Omega-3 polyunsaturated fatty acid supplementation versus placebo on vascular health, glycaemic control, and metabolic parameters in people with type 1 diabetes: a randomised controlled preliminary trial

Background: The role of omega-3 polyunsaturated fatty acids (n-3PUFA), and the potential impact of n-3PUFA supplementation, in the treatment and management of type 1 diabetes (T1D) remains unclear and controversial. Therefore, this study aimed to examine the efficacy of daily high-dose-bolus n-3PUFA supplementation on vascular health, glycaemic control, and metabolic parameters in subjects with T1D. Methods: Twenty-seven adults with T1D were recruited to a 6-month randomised, double-blind, placebo-controlled trial. Subjects received either 3.3 g/day of encapsulated n-3PUFA or encapsulated 3.0 g/day corn oil placebo (PLA) for 6-months, with follow-up at 9-months after 3-month washout. Erythrocyte fatty acid composition was determined via gas chromatography. Endpoints included inflammation-associated endothelial biomarkers (vascular cell adhesion molecule-1 [VCAM-1], intercellular adhesion molecule-1 [ICAM-1], E-selectin, P-selectin, pentraxin-3, vascular endothelial growth factor [VEGF]), and their mediator tumor necrosis factor alpha [TNFα] analysed via immunoassay, vascular structure (carotid intima-media thickness [CIMT]) and function (brachial artery flow mediated dilation [FMD]) determined via ultrasound technique, blood pressure, glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial metabolism. Results: Twenty subjects completed the trial in full. In the n-3PUFA group, the mean ± SD baseline n-3PUFA index of 4.93 ± 0.94% increased to 7.67 ± 1.86% (P  0.05). Conclusions: This study indicates that daily high-dose-bolus of n-3PUFA supplementation for 6-months does not improve vascular health, glucose homeostasis, or metabolic parameters in subjects with T1D. The findings from this preliminary RCT do not support the use of therapeutic n-3PUFA supplementation in the treatment and management of T1D and its associated complications. Trial Registration ISRCTN, ISRCTN40811115. Registered 27 June 2017, http://www.isrctn.com/ISRCTN40811115

High-density lipoprotein (HDL) cholesterol - more complicated than we think?

Introduction and objective. There are some clinical situations where a high level of HDL cholesterol (HDL-C) may be unfavourable. In these situations, HDL-C may undergo some changes, and even if its quantity is within the reference range, its quality is no longer the same. Brief description of state of knowledge. Diabetes is the state of elevated oxidative stress. Studies conducted to-date have revealed an increased production of the reactive forms of oxygen as the result of tissue damage in diabetes patients. The expression ‘dysfunctional HDL’ has been coined in the literature to describe high-density lipoproteins that lose their antioxidative and anti-inflammatory properties, that is, HDL-C that loses its basic functions. Recent observational studies have confirmed that the atheroprotective activity of properly functioning HDL-C is frequently impaired in clinical situations associated with oxidative stress. The presented review lays the foundation for a new approach to understanding how the functional properties of HDL help reduce cardiovascular risk. Conclusions. In the light of presented findings it seems that there is a need to seek a better diagnostic marker than HDL-C level. This study presents some possible directions for future research to bring us closer to the full understanding of the HDL particle and its role in patients with ischemic heart disease and type 2 diabetes

Quantitative analysis of clot density, fibrin fiber radius, and protofibril packing in acute phase myocardial infarction

Introduction Coronary artery disease is associated with impaired clot structure. The aim of this study was to investigate acute phase myocardial infarction (AMI) and provide detailed quantitative analysis of clot ultrastructure. Materials and methods Clot formation and breakdown, pore size, fiber density, fiber radius and protofibril packing were investigated in plasma clots from AMI patients. These data were compared to those from healthy controls. Results Analysis on clot formation using turbidity showed increased lag time, suggesting changes in protofibril packing and increased fiber size for AMI patients compared to healthy controls. Additionally, increased average rate of clotting and decreased time to maximum absorbance in AMI patients suggest that clots formed more quickly. Moreover, we observed increased time from max OD to max rate of lysis. Increased fibrinogen and decreased plasminogen in AMI patients were accounted for in represented significant differences. AMI samples showed increased time to 25% and 50% lysis, but no change in 75% lysis, representative of delayed lysis onset, but expediated lysis once initiated. These data suggest that AMI patients formed less porous clots made from more densely packed fibers with decreased numbers of protofibrils, which was confirmed using decreased permeation and increased fiber density, and decreased turbidimetry. Conclusions AMI plasma formed clots that were denser, less permeable, and lysed more slowly than healthy controls. These findings were confirmed by detailed analysis of clot ultrastructure, fiber size, and protofibril packing. Dense clot structures that are resistant to lysis may contribute to a prothrombotic milieu in AMI

Zastosowanie dapagliflozyny w leczeniu niewydolności serca ze zmniejszoną frakcją wyrzutową lewej komory

Niewydolność serca (HF) jest problemem zdrowotnym charakterystycznym dla starzejącej się populacji obciążonej chorobami serca i naczyń. Według ostatnich danych uzyskanych z Narodowego Funduszu Zdrowia (NFZ), a opracowanych przez Ministerstwo Zdrowia na HF w Polsce choruje ~1,24 mln Polaków, a co roku umiera 140 tys. z nich. Polska od kilku lat zajmuje 5. miejsce wśród krajów Unii Europejskiej pod względem liczby chorych z HF i znajduje się 1. miejscu wśród 34 krajów Organizacji Współpracy Gospodarczej i Rozwoju (OECD) pod względem liczby hospitalizacji z powodu HF (547 chorych na 100 tys. osób).Na przestrzeni ostatnich lat w diagnostyce i leczeniu pacjentów z HF ze zmniejszoną frakcją wyrzutową lewej komory (HFrEF) nastąpił znaczący postęp, którego konsekwencją była redukcja śmiertelności sercowo‑naczyniowej (SN) i całkowitej. Pomimo to, przeżycie 5‑letnie w przebiegu HF jest nadal gorsze od obserwowanego w niektórych typach nowotworów, zarówno w populacji mężczyzn, jak i kobiet. Dlatego też ciągle trwają poszukiwania leków poprawiających rokowanie w tej grupie chorych.Inhibitory kotransportera sodowo‑glukozowego typu 2 (SGLT‑2) to nowa grupa leków, która bez wątpienia będzie kolejnym kamieniem milowym w terapii chorych z HFrEF. W przedstawionej poniżej opinii ekspertów zawarta została historia dapagliflozyny, która z leku przeznaczonego do leczenia cukrzycy typu 2 (T2DM) stała się jednym z bardziej skutecznych leków poprawiających rokowanie, jakość życia oraz zmniejszających częstość hospitalizacji chorych z HF. W dokumencie opisane zostały najważniejsze badania z zastosowaniem dapagliflozyny oraz wskazania do jej zastosowania według opinii ekspertów Asocjacji Niewydolności Serca Polskiego Towarzystwa Kardiologicznego