Salivary Matrix Metalloproteinase-8 and-9 and Myeloperoxidase in Relation to Coronary Heart and Periodontal Diseases : A Subgroup Report from the PAROKRANK Study (Periodontitis and Its Relation to Coronary Artery Disease)

Background and Objective Matrix metalloproteinase (MMP) -8, -9 and myeloperoxidase (MPO) are inflammatory mediators. The potential associations between MMP-8, -9, MPO and their abilities to reflect cardiovascular risk remains to be evaluated in saliva. The objective of this study was to investigate the levels and associations of salivary MMP-8, -9, MPO and tissue inhibitors of metalloproteinase (TIMP)-1 in myocardial infarction (MI) patients and controls with or without periodontitis. Materials and Methods 200 patients with a first MI admitted to coronary care units in Sweden from May 2010 to December 2011 and 200 controls matched for age, gender, residential area and without previous MI were included. Dental examination and saliva sample collection was performed 6-10 weeks after the MI in patients and at baseline in controls. The biomarkers MMP -8, -9, MPO and TIMP-1 were analyzed by time-resolved immunofluorescence assay (IFMA), Western blot and Enzyme-Linked ImmunoSorbent Assay (ELISA). Results After compensation for gingivitis, gingival pockets and smoking, the mean salivary levels of MMP-8 (543 vs 440 ng/mL, p = 0.003) and MPO (1899 vs 1637 ng/mL, p = 0.02) were higher in non-MI subjects compared to MI patients. MMP-8, -9 and MPO correlated positively with clinical signs of gingival/periodontal inflammation while TIMP-1 correlated mainly negatively with these signs. The levels of latent and active forms of MMP-8 did not differ between the MI and non-MI groups. Additionally, MMP-8, MPO levels and MMP-8/TIMP-1 ratio were significantly higher in men compared to women with MI. Conclusions This study shows that salivary levels of the analyzed biomarkers are associated with periodontal status. However, these biomarkers could not differentiate between patients with or without a MI. These findings illustrate the importance to consider the influence of oral conditions when analyzing levels of inflammatory salivary biomarkers.Peer reviewe

Societal costs associated with pulmonary arterial hypertension: A study utilizing linked national registries

Pulmonary arterial hypertension (PAH) is a progressive disease with no cure. Healthcare resource utilization (HCRU; hospitalization, outpatient visits, and drug utilization) before diagnosis and productivity loss (sick leave and disability pension) before and after PAH diagnosis are not well known. By linking several Swedish national databases, this study have estimated the societal costs in a national PAH cohort (n = 749, diagnosed with PAH in 2008-2019) 5 years before and 5 years after diagnosis and compared to an age, sex, and geographically matched control group (n = 3745, 1:5 match). HCRU and productivity loss were estimated per patient per year.The PAH group had significantly higher HCRU and productivity loss compared to the control group starting already 3 and 5 years before diagnosis, respectively. HCRU peaked the year after diagnosis in the PAH group with hospitalizations (mean +/- standard deviation; 2.0 +/- 0.1 vs. 0.2 +/- 0.0), outpatient visits (5.3 +/- 0.3 vs. 0.9 +/- 0.1), and days on sick leave (130 +/- 10 vs. 13 +/- 1) significantly higher compared to controls. Total costs during the entire 10-year period were six times higher for the PAH group than the control group. In the 5 years before diagnosis the higher costs were driven by productivity loss (76%) and hospitalizations (15%), while the 5 years after diagnosis the main cost drivers were drugs (63%), hospitalizations (16%), and productivity loss (16%). In conclusion, PAH was associated with large societal costs due to high HCRU and productivity loss, starting several years before diagnosis. The economic and clinical burden of PAH suggests that strategies for earlier diagnosis and more effective treatments are warranted.Funding Agencies|Svensk Forening for Pulmonell Hypertension; Actelion Pharmaceuticals</p

The Science committee of the CCNAP: Eager to start

status: publishe

Early risk prediction in idiopathic versus connective tissue disease-associated pulmonary arterial hypertension : call for a refined assessment

