bluuebunny/crossref_metadata_2025 huggingface dataset:
INCREASED IONIZED CALCIUM-MAGNESIUM-RATIO IN ELDERLY HYPERTENSIVES - RELATIONSHIP TO ARTHERIOSCLEROSIS
Authors: Klaus Kisters Kisters , Lukas Kisters , Bernhard Gremmler , Jutta Sprenger , Uwe Gröber
Published: June 2022

Objective:

Changes in calcium and magnesium metabolism are involved in the pathogenesis of primary hypertension. The calcium and magnesium flux across the external membrane is regulated by a calcium pump (calcium-magnesium-ATPase), calcium and magnesium channels (TRPM 6 and 7) and a sodium-magnesium-antiport. An increased calcium-magnesium-ratio is known to be involved in the development of atherosclerosis. Early onset of these disorders are known in hypertension. In earlier animal studies this phenomenon has been described, too.

Design and method:

Our study was performed in 18 elderly hypertensives (9 male/9 female, with normal renal function, age beyond 60 years). No patient had diabetes mellitus, no diuretic therapy for at least 4 weeks before entry in study and no magnesium supplementation.

In each patient ionized calcium and magnesium was measured and the calcium-magnesium-ratio was calculated.

Measurements were performed by a Prime Plus Apparatus by NOVA Medical, Rödermark, Germany.

Results:

Ionized magnesium was measured 0.55 + /-0.04 mmol/L, normal range 0.54–0.80 mmol/L) in patients.

The ionized calcium-magnesium-ratio was 2.33+/-0.18 (normal range below 2.40).

About 40% of elderly hypertensives showed an increased ratio of ionized calcium and magnesium, which is known to be a marker for the development of artheriosclerosis.

Conclusions:

As described earlier, a magnesium deficiency can be involved in the pathogenesis of hypertension and in elderly.

The increased calcium-magnesium-ratio is also a pathogenetic factor for artheriosclerosis often found in elderly hypertensives with vascular damage, e.g. stroke, renal insufficiency or heart disease.
SEX SPECIFIC CHANGES OF CAROTID ARTERIAL FUNCTION IN RESPONSE TO VITAMIN D DEFICIENCY
Authors: Horváth Eszter Mária , Sipos Miklós , Gerszi Dóra , Dalloul Hicham , Bálint Bálint , Sziva Réka Eszter , Kollarich Réka , Magyar Péter , Török Marianna , Ács Nándor , Szekeres Mária , Hadjadj Leila , Nádasy György L. , Várbíró Szabolcs
Published: June 2022

Objective:

Male sex and Vitamin D deficiency is associated with increased ischemic stroke risk that may be partially explained by local changes of circulatory control. Our aim was to examine the vascular reactivity and histological changes of isolated carotid artery of female and male rats in Vitamin D deficient and Vitamin D supplemented state.

Design and method:

Female and male Wistar rats were fed with vitamin D reduced rat chow for eight weeks. Another group received normal chow with further supplementation of vitamin D. Phenylephrine induced contraction, acetylcholine and estrogen induced relaxation of carotid arteries was examined by wire myography. Elastic fiber density was evaluated on resorcin-fuchsin stained tissue sections. Smooth muscle cell actin (SMA), thromboxane A2 receptor and endothelial nitric oxide synthase (eNOS) density and protein tyrosine nitration (NT) was measured by immunohistochemistry.

Results:

Both male sex and vitamin D deficiency resulted in increased phenylephrine induced contraction. Inhibition of cyclooxygenases by indomethacin increased the degree of contraction only in vitamin D supplemented females. Male gender was associated with reduced acetylcholine induced relaxation, and it was not altered by vitamin D deficiency. Indomethacin increased relaxation in male vessels. Estrogen induced relaxation was significantly reduced by vitamin D deficiency in female but not in male animals. Vitamin D deficiency resulted in reduced elastic fiber density in female, but decreased smooth muscle cell actin density in male rats. Thromboxane A2 receptor density was increased in vitamin D deficient males. NT immunohistochemistry was low in both male group, whereas eNOS was reduced in vitamin D deficient males.

Conclusions:

In rats male gender was associated with increased phenylephrine induced contraction and reduced acetylcholine induced relaxation of the carotid artery. Vitamin D deficiency caused increased contraction in both sexes; did not change acetylcholine induced relaxation, but reduced the estrogen induced relaxation in female arteries. These functional differences were accompanied with sex specific histological changes of the vessel. The observed sex specific properties and responses of carotid artery to vitamin D deficiency may play a role in the gender difference of cardiovascular and stroke risk.
AMBULATORY PULSE PRESSURE COMPONENTS AT AGE 18–40 YEARS CAN PREDICT OUTCOMES
Authors: Gavish Benjamin , Bursztyn Michael , Staessen Jan
Published: June 2022

Objective:

Risk factors for young adults are of special interest. It has been previously shown that average 24-hour ambulatory pulse pressure (PP) can be expressed as a sum of two components: ‘elastic’ PP (elPP) and ‘stiffening’ PP (stPP) associated, respectively, with arterial stiffness at the diastolic blood pressure (BP) and the pressure dependence of stiffness during the systole. The study objective was to determine elPP and stPP (‘PP components’) from 24-hour ambulatory BP (24-hABP) monitoring and assess their prognostic value for selected types of events for the young age using the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO).

Design and method:

Longitudinal population-based study of young adults age 18–40 years from 9 cohorts; Europeans (6 cohorts), Asians (2 cohorts), and South Americans (1 cohort), with baseline observations that included 24-hABP records of adequate quality at baseline. Participants were followed up for events including the incidence of fatal and non-fatal coronary events and fatal and non-fatal heart failure (‘hard cardiac events’) and that of cerebrovascular death and non-fatal stroke (‘hard cerebrovascular events’). The PP components were determined from the individual 24-hABP record using a previously described procedure. For each PP component the hazard ratio (HR) per 1SD increase was determined using Cox regression model adjusted for cohorts (dummy variables) and the baseline characteristics given in Results.

