Postmenopausal bone health may be influenced by the presence of arterial hypertension and antihypertensive therapy

Introduction: Despite available evidence for a link between bone health and arterial hypertension (AH), the results of clinical trials remain conflicting. Thus, we conducted a cross-sectional study to analyze a possible association between blood pressure (BP), antihypertensive therapy and deteriorating bone health in postmenopausal women. Materials and Methods: The study included 84 women from Northeastern Bulgaria. Their mean age was 60.54 ± 7.07 years, and their mean duration of menopause was 11.45 ± 6.62 years. Bone health was assessed by dual-energy X-ray absorptiometry (DEXA) and by analysis of bone metabolic markers. Results: A significant negative correlation was established between bone mineral density (BMD) and diastolic BP. On the other hand, AH predominated in the studied population. However, among the subjects diagnosed with osteopenia and osteoporosis, a significantly higher proportion of AH was observed. In addition, differences were found according to the stage of AH and according to the intake of antihypertensive therapy, when assessing BMD and fracture risk. In subjects with newly diagnosed and respectively untreated AH as well as in the group of stage III AH, the lowest BMD and the highest fracture risk were found. Although we reported a significant difference in the mean age of women according to the presence of AH and its stages, after further analysis it was found that the presence of AH is an independent risk factor for bone health in postmenopausal women (OR = 2.14 (0.686–6.703); p = 0.015). Conclusion: According to the obtained results, we assumed that AH was risk factor for bone health in postmenopausal women, as it was associated with lower BMD and higher fracture risk. In addition, we found differences according to the stage of AH and antihypertensive therapy, which might be considered in the prevention, prophylaxis and treatment of osteoporosis

Newly-detected glucose disturbances in patients undergoing coronary angiography for known or suspected coronary artery disease

PURPOSES: Glucose disturbances are common in patients with coronary artery disease (CAD), however, usually, they remain undiagnosed. The aim of this study was to estimate the newly-diagnosed glucose abnormalities in patients undergoing coronary angiography for known or suspected CAD.MATERIAL AND METHODS: A routine oral glucose tolerance test (OGTT) was applied in 96 consecutive patients without previous history of type 2 diabetes mellitus (T2DM) undergoing coronary angiography. Glucose tolerance was defined according to WHO-2006 criteria by OGTT performed within a week after hospital discharge.RESULTS: Glucose disturbances prevailed over normoglycemia as 64.58% of the patients demonstrated hyperglycemia while 35.42% presented with normal glucose tolerance (NGT). Overall, 120 min-hyperglycemia (≥7.8 mmol/L) was found out in 52.08% of the participants and only 12.5% of the cases had isolated fasting hyperglycemia (fasting plasma glucose, FPG e6.1 mmol/L and postchallenge glucose <7.8 mmol/L). Based on plasma glucose values such as FPG and 2-hour post-OGTT glucose, the proportion of patients with newly diagnosed T2DM, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) was 26.04%, 28.12% and 10.42 %, respectively. Some 20% of the newly-diagnosed T2DM patients reached a diagnostic FPG value only, 32% reached 120 min.-plasma glucose (PG) value only while 48% met combined criteria.CONCLUSION: Glucose abnormalities identified by OGTT are more common than normoglycemia - in 64.58% versus 35.42% of the patients undergoing coronary angiography for known or suspected CAD. This finding strongly suggests that OGTT is the most valuable tool for the early detection of disturbed glucose regulation and should be performed routinely in the patients with known or suspected CAD.Scripta Scientifica Medica 2013; 45(3): 69-73

Skin autofluorescence as a clinical tool for non-invasive assessment of advanced glycation end products—clinical significance and influencing factors

Advanced glycation end products (AGEs) are heterogeneous compounds derived from nonenzymatic glycation of free amino groups in proteins, lipids, and nucleic acids. Since AGE formation is significantly increased in a number of pathological conditions, there is a huge interest in exploring cause-and-effect relationships between AGEs, various chronic diseases, and their complications. Due to the high physiological fluctuations in circulating AGEs and the lack of good reproducibility of measurement methods, the possibility to assess tissue AGE accumulation is beneficial. Since skin AGEs exhibit fluorescence properties, they can be measured by skin autofluorescence using an AGE Reader. This is a simple and non-invasive technique that has been validated against the gold standard for measuring tissue AGEs (skin biopsies) in a number of clinical trials. However, some endogenous and exogenous factors may limit the reliability of AGE Reader measurements, with special attention being given to skin phototype and some skin care products

Significance of stress hyperglycaemia in acute ischemic stroke – a literature review

Any kind of stress to the body can cause an abrupt increase in glucose levels. This gives reason to define the concept of stress hyperglycaemia (SH). In general, it refers to a sudden increase in blood glucose (BG) from normal levels in connection with the acute condition. Stress hyperglycaemia is associated with adverse outcomes in various categories of acutely ill patients, and this influence is particularly pronounced in those who are not adapted to chronically high BG levels. In this regard, acute ischemic stroke is often accompanied by SH, which can have an impact on its course and outcome. Blood glucose, as a modifiable risk factor for stroke that can be therapeutically affected, demands that we know the impact of abnormal glucose levels, the consequences they are associated with, and the prognostic power they carry

