Profile of Cardiovascular Risk Factors and Mortality in Patients with Symptomatic Peripheral Arterial Disease

INTRODUCTION: The present study examines cardiovascular risk factor profiles and 24-month mortality in patients with symptomatic peripheral arterial disease. DESIGN STUDY: Prospective observational study including 75 consecutive patients with PAD (67 ± 9.7 years of age; 52 men and 23 women) hospitalized for planned peripheral vascular reconstruction. Doppler echocardiograms were performed before surgery in 54 cases. Univariate analyses were performed using Student's t-test or Fisher's exact test. Survival analysis at 24-month follow-up was performed using the Cox regression model and Kaplan-Meier method including age and chronic use of aspirin as covariates. Survival curves were compared using the log-rank test. RESULTS: Hypertension and smoking were the most frequent risk factors (52 cases and 51 cases, respectively), followed by diabetes (32 cases). Undertreated dyslipidemia was found in 26 cases. Fasting glycine levels (131 ± 69.1 mg/dl) were elevated in 29 cases. Myocardial hypertrophy was found in 18 out of 54 patients. Thirty-four patients had been treated with aspirin. Overall mortality over 24 months was 24% and was associated with age (HR: 0.064; CI95: 0.014-0.115; p=0.013) and lack of use of aspirin, as no deaths occurred among those using this drug (p<0.001). No association was found between cardiovascular death (11 cases) and the other risk factors. CONCLUSION: There is a high prevalence of uncontrolled (treated or untreated) cardiovascular risk factors in patients undergoing planned peripheral vascular reconstruction, and chronic use of aspirin is associated with reduced all-cause mortality in these patients

Allelic variants of melanocortin 3 receptor gene (MC3R) and weight loss in obesity: a randomised trial of hypo-energetic high- versus low-fat diets

INTRODUCTION: The melanocortin system plays an important role in energy homeostasis. Mice genetically deficient in the melanocortin-3 receptor gene have a normal body weight with increased body fat, mild hypophagia compared to wild-type mice. In humans, Thr6Lys and Val81Ile variants of the melanocortin-3 receptor gene (MC3R) have been associated with childhood obesity, higher BMI Z-score and elevated body fat percentage compared to non-carriers. The aim of this study is to assess the association in adults between allelic variants of MC3R with weight loss induced by energy-restricted diets. SUBJECTS AND METHODS: This research is based on the NUGENOB study, a trial conducted to assess weight loss during a 10-week dietary intervention involving two different hypo-energetic (high-fat and low-fat) diets. A total of 760 obese patients were genotyped for 10 single nucleotide polymorphisms covering the single exon of MC3R gene and its flanking regions, including the missense variants Thr6Lys and Val81Ile. Linear mixed models and haplotype-based analysis were carried out to assess the potential association between genetic polymorphisms and differential weight loss, fat mass loss, waist change and resting energy expenditure changes. RESULTS: No differences in drop-out rate were found by MC3R genotypes. The rs6014646 polymorphism was significantly associated with weight loss using co-dominant (p = 0.04) and dominant models (p = 0.03). These p-values were not statistically significant after strict control for multiple testing. Haplotype-based multivariate analysis using permutations showed that rs3827103-rs1543873 (p = 0.06), rs6014646-rs6024730 (p = 0.05) and rs3746619-rs3827103 (p = 0.10) displayed near-statistical significant results in relation to weight loss. No other significant associations or gene*diet interactions were detected for weight loss, fat mass loss, waist change and resting energy expenditure changes. CONCLUSION: The study provided overall sufficient evidence to support that there is no major effect of genetic variants of MC3R and differential weight loss after a 10-week dietary intervention with hypo-energetic diets in obese Europeans

Allelic Variants of Melanocortin 3 Receptor Gene (MC3R) and Weight Loss in Obesity: A Randomised Trial of Hypo-Energetic High- versus Low-Fat Diets