Results:

Baseline characteristics of the 2635 participants were age 30 ± 5y, males 46%, average 24-hour ambulatory diastolic BP 70 ± 7 mmHg, and heart rate 75 ± 9 beats/min, body mass index 24 ± 4 Kg/m2, smoking 29%, drinking alcohol 43%, serum cholesterol 5.0 ± 1.1 mg/dL, history of cardiovascular disease 2.8%, diabetes mellitus 1.6%, and on antihypertensive drugs 2.1%. Hard cardiac and hard cerebrovascular events occurred during the 13.6 ± 6.2 years of follow up. The elPP and stPP were weakly correlated (r = 0.39). The table shows the calculated HR.

Conclusions:

For young adults 24-hour ambulatory elPP (but not stPP) shows protective power for hard cardiac events, while stPP (but not elPP) is a risk factor for hard cerebrovascular events.
AWARENESS OF RISK FACTORS AND COMPONENTS OF LIFESTYLE MODIFICATION IN ELDERLY PATIENTS WITH CARDIOVASCULAR COMORBIDITY AND CHRONIC KIDNEY DISEASE
Authors: Efremova Elena , Shutov Alexander
Published: June 2022

Objective:

Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease and cardiovascular mortality. Timely prevention and diagnosis of CKD in risk groups, primarily in elderly patients with cardiovascular comorbidity, is very important. The aim of this study was to investigate awareness of risk factors and components of lifestyle modification in elderly patients with cardiovascular comorbidity and CKD.

Design and method:

214 elderly patients with stable cardiovascular diseases (106 males, mean age 69.5 ± 7.6 years) were studied. CKD was diagnosed and classified according to the KDIGO guidelines (2012).Awareness of risk factors and components of lifestyle modification were assessed through questionnaires and interviews.

Results:

CKD with glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2(CKD-EPI, 2011) was diagnosed in 144 (67.3%) patients. Only one third of elderly patients with cardiovascular diseases and CKD (33.3%) were aware of their impaired renal function. 18 (12.5%) elderly patients with CKD did not have constant monitoring by medical specialists. Most of the patients had arterial hypertension - 201 (93.9%). Awareness of risk factors and components of lifestyle modification in elderly patients with cardiovascular comorbidity did not differ depending on the presence of CKD (p > 0.05). 181 (84.6%) elderly patients were informed about the benefits of salt restriction, 193 (90.2%) - about the benefits of daily eating vegetables and fruits, 165 (77,1%) - on the need for physical activity. 173 (80.8%) elderly patients with cardiovascular comorbidity never smoked and 178 (83.2%) - very rarely consume alcohol. Only half of elderly patients knew the level of total cholesterol (51.4%) and their cardiovascular risk (45.8%). Majority of elderly patients with cardiovascular comorbidity (95.8%) had home blood pressure monitor regardless of the presence of CKD. Every fourth patient (26.2%) kept a diary of blood pressure self-monitoring. Every fourth of elderly patient (26.6%) never controls blood pressure at home.

Conclusions:

Elderly patients with cardiovascular comorbidity and CKD are well informed about the components of lifestyle modification. only half of elderly patients are aware of their cholesterol levels and cardiovascular risk and engage in self-monitoring of blood pressure, despite the presence of cardiovascular diseases and CKD.
LIPOPROTEIN (A) LEVELS PREDICT PULSE WAVE VELOCITY IN SUBJECTS IN PRIMARY PREVENTION FOR CARDIOVASCULAR DISEASE WITH LARGE APO(A) ISOFORMS: DATA FROM THE BRISIGHELLA HEART STUDY
Authors: Cicero Arrigo F.G. , Fogacci Federica , Derosa Giuseppe , D’angelo Angela , Ventura Fulvio , Rizzoli Elisabetta , D’addato Sergio , Borghi Claudio
Published: June 2022

Objective:

In the last decades, high serum levels of lipoprotein(a) (Lp(a)) have been associated with increased cardiovascular disease (CVD) risk, in particular among individuals with smaller apolipoprotein(a) (apo(a)) isoforms than those with larger sizes. The aim of our analysis was to evaluate whether Lp(a) levels could predict early vascular aging, and whether smaller apo(a) isoforms have a predictive value of vascular aging different than larger apo(a) isoforms in a cohort of subjects free from CVD.

Design and method:

We considered the data of a subset of Brisighella Heart Study (BHS) participants free from CVD (462 men and 516 women) who were clinically evaluated during the 2012 BHS population survey. Predictors of arterial stiffness -measured as carotid-femoral pulse wave velocity (cf-PWV)- were estimated by the application of a step-wise linear regression model.

Results:

In our cohort, there were 511 subjects with small apo(a) size and 467 subjects with large apo(a) isoforms. Subjects with larger apo(a) isoform sizes had significantly lower serum levels of Lp(a). In the BHS subpopulation sample, cfPWV was predicted by age, systolic blood pressure (SBP), serum levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and sex, being higher HDL-C serum levels and female sex associated to lower values of cfPWV. In subjects with smaller apo(a) isoform sizes, predictors of cf-PWV were age, SBP, sex and serum levels of HDL-C, being higher HDL-C serum levels and female sex associated to lower values of cfPWV. In subjects with larger apo(a) isoform sizes, cf-PWV was predicted by age, SBP, serum levels of Lp(a) and sex, being female sex associated to lower values of cfPWV.