Total testosterone levels in men with acute coronary syndrome

Introduction:When acute systemic illness occurs due to stress, dysfunction of some of the endocrine axes often occurs. However, the specific mechanisms have not been elucidated. Acute coronary syndrome (ACS) is one model of acute physiological stress in which the hypothalamic-pituitary-gonadal axis is also affected.Aim:The aim of this study was to investigate the difference in total testosterone (T) levels in men with ACS compared to controls.Results:In 72 patients with ACS, the level of total testosterone was studied until the 48th hour after its onset. Thirty-five controls were also included in the study. After statistical processing of the data, we found that total T in the ACS group was statistically significantly lower compared to the controls group (t = -3.20, p = 0.001) There was also a statistically significant difference in the incidence of hypotestosteronemia between the two groups with 52.8% (n = 38) in the ACS group and 28.6% (n = 10) in the control group. (χ2(1) = 4.705, p = .030).Conclusion:Low levels of total T are common in patients with ACS. However, T values in the acute period after the onset of ACS should be interpreted with caution because of the changes occurring in the regulation of gonadal function

Type 2 diabetes mellitus is associated with increased arterial stiffness measured by the echo-tracking method

INTRODUCTION: Data for arterial stiffness (АS) in type 2 diabetes mellitus (Т2DM) patients is important for better management of cardiovascular complications and early therapeutic approach.AIM: The aim of this article is to obtain data for pulse wave velocity (PWVβ) and other AS parameters in patients with T2DM without cardiovascular atherosclerotic disease and compare them with controls.MATERIALS AND METHODS: This cross-sectional clinical investigation involves a sample of 100 patients with T2DM without cardiovascular complications and a control group of 30 healthy subjects.  In all patients one-point echo-tracking measurement of carotid artery (CA) stiffness with Aloka Prosound α7 machine were conducted and pulse wave velocity (PWVβ), β-stiffness index, arterial compliance (АС), augmentation index (AI), Peterson’s modulus (Ep) were measured.  RESULTS AND CONCLUSION: Our results showed the mean value of PWVβ on the left CA (L) in the group of patients with T2DM is 7.37 ± 1.32 m/sec and on the right CA (R) is 7.42 ± 1.33 m/sec. The performed t-test showed statistical significance of the differences of PWVβ (L) and PWVβ (R) in the studied group, compared to the control group (t = 3.764; p = 0.001 and t = 3.561; p = 0.001). The data showed significantly higher values of β-stiffness index (p = 0.001) and Ep (p = 0.001) in patients with T2DM compared to controls. AC was significantly lower in T2DM, when it is measured on the left CA (p = 0.001). AI was significantly higher in T2DM when it is measured on the right CA (p = 0.009).Patients with T2DM are associated with significantly increased AS parameters compared to controls

High osteoprotegerin serum levels in newly-diagnosed type 2 diabetic males without known coronary artery disease

PURPOSES: Osteoprotegerin (OPG) is an inhibitor of osteoclastogenesis, but is produced from vasculature, too. There is recent evidence of increased circulating OPG levels in patients with diabetes as well as in patients with coronary artery disease (CAD). Up to date, there are no sufficient data about OPG concentrations in newly-diagnosed type 2 diabetes mellitus (nT2DM) patients. The aim of our study was to determine the serum OPG levels in males with nT2DM without known concomitant CAD and to investigate the association of OPG with intima-media thickness (IMT) of common carotid arteries and glucometabolic arameters.MATERIAL AND METHODS: Serum OPG levels were measured in 31 nT2DM males and 15 age- and body mass index (BMI)-matched non-diabetic male subjects. IMT of common carotid arteries was measured by a 7.5-MHz B-mode ultrasonography. OPG was estimated by ELISA (BioMedica) in pmol/L.RESULTS: OPG was significantly higher in nT2DM patients when compared to controls (4.59±0.28 versus 3.20±0.30 pmol/L; p=0.004). In the whole group of subjects, there was a positive correlation of OPG levels with glucose parameters: fasting plasma glucose (FPG) (r=0.38; p=0.01), 2-hour post-challenge glucose (r=0.45; p=0.003) and HbA1c (r=0.46; p=0.002). Moreover, OPG correlated significantly with carotid IMT (Pr 0.40; p=0.01).CONCLUSION:  Serum OPG is significantly elevated in nT2DM males without known CAD compared to non-diabetic controls. OPG levels show associations not only with some glucose indices but also with IMT, one of the earliest atherosclerotic markers. Probably, these glucose indices and this vascular parameter are involved in OPG regulation. We could suggest that OPG rises early in the evolution of diabetic disorders. However, further investigations are needed.Scripta Scientifica Medica 2013; 45(3): 65-68

Arterial blood pressure and heart rate response in patients with acute ischemic stroke - Correlation with the severity of cardiovascular autonomic dysfunction