Despite systematic screening and improved treatment strategies, the prognosis remains worse in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) compared to patients with idiopathic/hereditary pulmonary arterial hypertension (IPAH). We aimed to investigate differences in clinical characteristics, outcome and performance of the European Society of Cardiology (ESC)/ European Respiratory Society (ERS) risk stratification tool in these patient groups. This retrospective analysis included incident patients with CTD-PAH (n=197, of which 64 had interstitial lung disease, ILD) or IPAH (n=305) enrolled in the Swedish PAH Register (SPAHR) 2008-2019. Patients were classified as low, intermediate or high risk at baseline, according to the "SPAHR-equation". One-year survival, stratified by type of PAH, was investigated by Cox proportional regression. At baseline, CTD-PAH patients had lower diffusing capacity for carbon monoxide and lower haemoglobin but, at the same time, lower N-terminal prohormone-brain natriuretic peptide, longer 6 min walk distance, better haemodynamics and more often a low-risk profile. No difference in age, World Health Organisation functional class (WHO-FC) or renal function between groups was found. One-year survival rates were 75, 82 and 83% in patients with CTD-PAH with ILD, CTD-PAH without ILD and IPAH, respectively. The 1-year mortality rates for low-, intermediate- and high-risk groups in the whole cohort were 0, 18 and 34% (p&amp;lt;0.001), respectively. Corresponding percentages for CTD-PAH with ILD, CTD-PAH without ILD and IPAH patients were: 0, 26, 67% (p=0.008); 0, 19, 39% (p=0.004); and 0, 16, 29% (p=0.001), respectively. The ESC/ERS risk assessment tool accurately identified low-risk patients but underestimated the 1-year mortality rate of CTD-PAH and IPAH patients assessed as having intermediate risk at diagnosis.Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission; Medical Faculty of Lund University; Swedish Rheumatism Association, King Gustaf V 80-year Fund; Osterlund Foundation; Kock Foundation; EULAR Orphan Disease Programme</p

(ob šestdesetletnici)

none56siPulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. The composition of the guidelines task force reflects themultidisciplinary nature of PH, including members of different medical societies, associations and working groups. The current document follows the two previous ESC and ERS Guidelines, published in 2004 and 2009, focusing on clinical management of PH. A systematic literature review was performed from MEDLINEw to identify new studies published since 2009 concerning the topic of PH. Task force members selected studies based on relevance and appropriateness.noneGaliè, Nazzareno; Humbert, Marc; Vachiery, Jean-Luc; Gibbs, Simon; Lang, Irene; Torbicki, Adam; Simonneau, Gérald; Peacock, Andrew; Vonk Noordegraaf, Anton; Beghetti, Maurice; Ghofrani, Ardeschir; Gomez Sanchez, Miguel Angel; Hansmann, Georg; Klepetko, Walter; Lancellotti, Patrizio; Matucci, Marco; Mcdonagh, Theresa; Pierard, Luc A; Trindade, Pedro T; Zompatori, Maurizio; Hoeper, Marius; Aboyans, Victor; Vaz Carneiro, Antonio; Achenbach, Stephan; Agewall, Stefan; Allanore, Yannick; Asteggiano, Riccardo; Paolo Badano, Luigi; Albert Barberà, Joan; Bouvaist, Hélène; Bueno, Héctor; Byrne, Robert A; Carerj, Scipione; Castro, Graça; Erol, Çetin; Falk, Volkmar; Funck-Brentano, Christian; Gorenflo, Matthias; Granton, John; Iung, Bernard; Kiely, David G; Kirchhof, Paulus; Kjellstrom, Barbro; Landmesser, Ulf; Lekakis, John; Lionis, Christos; Lip, Gregory Y H; Orfanos, Stylianos E; Park, Myung H; Piepoli, Massimo F; Ponikowski, Piotr; Revel, Marie-Pierre; Rigau, David; Rosenkranz, Stephan; Völler, Heinz; Luis Zamorano, JoseGaliè, Nazzareno; Humbert, Marc; Vachiery, Jean-Luc; Gibbs, Simon; Lang, Irene; Torbicki, Adam; Simonneau, Gérald; Peacock, Andrew; Vonk Noordegraaf, Anton; Beghetti, Maurice; Ghofrani, Ardeschir; Gomez Sanchez, Miguel Angel; Hansmann, Georg; Klepetko, Walter; Lancellotti, Patrizio; Matucci, Marco; Mcdonagh, Theresa; Pierard, Luc A; Trindade, Pedro T; Zompatori, Maurizio; Hoeper, Marius; Aboyans, Victor; Vaz Carneiro, Antonio; Achenbach, Stephan; Agewall, Stefan; Allanore, Yannick; Asteggiano, Riccardo; Paolo Badano, Luigi; Albert Barberà, Joan; Bouvaist, Hélène; Bueno, Héctor; Byrne, Robert A; Carerj, Scipione; Castro, Graça; Erol, Çetin; Falk, Volkmar; Funck-Brentano, Christian; Gorenflo, Matthias; Granton, John; Iung, Bernard; Kiely, David G; Kirchhof, Paulus; Kjellstrom, Barbro; Landmesser, Ulf; Lekakis, John; Lionis, Christos; Lip, Gregory Y H; Orfanos, Stylianos E; Park, Myung H; Piepoli, Massimo F; Ponikowski, Piotr; Revel, Marie-Pierre; Rigau, David; Rosenkranz, Stephan; Völler, Heinz; Luis Zamorano, Jos