Relationship of arterial wall parameters to cardiovascular risk factors and cardiovascular risk assessed by SCORE system

Objective. To investigate the relationship of arterial wall parameters (flow-mediated dilatation of the brachial artery, augmentation index, pulse wave velocity, stiffness index, carotid intima-media thickness) to conventional cardiovascular risk factors and cardiovascular risk assessed by SCORE system. Material and methods. A total of 209 subjects aged 40–65 years without clinically overt cardiovascular disease were examined. Parameters of arterial stiffness were obtained by two methods: augmentation index and carotid-radial pulse wave velocity by applanation tonometry and stiffness index by the means of finger photoplethysmography. Flow-mediated dilatation of the brachial artery, reflecting endothelial function, and carotid intima-media thickness was determined using a high-resolution B-mode ultrasonography. Results. Age and the presence of diabetes strongly influenced all parameters of the arterial wall (diabetes was not independent predictor when evaluating augmentation index). Mean arterial pressure and gender were independent predictors for arterial stiffness parameters – carotid-radial pulse wave velocity and augmentation index. Flow-mediated dilatation was strongly dependent on the diameter of the brachial artery, age, and body mass index. Using logistic regression, it was found that pulse wave velocity (P=0.014), intima-media thickness (P=0.004), and flow-mediated dilatation (P=0.020) were important parameters dividing subjects to the groups of increased (³5%) and low (<5%) cardiovascular risk assessed by SCORE system. The cutoff values for intima-media thickness and pulse wave velocity were 0.078 cm and 8.95 m/s, respectively. Conclusions. Arterial wall parameters are closely associated with conventional risk factors; they are influenced by age and the presence of diabetes. Arterial stiffness parameters are also influenced by mean arterial pressure; high-density lipoprotein cholesterol has influence on carotid intima-media thickness. Cutoff values for carotid intima-media thickness and carotid-radial pulse wave velocity could help to discriminate patients with increased cardiovascular risk

The Prevalence of Erectile Dysfunction and Its Association with Cardiovascular Risk Factors in Patients after Myocardial Infarction

Background and Objectives: This study estimates the prevalence and severity of erectile dysfunction and its association with cardiovascular risk factors in patients after a myocardial infarction. Materials and Methods: This study included men aged 35–80 years, diagnosed with myocardial infarction and examined in the Department of Preventive Cardiology of Vilnius University Hospital Santaros Klinikos between 2016 and 2020. Anthropometric characteristics, blood pressure, lipid profile, blood glucose levels and prevalence of cardiovascular risk factors were evaluated. The International Index of Erectile Function-5 was used to assess patients’ erectile function. Results: A total of 171 patients were analysed. The mean age was 57.6 ± 8.8 years. Of the patients, 42.1, 25.1 and 11.7% had three, four and five established cardiovascular risk factors, respectively. Of the patients, 100% were diagnosed with dyslipidaemia, 90.0%—arterial hypertension, 14.6%—diabetes, 23.3%—smoking, 43.7%—positive familial history and 54.5%—insufficient physical activity. The overall prevalence of erectile dysfunction was 62%. It was scored mild in 37.4%, mild-to-moderate—15.2%, moderate—5.3% and severe in 4.1% of the patients. The mean age was significantly different between severity groups (p < 0.001). The study demonstrated a negative correlation between age and total score of the questionnaire (r = −0.308, p < 0.001). Arterial hypertension was more frequent in the patients with erectile dysfunction (p = 0.02). Other cardiovascular risk factors were distributed similarly. Conclusions: Erectile dysfunction is common in patients after a myocardial infarction and its severity is age dependent. The prevalence of cardiovascular risk factors is high, with arterial hypertension significantly more frequent in patients with erectile dysfunction

Relationship of arterial wall parameters to cardiovascular risk factors and cardiovascular risk assessed by SCORE system

Tuberculosis is one of the biggest global health problems. One-third of the world’s population (2 billion) is latently infected with tuberculosis. The tuberculin skin test is commonly used to diagnose tuberculosis infection. This test has poor specificity and sensitivity, cross-reactivity with bacille Calmette-Guérin vaccination and many environmental mycobacteria, and poor sensitivity (only 75–90% in active tuberculosis). Mycobacterium tuberculosis activates a strong T cell-mediated immune response. That is why, a better marker for tuberculosis infection could be the presence of mycobacteria specific interferon-γ-secreting T cells. These cells can be identified in blood or any other sample, which contains T cells. The test specificity is 99.9% (in low-risk control groups), and the sensitivity is 97.2% (in subjects with culture-confirmed active disease). New in vitro diagnostic test of tuberculosis, based on tuberculosis-induced immunological mechanisms, seems to be more specific and useful as previous methods

Lower than average HDL cholesterol efflux capacity in Lithuanian population.

Background: The aim of our study was to evaluate high-density lipoprotein cholesterol (HDL-C) efflux capacity in healthy controls and patients with severe dyslipidemia. Evaluation of HDL function may be beneficial for better understanding of cardiovascular diseases, as well as for taking actions to minimize residual cardiovascular risk. Methods: During 2016–2017 a total of 93 participants – 48 (51.6%) women and 45 (48.4%) men – were included in this cross-sectional study. Data of 45 (48.4%) participants with severe dyslipidemia (SD) and 48 (51.6%) controls without dyslipidemia was used for statistical analysis. Total lipid panel, concentration of lipoprotein (a) and apolipoproteins were measured, data about cardiovascular risk factors were collected and detailed evaluation of HDL-C quality was performed for all patients. Results: Increased HDL-C concentration was associated with higher ApoA1 (r = 0.866 in controls, r = 0.63 in SD group), ApoA2 (r = 0.41 in controls, r = 0.418 in SD group) and LDL-C concentrations (r = − 0.412 in SD group), lower ApoE (r = − 0.314 in SD group) and TG concentrations (r = − 0.38 in controls, r = − 0.608 in SD group), lower ApoB/ ApoA1 ratio (r = − 0.567 in control group), below average HDL-C efflux capacity (r = − 0.335 in SD group), lower BMI (r = − 0.327 in controls, r = − 0.531 in SD group) and abdominal circumference (r = − 0.309 in women with SD). Below-average HDL-C efflux capacity was found in 67.7% (N = 63) of participants. It was more often found among patients with normal weight or BMI 30–31 kg/m2. HDL-C efflux capacity was inversely associated with HDL-C concentration (r = − 0.228). Conclusion: Abnormal HDL function may be associated with residual cardiovascular risk in Lithuanian populatio