Conclusions:

In our subpopulation sample, Lp(a) did not predict cfPWV. However, among subjects with larger apo(a) isoform sizes Lp(a) was a significant predictor of arterial stiffness.
GAMMA-GLUTAMYLTRANSPEPTIDASE IN POLYCYSTIC OVARY SYNDROME
Authors: Chaabouni Khansa , Mezghani Chema , Boudaya Mariem , Zouari Dhouha , Frikha Madiha , Chaabene Kais , Elleuch Aida , Ayadi Fatma
Published: June 2022

Objective:

Gamma-glutamyl transpeptidase (GGT) is implicated in oxidative stress previously reported in polycystic ovary syndrome (PCOS).

Objective:

to investigate gamma-glutamyltranspeptidase (GGT) activity in PCOS.

Design and method:

We have conducted a case control study. PCOS diagnosis was made based on Rotterdam criteria. Age and Body Mass index (BMI) paired controls were recruted. Biochemical parameters were made by automated methods (Cobas-Roche).

Results:

The study material consisted of 45 PCOS women and 40 controls. Overweight Obese women with PCOS had significant increased blood pressure and GGT activity. In all the study group, significant correlations were noted between GGT vs menstrual cycle length, GGT vs blood bressure, GGT vs fasting glucose, GGT vs triglycerides, and GGT vs high density lipoprotein cholesterol (HDLc). Moreover, in PCOS significant correlations were observed between GGT and body mass index.

Conclusions:

These findings suggest that clinical severity of PCOS would be associated to metabolic dysfunctions. The relevance of GGT to BMI and blood pressure in PCOS could be related to various hepatic, lipids, carbohydrates and oxydative alterations in this complex syndrome. Monitoring GGT levels in such patients coud help in disease supervision.
SUPERVISED AND UNSUPERVISED LEARNING TO DEFINE THE CARDIOVASCULAR RISK OF PATIENTS ACCORDING TO AN EXTRACELLULAR VESICLE MOLECULAR SIGNATURE
Authors: Burrello Jacopo , Burrello Alessio , Vacchi Elena , Bianco Giovanni , Caporali Elena , Grazioli Lorenzo , Amongero Martina , Bolis Sara , Vassalli Giuseppe , Cereda Carlo , Mulatero Paolo , Bussolati Benedetta , Melli Giorgia , Camici Giovanni , Monticone Silvia , Barile Lucio
Published: June 2022

Objective:

Secreted extracellular vesicles (EVs) are membrane-bound nanoparticles released from cells. Since their content reflect the specific signatures of cellular activation and injury, EVs display a strong potential as biomarkers in the cardiovascular (CV) field. We aimed at dissecting a specific EV signature able to stratify patients according to their CV risk and likelihood to develop fatal CV events.

Design and method:

A total of 404 patients were included in the analysis. For each subject, we evaluated several CV risk indicators (age, sex, BMI, hypertension, hyperlipidemia, diabetes, coronary artery disease, chronic heart failure, chronic kidney disease, smoking habit, organ damage) and the likelihood of fatal CV events at 10 years, according to the SCORE charts of the European Society of Cardiology. Serum EVs were isolated by immuno-capture and analyzed for the expression of 37 EV surface antigens by flow cytometry. Unsupervised and supervised learning algorithms were applied for clustering patients according to CV risk.

Results:

Based on expression levels of EV antigens, unsupervised learning classified patients into three clusters (cluster I, 288 patients; cluster II, 86 patients; cluster III, 30 patients). Prevalence of hypertension, diabetes, chronic heart failure and organ damage (defined as left ventricular hypertrophy and/or microalbuminuria) progressively increases from cluster I to cluster III, with an average 6.9-fold increase. Several EV antigens, including markers from platelets (CD41b-CD42a-CD62P), leukocytes (CD1c-CD2-CD3-CD4-CD8-CD14-CD19-CD20-CD25-CD40-CD45-CD69-CD86), and endothelium (CD31-CD105) were independently associated to the CV risk indicators and correlated to age, blood pressure, glucometabolic profile, renal function, and SCORE risk. EV specific signature obtained by supervised learning allowed the accurate classification of patients according to their 10-year risk of future CV events, as estimated with the SCORE risk charts.

Conclusions:

EV profiling, obtainable from minimally-invasive blood sampling, may be integrated into CV risk stratification, displaying a potential role in the tailored management of these patients.
HIGH LEVEL OF THE AMOUNT OF ECG PEAKS SV1+RV5–V6 PREDICT NEW CASES OF HYPERTENSION IN THE ORGANIZED POPULATION OF THE PETROCHEMICAL INDUSTRY WORKERS
Authors: Ali Ukla , Podpalov Vladislav
Published: June 2022

Objective:

Identify risk factors for new cases of hypertension according to a 10-year prospective study of the organized population of the petrochemical industry workers in Belarus.

Design and method:

New cases of hypertension were revealed according to a 10-year prospective study in 2004/2014 in the organized population of 1,431 workers of petrochemical industry. In 2004 871 subjects with normal blood pressure were divided into two groups. The first group included 260 workers without adverse working factors, the second group included 611 workers with adverse working factors. The survey included standard questionnaires for detection of cardiovascular risk factors, anthropometric measurements, data from instrumental and laboratory examination.

Results:

According to a 10-year prospective study, a high incidence of hypertension in the studied population was established (37.5%: 31.5% in persons without adverse working factors and 40.1% in persons with adverse working factors) (p < 0.05). A significant positive relationship was found between the incidence of hypertension and work in harmful working conditions (p < 0.05), the strongest connection of which had psycho-physiological factors of labor intensity (p < 0.01). There was revealed significant positive association between the amount of ECG peaks SV1+RV5–V6 (>24 mm) and the frequency of new cases of hypertension adjusted for age, sex and factor of working conditions (df = 1; x2Wald = 33,0; p < 0,001). There were identified other significant factors affecting new cases of hypertension after adjusting for age, sex and factor of working conditions: systolic (p < 0.001) and diastolic blood pressure (p < 0.001), heredity (p < 0.01), absence of higher education (p < 0.001), smoking in the past and present (p < 0.001), alcohol abuse (p < 0.001), low physical activity (p < 0.001), body mass index (p < 0,001), level of salt taste threshold (p < 0,001), level of triglycerides (p < 0,01), glucose (p < 0,001) and GFR (p < 0,001) according to multifactorial regression analysis. Development of hypertension was also associated with a lack of recreational activities (p < 0.001).

