Can thromboembolic risk be associated with erectile dysfunction in atrial fibrillation patients?

Background: Erectile dysfunction (ED) is highly prevalent in patients with diseases of cardiovascular system, including patients with atrial fibrillation (AF). Reasons for this high co-prevalence include endothelial dysfunction, inflammation, oxidative and emotional stress associated with AF. Association of AF-induced prothrombotic state and possible microthrombi in penile arteries with ED remains unclear. The present study aims to assess if probability of AF-associated risk of peripheral thromboembolism may be associated with ED in AF patients. Methods: Probability of thromboembolic complications was assessed with two commonly used risk scores CHADS2 and CHA2DS2-VASc in a group of continuous AF patients. All patients were also asked to fill an IIEF-5 questionnaire designed for screening for ED. Results: Mean CHADS2 score in the whole study group was 1.1 ± 1.0 points and CHA2DS2- -VASc was 1.5 ± 1.4 points. ED was present in 57.4% of the 129-person study population. In patients with ED, both CHADS2 (0.9 ± 1.0 vs. 1.3 ± 1.1; p = 0.03) and CHA2DS2-VASc (1.2 ± 1.1 vs. 1.8 ± 1.5; p = 0.03) scores were significantly higher than in the group without dysfunction. After dividing the patients according to age into groups younger than 65 years vs. ≥ 65 years, observed correlation was no longer significant in the younger group (p > 0.05). In patients ≥ 65 years, in whom the risk scores are routinely used, dysfunction both CHADS2 (1.1 ± 0.9 vs. 2.0 ± 0.9; p = 0.02) and CHA2DS2-VASc (2.3 ± 1.1 vs. 3.4 ± 1.3; p = 0.04) scores were higher in the group with ED. Conclusions: Erectile dysfunctions in AF patients are associated with elevated cardioembolic risk. We postulate that the diagnosis of ED should be considered an additional marker of prothrombotic state, and may be useful in clinical decision-making, especially in patients ≥ 65 years old.

Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion. Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation. Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 } 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05). Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group

Does obstructive sleep apnoea influence BNP concentrations in atrial fibrillation patients?

Background B-type natriuretic peptide (BNP) is a biomarker commonly used in diagnosing and assessing prognosis in heart failure patients. Its concentration can be elevated in various conditions associated with excessive heart wall stretch including atrial fibrillation and obstructive sleep apnoea (OSA). The aim of the study was to assess if BNP levels in atrial fibrillation patients are associated with the value of apnoea-hypopnea index (AHI). Material and methods Study population were consecutive patients with atrial fibrillation, who underwent overnight sleep study, and had blood taken for BNP concentration assessment. Subsequently, patients were divided into group according to AHI: Group I (< 5/h), Group II (5–15/h), and Group III (> 15/h). Results Analysis covered 158 patients (males, 64.6%; mean age, 58.3 ± 9.2 years). 83 (52.5%) patients had AHI < 5/h, Group II consisted of 44 (27.9%), and Group III of 31 (19.6%) patients. Mean BMI and neck circumference rose with AHI value severity. BMI was as follows 28.7 ± 4.3, 30.7 ± 4.7, and 31.8 ± 5.2 kg/m2 (p for trend < 0.01), while neck circumference was 39.2 ± 3.5, 41.5 ± 3.9, and 41.2 ± 3.2 cm, (p for trend = 0.001) for Group I, II, and III respectively. BNP concentration was the lowest in Group I (53.0 ± 57.0 pg/mL), in middle ranges in Group II (69.2 ± 89.9 pg/mL), and the highest in patients with AHI > 15 (104.0 ± 150.8 pg/mL; p for trend = 0.03). Conclusions Majority of patients with atrial fibrillation have AHI < 5/h and these generally have lower BMI, and neck circumference. Patients who have AHI exceeding ≥ 5/h BNP levels tend to be elevated, and its values rise along with AHI

Attitudes of Polish physicians towards new antihypertensive agents — a final report from the ALMONDS survey

Introduction. Arterial hypertension is the most frequent modifiable risk factor for cardiovascular disease and premature mortality globally. Availability of novel antihypertensive agents with unique pharmacological characteristics improves the efficacy and safety of antihypertensive therapy. The aim of the ALMONDS survey was to identify the attitude of Polish medical professionals towards novel pharmacological agents used in the therapy of hypertension. In particular, we sought to investigate the views regarding the “class effect” for antihypertensive agents. Material and methods. The study was conducted using a standardized survey, which was filled in by 784 specialists or trainees in cardiology, internal medicine, family medicine, and diabetology. The letter form and anonymity of the survey allowed to maximize the reliability of the collected data. Results. The majority of the study group were females 46-60 years of age. A substantial proportion of the physicians specialized in internal medicine and had more than 20 years of professional experience. The management was mostly guided by the Polish Society of Hypertension (PTNT) guidelines or the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. In patients with hypertension and coronary artery disease, the most commonly chosen drug treatment included a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor or an ACE inhibitor and a vasodilating beta-blocker. The latter combination was also selected most frequently in patients with hypertension and heart failure. In women in reproductive age, a vasodilating beta-blocker and a calcium antagonist were selected most frequently, while a combination of nebivolol and zofenopril was indicated as the best in young men with hyperkinetic circulation. In patients with resistant hypertension, the most frequently chosen regimen included furosemide, amlodipine, zofenopril, and nebivolol. Another popular combination included torasemide, lercanidipine, telmisartan, and carvedilol. Conclusions. The results of our study indicate that Polish medical professionals have clear preferences regarding specific pharmacological agents within drug classes. Vasodilating agents are preferred among beta blockers, newer agents among ACE inhibitors, dihydropyridines among calcium antagonists, and loop diuretics among diuretics. This attitude is generally consistent with the 2015 PTNT guidelines