Does education degree affect the patient’s attitude towards the treatment after myocardial infarction?

Objectives. To assess the association between education degree and attitude towards the treatment after myocardial infarction (MI). Design and Methods. The participants of this cross-sectional study were 191 (140 men and 51 women) outpatients in a period of 3 months – 5 years after acute MI (mean age 59 ± 9.2 years) from Vilnius University Hospital Santaros Klinikos. All patients were asked to complete two questionnaires: “Quality of Life and Treatment after Myocardial Infarction” and “Cholesterol-lowering Drugs Consumption Peculiarities”. The data was analyzed using the SPSS software. Results. The education degree (a higher (post-secondary education provided by a college or university) vs. a lower (secondary or vocational education) education degree) had similar influence on the patients’ occasional concern (43.2%; n = 35 vs. 52.9%; n = 55, respectively; p = 0.226) and on the frequent concern (25.9%; n = 21 vs. 26.9%; n = 28, respectively; p = 0.226) about MI. Patients with a higher education degree were more likely to identify themselves as the main subjects in MI treatment in comparison with patients that had a lower education degree (30.5%; n = 25 vs. 15.2%; n = 16, respectively, p = 0.033). More educated patients found it easier to follow up the doctor’s treatment plan than less educated patients (23.2%; n = 19 vs. 9.5%; n = 10, respectively; p = 0.035). Conclusions. More educated patients are more likely to follow up the doctor’s treatment plan and see it easier than less educated patients. Thus, more attention should be paid to less educated patients in order to increase their own impact on their post-MI treatmen

Severe dyslipidemia and concomitant risk factors in the middle-aged Lithuanian adults: a cross-sectional cohort study

Abstract Background Dyslipidemia is highly prevalent and is one of the major risk factors for cardiovascular disease in Lithuania. The purpose of this study was to determine the prevalence of severe dyslipidemia in Lithuanian middle aged primary prevention population and to investigate cardiovascular risk profile. Methods The group of 83,376 people were examined in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR), during 2009–2015 years. This study recruited middle aged men and women without overt cardiovascular disease. The prevalence of cardiovascular risk factors was compared between severe dyslipidemia group and control group. Results Severe dyslipidemia was present in 13.5% (11265) of the subjects; 66.6% (7508) were females. The subjects with severe dyslipidemia had significantly higher rates of arterial hypertension (63.5% vs. 44.2%, p  30 (kg/m2) (38.8% vs. 24.1%, p < 0.001), metabolic syndrome (47.2% vs. 9.2%, p < 0.001), unbalanced diet (66.5% vs. 53.5%, p < 0.001), insufficient physical activity (56% vs. 44.2%, p < 0.001), family history of cardiovascular disease (29.7% vs. 22.7%, p < 0.001) in comparison with control group. Subjects without dyslipidemia had significantly higher rates of smoking (26.4% vs. 22.7%, p < 0.001). The prevalence of familial hypercholesterolemia was 0.1%, very high hypertriglyceridemia - 0.2% and familial mixed dyslipidemia - 0.1% of the subjects examined in the LitHiR programme. Conclusions High prevalence of dyslipidemia remains a major problem in Lithuania. 9 out of 10 people have dyslipidemia, 1 out of 10 - severe dyslipidemia. Severe dyslipidemia is associated with higher frequency of other cardiovascular risk factors

Is the coronary artery calcium score the first-line tool for investigating patients with severe hypercholesterolemia?

Background: Coronary artery calcium (CAC) is known as a reliable tool for estimating risk of myocardial infarction, coronary death, all-cause mortality and is even used to evaluate suitable asymptomatic patients. We therefore aimed to evaluate whether CAC scoring can be applied in the algorithm for clinical examination of patients with severe hypercholesterolemia (SH). Methods: During the period of 2016–2017 a total of 213 asymptomatic adults, underwent computed tomography angiography to evaluate their CAC scoring. The sample consisted of 110 patients with SH and 103 age and sex matched controls without dyslipidemia and established cardiovascular disease. Results: In total there were 79 (37.2%) subjects with elevated (≥25th) CAC percentiles. Out of them 47 (59.5%) had SH and 32 (40.5%) did not. CAC score did not differ between groups (SH (+) 140.30 ± 185.72 vs SH (−) 87.84 ± 140.65, p = 0.146), however there was a comparable difference in how the participants of these groups distributed among different percentile groups (p = 0.044). Gender, blood pressure, tabaco use, physical activity, family history of coronary artery disease and diabetes mellitus were not associated with CAC score (p > 0.05). There were no significant correlations between biochemical parameters and CAC percentiles except for increase in lipoprotein(a) (p = 0.038). Achilles tendon pathology, visceral obesity, body mass index and increased waist-hip ratio were not associated with CAC percentiles either (p > 0.05). Conclusions: CAC score is not associated with presence of SH. CAC score is not an appropriate diagnostic tool in the algorithm for clinical examination of patients with SH. Further larger studies are needed to support our findings