IRISIN KAO PREDIKTOR MIKROALBUMINURIJE U PRETILIH BOLESNIKA S KORONARNOM BOLEŠĆU

Background. Irisin is a recently discovered protein involved in energy homeostasis and glucose metabolism, and is potentially involved in atherosclerosis, obesity, and cardiovascular diseases. The aim of the study was to investigate the irisin effect on microalbuminuria in obese patients with coronary artery disease (CAD). Methods. Sixty-four adult subjects with CAD combined with obesity (59.38% of males), mean age 59.43±10.29 years, were enrolled in the study. Control group included 30 sex- and age-matched subjects. Obese patients with CAD were divided into two groups: group 1 (n=31) without microalbuminuria, and group 2 (n=33) with microalbuminuria. The urine albumin to creatinine ratio (ACR, range 30-300 mL/ mg) indicated microalbuminuria. Specifi c enzyme-linked immunosorbent assay was used for serum irisin measurement. Results. Serum irisin concentrations were signifi cantly different in obese CAD patients with microalbuminuria 121.05 (103.07-133.19) ng/mL and those without it 130.21 (125.21-140.03) ng/mL compared to the control group 147.92 (139.04-172.55) ng/mL (p<0.001), and irisin level was signifi cantly lower in patients with microalbuminuria in comparison with normoalbuminuria (p=0.042). Univariate logistic regression analyses showed irisin to signifi cantly infl uence microalbuminuria (OR: 0.788, 95% CI 0.589-0.967, p=0.011). Multivariable logistic regression analyses revealed that serum irisin remained a signifi cant predictor of microalbuminuria (OR: 0.857, 95% CI 0.561-0.988, p=0.044). Conclusions. Lower irisin levels are an independent predictor of microalbuminuria in patients with CAD combined with obesity. Additional larger longitudinal studies are needed to confirm these findings.Pozadina: Irisin je nedavno otkriveni protein koji sudjeluje u energetskoj homeostazi i metabolizmu glukoze i potencijalno je uključen u aterosklerozu, pretilost, kardiovaskularne bolesti. Cilj studije bio je istražiti učinak irisina na mikroalbuminuriju u pretilih bolesnika s ishemijskom bolesti srca (IBS). Uzorak i metode: 64 odrasla ispitanika s koronarnom bolešću u kombinaciji s pretilošću (59,38 % muškaraca), prosječne dobi 59,43±10,29 godina; 30 ispitanika sastojalo se od kontrola usklađenih po spolu, dobi. Pregledani pretili bolesnici s IBS-om podijeljeni su u dvije skupine. Prva skupina (n=31) bila je bez mikroalbuminurije, a u drugoj su skupini (n=33) bili bolesnici s mikroalbuminurijom. Omjer albumina i kreatinina u mokraći (ACR u rasponu od 30-300 mL/mg) bio je pokazatelj mikroalbuminurije. Za mjerenje irisina u serumu korišten je enzimski imunosorbentni test. Rezultati: Utvrđeno je da se koncentracije irisina u serumu značajno razlikuju u pretilih bolesnika s IBS s mikroalbuminurijom 121.05 (103,07-133,19) ng/mL i bez mikroalbuminurije 130,21 (125,21-140,03) ng/mL u usporedbi s kontrolnom skupinom 147,92 (139,04-172,55) ng/mL, p<0,001, a razina irisina značajno je smanjena u bolesnika s mikroalbuminurijom u usporedbi s normoalbuminurijom, p=0,042. Univarijatne logističke regresijske analize pokazale su da je irisin značajno utjecao na mikroalbuminuriju (OR: 0,788, 95 % CI 0,589-0,967, p=0,011). Više varijabilne logističke regresijske analize otkrile su da je irisin u serumu ostao značajan prediktor mikroalbuminurije (OR: 0,857, 95 % CI 0,561-0,988, p=0,044). Zaključak: Niže razine irisina neovisni su prediktor mikroalbuminurije u bolesnika s koronarnom bolešću u kombinaciji s pretilošću, ali potrebne su daljnje veće longitudinalne studije kako bi se potvrdili ti nalazi

