Metabolic syndrome - important cancer risk factor

Zespół metaboliczny jest zespołem czynników ryzyka sercowo-naczyniowego, u podstawy którego leżą otyłość brzuszna, oporność na insulinę, podwyższone lub prawidłowe wysokie ciśnienie tętnicze oraz zaburzenia gospodarki lipidowej. Wyniki dotychczas przeprowadzonych badań wskazują, że istnieje ścisły związek między występowaniem zespołu metabolicznego a zwiększoną zapadalnością na wiele złośliwych nowotworów, jednak dotychczas zwykle pomijano ten fakt w codziennej praktyce lekarskiej. Kluczowym mechanizmem onkogenezy u chorych z zespołem metabolicznym jest mitogenne działanie insuliny, indukowanie przez nią proliferacji komórek, ich patologicznego wzrostu i różnicowania się. Wiadomo także, że insulina jest inhibitorem apoptozy. Ponadto otyłość brzuszna jest istotnym czynnikiem ryzyka karcynogenezy z powodu uwalniania przez tkankę tłuszczową wielu aktywnych białek i protein, które uczestniczą w onkogenezie, a także rozwoju miażdżycy, zapaleniu oraz dysfunkcji śródbłonka. Dlatego też leczenie zespołu metabolicznego jako prewencja nowotworów powinno koncentrować się na poprawie wrażliwości na insulinę przez redukcję masy ciała, zwiększoną aktywność fizyczną, właściwą dietę bogatą w błonnik, naturalne antyoksydanty, a także wczesne stosowanie metforminy. Pacjentów z zespołem metabolicznym należy objąć programem prewencyjnym jako populację znacznie zwiększonego ryzyka występowania nowotworów.Metabolic syndrome is defined as a combination of lipids disorders and cardiovascular risk factors: abdominal obesity, insulin resistance, arterial hypertension or high normal blood pressure. The positive relationships between majority of components of metabolic syndrome and development of some types of cancer was shown in several studies. This fact is often forgotten in our daily medical practice. The crucial mechanisms of oncogenesis in patients with metabolic syndrome include mitogenic influence of insulin with induction of cell proliferation, its pathological growth and differentation. It is also well known that insulin acts as apoptosis inhibitor preventing the destruction of neoplastic cells. Furthermore abdominal obesity was shown to be an important risk factor of carcinogenesis. Its pathogenic action is based on active peptides and proteins relisae which are linked with the atherosclerosis, inflammation, endothelium dysfunction and oncogenesis. Therefore treatment of metabolic syndrome as a prevention of some types of cancer should concentrate on improvement in insulin sensitivity by means of body mass reduction, increased physical activity, aprpopriate full of fibers diet, natural antyoxidants and also early administration of metformine. Patients with metabolic syndrom, as the population with significantly increased risk of cancer, should be includedd in dedicated prevention programmas

Relationship among the leptin-to-adiponectin ratio, systemic inflammation, and anisocytosis in well-controlled type 2 diabetic patients with atherosclerotic cardiovascular disease

Background: Previous studies have shown that red blood cell distribution width (RDW) is an independent predictor of poor prognosis in type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). The mechanisms underlying increased anisocytosis in patients with T2D and confirmed ASCVD remain poorly understood. Aims: We sought to evaluate the relationship among the leptin-to-adiponectin ratio, systemic low -grade inflammation, and RDW in optimally treated patients with T2D and established ASCVD. Methods: A total of 68 patients, aged 47 to 85 years (mean [SD], 65.3 [6.8] years) and including 21 women (30.9%), were enrolled and grouped according to median RDW into those with RDW < 13.5% (n = 33) and those with RDW ≥13.5% (n = 35). Results: Patients with RDW ≥13.5% had a significantly higher median (interquartile range [IQR]) serum leptin-to-adiponectin ratio (1.7 [0.49–2.3] ng/μg vs 0.66 [0.31–1.25] ng/μg; P = 0.04) and median (IQR) tumor necrosis factor α levels (1.58 [1.42–1.97] pg/ml vs 1.39 [1.18–1.57] pg/ml; P = 0.02). There were no significant differences in the concentrations of other inflammatory markers. The leptin-to-adiponectin ratio (r = 0.25; P = 0.04) and levels of tumor necrosis factor α (r = 0.32; P = 0.01) and soluble intercellular adhesion molecule 1 (r = 0.31; P = 0.01) were positively correlated with RDW, which was confirmed by univariate linear regression analysis. A multivariable regression model, which included demographic, clinical, and laboratory data, showed that white blood cell count (β = 0.25; 95% CI, 0.05–0.45; P = 0.01), soluble intercellular adhesion molecule 1 levels (β = 0.21; 95% CI, 0.02–0.41; P = 0.03), and mean corpuscular hemoglobin concentration (MCHC), (β = –0.48; 95% CI, 0.67 to –0.28; P < 0.001) were independent predictors of RDW in our patients. Conclusions: In well-controlled patients with T2D and ASCVD, the RDW values are associated with leptin-to-adiponectin imbalance and selected inflammatory markers

