Physical Activity, Aerobic Capacity, and Total Antioxidant Capacity in Healthy Men and in Men with Coronary Heart Disease

Objective. The purpose of the study was to assess total antioxidant capacity (TAC) of blood serum in relation with habitual leisure time physical activity (LTPA) and aerobic capacity in a group of 90 men with coronary heart disease (CHD) aged 34.8–77.0 years and in 90 age-matched peers without CHD. Methods. Two spectrophotometric methods were applied to assess TAC: Ferric Reducing Ability of Serum (TAC-FRAS) and 2.2-diphenyl-1-picryl-hydrazyl (TAC-DPPH) tests. Aerobic capacity was expressed as physical working capacity at 85% of the maximal heart rate (PWC85%HRmax). Results. CHD patients had higher values of TACFRAS (1.37±0.28 versus 1.27±0.23 mmol FeCl2·L−1; P<0.05) but there were no group differences for TAC-DPPH and for uric acid (UA). Negative correlation was found between LTPA (also when calculated per kg of body mass) and TAC-DPPH in CHD patients. In CHD patients, TAC-FRAS and UA were lower in subjects with higher aerobic capacity expressed as PWC85%HRmax/kg. Those associations were not found in healthy men. Conclusions. We conclude that TAC of blood serum is moderately adversely related to LTPA and aerobic capacity in patients with CHD. UA, as the main determinant of serum TAC, may be partially responsible for those associations

Gonadotropins and steroid hormones in older people: their mutual connections and relations to body mass indices

Introduction: Aging in mammals, including man, is accompanied by deep changes in hormone secretion. In the majority of cases, hormone secretion (mostly of gonadal steroids and adrenocortical hormone dehydroepiandrosterone — DHEA) undergoes pronounced decrease. This decrease is thought to contribute to the progression of aging. In contrast, the secretion of gonadotropins is sharply increased in older adults, as a result of gonadal deficiency. Recent data indicate that gonadotropin excess may also, by itself, influence the aging process. The aim of the present study was to investigate the mutual relation between steroid hormones and gonadotropins and their effect on body mass indices in older people. Material and methods: In a group of 100 patients (61 women and 39 men) aged over 75 years, blood serum concentrations of folliclestimulating hormone (FSH), luteinising hormone (LH), oestradiol (E2), testosterone, dehydroepiandrosterone sulphate (DHEAs), and cortisol were measured. All the patients were measured for the following: body weight (kg), body mass index (BMI) (kg/m2), and waist-to-height ratio (WtHR). The differences of the numerical data were evaluated by Student’s t-test and the correlations between them by means of Pearson’s test. Results and conclusions: The most interesting finding of this study was to show that FSH and LH are negatively correlated with body mass and indices such as BMI and WtHR in older women. Because in older women the mediation of ovary is unlikely, we conclude that gonadotropins may influence the body mass by their direct extra-gonadal action

Serum testosterone level correlates with left ventricular hypertrophy in older women

IntroductionSex hormones may play an important role in age-related cardiac remodeling. However, their impact on cardiac structure and function in females of advanced age still remains unclear. The aim of this study is to evaluate the relationship between sex hormones level and echocardiographic parameters in older women with concomitant cardiovascular diseases.Materials and MethodsThe study group included 52 community-dwelling women with mean age 79.5 ± 2.8 years, consecutive patients of an outpatient geriatric clinic. In all the subjects, a transthoracic echocardiogram was performed and serum testosterone, estradiol, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulphate, and cortisol levels were determined.ResultsTestosterone level correlated positively with interventricular septum diastolic dimension (IVSd) (rS=0.293, p&lt;0.05), left ventricular mass index (rS=0.285, p&lt;0.05), E/E’ ratio (rS=0.301, p&lt;0.05), and negatively with E’ (rS=-0.301, p&lt;0.05). Estradiol level showed a positive correlation with the posterior wall dimension (rS=0.28, p&lt;0.05). Besides, no significant correlations between clinical or echocardiographic parameters and other hormones were observed. Female subjects with diagnosed left ventricular hypertrophy (LVH) (n=34) were characterized by a significantly higher rate of hypertension (p=0.011), higher waist-to-height ratio (p=0.009), higher testosterone level (0.82 vs. 0.48 nmol/L, p=0.024), higher testosterone/estradiol ratio (16.4 vs. 9.9, p=0.021), and received more anti-hypertensive drugs (p=0.030). In a multiple stepwise logistic regression, the best determinants of LVH were the presence of hypertension (OR=6.51; 95% CI 1.62-26.1), and testosterone level (OR= 6.6; 95% CI 1.19-36.6).ConclusionsHigher serum testosterone levels may contribute to pathological cardiac remodeling, especially in hypertensive women. Estradiol, gonadotropins, DHEAS, and cortisol were not related to echocardiographic parameters

Guidelines for the diagnosis and management of osteoporosis in Poland : Update 2017

