Asymmetric dimethylarginine—nature, analytical methods for determination, and clinical applications

Аsymmetric dimethylarginine (ADMA) is a major endogenous and competitive inhibitor of nitric oxide (NO) synthesis. Reduced production and/or bioavailability of NO is considered the central mechanism responsible for endothelial dysfunction (ED) that precedes atherosclerosis manifestation. Аsymmetric dimethylarginine is a promising biomarker and a risk factor for cardiovascular desease (CVD). Elevated plasma concentrations of ADMA are associated with numerous CVD and metabolic diseases. This study aimed to review the current knowledge about biology and clinical implication of ADMA as a new class biomarker. A summary analysis of currently validated analytical methods for the determination of serum and plasma ADMA was performed

Laboratory Cardiovascular Risk Assessment in Individuals with Long-Standing Type I Diabetes Mellitus – Adipokines, Osteoprotegerin, Asymmetric Dimethyl-Arginine // Лабораторна оценка на сърдечно-съдов риск при лица с дългогодишен захарен диабет тип I - адипокини, остеопротегерин и асиметричен диметил-аргинин

This thesis focuses on studying diabetes mellitus type 1 (T1D) as a present-day disease with socially significant implications and laboratory cardiovascular risk (CVR) assessment in providing comprehensive patient care. With increased life expectancy, cardiovascular diseases (CVD) are becoming the main cause of mortality with T1D. To date, risk stratification and screening strategies for assessing CVR in T1D have been primarily extrapolated from studies of patients with T2D or the total population. Laboratory evaluation of CVR by introducing innovative biomarkers would allow optimisation of diagnostic and prognostic accuracy and therapeutic approaches. This thesis aims to analyse the prognostic value of: asymmetric dimethyl-arginine (ADMA), osteoprotegerin (OPG), adiponectin (ADNC) and leptin (Lep) against specific CVR assessment tools - ST1RE and ESC-2019. The prognostic value of ADMA, OPG, ADNC, Lep and blood count parameters were evaluated against a constructed model – a combination of established in clinical practice RFs for the development of CVD in DM (RiskFactor 3: HbA1C ≥ 7%, CRP ≥ 3 mg/l and AlbU ≥ 30 mg/l). Cut-off values were established and can be applied in routine practice. The present study also analysed the interactions between heamatomorphologic parameters and proposed biomarkers in the context of high CVR in individuals with long-standing T1D.Дисертационният труд е посветен на актуално социално-значимо заболяване – захарен диабет тип 1 (Т1Д) и лабораторна оценка на сърдечно-съдов риск (ССР) в комплексната грижа за болния. С увеличаване на продължителността на живот, сърдечно-съдовите заболявания (ССЗ) се превръщат в основна причина за смъртност при Т1Д. Към днешна дата стратификацията на риска и скрининговите стратегии за оценка на ССР при Т1Д са предимно ектраполирани от проучвания при пациенти с Т2Д или общата популация. Лабораторната оценка на ССР посредством въвеждането на иновативни биомаркери би позволила оптимизиране на диагностично-прогностичната акуратност и терапевтичните подходи. Целта на дисертационният труд е да се анализира прогностична стойност на: асиметричен диметиларгинин (АDMA), остеопротегерин (OPG), адипонектин (ADNC) и лептин (Lep) спрямо специфични инструменти за оценка на ССР - ST1RE и ESC от 2019 г. Оценена е и прогностична стойност на ADMA, OPG, ADNC и Lep спрямо комбинация от утвърдени в клиничната практика рискови фактори за развитие на ССЗ при захарен диабет (RiskFactor3: HbA1C ≥7%, CRP ≥3 mg/l и AlbU ≥30 mg/l). Изведени са cut-off стойности, които могат да бъдат приложени в рутинната практика. В настоящото проучване се анализирани и взаимодействията между хематоморфологични показатели и предложените биомаркери в контекста на висок ССР при лица с дългогодишен Т1Д

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