Ocena skuteczności zastosowania treningów pionizacyjnych oraz edukacji pacjenta w prewencji omdleń odruchowych u chorych z zespołem wazowagalnym, hospitalizowanych w Klinice Choroby Wieńcowej i Niewydolności Serca w latach 2010–2015

Introduction. Tilt training (TT) is a form of therapy usually proposed to patients with malignant or recurrent form of reflex  syncope syndrome, which causes deterioration of quality of life and carries the risk of injuries. Traditionally, TT involves  maintaining an upright posture against the wall for the extending period of time. The use of TT in the therapy of reflex  syncope has been mentioned in the guidelines of the European Society of Cardiology only as a possible method of  treatment in a selected group of patients (IIb, B).  The aim of the study was to assess the effectiveness of the therapy including intensified in-hospital tilt training and  simultaneous patient education in prevention of reflex syncope. Materials and methods. The study included 33 patients (19 women) aged 17–69 (average 40) with vasovagal syncope  syndrome who were hospitalized in 2010–2015 in the Department of Coronary Heart Disease and Heart Failure in order  to undergo TT therapy and syncope prevention education. The average number of TT sessions was 4 (1–9). Treatment  effects were assessed using telephone survey and the medical records analysis. The effectiveness of the applied therapy  in reflex syncope prevention and adherence to the therapy have been established, including the level of anxiety due to syncope recurrence, quality of life after treatment and subjective effectiveness of the applied therapy. Results. The mean follow-up period was 1.6 years. During the follow-up 22 patients (66.7%) continued TT, 30 (91%)  applied anti-syncope maneuvers, 29 (88%) increased the liquids consumption, 17 (51.5%) were trying to avoid high-risk  for syncope situations. Twenty-four patients (72.7%) had no recurrence of syncope during the follow-up period. Twenty-  -nine patients (88%) reported improvement in the quality of life. Thirty-one patients (94%) experienced reduction in the  anxiety level associated with the possibility of recurrent syncope. Average rating of usefulness of the undergone therapy,  assessed by the patients, in the prevention of reflex syncope was 9.3 out of 10. Conclusions. 1. High adherence to the syncope prevention recommendations is an important cause of the low recurrence  rates of syncope in the study group of patients with vasovagal syncope. 2. The use of the non-pharmacological  therapies such as tilt training and patient education has an important role for improving the quality of life and for reduction  of the anxiety in patients with vasovagal syncope. 3. Needs to be highlighted a very high subjective assessment  of patients with vasovagal syncope regarding the relevance and effectiveness of the applied therapy.Wstęp. Trening pionizacyjny (TT) jest formą terapii proponowaną pacjentom ze złośliwą lub nawracającą postacią zespołu omdleń odruchowych, które są przyczyną pogorszenia jakości życia oraz niosą ze sobą ryzyko urazów. W tradycyjnym ujęciu TT polega na ćwiczeniu utrzymywania pionowej pozycji ciała przy ścianie. Zastosowanie TT w terapii omdleń odruchowych uwzględniono w wytycznych Europejskiego Towarzystwa Kardiologicznego jedynie jako możliwą do wykorzystania metodę leczenia w wybranej grupie pacjentów (poziom wiarygodności IIb, siła dowodów B). Celem pracy była ocena skuteczności zintensyfikowanej terapii obejmującej TT prowadzone w warunkach szpitalnych oraz jednoczesnej edukacji z zakresu profilaktyki występowania omdleń odruchowych. Materiał i metody. Badaniem objęto 33 pacjentów (19 kobiet) w wieku 17–69 lat (średnio 40 lat) z zespołem omdleń wazowagalnych (VVS), u których w latach 2010–2015 podczas hospitalizacji w klinice choroby wieńcowej i niewydolności serca zastosowano edukację w zakresie niefarmakologicznego postępowania przeciwomdleniowego oraz TT. Średnia liczba sesji TT wynosiła 4 (1–9). Efekty leczenia oceniono za pomocą ankiety telefonicznej oraz analizy dokumentacji medycznej. Oceniano efektywność zastosowanej terapii w prewencji omdleń, stopień przestrzegania zaleceń lekarskich, wpływ terapii VVS na poziom lęku przed nawrotem omdleń, jakość życia pacjentów, a także subiektywną skuteczność stosowanej terapii. Wyniki. Średni okres obserwacji wynosił 1,6 roku. Spośród badanych 22 osoby (66,7%) kontynuowały TT, 30 osób (91%) stosowało manewry przeciwomdleniowe, 29 osób (88%) stosowało zalecenia dotyczące ilości spożywanych płynów, a 17 osób (51,5%) unikało sytuacji sprzyjających omdleniom. U 24 osób (72,7%) nie doszło do nawrotu omdleń w badanym okresie. Poprawę jakości swojego życia stwierdziło 29 osób (88%), a 31 (94%) odczuło zmniejszenie poziomu lęku związanego z możliwością nawrotu omdlenia. Średnia ocena przydatności odbytej przez badanych pacjentów terapii w prewencji omdleń odruchowych wyniosła 9,3 w 10-stopniowej skali. Wnioski. 1. Wysoki poziom przestrzegania zaleceń lekarskich dotyczących profilaktyki przeciwomdleniowej przez pacjentów z VVS jest istotną przyczyną niskiej częstości nawrotów omdleń w badanej grupie. 2. Zastosowanie TT oraz terapii niefarmakologicznej wpłynęło na polepszenie jakości życia i zmniejszenie poziomu lęku u osób z VVS. 3. Zwraca uwagę bardzo wysoka subiektywna ocena pacjentów z VVS, dotycząca przydatności oraz skuteczności zastosowanego postępowania — TT i edukacji przeciwomdleniowej.