INTRODUCTION: The melanocortin system plays an important role in energy homeostasis. Mice genetically deficient in the melanocortin-3 receptor gene have a normal body weight with increased body fat, mild hypophagia compared to wild-type mice. In humans, Thr6Lys and Val81Ile variants of the melanocortin-3 receptor gene (MC3R) have been associated with childhood obesity, higher BMI Z-score and elevated body fat percentage compared to non-carriers. The aim of this study is to assess the association in adults between allelic variants of MC3R with weight loss induced by energy-restricted diets. SUBJECTS AND METHODS: This research is based on the NUGENOB study, a trial conducted to assess weight loss during a 10-week dietary intervention involving two different hypo-energetic (high-fat and low-fat) diets. A total of 760 obese patients were genotyped for 10 single nucleotide polymorphisms covering the single exon of MC3R gene and its flanking regions, including the missense variants Thr6Lys and Val81Ile. Linear mixed models and haplotype-based analysis were carried out to assess the potential association between genetic polymorphisms and differential weight loss, fat mass loss, waist change and resting energy expenditure changes. RESULTS: No differences in drop-out rate were found by MC3R genotypes. The rs6014646 polymorphism was significantly associated with weight loss using co-dominant (p = 0.04) and dominant models (p = 0.03). These p-values were not statistically significant after strict control for multiple testing. Haplotype-based multivariate analysis using permutations showed that rs3827103-rs1543873 (p = 0.06), rs6014646-rs6024730 (p = 0.05) and rs3746619-rs3827103 (p = 0.10) displayed near-statistical significant results in relation to weight loss. No other significant associations or gene*diet interactions were detected for weight loss, fat mass loss, waist change and resting energy expenditure changes. CONCLUSION: The study provided overall sufficient evidence to support that there is no major effect of genetic variants of MC3R and differential weight loss after a 10-week dietary intervention with hypo-energetic diets in obese Europeans

Ankle-brachial index, high-sensitivity C-reactive protein and endothelial function in a cardiovascular risk population

Atherosclerotic vascular disease is the leading cause of death in the Western world. Its main three manifestations are coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Asymptomatic peripheral arterial disease is usually diagnosed using the ankle brachial index, and values ≤ 0.90 are used to determine the diagnosis. The classical risk factors of peripheral arterial disease, such as smoking and diabetes, are well known and early interventions are mandatory to improve the prognosis. What is not well known is the role of inflammation as a risk factor. Yet, a novel approach to cardiovascular diseases is the measurement of endothelial function. In this thesis, we studied the ankle-brachial index, C-reactive protein and endothelial function in a cardiovascular risk population. A total of 2856 subjects were invited to the study and 2085 (73%) responded. From these subjects, a cohort of 1756 risk persons was screened. We excluded the subjects with previously known cardiovascular disease or diabetes, because they were already under systematic follow-up. Out of the study subjects, 983 (56%) were women and 773 (44%) men. The ankle brachial index and high-sensitivity C-reactive protein were measured from 1047 subjects. Endothelial function was assessed by measuring reactive hyperemia pulse amplitude tonometry from 66 subjects with borderline peripheral arterial disease. In this study, smoking was a crucial risk factor for peripheral arterial disease. Subclinical peripheral arterial disease seems to be more common in hypertensive patients even without comorbidities. The measurement of the ankle brachial index is an efficient method to identify patients at an increased cardiovascular risk. High-sensitivity C-reactive protein did not correlate with the ankle brachial index or peripheral arterial disease. Instead, it correlated with measures of obesity. In a cardiovascular risk population with borderline peripheral arterial disease, nearly every fourth subject had endothelial dysfunction. This might point out a subgroup of individuals in need of more intensive treatment for their risk factors.Siirretty Doriast

Periferik arter hastalığında hareketli masa teknikli kontraslı manyetik rezonans anjiyografinin dijital subtraksiyon anjiyografi ile karşılaştırılması

