Insulinska rezistencija, sistemska inflamacija i aterogeni faktori rizika kod bolesnika sa koronarnom bolešću i različitim hiperglikemijskim statusom

Uvod. Nedijagnostikovana hiperglikemija je česta kod bolesnika sa koronarnombolešću, koja je vodeći uzrok smrtnosti kod oboljelih od tipa 2 dijabetesa(T2DM). Nedovoljno je poznata povezanost blažih hiperglikemijskih stanja,kao što je predijabetes sa koronarnom bolešću. Cilj ove studije bio je uporeditikardiometabolički profil rizika i koronarne lezije kod bolesnika sa različitimporemećajima tolerancije na glukozu podvrgnutih koronarnoj angiografiji.Metode. Kod 106 bolesnika sa angiografski dijagnostikovanom koronarnombolešću, evaluiran je glikemijski status pomoću testa oralnog opterećenja glukozom(OGTT) na osnovu kojeg su klasifikovani u grupe sa normoglikemijom(NGT), predijabetesom (IGF/IGT) i dijabetesom tipa 2 (T2DM). Kod svih jeurađeno mjerenje tjelesne težine (TT), obima struka (OS), izračunat indekstjelesne mase (BMI), određeni lipidi, indeks insulinske rezistencije HOMA,insulin, hsCRP, albumin u urinu, broj signifikantnih koronarnih lezija (stenoza> 50%).Rezultati. Od 106 ispitanih bolesnika sa koronarnom bolešću 32,1% imaloje novootkriveni T2DM, 35,8% predijabetes i 32,1% normalnu tolerancijuglukoze. Nije bilo razlika između tri grupe koronarnih bolesnika u odnosuna pol, pušački status, tjelesnu masu, prisustvo hipertenzije i hereditet koronarnebolesti. Pacijenti sa T2DM u odnosu na pacijente sa normoglikemijomsu bili stariji (p = 0,036), imali veći obim struka (p = 0,028), BMI (p = 0,045) iHOMA-IR (p = 0,001). Vrijednosti ukupnog holesterola, LDL, HDL i triglicerida,hsCRP, albuminurije se nisu razlikovale između grupa. Nije nađenarazlika u učestalosti jednosudovne, dvosudovne, tro i više sudovne bolesti.Zaključak. Nađena je visoka učestalost dijabetesa i predijabetesa u populacijipacijenata sa stabilnom hroničnom koronarnom bolešću. Nađena je povezanostgojaznosti, naročito centralne, starosti i insulinske rezistencije sa T2DM, štopotvrđuje ulogu ovih faktora u nastanku bolesti

Albuminurija i intima-media kompleks karotidnih arterija kao surogat markeri ateroskleroze kod pacijenata sa tipom 2 dijabetesa

Uvod. Kliničko procjenjivanje aterosklerotskih komplikacija u tipu 2 dijabetesmelitusa (DM) je preusmjereno na otkrivanje subkliničkih oblika aterosklerozeprimjenom neinvazivnih dijagnostičkih metoda. Surogat markeri subkliničkeateroskleroze su intima media kompleks (IMK) karotidnih arterija i albuminurija.Cilj rada je bio da se analizira povezanost prisustva albuminurije idebljine IMK karotidnih arterija sa nijemom ishemijom miokarda kod pacijenatasa tipom 2 DM.Metode. Istraživanje je obuhvatilo 62 ispitanika oboljela od tipa 2 dijabetesabez istorije o prisutnosti kardiovaskularnih bolesti (KVB), starosne dobi 40-70godina. Ispitanicima je urađena ergometrija i na osnovu dobijenih rezultatao prisutnosti ishemijske bolesti srca (IBS) podijeljeni su u dvije grupe. Prvugrupu je sačinjavalo 25 ispitanika kojima je dokazana IBS, a drugu grupu37 ispitanika bez IBS. Ispitanicima je ultrazvučno izmjerena debljina IMKkarotidnih arterija i određen albumin u 24-časovnom urinu, te su dobijenevrijednosti upoređene sa rezultatima ergometrijskog testiranja u obje grupe.Rezultati. Pacijenti sa IBS su bili stariji, sa dužim trajanjem dijabetesa, dislipidemijomi višim vrijednostima HbA1c u odnosu na grupu bez IBS (p<0,05).Utvrđena je statistički značajno veća vrijednost debljine IMK karotidniharterija u grupi ispitanika sa IBS (1,08±0,17 mm) u odnosu na ispitanike bezIBS (0,78±0,17 mm) (p<0,001). U grupi ispitanika sa IBS, albuminurija je bilaprisutna kod 22 ispitanika, dok je kod ispitanika bez IBS, albuminurija bilaprisutna kod 9 ispitanika, što je statistički značajno više u grupi ispitanika saIBS u odnosu na kontrolnu grupu (p<0,001).Zaključak. Pacijenti sa povećanom debljinom IMK karotidnih arterija i prisutnomalbuminurijom imaju veći rizik od nastanka IBS.Ključne riječi: dijabetes melitus, intima media kompleks, albuminurij