Anthracycline-induced cardiotoxicity prevention with angiotensin-converting enzyme inhibitor ramipril in women with low-risk breast cancer : results of a prospective randomized study

Background: Anthracycline‑induced cardiotoxicity (AIC) remains the main long‑term irreversible side effect in malignancy survivors. Cardiotoxicity prevention is one of the most reasonable approaches. Aims: In this prospective randomized open‑label study, we aimed to verify whether ramipril protects from early‑onset AIC in women with breast cancer (BC). Methods: We analyzed data from 96 women (median age, 47 years) with BC after breast surgery, without significant cardiovascular diseases, who were eligible for adjuvant anthracyclines. They were randomized to a ramipril or control arm. Cardiotoxicity was estimated with repeat echocardiography and themeasurement of troponin I and N‑terminal fragment of the prohormone brain natriuretic peptide (NT‑proBNP) levels over 1‑year follow‑up. Anthracycline‑induced cardiotoxicity was defined as a decrease in left ventricular ejection fraction (LVEF), elevated biomarker levels, and/or occurrence of heart failure (HF) or cardiac death. Results: A decrease in LVEF above 10‑percent points occurred in 6.3% of ramipril patients and 18.5% ofcontrols (P = 0.15). No cases of HF, cardiac death, or LVEF decline below 50% were reported. The percentage of patients with elevated NT‑proBNP levels increased with time in controls (P = 0.003) and remained unchanged in the ramipril arm. At the end of follow‑up, an increase in NT‑proBNP levels was more common and decline was less common in the control than ramipril arm (P = 0.01). No significant differences in troponin levels were found between the study arms. Ramipril was well tolerated in normotensive women. Conclusions: In relatively young women with BC without serious comorbidities, who received anthracyclines, 1‑year treatment with ramipril exerts potentially protective effects on cardiotoxicity assessed with NT‑proBNP levels

How does the estimated phase of menstrual cycle or menopause influence the prevalence of vasovagal syncope induced by head-up tilt test