Conclusions:

In addition to classical risk factors level of the amount of ECG peaks SV1+RV5–V6 > 24 mm is a new predictor of development of hypertension in the Belarusian organized population.
CLINICAL CHARACTERISTICS OF WOMEN REFERRED TO CARDIAC SPECT: WHEN AND WHO? DATA FROM LATVIAN CARDIAC SPECT REGISTRY
Authors: Vitola Barbara , Mintale Iveta , Trusinskis Karlis , Kalnina Marika , Kedrova Jelena , Erglis Andrejs
Published: June 2022

Objective:

Population based cross-sectional study of cardiovascular risk (CVR) factors in Latvia from year 2009 till 2019 revealed that women in age 25 -74 are in a very high CVR group: 61% of women have dyslipidemia, more than 33% have arterial hypertension (AH) and 28% are overweight. The data indicates the necessity for focused diagnostics and early detection of cardiovascular disease. The aim of study was to define the clinical profile and risk factors for women with suspected coronary artery disease (CAD) reffered to cardiac single photon emission computed tomography (SPECT) in Latvia and to find out the correlation between nuclear test result and patient clinical presentation.

Design and method:

Cardiac SPECT was performed in a single centre from 2018 till 2021. The women patients were analyzed by risk factors and previous diagnosis of CAD. Exercise test was performed in all cases. Patients were divided into 2 groups: normal myocardial perfusion or true myocardial perfusion defect, defined as area of ischemia more than 10% of the left ventricle myocardium mass.

Results:

726 SPECT data were analyzed. The mean age of women patients was 62.6 ± 10.6 years. More than half of the patients (n = 486,66.9%) were overweight (BMI> 25.0 kg/m2) and 33.3%(n = 242) were obese (BMI> 30.0 kg/m2). 87 (11.9%) women were current or ex-smokers. Dyslipidemia was present in in 614 (84.6%), AH in 535 (73.7%) and type 2 Diabetes mellitus (T2DM) in 60 (8.3%) patients. 104 (14.3%) patients were asymptomatic, but with intermediate to high pre-test probability for CAD. Known CAD was present in 298 (41.0%) patients. Exercise test was found positive in 306 (42.1%) patients and the test result was not always associated with ischaemia in SPECT (p = 0.063). True myocardial perfusion defect was detected in 125 patients (17.2%). Correlation was found between significant perfusion defect in SPECT and risk factors - AH (p = 0.013) and dyslipidemia (p = 0.029).

Conclusions:

The registry proves the high value of imaging with cardiac SPECT for diagnostics of CAD. Women patients with intermediate or high pre-test probability – even asymptomatic or with non informative exercise test should be reffered for cardiac SPECT.
PREVALENCE OF TARGET ORGAN DAMAGE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN IBERICAN STUDY
Authors: Secin Anny Altagracia Romero , Moreno Francisco Javier Alonso , Martínez Teresa Rama , Rivero Javier Benitez , Amengual Ana Moyá , Escobar Francisco Jesús Morales , Hernández Héctor Suárez , Roca Francisco Valls , Fernández Juan Jesús García , Sanjurjo Sergio Cinza
Published: June 2022

Objective:

The general aim of IBERICAN study is to know the prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease in Spain. The aim of this abstract is to know the prevalence of subclinical target organ damage (TOD) and type 2 of Diabetes mellitus (T2DM) in population of the IBERICAN Study.

Design and method:

The IBERICAN Study is a longitudinal, observational, and multicentric study with subjects between 18 to 85 years of age, recruited in Primary Care (PC) and who will be follow up at least 10 years. The final sample size is estimated in 8,066 patients. We show the baseline characteristics of the patients in the first visit (n = 8,066). To define the TOD, we consider the ESH 2013 Guide criteria: pressure pulse in aged > 60 mmHg, ankle/brachial index < 0.9, microalbuminuria: albumin/creatinine ratio (between 30 - 299 mg/g), glomerular filtration (CDK-EPI < 60 ml/min), left ventricular hypertrophy (electrocardiogram or ECHO).

Results:

1,434 patients had T2DM (20.1%), 56.4% men. 44.8% of patients with T2DM had TOD. Of the patients with TOD, the mean BMI was 31.7 ± 9.6 Kg/m2. By type of TOD: pulse pressure at > 60 mmHg: 29.2%; ankle/brachial index < 0.9: 3.0%; microalbuminuria: 17.0%; left ventricular hypertrophy: 7.0%. The prevalence of cardiovascular risk factors in patients with T2DM and TOD compared to non-TOD was: Hypertension 84.8% vs 68.4%, p< 0.001; dyslipidemia 78.2% vs 71.6%, p < 0.01; obesity 52.0% vs 49.7% p = 0.376; alcohol consumption 17.0% vs 15.2% p = 0.369; smoking 12.4% vs 14.7%, p = 0.202; sedentary lifestyle 38.5% vs 33.7%, p = 0.061.

Conclusions:

The prevalence of TOD in patients with T2DM in primary care is high, half of the patients. By type of TOD, elevated pulse pressure in the elderly and microalbuminuria were the most prevalent. Arterial hypertension and dyslipidemia were more prevalent in patients with TOD.
ASSOCIATION BETWEEN URIC ACID AND METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS
Authors: Otmane Amel , Makrelouf Mohamed , Zenati Akila
Published: June 2022

Objective:

Obesity and metabolic syndrome are implicated in the pathophysiology of hypertension.

The aim of this work is to analyse the association between uricemia and components of the metabolic syndrome and insulin resistance in hypertensive patients.