Association between vitamin D levels and arterial hypertension in women at very high cardiovascular risk

Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m2. Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients.Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m2. Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients

Validation of Aura Microwave Limb Sounder O-3 and CO observations in the upper troposphere and lower stratosphere

International audienceGlobal satellite observations of ozone and carbon monoxide from the Microwave Limb Sounder (MLS) on the EOS Aura spacecraft are discussed with emphasis on those observations in the 215–100 hPa region (the upper troposphere and lower stratosphere). The precision, resolution and accuracy of the data produced by the MLS “version 2.2” processing algorithms are discussed and quantified. O3 accuracy is estimated at ~40 ppbv +5% (~20 ppbv +20% at 215 hPa) while the CO accuracy is estimated at ~30 ppbv +30% for pressures of 147 hPa and less. Comparisons with expectations and other observations show good agreements for the O3 product, generally consistent with the systematic errors quoted above. In the case of CO, a persistent factor of ~2 high bias is seen at 215 hPa. However, the morphology is shown to be realistic, consistent with raw MLS radiance data, and useful for scientific study. The MLS CO data at higher altitudes are shown to be consistent with other observations

The chemerin knockout rat reveals chemerin dependence in female, but not male, experimental hypertension

Measures of the adipokine chemerin are elevated in multiple cardiovascular diseases, including hypertension, but little mechanistic work has been done to implicate chemerin as being causative in such diseases. The chemerin knockout (KO) rat was created to test the hypothesis that removal of chemerin would reduce pressure in the normal and hypertensive state. Western analyses confirmed loss of chemerin in the plasma and tissues of the KO vs. wild‐type (WT) rats. Chemerin concentration in plasma and tissues was lower in WT females than in WT males, as determined by Western analysis. Conscious male and female KO rats had modest differences in baseline measures vs. the WT that included systolic, diastolic, mean arterial and pulse pressures, and heart rate, all measured telemetrically. The mineralocorticoid deoxycorticosterone acetate (DOCA) and salt water, combined with uninephrectomy as a hypertensive stimulus, elevated mean and systolic blood pressures of the male KO higher than the male WT. By contrast, all pressures in the female KO were lower than their WT throughout DOCA‐salt treatment. These results revealed an unexpected sex difference in chemerin expression and the ability of chemerin to modify blood pressure in response to a hypertensive challenge.—Watts, S. W., Darios, E. S., Mullick, A. E., Garver, H., Saunders, T. L., Hughes, E. D., Filipiak, W. E., Zeidler, M. G., McMullen, N., Sinal, C. J., Kumar, R. K., Ferland, D. J., Fink, G. D. The chemerin knockout rat reveals chemerin dependence in female, but not male, experimental hypertension. FASEB J. 32, 6596–6614 (2018). www.fasebj.orgPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154357/1/fsb2fj201800479.pd

Produkty tytoniowe oparte na podgrzewaniu tytoniu (heat-not-burn) a zdrowie pacjentów — opinia grupy ekspertów

Smoking, especially of cigarettes, is one of the best-recognised and most widely studied risk factors for cardiovascular disease and death. Despite the availability of many methods of counteracting tobacco addiction, their effective- ness is still insufficient. An alternative to smoking cigarettes could be tobacco products based on heating tobacco (‘heat-not-burn’), the use of which may be associated with a lower cardiovascular risk. this article presents a summary of the current state of knowledge and the recommendations of Polish experts regarding the safety of these products.Nikotynizm jest jednym z uznanych i szeroko zbadanych czynników ryzyka chorób układu sercowo-naczyniowego oraz zgonu. Palenie papierosów stanowi również jeden z najistotniej- szych czynników ryzyka zachorowań oraz zgonu z powodu chorób serca i naczyń krwionośnych. Mimo dostępności wielu metod wspomagających leczenie uzależnienia od tytoniu ich skuteczność pozostaje niewystarczająca. Alternatywę dla palenia papierosów mogą stanowić produkty tytoniowe oparte na podgrzewaniu tytoniu, których stosowanie może się łączyć z niższym ryzykiem sercowo-naczyniowym. W niniejszym artykule przedstawiono podsumowanie aktualnego stanu wiedzy i zaleceń polskich ekspertów w zakresie bezpieczeństwa stosowania tych produktów