Background: The purpose of this study was to evaluate the prevalence of syncope induced by head-up tilt test (HUTT) and the type of positive vasovagal response to the orthostatic stress in a relationship to the estimated phase of menstrual cycle (follicular phase, luteal phase) or menopause. Methods: We observed a cohort of 500 women at age 13–89 years (median of age 37.5), referred to HUTT. Phase of the menstrual cycle was determined on the basis of the usual length of menstrual cycle and the day of the cycle at the time of the study. We assumed that the length of the luteal phase is constant and it is 14 days. Results: In premenopausal patients, the occurrence of the mixed and cardioinhibitory response was significantly more frequent in comparison to postmenopausal women (48.8 vs. 35.1% and 19.7 vs. 12.4%, respectively; p < 0.00001), while the occurrence of the vasodepressive one was significantly less frequent (7.3% vs. 28.6%; p < 0.00001) in that group of patients. Women in follicular phase presented vasodepressive response during HUTT more often than woman in the luteal phase (10.0% vs. 4.1%, p < 0.00001). Conclusions: Among women referred for HUTT, the prevalence of the vasovagal syndrome did not differ between those that were pre- and post-menopausal. Higher incidence of vasodepressive reaction in postmenopausal women was observed. Among the premenopausal women, the vasodepressive type of vasovagal syndrome occurred more often in follicular then in luteal phase

Myocardial dysfunction and chronic heart failure in patients with long-lasting type 1 diabetes : a 7-year prospective cohort study

The aim of the study is to evaluate the prevalence and incidence of myocardial dysfunction (MD) and heart failure (HF) in long-lasting (≥10 years) type 1 diabetes without cardiovascular disorders or with hypertension or coronary heart disease (CHD). The study included 1,685 patients with type 1 diabetes (mean baseline age, 51 years; diabetes duration, 36 years). In all patients, echocardiography was performed, NT-proBNP levels were measured, and clinical symptoms were evaluated. A 7-year follow-up was conducted to monitor systolic and diastolic manifestations of MD and HF. At the end of the follow-up period, the prevalence of HF in the entire group was 3.7 %, and the incidence was 0.02 % per year. The prevalence of MD was 14.5 % and the incidence –0.1 % per year. MD and HF were observed only in hypertensive or CHD patients. At baseline, subjects with diastolic HF constituted 85 % of the HF population and those with systolic HF the remaining 15 %. Baseline HF predictors included age, diabetes duration, HbA(1c) levels, CHD, systolic blood pressure >140 mmHg, and GFR <60 mL/min/1.73 m(2). In patients with type 1 diabetes, MD and HF occurred only when diabetes coexisted with cardiovascular disorders affecting myocardial function. The prevalence and incidence of HF in patients with hypertension and CHD were relatively low. While the cause of this observation remains uncertain, it could probably be explained, at least partially, by the cardioprotective effect of concomitant treatment

Pulmonary artery dilatation during normal pregnancy

Background: During pregnancy the cardiovascular system undergoes complex alterations; however, there have been few studies concerning pulmonary artery behaviour during gestation. Aim: The aim of this study was to evaluate changes in the pulmonary artery diameter (PAD) during gestation, with respect to left ventricular (LV) load and remodelling, as well as to systemic vascular resistance (SVR). Methods: It was a prospective cohort study, which included 69 consecutive healthy outpatient women with a singleton pregnancy. Echocardiography and ultrasonography of the uterine arteries were performed at two visits (V1 and V2) during pregnancy, and only echocardiography at one visit postpartum. Results: Pulmonary artery diameter increased in all women, from 20.0 mm at V1 to 22.7 mm at V2 (p &lt; 0.001), and it returned to the reference range postpartum (19.5 mm; p &lt; 0.001 vs. V2). Echocardiography did not reveal any other abnormalities, including the signs of intracardiac shunt or right ventricular pressure overload. During V2, PAD positively correlated with the following echocardiographic parameters: LV end-diastolic diameter (r = 0.386; p = 0.002), LV end-systolic diameter (r = 0.345 p = 0.006), LV end-diastolic volume (r = 0.308; p = 0.016), LV mass (r = 0.459; p &lt; 0.001), left atrial area (r = 0.334; p = 0.009), LV cardiac output (r = 0.338; p = 0.011), and aortic diameter (r = 0.369; p = 0.003). Furthermore, there was a negative linear correlation between PAD and SVR (r = –0.307; p = 0.025) and pulsatility index (r = –0.318; p = 0.012). Conclusions: Our study shows pulmonary artery dilatation in healthy pregnant women without any other abnormal echocardiographic findings. These changes in PAD are associated with volume overload and low vascular resistance, and during postpartum they usually subside