Design and method:

It is a prospective study, 245 hypertensive patients (57 ± 8.49 years: women (79,60%)/ men (20,40%), 115 patients with MetS and 130 without MetS were examined for metabolic status in fasting blood (glycemia, triglycerides,total cholesterol, HDLc, LDLc, uric acid, CRPus and HOMA-IR. The definition of the National Cholesterol Education Program Adult Treatment Panel III for Mets. Insulin resistance estimated by the HOMA-IR.

Results:

The prevalence of metabolic syndrome in our series is 48%, we observed that 45% of patients are sedentary, 47% are overweight and 36.25% of them are obese.

Insulin resistance assessed by the HOMA index is 45%. The results of the uricemia in the patients reveal levels of (51.81 ± 13.8) mg/l for the HTA with sMet, and 45.73 ± 13.7 for the group without sMet. It is higher in obese hypertensive patients, the difference is significant (p = 0.0005).

Correlation analysis between uric acid and components of the metabolic syndrome revealed a significant association with BMI (p = 0.003), waist circumference (p = 0.0006), HOMA-IR (p = 0.0006) and CRPus (p = 0.04) in the sMet group. In the group without sMet no significant correlation was found with the parameters studied.

Conclusions:

The data obtained in our series reveal that hyperuricemia could be a cardiovascular risk factor. Several experimental and epidemiological studies also support a direct or indirect role of hyperuricemia in the pathogenesis of the metabolic syndrome in hypertension.
CARDIOVASCULAR RISK FACTORS IN TYPE 1 DIABETES MELLITUS: ANY DIFFERENCE BETWEEN ADOLESCENTS AND YOUNG ADULTS FOR SUBCLINICAL ATHEROSCLEROSIS?
Authors: Bortolotti Stefano , Cattazzo Filippo , Tagetti Angela , Marcon Denise , Rosin Elena , Minuz Pietro , Maffeis Claudio , Fava Cristiano
Published: June 2022

Objective:

Atherosclerosis is one of the most dangerous complications of type 1 diabetes mellitus (T1DM) leading to cardiovascular (CV) diseases. There are only a few data about the relative burden of the other CV risk factors apart from DM in determining subclinical atherosclerosis at different ages in patients with T1DM. Thus, the aim of the present study was to compare adolescents and young adults with T1DM about the association of the different CV risk factors with subclinical vascular damage.

Design and method:

In sixty children and sixty adults with T1DM matched for sex and glycated haemoglobin [HbA1c] level, carotid intima-media thickness (cIMT), carotid coefficient of distensibility (cDC) and Pulse Wave Velocity (PWV) were measured by carotid ultrasonography and the SphygmoCor XCel device. Peripheral and central systolic/diastolic blood pressure (pSBP/pDBP; cSBP/cDBP), body mass index (BMI), HbA1c, nonHDL/HDL-cholesterol ratio were also analyzed. Demographic and hemodynamic variables are shown in Table-1.

The relationship between risk factors and markers of subclinical vascular damage was assessed in each group by linear regression models using as covariates: gender, BMI, age, HbA1c, nonHDL/HDL-cholesterol ratio, and either pBP or cBP.

Results:

cIMT was associated neither with hemodynamic parameters nor with metabolic risk factor in both adolescents and adults. In adolescents, cDC was associated with pSBP (±SEM -017 ± 0.09 p-value = 0.013) whereas PWV showed an association with cSBP (±SEM 0.37 ± 0.008; p-value:0.003), cDBP (±SEM 0.46 ± 0.02; p-value:0.000), pDBP (±SEM 0.35 ± 0.01; p-value:0.003), and non-HDL/HDL ratio (±SEM 0.35 ± 0.12; p-value:0.007). In young adults, cDC was associated with cDBP (±SEM -0.28 ± 0.13; p-value:0.005) and pDBP (±SEM -0.26 ± 0.15 p-value = 0.02) whereas PWV was associated with cDBP (±SEM 0.36 ± 0.009; p-value:0.02), pSBP (±SEM 0.37 ± 0.01; p-value:0.002) and pDBP (±SEM 0.37 ± 0.02; p-value: 0.004).

Conclusions:

Subclinical vascular damages in T1DM are associated especially with hemodynamic factors, such as SBP and DBP, both in adolescents and young adults. Our findings suggest that BP control may be paramount starting early in patients with T1DM.
A TURN IN THE WRONG DIRECTION. WHAT IS MISSING?
Authors: Casian Mihnea , Gurzun Maria Magdalena , Ionita Iulia Theodora , Munteanu Alice Elena
Published: June 2022

Objective:

The case highlights the importance of specific non-traditional cardiovascular risk factors in a patient with premature severe cardiovascular disease, despite an apparently adequate control of traditional cardiovascular risk factors.

Design and method:

Clinical Case.

Results:

We present the case of a 38 year-old female with Turner syndrome, with cardiovascular risk factors (mild dislypidemia, type 2 diabetes, grade 1 ESC/ ESH hypertension) who presents to the emergency department for newly-onset constrictive chest pain. Her chronic treatment consisted of a low-dose ACEi and metformin. Clinical exam was unremarkable, except for specific clinical phenotype, with normal BP values in both arms and without any signs of congestion. The electrocardiogram showed sinus rhythm of 65 beats/min, narrow QRS, negative T waves in inferior leads, as well a Q wave in lead III. Hs- troponin (1046pg/ml, ULN: 10pg/ml) and NT-proBNP levels (820,9pg/ml) were elevated. Echocardiography revealed a normal ejection fraction, with localized hypokinesia of the inferior wall and no significant valvular disease. The aortic valve was tricuspid and no signs of aortic coarctaction were observed from the suprasternal view. Coronarography was performed, showing significant CAD, with multiple lesions on ADA, LCXA and RCA. The two suboclusive lesions from the RCA were addressed using two drug eluting stents. The evolution was favourable under specific treatment. The baseline levels of LDLc (117 mg/dl) and glycosylated haemoglobin (5,7%) were not as high as we initially expected, given the severe CAD. Furthermore, the ambulatory 24 h BP monitoring after discharge confirmed that the previous treatment with low-dose ACEi was efficient in maintaining the target BP values.

