Retrograde nontransseptal balloon mitral valvuloplasty by the brachial artery approach

Retrograde nontransseptal balloon mitral valvuloplasty is a purely transarterial technique for percutaneous treatment of mitral stenosis. We report the first use of this technique via the brachial artery for a patient with aortoiliac atherosclerosis, and we comment on the difficulties and perspectives of this approach. (C) 2000 Wiley-Liss, Inc

Differential pulse pressure response to various antihypertensive drug families

Pulse pressure (PP) is emerging as a major pressure predictor of cardiac disease. The study comprised 10185 untreated patients with essential hypertension. A total of 5395 men and 4790 women 56±13 years old, with uncomplicated essential hypertension, after a 15-day washout period and after 6 months of antihypertensive monotherapy were included. All patients included in the final cohort were responders and had normalized their blood pressure. PP was decreased least with diuretics (-5mm Hg) and most with angiotensin II receptor blockers (ARBs) and calcium antagonists (-15mm Hg), followed by angiotensin-converting enzyme inhibitors (ACEI) (-12mm Hg) α- and β-blockers (-10 and -9mm Hg), differentiating among antihypertensive classes (P<0.001). The magnitude of PP fall was related to the degree of left ventricular (LV) mass reduction (P<0.001), seen best with ARBs (r=0.42) and least with ACEIs (r=0.18). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists, whereas diuretics confer poor response. PP was decreased least with diuretics (-5mm Hg) and most with ARBs and calcium channel blockers (-15mm Hg), followed by ACEI (-12mm Hg) α- and β-blockers (-10 and -9mm Hg), differentiating among antihypertensive classes (P<0.001). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists

Dairy products consumption is associated with decreased levels of inflammatory markers related to cardiovascular disease in apparently healthy adults: The ATTICA study

Objective: The aim of this work was to investigate the association between consumption of dairy products and levels of various inflammatory markers among adults with no evidence of cardiovascular or other chronic disease. Methods: The ATTICA study is a cross-sectional survey that enrolled 1514 men (18–87 years old) and 1528 women (18–89 years old) from the Attica region in Greece. Fasting blood samples were collected and dietary habits (including consumption of dairy products [i.e., milk, cheese, and yogurt]) were evaluated using a validated food frequency questionnaire. Results: We observed that C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) levels of individuals consuming between 11 and 14 servings of dairy products per week were almost 16%, 5%, and 12% lower, respectively, than in those consuming fewer than 8 servings (p < 0.05), while those consuming more than 14 servings per week had 29%, 9%, and 20% lower levels of CRP, IL-6, and TNF-α, respectively (p < 0.01), even after adjustments were made for age, gender, smoking, physical activity, body mass, dietary habits, and other potential confounders. Conclusion: We identified an inverse association between dairy products consumption and levels of various inflammatory markers among healthy adults. Additional clinical trials are needed to refute or confirm our findings. © 2010 American College of Nutrition

Closed relation between carotid and ascending aortic atherosclerosis in cardiac patients

Background - Carotid atherosclerosis and aortic atherosclerosis are both associated with coronary artery disease and cerebral thromboembolism. However, the relationship between asymptomatic carotid and aortic atherosclerosis is not well known. Methods and Results - Sixty-two consecutive cardiac patients (mean age 57 years) without a history of atherosclerotic cardiovascular disease who were referred for transesophageal echocardiography were included. By means of a high-resolution ultrasound technique, normal carotid arteries were found in 12 patients (19.4%), whereas 15 patients (24.2%) had increased intima-media thickness, and the remaining 35 patients (56.5%) had atherosclerotic plaques (intima-media thickness ≥1.3 mm). Transesophageal echocardiography characterized ascending aortic intimal morphology as normal in 1 patient (1.6%), as thickening in 22 patients (35.5%), and as atherosclerotic plaques in 39 patients (62.9%). Patients with both carotid and aortic plaques were older compared with patients without plaques; also, a higher percentage of patients with carotid and aortic plaques suffered from hypertension and diabetes mellitus compared with patients without plaques (P<0.001). The incidence of carotid plaques was 74.3% (29 of 39 patients) in the subgroup with aortic plaques; there was a stepwise increase in the percentage of patients with carotid plaques among the patients with increasing grades of aortic atherosclerosis. Furthermore, the incidence of ascending aortic plaques was 82.8% (29 of 35 patients) in the subgroup with carotid plaques. Regression analysis revealed that age and carotid plaques were independently related to the presence of aortic plaques. In the entire study population, the presence of carotid plaques had a high positive predictive value (83%), an acceptable sensitivity (75%) and specificity (74%), and a relatively low negative predictive value (63%) for the presence of aortic plaques. Conclusions - In cardiac patients without clinical evidence of atherosclerotic cardiovascular disease, a high prevalence of combined aortic and carotid plaques were detected. The presence of carotid plaque reflects the presence of aortic plaque, whereas the absence of carotid plaque may not reflect the absence of aortic plaque

