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1.
Decreased serum levels of CTRP12/adipolin in patients with coronary artery disease in relation to inflammatory cytokines and insulin resistance.
Fadaei, R, Moradi, N, Kazemi, T, Chamani, E, Azdaki, N, Moezibady, SA, Shahmohamadnejad, S, Fallah, S
Cytokine. 2019;:326-331
Abstract
Coronary artery disease (CAD) is the leading cause of death worldwide. Atherosclerosis as the main underlying mechanism of CAD is associated with inflammation and adipose tissue dysfunction. C1q/TNF-related protein12 (CTRP12) is a newly discovered adipokine which is a paralog of adiponectin. CTRP12 has anti-inflammatory and insulin sensitizing effects. Circulating levels of this adipokine have been reported to be lower in patients with type 2 diabetes and women with polycystic ovarian syndrome. The present study was undertaken for the first time to evaluate serum levels of CTRP12 in CAD patients and its association with anthropometric and biochemical parameters. Serum levels of CTRP12 were measured using ELISA kit in 188 CAD patients (angiography confirmed) and 70 controls. The serum levels of adiponectin, TNF-α and IL-6 were measured using ELISA kits. Serum levels of CTRP12 were found to be lower in CAD patients (585.48 ± 201.67 pg/mL) than in the controls (814.86 ± 247.85 pg/mL; p < 0.001). CTRP12 also showed an independent association with the risk of CAD (OR [CI] = 0.998 [0.996-0.999]; p = 0.019). Moreover, it showed an inverse correlation with HOMA-IR (r = -0.298; p = 0.012) and TNF-α (r = -0.269; p = 0.023) and a positive correlation with adiponectin (r = 0.344; p = 0.003) in the controls. In CAD patients, CTRP12 was inversely correlated with BMI (r = -0.181, p = 0.013), HOMA-IR (r = -0.199; p = 0.006), TNF-α (r = -0.259; p < 0.001) and IL-6 (r = -320; p < 0.001) and a positive correlation with high density lipoprotein-cholesterol(r = 0.342; p < 0.001) and adiponectin (r = 0.398; p < 0.001). The present study showed for the first time that serum levels of CTRP12 are independently associated with CAD and that CTRP12 is associated with several CAD risk factors. The results suggest a possible link between CTRP12 and pathogenic mechanisms of atherosclerosis, such as inflammation and high density lipoprotein-cholesterol metabolism; however, more study is required in this regard.
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Coronary artery calcifications and diastolic dysfunction versus visceral fat area in type 1 diabetes: VISCERA study.
De Block, CEM, Shivalkar, B, Goovaerts, W, Brits, T, Carpentier, K, Verrijken, A, Van Hoof, V, Parizel, PM, Vrints, C, Van Gaal, LF
Journal of diabetes and its complications. 2018;(3):271-278
Abstract
AIMS: Type 1 diabetic patients (T1DM) experience a higher cardiovascular disease and mortality risk than controls. We investigated whether visceral adipose tissue (VAT) contributes to coronary artery calcifications (CAC) and cardiac dysfunction in T1DM. METHODS A cross-sectional study of 118 T1DM patients without a history of cardiovascular disease (men/women: 68/50, age 46±12years, HbA1c 7.6±0.9%, BMI 25.8±4.1kg/m2) was conducted. CAC and VAT were measured using a CT scan. CAC was scored using the Agatston method. Cardiac functional abnormalities were assessed by echocardiography. RESULTS CAC scored ≥10 in 42% of patients. Systolic function was normal in all, but diastolic dysfunction was present in 75%. Forty-six percent had VAT≥100cm2. CAC score≥10 occurred more often in subjects with VAT≥100cm2 (54% vs 31%; p=0.01). Age (OR=1.10; p<0.0001), diabetes duration (OR=1.10; p=0.008), gender (OR=4.28; p=0.016), LDL-cholesterol (OR=1.03; p=0.009) and metabolic syndrome (OR=5.79; p=0.005) were independently associated with a CACS≥10. Subjects with CACS≥10 were more prone to have diastolic dysfunction (84 vs 54%; p=0.03). Factors independently associated with diastolic dysfunction were age (OR=1.11; p=0.002), waist circumference (OR=1.10; p=0.016) and VAT (OR=0.99; p=0.035). CONCLUSIONS Excess VAT in T1DM, present in 46%, is associated with diastolic dysfunction and CAC, present in respectively 75% and 42% of patients. Timely detection might improve future cardiovascular risk.