Conclusions:

Turner syndrome is associated with a variety of cardiovascular manifestations, such as aortic coarctation, which leads to secondary hypertension, as well as an increased risk of cardiovascular events. In our patient, the hypertension was essential, without any arguments for secondary hypertension, as we would have expected. Furthermore, despite the fact the patient exhibited several traditional cardiovascular risk factors, they were controlled within the recommended targets (with the exception of LDLc, slightly higher than 100 mg/dl). The disease duration appears to be critical, as the patient was diagnosed with hypertension more than 15 years ago. We concluded that the advanced premature CAD is most likely the result of the hormonal imbalance and lack of hormone replacement therapy, for which the patient was no longer eligible. Drastic control of traditional cardiovascular risk factors in this case will probably prove to be insufficient.
SERUM URIC ACID LEVELS ARE NOT ASSOCIATED WITH THE SEVERITY OF ACUTE ISCHEMIC STROKE
Authors: Kiosi Maria , Kostourou Danai-Thomais , Mentizis Pavlos , Gkounta Anastasia , Minopoulou Ioanna , Kourtidou Christina , Chatzopoulos Georgios , Gogou Christiana , Kontana Anastasia , Kyziroglou Maria , Tziomalos Konstantinos
Published: June 2022

Objective:

Previous studies reported discrepant results regarding the association between serum uric acid levels and the severity of acute ischemic stroke. We aimed to evaluate this association.

Design and method:

We prospectively studied 1,107 consecutive patients who were admitted for acute ischemic stroke (42.1% males, age 79.8 ± 7.2 years). Stroke severity was evaluated at admission with the National Institutes of Health Stroke Scale (NIHSS) and severe stroke was defined as NIHSS > = 21. Serum uric acid levels were measured at the second day after admission in the fasting state.

Results:

Serum uric acid levels did not correlated with the NIHSS (r = 0.018, p = NS) and did not differ between patients with severe stroke and those with non-severe stroke (5.9 ± 2.2 and 5.7 ± 1.8 mg/dl, respectively; p = NS). In binary logistic regression analysis, independent predictors of severe stroke were age (relative risk (RR) 1.079, 95% confidence interval (CI) 1.042–1.117, p < 0.001), female gender (RR 1.841, 95% CI 1.138–2.980, p < 0.05), atrial fibrillation (RR 1.678, 95% CI 1.076–2.618, p < 0.05) and diastolic blood pressure at admission (RR 1.020, 95% CI 1.005–1.035, p < 0.01).

Conclusions:

Serum uric acid levels do not appear to be associated with the severity of acute ischemic stroke.
THE MORTALITY RISK IN PATIENTS HOSPITALIZED FOR ISCHEMIC STROKE BETWEEN 2003 AND 2019
Authors: Mayer Otto , Kielbergerov Lenka , Bruthans Jan
Published: June 2022

Objective:

Stroke represents the ultimate complication of hypertension. Mainly due to improved hypertension control, stroke incidence and mortality from cerebrovascular events decreased in the Czech Republic since the ‘80 s. On the other hand, how this favorable trend affects the case fatality and consequent mortality of individuals who suffered from stroke remains questionable. In patients hospitalized for ischemic stroke, we evaluated the mortality trends in the last two decades.

Design and method:

9076 patients [mean age 71.8 (±SD 12.3), 51.9% males] hospitalized for ischemic stroke at baseline between 2003 and 2019 were followed in the prospective study. The vital status we ascertained up to 31.12.2020, all other circumstances from the hospital information system

Results:

In total, 5583 of our patients died during follow-up. The case fatality was 9.1%, 30-day mortality 14.2%, and 1-year mortality 28.4%. In patients hospitalized from 2003–2015, the 5-year mortality was 49.8%. No significant changes were noted for case fatality, 30-days, 1-year mortality, as well as 5-years mortality risk across the year of hospitalization or more extensive periods (2003–07, 2008–11, 2012–15 and 2016–19). As expected, any age decade of patients was associated with two-fold higher mortality risk, and a significant predictor was also hospitalization >10 days. In contrast, the male gender did not predict increased risk Intravenous thrombolysis as part of initial management markedly increased over time (from 2.4% in 2003–07 to 48.1% in 2016–19), but this procedure did not significantly affect the mortality risk (neither 1-year nor 5- years in partial sample).

Conclusions:

Despite favorable trends in cerebrovascular events from a population perspective, the individual prognosis of patients who have suffered a stroke remains very poor.
HEART RATE VARIABILITY AND BRAIN FUNCTIONING IN HYPERTENSIVE PATIENTS
Authors: German-Sallo Marta , Preg Zoltan , Pál Tünde , Andrássy Krisztina , Tatar Maria-Cristina , Szentendrey Dalma Bálint
Published: June 2022

Objective:

Decreased heart rate variability (HRV) reflecting autonomic nervous dysfunction has been associated with increased mortality in cardiovascular diseases. Less is known about the relationship between HRV and hypertension associated cognitive impairment. The study aimed to compare HRV parameters in well-controlled hypertensive patients with and without cognitive dysfunction, as marker of functional brain damage caused by hypertension.

Design and method:

Data about 226 hypertensive patients were obtained, 53% males, between 37 and 98 years (mean age 66 years ± 10). The mean blood pressure was 135/81 mmHg (±19/11 mmHg) (under hypertensive medication). Cognitive abilities were measured with the multi-domain Montreal Cognitive Assessment questionnaire (MoCA) defining cognitive decline below 24 points. All patients had 24- hour Holter monitoring. Time domain [pNN(50), NN(50) SDNN, rMSSD] and the LF/HF frequency domain HRV parameters were analyzed in patients with normal and impaired cognition, and in different cognitive domains with the IBM SPSS v20 software.

