Subclinical and clinical atherosclerosis in Non-alcoholic Fatty Liver Disease is associated with the presence of hypertension

Background and aims Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular risk. However, whether NAFLD contributes independently to the development of cardiovascular disease is not fully understood. Our study aimed at assessing the differences in several indices of atherosclerosis, arterial stiffness and cardiac morphology among patients with isolated NAFLD, isolated hypertension (HT) or with combination of the two conditions. Methods and results One hundred and sixty-nine participants (mean age=50.4±10.2 yrs; males=73.6 %) were divided according to the presence of NAFLD and HT in three groups: only-NAFLD (55 patients), only-HT (49 patients) and NAFLD+HT (65 patients). Exclusion criteria were BMI≥35Kg/m2 and presence of diabetes mellitus. Carotid ultrasonography was performed to measure markers of atherosclerosis and arterial stiffness. Cardiac remodeling was analyzed using echocardiography. Prevalence of subclinical and overt atherosclerosis was significantly higher in the NAFLD+HT patients as compared to the other two groups (atherosclerotic plaques: 43.1%, 10.9%, 22.4% (p<0.001), in NAFLD+HT, NAFLD and HT groups). No differences were found among indices of arterial stiffening and cardiac remodeling across the three groups. In multivariate regression analysis the coexistence of NAFLD and HT was an independent risk factor for overt atherosclerosis (OR=4.88; p=0.03), while no association was found when either NAFLD or HT was considered alone. Conclusion Overt atherosclerosis was significantly present only in NAFLD+HT patients, but not in patients presenting with isolated NAFLD. This implies that the impact of NAFLD on vascular structure and function could depend on the coexistence of other major cardiovascular risk factors, such as HT

Effect of vitamin D supplementation on blood pressure:a systematic review and meta-analysis incorporating individual patient data

D-PRESSURE Collaboration: et al.[Importance]: Low levels of vitamin D are associated with elevated blood pressure (BP) and future cardiovascular events. Whether vitamin D supplementation reduces BP and which patient characteristics predict a response remain unclear.[Objective]: To systematically review whether supplementation with vitamin D or its analogues reduce BP.[Data Sources]: We searched MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.com augmented by a hand search of references from the included articles and previous reviews. Google was searched for gray literature (ie, material not published in recognized scientific journals). No language restrictions were applied. The search period spanned January 1, 1966, through March 31, 2014.[Study Selection]: We included randomized placebo-controlled clinical trials that used vitamin D supplementation for a minimum of 4 weeks for any indication and reported BP data. Studies were included if they used active or inactive forms of vitamin D or vitamin D analogues. Cointerventions were permitted if identical in all treatment arms.[Data Extraction and Synthesis]: We extracted data on baseline demographics, 25-hydroxyvitamin D levels, systolic and diastolic BP (SBP and DBP), and change in BP from baseline to the final follow-up. Individual patient data on age, sex, medication use, diabetes mellitus, baseline and follow-up BP, and 25-hydroxyvitamin D levels were requested from the authors of the included studies. For trial-level data, between-group differences in BP change were combined in a random-effects model. For individual patient data, between-group differences in BP at the final follow up, adjusted for baseline BP, were calculated before combining in a random-effects model.[Main Outcomes and Measures]: Difference in SBP and DBP measured in an office setting.[Results]: We included 46 trials (4541 participants) in the trial-level meta-analysis. Individual patient data were obtained for 27 trials (3092 participants). At the trial level, no effect of vitamin D supplementation was seen on SBP (effect size, 0.0 [95% CI, −0.8 to 0.8] mm Hg; P = .97; I2 = 21%) or DBP (effect size, −0.1 [95% CI, −0.6 to 0.5] mm Hg; P = .84; I2 = 20%). Similar results were found analyzing individual patient data for SBP (effect size, −0.5 [95% CI, −1.3 to 0.4] mm Hg; P = .27; I2 = 0%) and DBP (effect size, 0.2 [95% CI, −0.3 to 0.7] mm Hg; P = .38; I2 = 0%). Subgroup analysis did not reveal any baseline factor predictive of a better response to therapy.[Conclusions and Relevance]: Vitamin D supplementation is ineffective as an agent for lowering BP and thus should not be used as an antihypertensive agent.Peer reviewe

Could vitamin D supplements be a new therapy for heart failure? Possible pathogenic mechanisms from data of intervention studies

Vitamin D deficiency may play a role in the pathogenesis of chronic heart failure (HF), but whether giving patients supplements to raise vitamin D into the normal range improves their survival is not clear. It has been demonstrated that vitamin D deficiency is common in patients with HF, especially the elderly, in obese and in dark skinned people, and that low vitamin D levels are associated with adverse outcome. The epidemiological data have been confirmed by experimental data, which show that knockout mice for the vitamin D receptor developed myocardial hypertrophy and dysfunction. Data from interventional studies are scarce and discordant, and more research is urgently needed to confirm whether add-on supplementation therapy with vitamin D has a role in the management of patients with chronic HF

Looking for women in hepatology: Sex authorship differences in clinical practice guidelines and position statements

First female authorship is slowly increasing in scientific publications, but it is still inconsistent and seems to vary across different medical disciplines and specialties. When looking at the authorship in gastroenterology and/or hepatology original papers, it was estimated that the proportion of first female authors increased from 9% in 1992 to 29% in 2012, whereas for last authors, the proportion of female authors increased from 5% in 1992 to 14% in 2012. However, clinical practice guidelines or position statements may potentially adopt different authorship rules when compared to original articles