The impact of novel exercise criteria and indices for the diagnostic and prognostic ability of exercise testin

Exercise testing (ET) stands as one of the most easy, affordable, cost effective, non invasive methods for diagnosing coronary heart disease. Its sensitivity, specificity and prognostic value, especially in the prime era of its implementation in the cardiac diagnostic procedure, is relatively limited. Novel exercise criteria and indices based either on ST segment changes or ST segment independent parameters, such as "Athens QRS score", have greatly improved the diagnostic ability and accuracy of ET. Complex ECG-derived indices linked to ST changes along with the use of right-sided precordial leads have also enhanced the diagnostic accuracy of ET with respect to the extent of ischemic heart disease and the detection of specific culprit vessels. ET contains also a prognostic value, since several ET-derived parameters have been associated with adverse outcome, including ST changes, blood pressure and heart rate response to exercise and duration of exercise. © 2010 Elsevier Ireland Ltd

Arterial stiffness in offspring of hypertensive parents: A pilot study

Offsprings of hypertensive parents are reported to have higher blood pressure, decreased aortic elasticity and higher arterial stiffness indices. The present study comprised 55 offsprings aged 14 to 30 years who were divided in two groups according to their familial hypertension history. Arterial stiffness was evaluated by measuring central augmentation index with the Sphygmocor device and pulse wave velocity carotid-brachial and carotid-femoral with the Complior SP device. The purpose of the present study was to evaluate the role of positive familial history of hypertension in arterial function in young subjects. © 2007 Elsevier Ireland Ltd. All rights reserved

The effect of smoking on inflammation, prothrombotic state and endothelial dysfunction in patients with essential hypertension

Objective: Smoking is a modifiable cardiovascular risk factor. It has been reported to affect inflammatory, coagulation indices and homocysteine. The purpose of the present study was to evaluate the effect of smoking on inflammatory, coagulation indices and homocysteine as well as on traditional risk factors, in a large cohort of patients with essential hypertension. Methods: The study comprised 4000 consecutive patients, with uncomplicated essential hypertension (2572 non-smokers and 1428 smokers). Inflammatory indices such as high-sensitivity C-reactive protein (hsCRP), white blood cell count (WBC) and serum amyloid A (SAA) as well as coagulation markers such as serum fibrinogen, plasminogen activator inhibitor (PAI-1) and homocysteine were measured in all patients. Finally, all patients were asked about their smoking habits and, thus, information about smoking intensity and smoking duration was obtained. Results: All studied markers were significantly higher in smokers compared with non-smokers after adjusting for age and gender (p < 0.001). Furthermore, hsCRP, serum fibrinogen and WBC were positively associated with both increasing smoking intensity and time since smoking initiation, while SAA was positively associated with smoking intensity (p = 0.003) and PAI-1 with smoking duration (p = 0.003). No such association was noticed with homocysteine (p = not significant). Conclusions: Smoking affects inflammatory, coagulation indices, homocysteine and traditional risk factors in patients with essential hypertension independently of age and gender. © 2009 Adis Data Information BV. All rights reserved

Metabolic syndrome and the skin: A more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation. © 2018 The Author(s)