Results:

Cognitive dysfunction was present in 63.73% of the studied group. Time domain parameters pNN(50), NN(50) and r MSSD were significantly higher in patients with altered cognition (p = 0.002, p = 0.001, p = 0.02). Frequency domain HF was also significantly higher in this group (p = 0.03). Male individuals had significantly higher LF/HF ratio (men 1.08% vs. women 0.97%, p = 0.006). Patients with hypertension grade II had higher LF/HF ratio compared to grade III (1.069 vs. 0.98%, p = 0.01). Analyzes of cognitive domains in the total study group revealed low SDNN, rMSSD values in language, abstraction domains, with statistical significance in the domains of visuospatial-executive (SDNN p = 0.013, rMSSD p = 0.001) and attention (SDNN p = 0.044). Higher LF/HF ratio was found in all cognitive domains, excepting attention, with statistical difference in delayed recall (p = 0.015).

Conclusions:

Our data suggest a gender difference regarding sympathovagal balance in hypertensive patients with enhanced sympathetic activity in males. Although higher HRV was observed in cognitively impaired well-controlled hypertensive patients, time domain HRV parameters reflecting impaired autonomic nervous function were related to some specific cognitive domains. Future studies are needed to better understand these findings.
COGNITIVE IMPAIRMENT AND CAROTID INTIMA-MEDIA THICKNESS IN PATIENTS WITH RESISTANCE HYPERTENSION
Authors: Gulkevych Oksana , Mishchenko Larysa , Logvynenko Alla , Matova Olena
Published: June 2022

Objective:

To determine predictors of cognitive impairment in patients with resistance hypertensin (RH) after 3-years of follow-up.

Design and method:

In 98 patients with RH (average age 52.4 ± 1.2, 60 males, mean hypertension history at the baseline 12.8 ± 0.9 years) we measured office blood pressure, ultrasonographically diameter (D) of common carotid (CCA) artery, carotid intima-media thickness (IMT), performed Montreal cognitive assessment (MoCA) test, ambulatory blood pressure monitoring twice: initially and after a mean period of 3 years. Also morning fasting venous blood samples were obtained from all subjects for uric acid, lipid profile, glucose assays. Age and other cardiovascular risk factors were included in the analysis.

Results:

There was a significant deterioration in the MoCA results during the follow-up: 23.2 ± 0.2 at the baseline vs 22.6 ± 0.2 after 3 years, p = 0,02. The cognitive decline was significantly associated with initial measurement of IMT (b = -0.232, p = 0.01). This association was independent of age, body mass index and hypertension history. No statistically significant associations were obtained between the MoCA results and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, LDL cholesterol, serum uric acid, glucose.

Conclusions:

Our data suggested that cognitive impairment in patients with resistance hypertension associated with severity of the carotid structure damage and carotid intima-media thickness at the baseline was independent predictor of cognitive decline in these patients.
ASSOCIATION BETWEEN TRIGLYCERIDE-GLUCOSE INDEX AND LOW APPENDICULAR LEAN MASS IN CHINESE ADOLESCENTS
Authors: Zhou Jinyu , Bai Ling , Tong Lingling , Ding Wenqing
Published: June 2022

Objective:

It has been verified that the triglyceride-glucose (TyG) index is an effective surrogate marker of insulin resistance in numerous studies. This study aims to explore the association between TyG index and appendicular lean mass (ALM) in Chinese adolescents.

Design and method:

A total of 1336 adolescents (805 boys, 60.25%) aged 12 to 18 years in China were randomly selected through a stratified cluster sampling. All participants were divided into four groups according to the tertiles of TyG index, and ALM was measured by Bioelectrical Impedance Analysis (BIA).

Results:

After adjusted for age, ALM/weight was negatively associated with the TyG index both in boys (r = -0.267, P < 0.001) and girls (r = -0.209, P < 0.001), while other indexes were positively correlated with TyG index (all P values < 0.05), especially for fasting plasma glucose (Boys: r = 0.476, P < 0.001; Girls: r = 0.393, P < 0.001). The results of binary logistic regression showed that the low ALM/weight in the third tertile of TyG index versus the control was 2.36(1.42–3.94) in boys while there was no association between TyG index group and ALM/weight in girls(P = 0.087). This relationship remained similar after adjusting for confounding factors such as total cholesterol level, fasting plasma glucose, and mean blood pressure.

Conclusions:

Elevated TyG index was associated with the risk of low ALM/weight independent of confounding factors in Chinese boys.
ISRADIPINE FOR THE TREATMENT OF ACUTE SEVERE HYPERTENSION IN CHILDREN
Authors: Short Braden , Moon Kwi , Larkins Nicholas G. , Hijazzi Sally
Published: June 2022

Objective:

There is scarce data on the use of oral agents to treat acute severe hypertension in children, despite being common practice for children with no or minimal symptoms. The aim of this study was to evaluate the safety and efficacy of isradipine in children with acute hypertensive episodes, following a hospital-wide change from nifedipine to isradipine as the preferred calcium channel blocker for acute severe hypertension.

Design and method:

We reviewed the first 10 inpatients to receive isradipine at the sole tertiary paediatric hospital in Western Australia from June 2021. Patient characteristics and blood pressure (BP) measurements (systolic, diastolic and mean arterial pressure (MAP)) at baseline and during the six hours following isradipine administration were extracted. Linear regression and Spearman rank correlation coefficient were used to examine the relationship between dose and BP reduction. Adverse events and requirement for additional antihypertensives were also recorded.

