Comparative HPLC-DAD-ESI(+)MS Fingerprint and Quantification of Phenolic and Flavonoid Composition of Aqueous Leaf Extracts of <i>Cornus mas<i> and <i>Crataegus monogyna</i>, in Relation to Their Cardiotonic Potential

Our study aimed to compare the phenolic and flavonoid composition of two medicinal plants from the wild flora of Romania, traditionally known to be efficient in preventing cardiotoxicity: Cornus mas and&nbsp;Crataegus monogyna. As most previous studies have focused on fruits, our investigations aimed to fingerprint and quantify the two classes of compounds in&nbsp;aqueous leaf extracts, based on HPLC-DAD-ESI(+)MS analysis. The specific HPLC-DAD fingerprint was coupled with UV spectra at 280 and 340 nm to discriminate between three subclasses of compounds: two hydroxycinnamic acids and a flavonoid glycoside. While the C. monogyna extract contained more than 98% vitexin isomers (2'- and 4'-O-rhamnoside), the C. mas extract was very complex, containing a mixture of phenolic derivatives and flavonoid glycosides. The spectral patterns of C. mas, combined with the molecular mass and specific fragmentations allowed the identification of epi-catechin, coumaric and caffeic acids and quercetin derivatives. Based on LC-MS peak area and parallel calibrations with gallic acid and rutin, the mean concentration for flavonoids in C. mas was 13 mg/100 ml, while aprox. 65 mg/100 ml in C. monogyna extracts. Using the Folin method, the total phenol content was 105 mg/100 ml in C. mas and around three times less in the C. monogyna extract, while the antioxidant activity was increased only 1.5-1.7 times in C. mas extract compared to C. monogyna. These findings suggest a higher stability and potential of flavonoids to act as antioxidants in hydrophilic environment

The Importance of DS-14 and HADS Questionnaires in Quantifying Psychological Stress in Type 2 Diabetes Mellitus

Background and Objectives: The comorbid association between type 2 diabetes mellitus (T2DM) and a psychological profile characterized by depression and/or anxiety has been reported to increase the risk of coronary heart disease (CAD), the most striking macrovascular complication of diabetes. The purpose of the present study was to quantify anxiety, depression and the presence of type D personality, and to correlate the scores obtained with cardiovascular risk factors and disease severity in diabetic patients. Materials and methods: The retrospective study included 169 clinically stable diabetic patients divided into two groups: group 1 without macrovascular complications (n = 107) and group 2 with CAD, stroke and/or peripheral vascular disease (n = 62). A biochemical analysis and an assessment of psychic stress by applying the Hospital Anxiety and Depression Scale (HADS)and the Type D scale (DS-14) to determine anxiety, depression and D personality scores were done in all patients. Statistical analysis was made using SPSSv17 and Microsoft Excel, non-parametric Kruskal&ndash;Wallis and Mann&ndash;Whitney tests. Results: Following application of the HAD questionnaire for the entire group (n = 169), anxiety was present in 105 patients (62.2%), and depression in 96 patients (56.8%). Group 2 showed significantly higher anxiety scores compared to group 1 (p = 0.014), while depression scores were not significantly different. Per entire group, analysis of DS-14 scores revealed social inhibition (SI) present in 56 patients (33%) and negative affectivity (NA) in 105 patients (62%). TheDS-14 SI score was significantly higher in group 2 compared to group 1 (p = 0.036). Type D personality, resulting from scores above 10 in both DS-14 parameter categories, was present in 51 patients of the study group (30%). There was a direct and significant correlation (r = 0.133, p = 0.025) between the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) score and the LDL-c values. Conclusions: The results of this study demonstrated that more than a half of patients with diabetes had anxiety and/or depression and one third had Type D personality, sustaining that monitoring of emotional state and depression should be included in the therapeutic plan of these patients. New treatment strategies are needed to improve the well-being of diabetic patients with psychological comorbidities

Evaluation of Psychological Stress Parameters in Coronary Patients by Three Different Questionnaires as Pre-Requisite for Comprehensive Rehabilitation

Background: Negative psychological conditions are common in patients with cardiovascular diseases. Although depression has been scrutinized over the years in these patients, only recently has anxiety emerged as another important risk factor. The purpose of this study was to compare the parameters of psychological stress in a population of coronary patients with and without myocardial revascularization procedures and to analyze lifestyle and socio-economic contributors to the state of health of these patients before inclusion in a comprehensive individualized rehabilitation program. Methods: This study included 500 patients with coronary artery disease (CAD) in stable condition divided in 2 groups: 200 patients who underwent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) (Group 1) and 300 patients without myocardial revascularization (Group 2) with stable angina or thrombolyzed myocardial infarction. The protocol included screening for anxiety/depression after procedure using three different scales: Duke Anxiety-Depression Scale, Hospital Anxiety and Depression Scale (HADS) and the Type D Personality Scale (DS-14) scale that evaluates negative affectivity (NA) and social inhibition (SI). Results: Significant differences between groups were observed for HAD-A (9.1 &plusmn; 4.18 for Group 1 vs. 7.8 &plusmn; 4.03 for Group 2, p = 0.002) and DUKE scores (30.2 &plusmn; 12.25 for Group 1 vs. 22.7 &plusmn; 12.13 for Group 2, p &lt; 0.001). HAD-A scores (p = 0.01) and DUKE scores (p = 0.04) were significantly higher in patients who underwent PTCA vs. CABG. CAD patients without myocardial revascularization (Group 2, n = 300) presented anxiety in proportion of 72.3% (n = 217) out of which 10.7% (n = 32) had severe anxiety, and 180 patients had depression (a proportion of 60%) out of which 1.3% (n = 4) presented severe depression. The correlation between the presence of type 2 diabetes mellitus (T2DM) and type D personality in revascularized patients (n = 200) was significant (Chi2 test, p = 0.010). By applying multinomial regression according to the Cox and Snell R-square model and multivariate linear regression by the Enter method, we demonstrated that male gender, age and marital status proved significant predictors for psychological stress in our study population. Conclusions: The results obtained in this study provide a framework for monitoring anxiety, depression and type D personality in coronary patients before inclusion in comprehensive rehabilitation programs. Behavioral and psychological stress responses in patients with CAD significantly correlate with risk factors, and could influence the evolution of the disease. Moreover, other factors like gender, income and marital status also seem to play a decisive role. Evaluation of psychological stress parameters contributes to a better individualization at the start of these programs, because it allows adjusting of all potential factors that may influence positive outcomes