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Study of Correlation of Serum Vitamin D Levels with Arterial Stiffness and Cardiovascular Morbidity in Elderly Individuals of Western Rajasthan.
Suthar, OP, Mathur, S, Gupta, V, Agarwal, H, Mathur, A, Singh, P, Sharma, SL
The Journal of the Association of Physicians of India. 2018;(3):18-21
Abstract
INTRODUCTION Vitamin D deficiency is highly prevalent condition in western countries as well as in India. Lower level of vitamin D is associated with increased arterial stiffness by activating renin-angiotensin-aldosterone system leading to increased cardiovascular morbidity and mortality including increased risk of coronary artery disease, stroke, peripheral vascular disease, hypertension, diabetes mellitus and metabolic syndrome. Our aim was to study the correlation between serum vitamin D level, various measures of arterial stiffness and cardiovascular morbidity in elderly individuals. MATERIAL AND METHOD The present study was conducted in collaboration with Department of Medicine, Department of Cardiology and Regional Geriatric Centre, NPHCE, MDM Hospital attached to Dr. S.N. medical college Jodhpur. Total 100 elderly individuals 60 yrs and above attending hospital for minor short illness, acute illness or for routine health checkup or with acute coronary events are included in the study. Vitamin D level was assessed by chemiluminescent immunoassay. Pulse Wave Velocity was determined by Periscope. RESULTS In subjects with coronary artery disease, 28.30% were vitamin D deficient, 49.05% were vitamin D insufficient and only 22.64% are vitamin D sufficient. In healthy subjects, 25.53% were vitamin D deficient, 23.40% were vitamin D insufficient and 51.04% were vitamin D sufficient. The difference between these groups was statistically highly significant. (p value-0.006). Various measures of arterial stiffness including Rt baPWV, Lt baPWV, cf PWV and pulse pressure are more in vitamin D deficient group as compared to vitamin D sufficient group. The difference was statistically significant. CONCLUSION Vitamin D deficiency is quite common condition in elderly individuals which besides its bone mineralization action is also involved in cardiovascular functions. Deficiency of vitamin D may cause increase in arterial stiffness and widening of pulse pressure which are the predictor of atherosclerosis and cardiovascular morbidity and mortality.
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Coronary Heart Disease, Diabetes, and Sexuality in Men.
Hackett, G, Krychman, M, Baldwin, D, Bennett, N, El-Zawahry, A, Graziottin, A, Lukasiewicz, M, McVary, K, Sato, Y, Incrocci, L
The journal of sexual medicine. 2016;(6):887-904
Abstract
Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.
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Prognostic interactions between cardiovascular risk factors.
Vishram, JK
Danish medical journal. 2014;(7):B4892
Abstract
BACKGROUND Cardiovascular disease (CVD) still remains the leading cause of death worldwide, especially in Europe where the prevalence of hypertension is 60% higher compared with the United States and Canada and the clustering of hypertension and the metabolic disorders central adiposity, dyslipidemia and dysglycemia, known as the metabolic syndrome (MetS), affects 25% of the population. Despite the great initiatives of many primary prevention strategies, risk factor control is still poor. In an attempt to optimize risk factor control, two issues among others have been of great debate in the past decade: (1) the superiority of systolic blood pressure (SBP) as a risk factor in the elderly; and (2) the clinical relevance of MetS. However, in order to further elucidate these issues, we need to get a deeper understanding of how the cardiovascular risk factors interact with one another. Thus, prognostic interactions were used in the present PhD thesis to test the following hypotheses: Primary hypotheses: (1) The superiority of SBP over diastolic blood pressure (DBP) as a risk factor occurs at an earlier age if an individual presents with other cardiovascular risk factors. (2) The prevalence and prognostic significance of MetS differ according to age and gender. The first hypothesis is explored in paper 1 (for the endpoint fatal and nonfatal (total) stroke) and paper II (for mortality from coronary heart disease (CHD), stroke, and all-causes), while the second hypothesis is explored in paper III (for total CHD, total stroke, and CVD mortality). METHODS Using 34-42 cohorts from the MORGAM Project with baseline between 1982-1997, approximately 68 000-86 000 apparently healthy men and women aged 19-78 years, without CVD (papers I-III) and not receiving antihypertensive treatment (papers I-II) were included. During 12-13 years of follow-up, the incident events of total stroke were up to 1957, of total CHD were 4368, and of all-cause mortality were 7903. In papers I-II, event risk was analyzed by