Results:

A total of 10 patients (median 7 years, interquartile range [IQR] 4–11 years, youngest 2 years) received 23 doses of isradipine for discrete episodes of acute severe hypertension. The median systolic BP and MAP at treatment initiation were 140 mmHg (IQR 132–148) and 111 mmHg (IQR 104–119), respectively. The median dose administered was 0.09 mg/kg/dose (IQR 0.06–0.09). The median reduction of systolic and diastolic blood pressure were 13% (IQR 9–20%) and 11% (IQR 2–28%), respectively. The MAP dropped by 13% (IQR 7 to 25%). BP reached treatment targets following 18 doses (78%). In the 5 cases requiring a further antihypertensive dose, 3 received clonidine, one a further dose of isradipine, and one their regular antihypertensive agent. The systolic BP and MAP fell by more than 25% following a total of 4 (17%) and 6 (26%) of doses, respectively. There was no relationship between dose and outcome over the narrow range of mg/kg/dose administered. No child had a BP drop of more than 50% or any adverse events recorded.

Conclusions:

Isradipine was a safe and effective treatment for acute severe hypertension among our initial cohort. Further data is being collected to expand the pharmacodynamic information available for isradipine use in children.
DIFFERENCES IN METABOLOMICS IN CHILDREN WITH HIGH AND LOW ARTERIAL STIFFNESS. A CASE-CONTROL STUDY
Authors: Poikilidou Maria , Yavropoulou Maria , Tsave Olga , Stamou Maria , Grammatikopoulou Artemida , Georgianos Panagiotis , Zebekakis Pantelis
Published: June 2022

Objective:

Studies in children have shown a progressive increase in arterial stiffness by measuring pulse wave velocity (PWV) during childhood, indicating a structural alteration to the arterial wall starting already in early life. Metabolomic studies also show differences in molecules between different disease states in children. The aim of the current study was to identify molecular markers between age and gender-matched children with high and low PWV.

Design and method:

The study included the screening of 132 children that came for random visits to a tertiary pediatric clinic. 50 children (25 in the highest PWV tertile-Group 1, and 25 in the lowest PWV tertile-Group 2) were chosen for the metabolomic study. The groups were matched for age and gender and underwent an ABPM, and PWV, Aix measurements as well as measurements of central BP. We used t-test to explore differences between the two groups. We used mass spectrometry and constructed a heat map displaying the differences in each metabolite concentration between the two groups.

Results:

The mean age of the study population was 11.4 ± 2.7 years. Group 1 had significantly higher BMI percentiles than Group 2 (94.7 ± 8.7 and 74.3 ± 27.6, p < 0.001), higher 24-hour SBP (117.3 ± 110.9 ± 9.0mmHg, p = 0.025) and higher 24-hour DBP (70.7 ± 7.3 vs 65.8 ± 5.8mmHg, p = 0.018), higher central SBP (95.1 ± 8.5 vs 89.3 ± 9.7mmHg, p = 0.028), and DBP 69.6 ± 8.6 vs 60.8 ± 11.0mmHg, p = 0.003). Similarly, significant differences occurred also between clinic SBP and DBP. Table 1. shows the metabolites that were significantly upregulated in Group 1.

Conclusions:

The current metabolomic study found differences in certain metabolites between children in the highest and lowest ends of arterial stiffness. These metabolites involve sphingolipids, sterol lipids, fatty acyls, carboxylic acids, glycerophospholipids as well as other compounds that are not yet fully identified on their properties.
VASCULAR AGE IN ADOLESCENTS WITH PRIMARY HYPERTENSION
Authors: Obrycki Lukasz , Pac Michal , Sarnecki Jedrzej , Feber Janusz , Litwin Mieczyslaw
Published: June 2022

Objective:

There is evidence that children with primary hypertension (PH) are more mature than their normotensive peers in terms of bone and the immune system age. The aim of our study was to evaluate vascular age and its relationship with hypertension-mediated organ damage (HMOD) in adolescents with PH.

Design and method:

We assessed 362 children [90 girls; 15.5 (13.9;16.8) years] referred for work-up of office hypertension and 64 normotensive (NT) subjects [12 girls; 14.5 (13.8;15.6) years] not different in terms of age, body mass (BM) and BMI. We analyzed age- and height-related pulse wave velocity (PWV); the expected vascular age (based on measured PWV) was obtained from pooled pediatric and adult PWV norms and the difference (VascAgeDiff) between the vascular and chronological age was calculated. In all patients we obtained ambulatory blood pressure monitoring (ABPM) and HMOD: left ventricular mass index (LVMi), carotid intima-media thickness (cIMT) and pulse wave analysis (PWA) parameters: stroke volume (SV), cardiac output (CO), aortic BP (AoBP), total peripheral resistance (TPR).

Results:

Based on office, ABPM and AoBP, patients were classified into white coat hypertension (WCH) - 166 patients, ambulatory prehypertension (AmbPreHT) – 32; spurious hypertension (sHT – isolated systolic hypertension and normal AoBP) – 55; true hypertension (tHT – elevated office, ambulatory and AoBP) – 99. VascAgeDiff progressively increased from NT through sHT, WCH, AmbPreHT to tHT (3.5; 6.2; 7.2; 10.0; 10.7 years; p < 0.01). VascAgeDiff correlated (univariate analysis) significantly with weight, BMI z-score, office systolic (SBP) and diastolic blood pressure (DBP), AoBP, 24-h mean arterial pressure, 24-h DBP, CO, serum uric acid and LDL cholesterol level (p < 0.05). Multivariate regression analysis including above mentioned parameters revealed that significant predictors of VascAgeDiff were: weight, SBP, DBP, AoBP, CO and serum LDL cholesterol (p < 0.05).

Conclusions:

Out study suggests early vascular aging in adolescents with PH, even at mildly increased BP levels (WCH, prehypertension). Vascular changes were associated with increased weight, DBP, AoBP, CO and LDL cholesterol.