IRISIN KAO PREDIKTOR MIKROALBUMINURIJE U PRETILIH BOLESNIKA S KORONARNOM BOLEŠĆU

Background. Irisin is a recently discovered protein involved in energy homeostasis and glucose metabolism, and is potentially involved in atherosclerosis, obesity, and cardiovascular diseases. The aim of the study was to investigate the irisin effect on microalbuminuria in obese patients with coronary artery disease (CAD). Methods. Sixty-four adult subjects with CAD combined with obesity (59.38% of males), mean age 59.43±10.29 years, were enrolled in the study. Control group included 30 sex- and age-matched subjects. Obese patients with CAD were divided into two groups: group 1 (n=31) without microalbuminuria, and group 2 (n=33) with microalbuminuria. The urine albumin to creatinine ratio (ACR, range 30-300 mL/ mg) indicated microalbuminuria. Specifi c enzyme-linked immunosorbent assay was used for serum irisin measurement. Results. Serum irisin concentrations were signifi cantly different in obese CAD patients with microalbuminuria 121.05 (103.07-133.19) ng/mL and those without it 130.21 (125.21-140.03) ng/mL compared to the control group 147.92 (139.04-172.55) ng/mL (p<0.001), and irisin level was signifi cantly lower in patients with microalbuminuria in comparison with normoalbuminuria (p=0.042). Univariate logistic regression analyses showed irisin to signifi cantly infl uence microalbuminuria (OR: 0.788, 95% CI 0.589-0.967, p=0.011). Multivariable logistic regression analyses revealed that serum irisin remained a signifi cant predictor of microalbuminuria (OR: 0.857, 95% CI 0.561-0.988, p=0.044). Conclusions. Lower irisin levels are an independent predictor of microalbuminuria in patients with CAD combined with obesity. Additional larger longitudinal studies are needed to confirm these findings.Pozadina: Irisin je nedavno otkriveni protein koji sudjeluje u energetskoj homeostazi i metabolizmu glukoze i potencijalno je uključen u aterosklerozu, pretilost, kardiovaskularne bolesti. Cilj studije bio je istražiti učinak irisina na mikroalbuminuriju u pretilih bolesnika s ishemijskom bolesti srca (IBS). Uzorak i metode: 64 odrasla ispitanika s koronarnom bolešću u kombinaciji s pretilošću (59,38 % muškaraca), prosječne dobi 59,43±10,29 godina; 30 ispitanika sastojalo se od kontrola usklađenih po spolu, dobi. Pregledani pretili bolesnici s IBS-om podijeljeni su u dvije skupine. Prva skupina (n=31) bila je bez mikroalbuminurije, a u drugoj su skupini (n=33) bili bolesnici s mikroalbuminurijom. Omjer albumina i kreatinina u mokraći (ACR u rasponu od 30-300 mL/mg) bio je pokazatelj mikroalbuminurije. Za mjerenje irisina u serumu korišten je enzimski imunosorbentni test. Rezultati: Utvrđeno je da se koncentracije irisina u serumu značajno razlikuju u pretilih bolesnika s IBS s mikroalbuminurijom 121.05 (103,07-133,19) ng/mL i bez mikroalbuminurije 130,21 (125,21-140,03) ng/mL u usporedbi s kontrolnom skupinom 147,92 (139,04-172,55) ng/mL, p<0,001, a razina irisina značajno je smanjena u bolesnika s mikroalbuminurijom u usporedbi s normoalbuminurijom, p=0,042. Univarijatne logističke regresijske analize pokazale su da je irisin značajno utjecao na mikroalbuminuriju (OR: 0,788, 95 % CI 0,589-0,967, p=0,011). Više varijabilne logističke regresijske analize otkrile su da je irisin u serumu ostao značajan prediktor mikroalbuminurije (OR: 0,857, 95 % CI 0,561-0,988, p=0,044). Zaključak: Niže razine irisina neovisni su prediktor mikroalbuminurije u bolesnika s koronarnom bolešću u kombinaciji s pretilošću, ali potrebne su daljnje veće longitudinalne studije kako bi se potvrdili ti nalazi

Therapeutic strategy in patients with long-lasting essential hypertension with comorbid type 2 diabetes mellitus and obesity

Background: Presently the level of blood pressure (BP) control is extremely unsatisfactory in hypertensive patients throughout the world. The aim of our study was to find the optimal drug therapy for patients with hard-to-treat essential hypertension (EH) associated with type 2 diabetes mellitus (T2DM) and obesity, namely the comparison of strategies of fixed and non-fixed combination. Material and methods: Eighty-seven patients with EH, T2DM and obesity were enrolled into the study. Two groups were formed: the 1st group — 41 patients received antihypertensive therapy in the form of unfixed combination of drugs (“multi-pill”) perindopril, indapamide and amlodipine; the 2nd — 46 patients, who received the same drugs, but in a fixed-dose combination (“single pill”). Results: A favorable treatment result was found for fixed-dose combination of antihypertensive drugs, with significant reduction in the frequency of visits to the doctor: relative risk (RR) — 1.27 (95% CI: 1.01‒1.61), p = 0.045, and odds ratio (OR) — 3.10 (95% CI: 1.05‒9.13), p = 0.04. That indicates that patients on fixed-dose combination were less likely to visit a doctor with complaints. Patients on single-pill therapy were less likely to get to progression (worsening) group in contrast to multi-pill non-fixed combination: RR — 1.37 (95% CI: 1.02‒1.84), p = 0.03; OR — 2.91 (95% CI: 1.12‒7.59), p = 0.03. Conclusion: The single-pill triple combination has significant advantage compared to multi-pill regimen in hard-totreat hypertensive patients with comorbid T2DM and obesity. Fixed-dose triple combination leads to significantly faster achievement of blood pressure control

Soluble ST2 in Predicting Adverse Outcome after Revascularization with Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Aim: The aim of the study was to investigate the relationship between the soluble suppression of tumorigenicity 2 (sST2) level and the degree of epicardial blood flow recovery in patients with myocardial infarction with ST-segment elevation (STEMI) after percutaneous coronary intervention. Material and Methods: The study involved 61 patients (83.6% males), with a mean age of 59.85±10.01 years. sST2 level was measured by enzyme immunoassay. Patients were divided into two groups. The first group (n=12) included patients with thrombolysis in myocardial infarction (TIMI) ?II flow grade, the second group (n=49) with TIMI III flow grade. Results: The sST2 level was significantly higher in the first hours of the disease in the group with decreased epicardial blood flow (TIMI ?II) after percutaneous coronary intervention (p=0.003). Receiver operating characteristics curve analysis showed that sST2 levels over 34.2 ng/ml, detected on admission, was an independent predictor of adverse revascularization (TIMI ?II) in patients with STEMI with a sensitivity of 92.3% and a specificity of 62.5%; the area under curve was 0.811 (95% CI: 0.651 - 0.873; p=0.001). Both the univariate (OR: 1.020, 95% CI: 1.001-1.041, p=0.028) and multivariate (OR: 1.030; 95% CI: 1.002-1.057; p=0.033) analyzes showed that sST2 was a significant predictor of the unfavorable outcome of epicardial vascular revascularization (TIMI ???). Conclusion: sST2 is highly associated with the degree of blood flow recovery after percutaneous coronary intervention in patients with STEMI and is of great clinical importance as a prognostic marker