multivariate-adjusted Cox regressions including SBP and DBP simultaneously, as well as other cardiovascular risk factors and any significant interactions between variables. In paper III, MetS prevalence and prognostic significance was considered according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program - Adult Treatment Panel (NCEP-ATP III), and the influence of possible interactions between age and gender on MetS prevalence and prognostic significance was explored using logistic as well as multivariate-adjusted Cox regressions. MetS was analyzed separately for men and women in various age-groups. RESULTS Taking into account the significant interactions between cardiovascular risk factors, the results were as follows: Papers I-II: Age-related shifts were shown for the independent relative importance of SBP and DBP as risk factors for stroke (both total and fatal) and all-cause mortality, but not for CHD mortality where SBP remained significant in all ages. The prognostic shift to the superiority of SBP was significantly established in the 6th decade, and only for stroke mortality was this shift influenced by other cardiovascular risk factors, such that it occurred at an earlier age in men from high-risk countries and with a higher cholesterol level. However, from mid-age and onwards, a potential harmful effect of low DBP for the risk of total stroke and all-cause mortality was present. Paper III: The prevalence and prognostic significance of MetS showed great variations among countries and were influenced by both age and gender. With older age, the prevalence of MetS increased 5-fold in women from ages 19-39 years to 60-78 years and 2-fold in men. The CVD risk associated with MetS was (1) higher in women than in men especially when using the NCEP-ATP III criteria, and (2) independently of age in men whereas in women total CHD risk decreased significantly and the total stroke risk tended to increase (although not significant) with older age. CONCLUSION The present thesis elucidates through prognostic interactions the complex interplay between cardiovascular risk factors. Our results indicate the independent prognostic superiority of SBP in elderly Europeans, and only for stroke mortality risk this prognostic superiority of SBP was influenced by other cardiovascular risk factors such that it was established at an earlier age. The prevalence and prognostic significance of MetS differed according to both age and gender. In women, MetS was associated with higher relative event risks and the MetS associated relative CHD risk decreased with advancing age.
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Hypertriglyceridemia influences the degree of postprandial lipemic response in patients with metabolic syndrome and coronary artery disease: from the CORDIOPREV study.
Alcala-Diaz, JF, Delgado-Lista, J, Perez-Martinez, P, Garcia-Rios, A, Marin, C, Quintana-Navarro, GM, Gomez-Luna, P, Camargo, A, Almaden, Y, Caballero, J, et al
PloS one. 2014;(5):e96297
Abstract
OBJECTIVE To determine whether metabolic syndrome traits influence the postprandial lipemia response of coronary patients, and whether this influence depends on the number of MetS criteria. MATERIALS AND METHODS 1002 coronary artery disease patients from the CORDIOPREV study were submitted to an oral fat load test meal with 0.7 g fat/kg body weight (12% saturated fatty acids, 10% polyunsaturated fatty acids, 43% monounsaturated fatty acids), 10% protein and 25% carbohydrates. Serial blood test analyzing lipid fractions were drawn at 0, 1, 2, 3 and 4 hours during the postprandial state. Total and incremental area under the curves of the different postprandial parameters were calculated following the trapezoid rule to assess the magnitude of change during the postprandial state. RESULTS Postprandial lipemia response was directly related to the presence of metabolic syndrome. We found a positive association between the number of metabolic syndrome criteria and the response of postprandial plasma triglycerides (p<0.001), area under the curve of triglycerides (p<0.001) and incremental area under the curve of triglycerides (p<0.001). However, the influence of them on postprandial triglycerides remained statistically significant only in those patients without basal hypertriglyceridemia. Interestingly, in stepwise multiple linear regression analysis with the AUC of triglycerides as the dependent variable, only fasting triglycerides, fasting glucose and waist circumference appeared as significant independent (P<0.05) contributors. The multiple lineal regression (R) was 0.77, and fasting triglycerides showed the greatest effect on AUC of triglycerides with a standardized coefficient of 0.75. CONCLUSIONS Fasting triglycerides are the major contributors to the postprandial triglycerides levels. MetS influences the postprandial response of lipids in patients with coronary heart disease, particularly in non-hypertriglyceridemic patients.