Inflammatory cardiovascular risk markers and silent myocardial ischemia in type 2 diabetic patients

Background/Aim. A special feature of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM) is that it is often a symptomatic and occurs as a consequence of cardiovascular autonomic neuropathy. Dysregulation of the autonomic nervous system is associated with elevated values of inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and interleukin- 6 (IL-6), which accelerate atherosclerosis and the occurrence of cardiovascular complications in patients with T2DM. The aim of the study was to evaluate the importance of determining inflammatory cardiovascular risk markers IL-6 and hs-CRP in screening for the presence of CHD in asymptomatic patients with T2DM. Methods. The study included 169 patients with T2DM without any symptoms and signs of CHD. Ergometric testing proved or ruled out the presence of silent CHD. The levels of hs- CRP and IL-6 were determined by ELISA. Results. IL-6 values were significantly higher in patients with a positive ergometric test (6.83 ± 1.99 pg/mL) compared to patients with a negative ergometric test (3.04 ± 1.39 pg/mL) (p < 0.001). We also found that hs-CRP values in patients with a positive ergometric test were significantly higher compared to patients with a negative ergometric test (6.37 ± 2.25 vs 1.67 ± 1.41 mg/L; p < 0.001). Combinations of IL-6 and hs-CRP with age, HbA1c values, and duration of diabetes, presented through three binary logistic regression models, are significant predictors of silent CHD proven by ergometric testing, ie, with their increase, the probability of a positive ergometric test also increases (p < 0.01). The sensitivity of the associated finding of elevated IL-6 and hs-CRP values in the detection of silent CHD by ergometric testing was 90%, and the specificity was 86%. Conclusion. Hs-CRP and IL-6 are significant predictors of silent CHD, and their determination could be recommended for improving cardiovascular risk stratification in asymptomatic patients with T2DM

The Effect of Three-Month Vitamin D Supplementation on the Levels of Homocysteine Metabolism Markers and Inflammatory Cytokines in Sera of Psoriatic Patients

Psoriasis is an autoimmune and inflammatory skin disease. Psoriatic patients express higher levels of plasma homocysteine (Hcy) concentration and pro-inflammatory mediators than healthy people; this is frequently associated with vitamin D deficiency. The aim of this clinical study was to investigate the effects of high doses of vitamin D supplementation on the parameters of Hcy metabolism and cytokines in sera of psoriatic patients. This prospective study was conducted on 40 psoriatic patients who had the vitamin D deficiency. All patients received vitamin D 5000 IU/day for three months. Clinical and biochemical measurements were taken at baseline and at follow up (3 months). The results showed that the severity of clinical features, measured by the psoriasis area severity index (PASI) score, were considerably improved in patients after vitamin D supplementation. After vitamin D supplementation, most of the patients (n = 25 or 62.5%) had mild clinical form (p 12 serum levels in comparison to the levels that had been measured at the beginning of the study (56.77 ± 14.66 nmol/L and 301.08 ± 95.02 pg/mL vs. 103.85 ± 32.20 nmol/L and 362.81 ± 118.56 pg/mL, respectively; p < 0.001). Moreover, serum levels of Hcy and folate were significantly lower at the end of the study in comparison with the initial levels (12.45 ± 1.92 µmol/L and 8.01 ± 3.88 mg/mL vs. 10.38 ± 1.66 µmol/L and 6.27 ± 2.60 mg/mL, respectively). High doses of vitamin D supplementation led to a significant decrease in pro-inflammatory cytokines (IFN-ɤ, TNF-α, IL-1β, IL-6, IL-8, and IL-17) and high-sensitivity C-reactive protein (hsCRP), whereas the production of anti-inflammatory cytokines (IL-10, IL-5) was up-regulated. In conclusion, supplementation with high doses of vitamin D could be one of the possible preventive and therapeutic measures to reduce systemic inflammation in psoriatic patients