Periferik arter hastalığı (PAH), ateroskleroza bağlı olarak bir veya daha fazla periferik arteriyel yapının parsiyel veya tam obstrüksiyonu olarak tanımlanır. Üst ekstremite ve başboyun damarları da aterosklerozdan etkilenmesine rağmen, PAH tanımı pratikte alt ekstremite arterlerinin aterosklerotik hastalığı için kullanılmaktadır. En önemli risk faktörleri kardiyovasküler hastalıklardakine benzer şekilde; hipertansiyon, dislipidemi, sigara ve diyabettir. Manyetik rezonans anjiyografi (MRA) son yıllardaki teknik gelişmeler ile birlikte aort ve periferal vasküler yapıların görüntülenmesinde tercih edilen noninvaziv görüntüleme yöntemi haline gelmiştir. Bu çalışmanın amacı periferik arteriyel hastalıkta hareketli masa tekniği ile kontrastlı Flash 3D MRA’nın etkinliğinin araştırılmasıdır. Bu çalışmaya Haziran 2005 ile Aralık 2007 tarihleri arasında periferik arter hastalığı ön tanısı ile bölümümüze başvuran ve hareketli masa tekniği ile kontrast sonrası Flash 3D T1 ağırlıklı MRA ve sonrasında 30 gün içerisinde dijital subtraksiyon anjiyografi (DSA) uygulanan 43 hasta dahil edilmiştir. DSA altın standart kabul edilerek MRA’nın duyarlılığı, özgüllüğü, tanısal doğruluğu saptanmıştır. Ayrıca görüntüleme bulgularının yanı sıra hastaların semptomları, aterosklerotik risk faktörleri sorgulanmış ve bazı laboratuar parametreleri kaydedilmiştir. Hareketli masa tekniği ile elde olunan dinamik Flash 3D MRA %70 ve üzeri darlıklarda %91 duyarlı; %97.3 özgül; tam oklüzyon tanısında ise duyarlılık %90; özgüllük %99.3 bulunmuştur. Tanısal doğruluk oranı her ikisinde de %96 bulunmuştur. Bu oranlarla periferik arter hastalığı tanısında kontrastlı 3D MRA ile DSA arasında istatistiksel olarak anlamlı farklılık olmadığı gösterilmiştir (p>0.05). Hareketli masa tekniğiyle elde olunan kontrastlı Flash 3D MRA, periferik arter hastalığı tanısında, cerrahi planlanmasında ve takibinde güvenle kullanılabilecek hızlı noninvaziv bir görüntüleme yöntemidir. Peripheral arterial disease (PAD) is described as partial or total occlusion of one or more peripheral arteries due to atherosclerosis. Although upper extremity arteries and carotid arterial systems are effected from atherosclerosis, in practice the term of PAD is used only for lower extremity atherosclerotic arterial diseases. Similar to cardiovascular diseases, risk factors are hypertension, dyslipidemia, smoking and diabetes mellitus. Aortic bifurcation is commonly involved. After the recent technical developments, magnetic resonance anjiography (MRA) has become the most preferable noninvasive imaging modality for determining the changes in the aorta and peripheral vascular structures. The aim of this study is to evaluate the accuracy of contrast enhanced moving bed Flash 3D MRA in the depiction of significant stenoses and occlusions, with intraarterial DSA serving as the reference standard. We have evaluated the efficacy of contrast enhanced moving bed Flash 3D MRA versus digital subtraction angiography (DSA) in 43 patients with peripheral arterial disease who underwent DSA after MRA within 30 days. DSA was accepted as gold standard and the sensitivity, specificity and accuracy of MRA were determined. Also the symptoms, atherosclerotic risk factors and laboratory parameters of patients were noted. Overall sensitivity and specificity values of contrast enhanced moving bed Flash 3D MRA for significant (>70%) stenosis were 91% and 97.3%; for total occlusion, sensitivity and specificity values were 90% and 99.3% respectively. For both of them, the accuracy was 96%. No significant difference is found between contrast enhanced moving bed 3D MRA and DSA for the diagnosis of peripheral arterial disease (p>0.05). In conclusion, contrast enhanced moving bed Flash 3D MRA is a reliable, fast, noninvasive imaging modality in the diagnosis of patients, in planning of interventional procedures and follow-up of the patients with peripheral arterial disease

Evaluation of Serum Magnesium Level in Type 2 Diabetes Mellitus and it's Complications.

Diabetes mellitus is a metabolic disease of growing concern not only Because of it's adverse effect on various metabolism of the body, but also Because it puts the patient at higher risk of developing various macro and Microvascular complications like cardiovascular disease (Ischaemic heart - Disease), cerebrovascular disease, peripheral arterial disease, retinopathy, Nephropathy, neuropathy etc. Low serum magnesium has been proposed as a risk factor not only for The development of Diabetes mellitus but also has been linked to the emergence Of it's various micro and macrovascular complications. In some studies, diabetes mellitus has been found to lead to loss of Magnesium in the urine, associated with glycosuria, which further lowers the Magnesium in the plasma of Diabetic patients, aggravating the risk for Development of it's complications. But various studies on human and animal Model has given contradictory results regarding the association of low Magnesium and various macro and microvascular complication of DM. Since the prevalence of DM is found to increase very fast, the interest Developed to determine the actual level of magnesium in Type 2 Diabetic Mellitus and it's complications, and to asscertain how far it correlates with the Established biochemical parameter of this metabolic diseases and whether it's Determination could be a helpful indicator in assessing the development and Intensity of it's complications. Hence with the above view this work "Evaluation of Serum Magnesium Level in Type 2 Diabetes Mellitus and it's Complications" has Been taken up for the study

L'arteriopatia perifèrica i la seva relació amb paràmetres clínics nutricionals, el risc cardiovascular i la qualitat de vida, en una població amb factors de risc cardiovascular de l'atenció primària de l'àrea mediterrània