Risk of kidney dysfunction in NAFLD

Background: The timely identification of traditional and non-traditional precursors and risk factors for chronic kidney disease (CKD) (a common systemic disease defined as a decreased kidney function documented by reduced glomerular filtration rate, or markers of kidney damage, or both) is relevant in clinical practice, as CKD increases the risk of end-stage renal disease and other serious comorbidities. A possible relationship between non-alcoholic fatty liver disease (NAFLD) (which is to date the most common chronic disease worldwide) and CKD has recently gained significant attention of researchers. Methods: A systematic literature search using appropriate keywords was made in order to identify relevant articles that have investigated the association between NAFLD and CKD. Results: Several observational studies and meta-analyses have reported the existence of an independent association between NAFLD and risk of CKD in patients with and without diabetes. However, whilst the association between NAFLD and risk of prevalent CKD is strong across various patient populations, whether NAFLD is independently associated with the development and progression of CKD is still debatable. Moreover, emerging evidence now suggests a potential association between patatin-like phospholipase domain-containing protein-3 (PNPLA3) rs738409 genotype (the most important genetic variant associated to NAFLD) and decreasing kidney function, independent of NAFLD. Conclusion: Convincing evidence now indicates that CKD is increased among patients with NAFLD. For this reason, patients with NAFLD should be regularly monitored for renal function and, on the other hand, NAFLD should be considered in all patients with CKD, especially if they are obese or have type 2 diabetes

Severe haemolytic anaemia after valvuloplasty and annuloplasty: a case report

Haemolytic anaemia is a well-recognised but rare complication of heart-valve prostheses. The authors report a case of an 80-year-old woman with severe haemolytic anaemia previously treated with valvuloplasty and annuloplasty without rings. To our knowledge, no cases of haemolysis have been described with this type of surgery

Severe haemolytic anaemia after valvuloplasty and annuloplasty

Haemolytic anaemia is a well-recognised but rare complication of heart-valve prostheses. The authors report a case of an 80-year-old woman with severe haemolytic anaemia previously treated with valvuloplasty and annuloplasty without rings. To our knowledge, no cases of haemolysis have been described with this type of surgery

Endothelial progenitor cells and aptoptosis in patients with heart failure

Objective: One the main features of heart failure is endothelial disfunction and some authors claimed this is caused by endothelial cell apoptosis. Scope of the study is to evaluate in a group of patients with heart failure the number of EPC (endothelial progenitor cells) both ex vivo and in culture in parallel with the assessment of EPC apoptosis and the echocardiographic evaluation of systolic and diastolic left ventricular function. Design and Method: We studied 30 patients with congestive heart failure (CHF) and 16 healthy control subjects CS) by measuring the number of EPC both ex vivo and after 4 days in culture. We measured also EPC apoptosis together with echocardiographic parameters of systolic and diastolic left ventricular function. Results and Conclusion: The EPC count measured both ex vivo (CD34+/KDR+; M \ub1 ES, CHF, 9.5 \ub1 1.1%, CS, 5.1 \ub1 0.8%, p < 0.02) and after culture (KDR+/CD34+; M \ub1 ES, CHF, 51.2 \ub1 6.6%; CS, 23.5 \ub1 8.8%, p < 0.0001) was significantly increased in CHF patients as compared to CS. In CHF patients EPC number measured in culture is directly correlated with hs-CRP (p = 0.035, r = 0.497). The EPC apoptosis does not show any statistically difference between CHF patients and CS. In CHF patients the number of apoptotic EPC was inversely correlated with total (r = 120.418, p = 0.02) and LDL cholesterol (r = 120.399, p = 0.03). We hypnotize that the increased oxidative stress characterizing heart failure may explain the increased EPC number which may have a compensatory significance for endothelial dysfunction as EPC number is directly linked to a crucial flogistic parameter as CRP. EPC apoptosis is not altered in CHF patients and does not seem to be related with the increased EPC number. The inverse correlation between EPC apoptosis and LDL cholesterol may represent the clinical equivalent of the in vitro ability of oxidized LDL to inhibit the macrophage binding to apoptotic endothelial cells

Late radiation-induced cardiac conduction system abnormalities

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Effects of six months of vitamin D supplementation in patients with heart failure: a randomized double-blind controlled trial

BACKGROUND AND AIM: Low plasma vitamin D levels have been associated with heart failure (HF). This research attempts to explain the role of vitamin D supplementation on myocardial function in elderly patients with HF. METHODS AND RESULTS: Twenty-three chronic HF patients were randomized in a small parallel group, double-blind, placebo-controlled trial. All patients, with a mean age of 74 years and vitamin D levels <30 ng/mL, received 800,000 IU (4000 IU/daily) of cholecalciferol or placebo for 6 months. The outcomes measured at baseline and after 6 months were ejection fraction (EF) and other echocardiography parameters, carboxyterminal propeptide of procollagen type I (PIP), natriuretic peptides, lipid profile, renin, parathyroid hormone, blood pressure, and body mass index (BMI). In 13 patients under active treatment for 6 months, mean plasma 25-hydroxy vitamin D concentrations (15.51 vs. -1.40 ng/mL, p < 0.001) and plasma calcium (from 9.3 to 9.6 mmol/L, p < 0.05) increased significantly. However, other biomarkers of bone metabolism did not differ between the treatment and placebo groups. EF increased significantly in the intervention group (6.71 vs. -4.3%; p < 0.001), and the serum concentration of PIP increased only in the placebo group after 6 months (1140.98 vs. -145 mcg/L; p < 0.05). Systolic blood pressure was lower after 6 months of cholecalciferol treatment (from 129.6 to 122.7 mm Hg, p < 0.05). No significant variations were observed for other parameters. CONCLUSIONS: Six months of vitamin D supplementation significantly improves EF in elderly patients with HF and vitamin D deficiency