15 research outputs found
Thromboembolism Prevention via Transcatheter Left Atrial Appendage Closure with Transeosophageal Echocardiography Guidance
The Pathophysiology of HIV-/HAART-Related Metabolic Syndrome Leading to Cardiovascular Disorders: The Emerging Role of Adipokines
Individuals infected with human immunodeficiency virus (HIV) frequently demonstrate metabolic syndrome (MS) associated with increased incidence of cardiovascular disorders. Characteristics of HIV infection, such as immunodeficiency, viral load, and duration of the disease, in addition to the highly active antiretroviral therapy (HAART) have been suggested to induce MS in these patients. It is well documented that MS involves a number of traditional cardiovascular risk factors, like glucose, lipids, and arterial blood pressure abnormalities, leading to extensive atherogenic arterial wall changes. Nevertheless, the above traditional cardiovascular risk factors merely explain the exacerbated cardiovascular risk in MS. Nowadays, the adipose-tissue derivatives, known as adipokines, have been suggested to contribute to chronic inflammation and the MS-related cardiovascular disease. In view of a novel understanding on how adipokines affect the pathogenesis of HIV/HAART-related MS and cardiovascular complications, this paper focuses on the interaction of the metabolic pathways and the potential cardiovascular consequences. Based on the current literature, we suggest adipokines to have a role in the pathogenesis of the HIV/HAART-related MS. It is crucial to understand the pathophysiology of the HIV/HAART-related MS and apply therapeutic strategies in order to reduce cardiovascular risk in HIV patients
A case-control validation of Type D personality in Greek patients with stable coronary heart disease
BACKGROUND: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. METHODS: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Cronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. CONCLUSIONS: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality
The Pathophysiology of HIV-/HAART-Related Metabolic Syndrome Leading to Cardiovascular Disorders: The Emerging Role of Adipokines. Exp Diabetes Res; 2012: 103063. Epub Dec. 8. Available at
Individuals infected with human immunodeficiency virus (HIV) frequently demonstrate metabolic syndrome (MS) associated with increased incidence of cardiovascular disorders. Characteristics of HIV infection, such as immunodeficiency, viral load, and duration of the disease, in addition to the highly active antiretroviral therapy (HAART) have been suggested to induce MS in these patients. It is well documented that MS involves a number of traditional cardiovascular risk factors, like glucose, lipids, and arterial blood pressure abnormalities, leading to extensive atherogenic arterial wall changes. Nevertheless, the above traditional cardiovascular risk factors merely explain the exacerbated cardiovascular risk in MS. Nowadays, the adipose-tissue derivatives, known as adipokines, have been suggested to contribute to chronic inflammation and the MS-related cardiovascular disease. In view of a novel understanding on how adipokines affect the pathogenesis of HIV/HAART-related MS and cardiovascular complications, this paper focuses on the interaction of the metabolic pathways and the potential cardiovascular consequences. Based on the current literature, we suggest adipokines to have a role in the pathogenesis of the HIV/HAART-related MS. It is crucial to understand the pathophysiology of the HIV/HAART-related MS and apply therapeutic strategies in order to reduce cardiovascular risk in HIV patients
Usefulness of cardiovascular magnetic resonance imaging in supraventricular tachycardia ablation in a scleroderma patient
HIV-positive patients treated with protease inhibitors have vascular changes resembling those observed in atherosclerotic cardiovascular disease
A metabolic syndrome associated with atherosclerosis and cardiovascular
disease has been described in HIV-positive individuals. In the present
study we investigated whether HIV-positive individuals and CAD (coronary
artery disease) patients have similarities in their vascular function
and structure. In a case-control study, we compared measurements of
carotid artery IMT (intima-media thickness) and brachial artery FMD
(flow-mediated vasodilation) in HIV-positive individuals with age- and
sex-matched controls with similar risk factors and patients with
established CAD. Seventy-one HIV patients, age 42 +/- 13.9 years (91 %
male), were compared with 29 CAD patients and 25 controls. HIV patients
had higher IMT than controls and similar IMT to CAD patients (0.64 +/-
0.2 compared with 0.55 +/- 0.05 and 0.66 +/- 0.08 mm respectively; F =
4.2, P = 0.01). Patients taking protease inhibitors had higher IMT (0.69
+/- 0.2 compared with 0.57 +/- 0.15 mm; P = 0.01), blood pressure,
cholesterol and triacylglycerols than those not taking protease
inhibtors (P < 0.05). In multiple regression analyses, increasing blood
pressure (beta: 0.37, P = 0.001), glucose (beta: 0.26, P = 0.016),
cholesterol (beta: 0.24, P = 0.033), duration of HIV disease (beta:
0.33, P = 0.008) and use of protease inhibitors (beta: 0.27, P = 0.04)
were the most important determinants of IMT respectively. FMD was
associated only with triacylglycerol measurements. Patients with HIV
present arterial changes resembling those found in patients with
atherosclerotic cardiovascular disease. These vascular changes are
closely related to protease-inhibitor-induced changes of metabolic
parameters. Thus intensive treatment of these metabolic parameters might
retard atherosclerosis in HIV patients
Microcirculatory Vascular Dysfunction in HIV-1 Infected Patients Receiving Highly Active Antiretroviral Therapy
P>Objectives:
We investigated whether HIV-1 infected patients receiving highly active
antiretroviral therapy (HAART) and HIV-1 infected patients who had never
received HAART had differences in their vascular microcirculatory
function.