Objectiu. Prevalença Arteriopatia Perifèrica(AP) Silent en població amb FRCV. Relació amb nutrició i QVRS Disseny. Descriptiu Observacional Retrospectiu - Prospectiu, a l'atenció primàriaSubjectes. 350 pacients, sense malaltia cardiovascular i amb polsos presents.Mesuraments. variables: edat, sexe, FRCV paràmetres antropomètrics, analítica, ECG, taules predicció RCV, turmell/braç, enquestes dietètiques i valoració QVRS. Estadística descriptiva, proves Khi-quadrat, Fisher, t d'Student-Fisher; regressió múltiple ,IC 95 % i p Augmenten risc: Cintura/Maluc(OD:1,3) Cintura(OD:2,15), Cintura/Cuixa(OD:2,8), alta ingesta greixos Saturats(OD:1,67),baixa ingesta de greixos NO Saturats(OD:4,82), HTA(OD:1,225)Protectors: Normopès(OD:0,11), Grau Baix Pressió del Pols(OD:0,266) i microalbuminúria normal(OD:0,463). No relació amb QVRS.Conclusions. L'AP es presenta asimptomàtica amb prevalença elevada. Distribució greix abdominal i HTA factors més importants. Relació amb dany renal. Cap taula prediu l'AP. No relació amb QVRS.Objectivo. Prevalencia Arteriopatia Periférica(AP) Silente en población con FRCV. Relación con nutrición y QVRS Diseño. Descriptivo Observacional Retrospectivo -Prospectivo, en la atención primariaSujetos. 350 pacientes, sin enfermedad cardiovascular y con pulsos presentes.Medidas. variables: edad, sexo, FRCV parámetros antropométricos, analítica, ECG, tablas predicción RCV, tobillo/brazo, encuestas dietéticas y valoración QVRS. Estadística descriptiva, pruebas Chi-cuadrado, Fisher, t Student-Fisher; regresión múltiple ,IC 95 % y p Aumentan riesgo: Cintura/Cadera(OD:1,3) Cintura(OD:2,15), Cintura/Muslo(OD:2,8), alta ingesta grasas Saturadas(OD:1,67), baja ingesta de grasas NO Saturadas(OD:4,82), HTA(OD:1,225)Protectores: Normopeso(OD:0,11), Grado Bajo Presión del Pulso(OD:0,266) y microalbuminuria normal(OD:0,463). No relación con QVRS.Conclusiones. La AP se presenta asintomática con prevalencia elevada. Distribución grasa abdominal y HTA factores más importantes. Relación con daño renal. Ninguna tabla predice la AP. No relación con QVRS.Aim. Predominance Arteriopatia Periférica (AP) in population with FRCV. Relation with nutrition and QVRSDesigned. Descriptive Observacional Retrospectivo - Pilot, in the primary health careSubjects. 350 patients, without cardiovascular disease and present pulses.Measurements. age, sex, FRCV anthropometric parameters, analytical, ECG, stage prediction RCV, ankle / arm, dietetic surveys and evaluation QVRS. Descriptive statistics, you prove Chi-Square, Fisher, t Student-Fisher; multiple retrogression, IC 95 % and p Results. 350 patients, 62,45 years (30-74). 250 (71,4 %) men. 39,4%smoking, 82,3%HTA, 81,4%hypercholesterolemia, 42%diabetis. 26,3%AP. 44,57% Insufficiency , 55,43% Calcification They Increase risk: Waist / hip (OD:1,3) Waist (OD:2,15), Waist / thigh (OD:2,8), high ingestion Saturated fats (OD:1,67), low ingestion of not Saturated fats (OD:4,82), HTA (OD:1,225) Protective: normal-weight (OD:0,11), Grade Under Pressure of the Pulse (OD:0,266) and normal microalbuminuria (OD:0,463). Not relation with QVRS.Conclusions. The AP appears asymptomatic with high predominance. Abdominal greasy distribution and HTA more important factors. Relation with renal damage. The AP predicts no table. Not relation with QVR

Pharmacotherapy of intermittent claudication

Intermittent claudication (IC) is leg muscle pain, cramping and fatigue brought on by exercise and is the primary symptom of peripheral arterial disease. The goals of pharmacotherapy for IC are to increase the walking capacity/quality of life and to decrease rates of amputation. In 1988, pentoxifylline was the only drug that had reasonable supportive clinical trial evidence for being beneficial in IC. Since then a number of drugs have shown benefit or potential in IC. Cilostazol, a specific inhibitor of phosphodiesterase 3 and activator of lipoprotein lipase, clearly increases pain-free and absolute walking distances in claudicants. However, cilostazol does cause minor side effects including headache, diarrhoea, loose stools and flatulence. Naftidrofuryl, a serotonin (5-HT2) receptor antagonist and antiplatelet drug, is beneficial in claudicants. Inhibitors of platelet aggregation (including nitric oxide from L-arginine or glyceryl trinitrate) and anticoagulants (low molecular weight heparin, defibrotide) probably have both short and long-term benefits in IC. In addition, intravenous infusions of prostaglandins (PGs) PGE1 and PGI2 have an established role in severe peripheral arterial disease and the recent introduction of longer lasting and/or oral forms of the PGs makes them more likely to be useful in the IC associated with less severe forms of the disease. There are some exciting new approaches to the treatment of IC, including propionyl-L-carnitine and basic fibroblast growth factor (bFGF)