Characteristics of atrial fibrillation in older people

The prevalence of atrial fibrillation (AF) increases with aging. It is associated with serious health consequences. The degenerative changes and the comorbidities result in anatomical substrate for this arrhythmia. Patients over 65 years old have higher embolic risk. Prescription of non-vitamin K antagonists is recommended after evaluation of the hemorrhagic risk as well. The preferred strategy – rhythm or rate control is selected based on the patient’s characteristics. Rhythm control is performed by electrical cardioversion, pharmacological cardioversion or ablation. For rate control, beta-blockers are mostly recommended

Design and specific features of a study of the long term cardiovascular and metabolic risk in type 1 diabetes mellitus

Among the traditional risk factors for cardiovascular diseases (CVD) in individuals with type 1 diabetes mellitus (T1DM), new ones are constantly being sought for timely prophylaxis and treatment. The increasing knowledge of the role of inflammation and visceral adipose tissue in the pathogenesis of T1DM complications is an integral part of the work of leading European centers. Obesity is a progressing risk factor and its role in the cardiovascular pathology of patients with T1DM is unclear. Lack of established practices and algorithms for management in these individuals has been poorly studied and presented to date. With prevalence of intensified insulin therapy in T1DM, leading sometimes to relatively high doses, and with the contemporary habits of eating, the patients’ risk of morbidity and mortality increases. Prioritization of cost-effective projects and specific timely commitment to protect disability in these patients is of utmost importance in scientific and healthcare aspects. The aim of this article is to present the design of the study of the cardiovascular and metabolic risk in patients with long-term T1DM

Epicardial fat as an imaging biomarker in the assessment of cardiometabolic risk in patients with type 1 diabetes with a duration of over 15 years

Diabetes mellitus is one of the most frequent metabolic diseases and is characterized by increased coronary risk. Data from epicardial fat quantification in long-term type 1 diabetes patients with poor control and healthy volunteers, performed with computed tomography and magnetic resonance tomography, is analyzed in relation to biochemical and anthropometric indicators. Statistically significant correlations are established between epicardial fat volume and body mass index in diabetic men, as well as between epicardial fat volume and dyslipidemic markers

Intensifying the treatment of familial hypercholesterolemia—the experience of a single center in Eastern Bulgaria

Introduction: Familial hypercholesterolemia (FH) is an established risk factor for the development of atherosclerotic cardiovascular diseases (CVD), which determines early morbidity and mortality. Intensive reduction of the high levels of low-density lipoprotein cholesterol (LDL-c) reduces the incidence of CVD.Aim: The aim of this article is to analyze changes in lipid levels after intensification of the treatment of patients with familial hypercholesterolemia.Participants and Methods: Lipid levels of 59 patients with familial hypercholestrolemia from Eastern Bulgaria were studied with the aim of optimizing the management at an FH treatment center at St. Marina University Hospital, Varna. The period covered was from October 2017 to July 2020. The diagnosis of FH was determined as probable or certain according to the Dutch Lipid Clinics Network (DLCN) with a score of ≥ 6 points. After evaluation of the inclusion criteria for initiating treatment with evolocumab, all patients were monitored every 6 months for their lipid status. Baseline demographic characteristics and changes in the levels of laboratory tests for total cholesterol, LDL-c, and HDL cholesterol (HDL-c) were analyzed. A t-test for grouped pairs was used to estimate the difference from the baseline.Results: Of all 59 who passed through the center, the majority were men (58%). The mean age was 57.66 ± 9.57 years, from 37 to 76 years. A total of 54% had ischemic heart disease, 30.5% had survived a myocardial infarction, and 12% had a previous stroke. The mean baseline of total cholesterol was 8.23 ± 3.65 mmol/L, that of LDL cholesterol was 5.31 ± 1.95 mmol/L, and that of HDL-c was 1.25 ± 0.4 mmol/L. After 6 months, LDL-c levels dropped down to an average of 2.46 ± 1.59 mmol/L (p <0.0001) and persisted for 2.5 years after onset. The same trend was observed for total cholesterol. Achieving different target levels of LDL-c was reached as early as the 6th month in 76% and 56% of the treated, respectively.Conclusion: The use of evolocumab in addition to statin therapy leads to a significant and lasting reduction in total and LDL cholesterol in patients with FH. A significant number of them achieve targeted levels of LDL-c, which reduces the risk of new cardiovascular events

Rhizome as the principle of organization of precedent phenomena and linguistic and cultural concepts

The article discusses the possibility of describing semantic relations of words and their etymology on the example of the fragments that form a semantic field of precedent phenomenon Cain and linguistic-cultural concept of deceit through the rhizome. Rhizome is one of the ways of organization of complex systems, unstructured and nonlinear way, leaving open the possibility to realize their inner potential to self-configuring. The report illustrates that the rhizome serves as a model of unconscious mental processes, characterized by the absence of tree structure, and a model of semantic relations of words, their etymology and their semantic changes. The concept of rhizomes can be applied to the description of non-system differences, unable clearly opposed each to other by the presence or absence of any characteristic. By analogy with the process of interaction of abstract-logical and intuitive thinking linguistic rhizome is characterized with the flow of opposite structures.В статье рассматриваются возможности описания семантических связей слов и их этимологии на примере фрагментов, формирующих семантическое поле прецедентного имени Каин и лингвокультурного концепта коварство через понятие ризома. Ризома представляет собой один из способов организации сложных систем, некий внеструктурный и нелинейный способ, оставляющий открытой возможность для реализации их внутреннего потенциала самоконфигурирования. Показано, что ризома служит моделью бессознательных ментальных процессов, характеризующихся отсутствием древовидной структуры, а также моделью семантических связей слов, их этимологии и изменений их семантики. Понятие ризомы можно применить к описанию несистемных различий, неспособных четко противопоставляться друг другу по наличию или отсутствию какого-либо признака. По аналогии с процессом взаимодействия абстрактно-логического и интуитивного мышления для лингвистических ризом характерны перетекания оппозициональных структур

