Heath literacy, illness perception and NAFLD/NASH awareness in primary care patients in Crete, Greece

Background and Aims

Patient health literacy (HL), illness perception and awareness are key factors driving health behaviour. This observational study aims to assess the level of HL, illness perception and awareness about non-alcoholic fatty liver disease (NAFLD)/steatohepatitis (NASH) in high-risk primary care (PC) patients in Greece, Spain and the Netherlands.

Methods

Eligibility criteria included: 1) aged ≥50 years, and 2) obesity, and/or metabolic syndrome, and/or diabetes. Patients consecutively visiting PC practices completed a questionnaire assessing socio-demographic characteristics and health habits. HL, illness perception and NAFLD/NASH awareness were assessed using the European Health Literacy Survey Questionnaire, the Brief Illness Perception Questionnaire and the Public Awareness of NAFLD Questionnaire respectively.

Results

Data are available at this moment from the Greek setting. Among the Greek participants (N = 141, 53.2% females, mean age 66 years) 66.7% had diabetes, 78% obesity and 71.6% metabolic syndrome, with 22.7% reporting active smoking. Most (71.6%) had heard about NAFLD by their personal physician. Obesity (78%), excess alcohol intake (45.8%), lack of exercise (38.7%) and diabetes (32.4%) were recognized as the commonest determinants of fatty liver disease, while 78% were aware of ultrasound as the main diagnostic modality and 47% did not know whether there is an available treatment. Only 39% of the participants find information of their treatments easily.

Conclusions

Our preliminary results show that the majority of patients seem to be aware about NAFLD/NASH and their determinants. It's alarming that a lot do not know about treatment, although they are high-risk.

Key messages

Our preliminary results show that the majority of patients seem to be aware about NAFLD/NASH and their determinants. It’s alarming that a lot of patients do not know about their treatment, although they are high-risk.

Long term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy

Background

We The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF).

Methods

We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice.

Results

The median follow up period was 8 years (mean follow-up 7±3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels >14.26 (p<0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR: 14.5, 95% confidence interval (CI): 5.3–39). in those patients.

Conclusions

Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Right ventricular longitudinal systolic strain as a predictor of new onset heart failure with preserved ejection fraction in hypertensive patients

Purpose

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods

We performed a retrospective observational study that included 452 patients with essential hypertension (266 males, aged 63±18 years) and 175 normotensives (100 males, aged 66±15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results

The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: −16.1±9.7 vs −20.0±5.1, RVLS-B: −11.7±3.7 vs −20.6±3.3, RVLS-M: −16.3±5.4 vs −20.7±4.9, p<0.05 for all). No significant difference was detected for the RVLS-A (−20.1±3.8 for hypertensives vs −21.31±6.5 for controls, p=NS). Thirty two hypertensive patients developed HFpEF (7%). A cut-off RVLS-G worse than −17% was significantly associated with new onset HFpEF (p<0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3–25.4).

Conclusions

Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.

Funding Acknowledgement

Type of funding sources: None.

Differential microRNAs profile analysis in pericoronary adipose tissue adjacent to atherosclerotic plaque

Background

Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. PCAT may be a source of microRNAs (miRs) that target other tissues and act as messengers for intercellular communication. In this study, we investigated whether the PCATsurrounding coronary occlusive atherosclerotic lesions shows specific miRs expression patterns compared to PCAT surrounding segments without significant atherosclerosis (plaque-free segments). We evaluated expression of miRs that are known to be implicated in the pathophysiology of atherosclerotic disease.

Methods

We included 40 patients (38 men, aged 62±12 years old) with 3-vessel coronary artery disease who underwent elective coronary bypass surgery. The PCAT was harvested from two sites: adjacent to coronary occlusive atheroscleroticlesion and plaque-free segment. miR-133a, miR-21, miR-26b, miR-9 and miR-143 expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

PCAT analysis revealed a significant downregulation of miR-133a levels in periplaque samples compared to those that were not adjacent to atheroscrerotic plaque (35.4±4.3 versus 87.2±130.5, p=0.03). We also found a significant decrease of miR-143 expression in segments adjacent to plaque compared to those surrounding plaque-free coronary artery (72.6±14.3 versus 213.2±222.5, p=0.01). No significant differences between the two sites were observed in PCAT expression of miR-21, miR-26b, miR-9 (170.7±205 versus 130.9±303.2, 129.8±64.3 versus 200.2±330.6, 40±0.2 versus 30.2±3.6, respectively, p=NS for all).