Background and purpose:Despite numerous studies, the mechanisms of blood pressure and heart rate regulation in cerebrovascular diseases remain not completely understood. The aim of the study was to determine the changes in blood pressure (BP) and heart rate (HR) in patients with an acute hemispheric ischemic stroke and to seek a relation to the severity of the cardiovascular autonomic dysfunction.Methods:20 healthy volunteers and 50 patients with an acute hemispheric ischemic stroke participated in the study. The values of BP and HR were registered. Cardiovascular autonomous disorders were examined with "Ewing battery" tests. Patients were divided into two groups according to the severity of the autonomous disorders.Results:Elevated BP values at admission were observed in 56% of our patients, and significantly higher values of systolic blood pressure (SBP) (p <0,001), diastolic blood pressure (DBP) (p = 0,001), and mean arterial pressure (p <0,001), as well as of the heart rate (p = 0,027) were found, compared to the control group. The most significantly increased values of the indicators were reported in patients with a stroke in the territory of the right middle cerebral artery with an involvement of the insular cortex. The results of the t-test performed, showed correlation only between the systolic blood pressure and the severity of the autonomic dysfunction, the values being significantly higher in patients with severe autonomic disorders (t = -2,14; p = 0.036).Conclusion:A variability in BP and HR with a tendency to increase was observed in patients with an acute hemispheric ischemic stroke (ICS) compared to controls, with the highest values reported in patients with ICS in the territory of right middle cerebral artery (TRMCA) with the involvement of the insular cortex (IC). A positive correlation was found between the values of systolic blood pressure (SBP) and the severity of autonomic dysfunction (AD)

Cortisol levels and HbA1c-based glycemic variables for the assessment of stress response in acute stroke

Introduction: In various acute conditions, including acute ischemic stroke (AIS), a stress response occurs, often leading to elevated blood glucose (BG) levels, the so-called stress hyperglycemia (SH). Its adequate assessment would be particularly useful in clinical practice, both for identifying high-risk patients and for therapeutic behavior.Aim: The aim of this article is to analyze cortisol levels and glycated hemoglobin (HbA1c)-based glycemic variables as markers for assessment of stress response in AIS and to look for an association with adverse clinical outcome.Materials and Methods: A cross-sectional study including 114 patients with AIS, stratified according to BG at admission (admBG) and the presence of diabetes mellitus (DM)—with normoglycemia, SH, previously and newly diagnosed type 2 DM was conducted. Serum cortisol levels, as well as HbA1c-based glycemic variables were evaluated according to the severity of stroke (assessed by National Institutes of Health Stroke Scale, NIHSS score) and the prevalence of fatal outcome.Results: The SH group demonstrated the greatest AIS severity at admission, accompanied by the highest serum cortisol levels, with a significant difference in both indicators compared to the NG group (NIHSS 15.33 ± 8.39 vs.10.63 ± 6.12, p = 0.016; serum cortisol 1039 ± 668 vs. 701.7 ± 380.8 p = 0.046). Furthermore, in patients with a fatal outcome compared to survivors, we observed significantly more severe AIS (NIHSS 15.93 ± 5.31 vs. 9.72 ± 6.31, p < 0.0001), as well as higher serum cortisol levels (1060 ± 572.1 vs. 610.5 ± 284.8, p < 0.0001). In contrast to admBG, HbA1c-based glycemic variables demonstrated the highest values in the SH group. Both cortisol and glycemic variables, but not admBG, showed positive correlation with AIS severity at admission.Conclusion: Serum cortisol levels could be useful in assessing the severity of AIS and identifying high-risk patients. HbA1c-based glycemic variables are better determinants of stress response than absolute BG values

Levels of carboxylated and undercarboxylated osteocalcin in patients with type 2 diabetes

Introduction: Osteocalcin (OC) is a bone-derived protein that undergoes vitamin K-dependent carboxylation. The undercarboxylated form of the protein (ucOC) is released in the circulation during the process of bone resorption. Experimental studies on mice and rats have revealed that ucOC is involved in the regulation of energy homeostasis, linking in this way the bone, pancreas, and adipose tissue metabolism. Experimental studies suggest no hormonal role for the carboxylated form (cOC) of the protein.Aim: In the current study we aimed to examine the levels of OC in its carboxylated and undercarboxylated form in patients with type 2 diabetes and control subjects, and to compare the vitamin K status between the two groups. Materials and Methods: The present cross-sectional study involved a sample of 46 adults type 2 diabetes patients and a control group of 19 individuals. The carboxylated and undercarboxylated forms of OC were measured in serum by using highly sensitive sandwich-type enzyme immunoassay kits. Vitamin K status was evaluated by the ratio ucOC/cOC. Student’s two-tailed unpaired t-test was used to compare the groups.Results: UcOC and cOC serum levels were significantly lower in patients with type 2 diabetes compared to controls. We found no difference in the vitamin K status between the groups.Conclusion: Our results show that OC might be involved in the regulation of carbohydrate metabolism. In humans, it appears that the carboxylation state might not be essential for the hormonal role of the protein as in mice and rats