In the rapidly ageing society in Poland, osteoporosis is a growing epidemiological problem, and osteoporosis-related fractures are a cause of chronic disability and considerable increase of death risk. It turns out that 80 to 90% of patients suffering from osteoporosis, including osteoporosis accompanied by fractures, do not receive adequate pharmacotherapy. In this paper, a Guideline Working Group of experts from the Multidisciplinary Osteoporosis Forum update the existing Polish guidelines concerning the diagnosis and management of osteoporosis (last revised in 2013), taking account of the latest literature, availability and reimbursement of drugs, and current health care organisation. In the revised guidelines, we still postulate that tasks are divided between primary care doctors (stage I) and specialists in osteoporosis management (stage II). We emphasise the necessity of early initiation of pharmacotherapy and rehabilitation in all patients with low-energy fractures. We recommend that the 10-year fracture risk should be estimated in all patients (including those without fractures) who are over 50 years of age, and that the Polish threshold for therapeutic intervention should be adopted: ≥ 10% for FRAX PL calculator. We add strategies of drug choice and therapy monitoring with imaging, and densitometric and biochemical diagnostics. We define basic guidelines concerning prevention of falls, rehabilitation, and dietary procedures, and elimination of environmental and other fracture risk factors. We point to two vital elements for improving osteoporosis management: 1) strategy of supervision over fractures management — Fracture Liaison Service (FLS), and, optimally, 2) strategies of short-term monitoring of the therapeutic efficacy with the use of biochemical markers

Leki złożone w terapii nadciśnienia tętniczego w Polsce : stanowisko ekspertów Polskiego Towarzystwa Nadciśnienia Tętniczego oraz sekcji farmakoterapii sercowo-naczyniowej Polskiego Towarzystwa Kardiologicznego

  The reasons for the publication of current expert consensus statement after 4 years from the previous one are: the growing number of evidence on the benefits of the use of single-pill combinations (SPCs) in hypertension (also with concomitant dyslipidaemia), the extension of indications for their use in the hypertension management algorithm and the emergence in recent years after the publication of Polish Society of Hypertension experts’ position statement in 2013 of new types of SPCs available to doctors in Poland, including triple-drug combinations of antihypertensives and the so-called “hybrids” SPCs containing not only antihypertensive drugs but also statins. The current position statement of experts summarizes the progress of knowledge and practical application of SPCs of antihy­pertensives in Poland. It seems that there will be a long gap in the introduction of new classes of antihypertensive drugs. The only noticeable progress in the pharmacotherapy of hypertension in the last 15 years, which may explain some increase in the effectiveness of blood pressure control in patients, is more common use of SPCs of antihypertensive drugs. Analysis of European Society of Hypertension (ESH) experts’ lectures during this year’s ESH 2017 Annual Meeting in Milan suggests that the next edition of the 2018 ESH Guidelines may include major changes in the antihypertensive therapy algorithm, suggesting the need for initiation of pharmacologic treatment with combination therapy, i.e. SPCs, in most patients with hypertension. Combination of an angiotensin converting enzyme (ACE) inhibitor + calcium antagonist should be considered optimal in patients with high and very high cardiovascular risk. Undoubtedly, the position of this combination is due to the ACCOM­PLISH trial in which such SPCs werefound to be more effective in reducing cardiovascular risk than SPCs composed of an ACE-inhibitor + thiazide diuretic. As a result of gradually increasing popularity of combined drugs, further SPCs that meet the criteria for optimal combination of antihypertensive drugs emerged in Poland between 2012 and 2017. Two of them provided the possibility of using SPCs in patients who do not need or should not use renin–angiotensin–aldosterone inhibitors. An interesting alternative is the SPC which contains antihypertensive agents along with other drugs used in cardiovascular prevention: statins and acetylsalicylic acid. This direction in the evolution of pharmacotherapy of hypertension is approaching the concept of “polypill”. In the opinion of the authors, the use of SPCs in antihypertensive therapy will increase in Poland, which may contribute to further improvement of pressure control in our country. At present, almost all useful anti-hypertensive agents are available in the form of two-drug SPCs. The combination of a sartan with beta-blocker for hypertensive patients with cardiac hypertrophy who do not tolerate ACE inhibitors and a “hybrid” SPCs of an ACE inhibitor + statin are still expected. Three-drug combinations: ACE inhibitor + beta-blocker + calcium antagonist, for patients with hypertension and coronary artery disease requiring intensive therapy, and ACE inhibitor + beta-blocker + statin, which will enable SPCs therapy for most patients, would also be useful

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicenter cohort study

Background: age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods: our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results: overall, mortality was found to increase starting from eGFR = 30-44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81-5.95) to ACR = 30-300 mg/g (HR = 1.96, 95%CI = 1.23-3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45-59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78-0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71-0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions: physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild-moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function