Conclusions

miR-133a and miR-143 expression in PCAT surrounding coronary occlusive atherosclerotic lesions were significantly downregulated compared to PCAT surrounding segments without significant atherosclerosis. Our study opens new perspectives in the role of PCAT in the pathophysiological mechanisms and the treatment of atherosclerotic disease and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.

Association between long non coding RNA levels and hypertension mediated organ damage

Purpose

Long non coding RNAs (lncRNAs) are emerging as important components of regulatory networks underlying cardiovascular development and pathophysiology. They exhibit distinctive roles in modulating tissue-specific epigenomic states that are critical for the transcriptional and epigenetic reprogramming that may underpin cardiovascular disease pathogenesis. We investigated the association between gene expression levels of the lncRNAs CARMEN and FENDRR in peripheral blood mononuclear cells (PBMCs) and asymptomatic hypertension mediated organ damage.

Methods

We included 56 patients with essential hypertension (38 women, mean age 77±8 years). Twenty nine normotensive individuals (14 women, mean age 76±10 years) were also included as controls. PBMCs were isolated and lncRNAs' expression levels were determined by quantitative real-time reverse transcription polymerase chain reaction. Hypertension mediated organ damage (MOD), namely carotid wall thickening, left ventricular hypertrophy, and albuminuria were assessed in all patients.

Results

Hypertensive patients showed significantly higher CARMEN (19.95±5.9 versus 5.69±2.82, p<0.001) and FENDRR (37.7±11.8 versus 10.21±8.02, p<0.001) expression levels compared with controls. Increased CARMEN expression levels in PBMCs showed a significant relationship with the number of organs involved (r=0.49, p=0.001). No significant relationship was revealed for FENDRR levels.

Conclusions

Our data reveal that in essential hypertension, increased CARMEN expression levels in PBMCs could be a marker of subclinical MOD. Further studies are needed to assess their role as potential biomarkers or future therapeutic targets in those patients.

Funding Acknowledgement

Type of funding source: None

MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Purpose

MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients.

Methods

We assessed the expression levels of miR-208b in 55 patients with acute myocarditis (48 men, mean age 33±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography.

Results

GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.9±10.9% versus −22.2±6.7%, p<0.05). Myocarditis patients showed significantly higher miR-208b (28.8±16.6 versus 6.40±1.1, p<0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p<0.05). This correlation was independent of the patients' clinical parameters.

Conclusions

Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

Funding Acknowledgement

Type of funding source: None

P3475Dabigatran inhibits the activation of endothelial progenitor cells induced by thrombin

Introduction

Thrombin is a coagulation serine protease, which also activates various cell types, including endothelial cells. Late-outgrowth endothelial cells (OECs) are a type of endothelial progenitor cells that contribute to endothelial regeneration and angiogenesis. Dabigatran is a direct oral anticoagulant that inhibits thrombin's action and is widely used in everyday clinical practice.

Purpose

We investigated the effect of dabigatran on thrombin-induced activation of OECs, using the membrane expression of adhesion molecule ICAM-1 as activation marker. Control experiments were conducted in mature human umbilical vein endothelial cells (HUVECs).

Methods

CD34+ cells were isolated from cord blood mononuclear cells, using human CD34 Microbead Kit and appropriately cultured for OEC formation. HUVECs were purchased from Lonza. Confluent OECs and HUVECs were incubated with 10 or 20 μM dabigatran for 10 min, before activation with 8 U/mL thrombin, for 24 h. The effect of dabigatran on ICAM-1 expression (anti-CD54-PE) was evaluated in both cell types as % gated CD31+/CD54+ cells, using flow cytometry.

Results

Thrombin induced ICAM-1 membrane expression by 33±15% on OECs and by 123±22% on HUVECs, compared with respective untreated cells (p<0.05 for both comparisons, from 6 different experiments). Dabigatran at 10 μM significantly inhibited ICAM-1 expression by 36±7% on OECs and 57±8% on HUVECs, as well as at 20 μM by 51±8% on OECs and 79±7% on HUVECs (p<0.05 for all comparisons, from 4 different experiments).

Conclusions

We show for the first time that dabigatran at concentrations relevant to those existing in vivo after oral administration, inhibits the thrombin-induced membrane expression of the adhesion molecule ICAM-1 on OECs, a phenomenon that is also observed on mature endothelial cells. The significance of this effect regarding the pathophysiological role of OECs and mature endothelial cells at the clinical level remains to be established.

Acknowledgement/Funding

Operational Program “Human Resources Development, Education and Lifelong Learning”. Co-financed by the European Union and Greek national funds