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Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: results from a randomized controlled trial.
Stroup, TS, Byerly, MJ, Nasrallah, HA, Ray, N, Khan, AY, Lamberti, JS, Glick, ID, Steinbook, RM, McEvoy, JP, Hamer, RM
Schizophrenia research. 2013;(1-3):190-5
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Abstract
PURPOSE This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. METHOD Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24 weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. RESULTS The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885). CONCLUSION Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.
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Cardiovascular risk and subclinical cardiovascular disease in polycystic ovary syndrome.
Bajuk Studen, K, Jensterle Sever, M, Pfeifer, M
Frontiers of hormone research. 2013;:64-82
Abstract
In addition to its effects on reproductive health, it is now well recognized that polycystic ovary syndrome (PCOS) is a metabolic disorder, characterized by decreased insulin sensitivity which leads to an excess lifetime risk of type 2 diabetes and cardiovascular disease. PCOS patients are often obese, hypertensive, dyslipidemic and insulin resistant; they have obstructive sleep apnea and have been reported to have higher aldosterone levels in comparison to normal healthy controls. These are all components of an adverse cardiovascular risk profile. Many studies exploring subclinical atherosclerosis using different methods (flow-mediated dilatation, intima media thickness, arterial stiffness, coronary artery calcification) as well as assessing circulating cardiovascular risk markers, point toward an increased cardiovascular risk and early atherogenesis in PCOS. The risk and early features of subclinical atherosclerosis can be reversed by non-medical (normalization of weight, healthy lifestyle) and medical (metformin, thiazolidinediones, spironolactone, and statins) interventions. However, the long-term risk for cardiovascular morbidity and mortality as well as the clinical significance of different interventions still need to be properly addressed in a large prospective study.
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Diabetic dyslipidemia: from evolving pathophysiological insight to emerging therapeutic targets.
Ng, DS
Canadian journal of diabetes. 2013;(5):319-26
Abstract
Diabetic dyslipidemia is characterized by hepatic very low density lipoprotein (VLDL) and intestinal chylomicron overproduction, reduced high density lipoprotein cholesterol (HDL-C) level, increased propensity of small dense LDL (sdLDL) and increased postprandial lipemia. This dyslipidemic profile is also strongly linked to other features of the metabolic syndrome. Diabetic dyslipidemia is a well-recognized risk factor for atherosclerotic cardiovascular diseases. Currently, statins remain the first line therapy primarily through reducing the atherogenic LDL. Clinical trials on other lipid modifying agents were met with variable success in selective patient populations. Emerging new insights into the pathophysiology of lipid metabolism, in general, and diabetic dyslipidemia, in particular, have opened up potentially novel therapeutic strategies to further reduce the risk associated with diabetic dyslipidemia and insulin resistant state.
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Using noncontrast cardiac CT and coronary artery calcification measurements for cardiovascular risk assessment and management in asymptomatic adults.
Rumberger, JA
Vascular health and risk management. 2010;:579-91
Abstract
The presence of mural calcification has, for decades, been recognized as a marker for atheromatous plaque in the coronary arteries and the aorta, but only in the past decade has the application of noncontrast computed tomography (CT) been shown to be a reproducible, safe, and convenient test, which now is available worldwide. However, awareness of coronary artery calcium scanning is insufficient and the practitioner must be aware of the available literature as well as understanding clinical recommendations for applications and interpretation. It is best applied in the medium/intermediate risk, asymptomatic adult regardless of ethnicity across broad age ranges for both men and women; additional prognostic information is also afforded from the calcium distribution in the coronary artery system. Additionally, information can also be derived from the same CT scan regarding heart and aorta size and assessment of the epicardial fat pad (an anatomic marker for the metabolic syndrome). Details of how this test can aid in cardiovascular risk assessment and management in adults are provided.