in placentas of pregnancies complicated with severe EPH-gestosis. The placentas of pregnancies complicated with severe EPH-gestosis also include the highest amounts of aminoacids and low-molecular peptides.

[Activity of cathepsin B and cystatins in the placenta during EPH-gestosis]

Activity of cathepsin B using Bz-DL-Arg-pNA contents of SH-group by means of Ellman method, activity of cystatins against papain using casein as a substrate and contents of deoxyribonuclein acids by Burton method were determined in 64 placentas of pregnancies with EPH-gestosis and in 36 placentas of physiological pregnancies. The placentas from pregnancies with EPH-gestosis showed markedly higher activity of cathepsin B, no difference in the contents of SH-group, slightly higher activity of cystatins and they contain less deoxyribonucleic acids than the placentas from physiological pregnancies. The obtained results show that proteolytic--anti-proteolytic balance in placentas from pregnacies with EPH-gestosis is changed to the advantage of cathepsin B. This protease may in formation of structural and functional changes observed in placentas during EPH-gestosis.