Understanding Vascular Age: Are Clinical scoring systems useful for Early Vascular Aging Syndrome Prediction ?

Introduction Early vascular aging syndrome (EVAS) is defined as increased arterial stiffness compared to age and sex matched patients, EVAS is measured by pulse wave velocity (PWV). Aim In our study we aim to identify in patients with high risk of EVAS using the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores. Methods The CHADS2, CHA2DS2-VASc-HS and CHADS2VASC scoring systems are advised to determine management strategies in patients with nonvalvular atrial fibrillation. As they contain similar risk factors for the development or presence of EVAS, we believed that this risk scoring system could also be used to predict EVAS. This study was designed as a retrospective observational study. 2108 consecutive patients who had undergone 24-h blood pressure monitoring and measured PWV levels were included in the study. The patients were divided into the two groups according to corrected Pwv values. Results CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were positively correlated with PWV values (r =0.251, p = 1.5 with a sensitivity of 49% and a specificity of 50 % (AUC 0.605; 95% [CI] 0.58-0.63) in the ROC curve analyses. Conclusions The CHA2DS2-VASc-HS scoring system might be used in daily clinical practice to calculate the total risk assessment of EVAS. This score is relatively simple to use and time-saving technique

The Effect of Urine pH and Urinary Uric Acid Levels on the Development of Contrast Nephropathy

Background: Hyperuricemia may cause acute kidney injury by activating inflammatory, pro-oxidative and vasoconstrictive pathways. In addition, radiocontrast causes an acute uricosuria, potentially leading to crystal formation. We therefore aimed to investigate the effect of urine acidity and urine uric acid level on the development of contrast-induced nephropathy (CIN) in patients undergoing elective coronary angiography. Methods: We enrolled 175 patients who underwent elective coronary angiography. CIN was defined as a >25% increase in the serum creatinine levels relative to basal values 48–72 h after contrast use. Prior to coronary angiography and 48–72 h later, serum uric acid, urea, creatinine, bicarbonate levels, and spot uric acid to creatinine ratio (UACR) were measured. Results: Of the 175 subjects included, 29 (16.6%) developed CIN. Those who developed CIN had a higher prevalence of diabetes, higher UACR (0.60 vs. 0.44, p = 0.014), higher contrast volume, and lower serum sodium level. With univariate analysis of a logistic regression model, the risk of CIN was found to be associated with diabetes (p = 0.0016, OR = 3.8 [95% CI: 1.7–8.7]), urine UACR (p = 0.0027, OR = 9.6 [95% CI: 2.2–42.2]), serum sodium (p = 0.0079, OR = 0.8 [95% CI: 0.77–0.96]), and contrast volume (p = 0.0385, OR = 1.8 [95% CI: 1.03–3.09]). In a multiple logistic regression model with stepwise method of selection, diabetes (p = 0.0120, OR = 3.2 [95% CI: 1.3–8.1]) and UACR (p = 0.0163, OR = 6.9 [95% CI: 1.4–33.4]) were the 2 risk factors finally identified. Conclusions: We have demonstrated that higher urine UACR is associated with the development of CIN in patients undergoing elective coronary angiography