Methods:
We assessed the forearm blood flow before and after four minutes of
ischemic occlusion of the brachial artery using venous occlusion strain
gauge plethysmography. The hyperaemic forearm blood flow was recorded
for three minutes at 15 second intervals. We calculated the maximal
percent increase of the forearm blood flow during hyperemia. Forty
HIV-infected male patients receiving HAART were compared to 20 age- and
BMI- matched, male HIV-infected patients who had never received HAART
(control group).
Results:
Patients on HAART had similar baseline forearm blood flow but lower
maximal and percentage (%) change in forearm blood flow than control
patients (4.2 +/- 1.7 vs. 4.1 +/- 1.7 l/ 100mL/min P = 0.8, 32 +/- 11.2
vs. 38.9 +/- 10.5 l/100 mL/min. P = 0.04 and 714 +/- 255 vs. 907 +/-
325%, P = 0.01, respectively). Patients receiving HAART had higher
cholesterol than control patients (221 +/- 58 vs. 163 +/- 38 mg/dL, P =
0.001). HAART was associated with the percentage change in the blood
flow during hyperemia (coefficient regression B = -0.32, P = 0.02) after
adjustment for age, cholesterol and viral load.
Conclusions:
HIV-infected patients receiving HAART present abnormalities of arterial
microcirculation in comparison with never-treated patients
A case-control validation of Type D personality in Greek patients with stable coronary heart disease
Background: Type D personality has been associated with a variety of
emotional and social difficulties as well as with poor prognosis in
patients with established coronary heart disease (CHD). We examined the
psychometric properties and validity of the Type D Scale-14 (DS14) and
the prevalence of Type D personality among Greek patients with CHD while
taking into account demographic; clinical, such as diabetes mellitus,
hypertension, and hypercholesterolemia; as well as psychological
variables such as depression, anxiety, and psychological stress.
Methods: Ninety-six patients with stable coronary heart disease and 80
healthy participants from the general population completed the Greek
version of the DS14 and the Hospital Anxiety and Depression Scale
(HADS).
Results: Cronbach’s a coefficient for the negative affectivity (NA) and
social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88
and 0.76 for the control group, respectively. Internal-structural
validity was assessed by a factor analysis (two-factor solution), and
the factor structure of the original DS14 was replicated. Using the
standardized cutoff point of NA >= 10 and SI >= 10, instead of the
median scores, in order to have compatible results with the majority of
studies, the prevalence of Type D personality was 51% for the CHD
patients and 13% for the control group. Higher NA and SI were connected
with higher anxiety, depression, and total psychological stress.
Finally, more patients with CHD and Type D personality than those
without were diagnosed with type 2 diabetes; however, no differences
were observed in hypertension or hypercholesterolemia.
Conclusions: These results indicate that the Type D construct is
reliable and valid in a Greek population. The prevalence of Type D
personality was higher in patients with stable coronary heart disease
than in people from the general population. The DS14 subscales were
positively correlated with higher anxiety, depression, and total
psychological stress. Regarding other CHD risk factors, only diabetes
mellitus was found more frequently in CHD patients with Type D
personality