Cardiovascular Risk in Individuals with Long-Standing Type 1 Diabetes Mellitus // Сърдечно-съдов риск при лица със захарен диабет тип 1 с продължително протичане

Type 1 diabetes mellitus (T1DM) is a chronic metabolic disease with an increasing incidence, the main pathophysiological mechanism of which is the lack of insulin production due to autoimmune destruction of pancreatic β-cells. The incidence of T1DM has been steadily increasing over the years by 2.3-3.4% per year. Cardiovascular disease (CVD) remains the leading cause of death worldwide, killing 16.7 million people annually and accounting for 38% of all causes of death. There is a difference in the risk profile of T1DM and type 2 diabetes mellitus (T2DM). In the literature, much data from studies mainly concern T2DM, while the results in T1DM are scarce and insufficient. The present study aimed to assess the risk of cardiovascular disease in individuals with long-standing type 1 diabetes. The clinical study was conducted using a case-control study protocol. A total of 183 participants were studied, in a ratio of 2:1, of which 124 individuals with at least a 15-year history of type 1 diabetes mellitus and 59 healthy controls without known cardiovascular and metabolic diseases, matched by gender, age and approx. by body mass index. Systolic blood pressure (SBP) is significantly higher in patients with T1DM compared to their healthy peers, regardless of gender. The prevalence of arterial hypertension (AH) is higher in patients with long-standing diabetes, even at a younger age. The problems related to arterial pressure and the spread of arterial hypertension in patients with a long history of T1DM were specified. Individuals with T1DM in young and middle age have multiple risk factors for the development of CVD compared to their peers without glucose impairment. Their vascular age is significantly higher than their chronological age and predisposes them to early atherosclerosis. This necessitates early and multifactorial prevention from a younger age to avoid or delay CVD events. On the other hand, introducing modern imaging methods and new biomarkers in CVD risk stratification would help to more precisely differentiate and individualize risk to more accurately target preventive measures to those with very high and very high CVD risk.Захарният диабет тип 1 (Т1ЗД) е хронично метаболитно заболяване с нарастваща честота, като основният патофизиологичен механизъм при него е липсата на производство на инсулин поради автоимунно разрушаване на β-клетките на панкреаса. Честотата на Т1ЗД непрекъснато нараства през годините с 2,3-3,4% годишно. Сърдечно-съдовите заболявания (ССЗ) остават водеща причина за смърт в световен мащаб, като предизвикват фатален изход при 16,7 млн. души годишно и представляват 38% от всички причини за смърт. Съществува разлика в рисковия профил на Т1ЗД и тип 2 захарен диабет (Т2ЗД). В литературата са налице множество данни от проучвания, които касаят предимно Т2ЗД. Цел на настоящото проучване е да се оцени рискът от възникване на сърдечно-съдови заболявания при лица с тип 1 захарен диабет с голяма давност. Клиничното проучване е проведено по протокол за изследване тип случай-контрола. Изследвани са общо 183 участници, в съотношение 2:1, от които 124 лица с поне 15-годишна давност на тип 1 захарен диабет (Т1ЗД). Систолното артериално налягане (САН) е значително по-високо при пациенти с Т1ЗД в сравнение с техните здрави връстници, независимо от пола. Разпространението на артериална хипертония (АХ) е по-високо при пациенти с диабет с продължителна давност дори в по-млада възраст. Конкретизираха се проблемите, свързани с артериалното налягане и разпространението на артериална хипертония при пациенти с дългогодишна давност на Т1ЗД. Лицата с Т1ЗД в млада и средна възраст имат наличие на множество рискови фактори за развитие на ССЗ в сравнение с техни връстници без глюкозно нарушение. Съдовата им възраст е значително по-висока от хронологичната и предразполага за ранна атеросклероза. Това налага започване на ранна и многофакторна профилактика от по-млада възраст, за да се избегнат или отложат инциденти от ССЗ. От друга страна, въвеждането на съвременни образни методи и нови биомаркери в стратификацията на риска от ССЗ биха помогнали за по-прецизното диференциране и индивидуализиране на риска с цел по-точно насочване на превантивните мерки към тези с наистина висок и много висок СС риск

The role of education and its link to metabolic control in patients with type 1 diabetes mellitus with long duration

Type 1 diabetes mellitus (T1DM) is a disease with constantly increasing incidence. Acquiring knowledge and diabetes skills is an invariable and important part of the disease treatment during all life cycles. The association between socioeconomic status and, in particular, the level of educational qualification and the metabolic control in patients with long-duration of T1DM is not enough studied. The results received in the current study show that there is, although weak, association between the level of education and the glycaemic control, the presence of dyslipidaemia, and obesity in patients with T1DM with long duration

Correlation between coronary calcium score and epicardial fat in patients with long-term type 1 diabetes and healthy controls – preliminary results

In recent years еpicardial adipose tissue has been reported to be an independent predictor of coronary risk, along with the already well established coronary calcium score. In our study we look for a corellation between these two markers in patients with long-term diabetes mellitus type 1 and healthy controls. Epicardial fat volume is quantified by semiautomatically and manually segmenting images acquired with computed tomography and magnetic resonance tomography. The two types of images demonstrate excellent correlation between them. A mild to moderate correlation between epicardial fat volume and coronary calcium score is found, regardless of which type of image the fat is calculated from