Effect of treatment with continuous positive airway pressure (CPAP) on different vascular risk factors and markers of endothelial function and cell damage in patients with obstructive sleep apnea-hypopnea síndrome

Falta palabras claveIntroducción: El síndrome de apnea-hipopnea obstructiva del sueño (SAOS) provoca episodios repetidos de hipoxemia-reoxigenación y oscilaciones de la presión intratorácica que pueden conducir a activación del sistema nervioso simpático, estrés oxidativo, inflamación subclínica y disfunción endotelial, entre otras consecuencias. Ello podría a su vez generar daño vascular y desarrollo de lesiones ateroscleróticas. De hecho, el SAOS se ha relacionado consistentemente con patología cardiovascular prevalente e incidente. El tratamiento con CPAP, mediante la corrección de los episodios de apneas e hipopneas, podría mejorar o incluso revertir los mecanismos fisiopatológicos subyacentes presente en los pacientes con SAOS y con ello reducir el riesgo vascular asociado a dicho trastorno. Objetivos: Determinar, en pacientes con SAOS moderado a severo, el efecto del tratamiento con CPAP sobre distintos marcadores de función endotelial y daño celular, así como sobre otras condiciones asociadas a riesgo vascular, como presión arterial, resistencia a la insulina y lípidos, proteína C-reactiva (PCR) y marcadores de fibrosis. Como objetivo secundario, también estudiamos si la presencia de diagnóstico de hipertensión puede influir sobre el efecto que el tratamiento con CPAP puede tener sobre los mismos marcadores y condiciones. Conclusiones: En pacientes con SAOS moderado a severo el tratamiento con CPAP, al corregir los episodios de apneas e hipopneas, puede mejorar el riesgo vascular de dichos pacientes a través de una reducción de la presión arterial y mejoría de la función endotelial y resistencia a la insulina. El efecto de la CPAP puede venir determinado en cada caso por la severidad del SAOS y la presencia de hipertensión (aun cuando ésta esté bien controlada).Introduction: Obstructive sleep apnea-hypopnea syndrome (OSA) leads to repetitive episodes of hypoxemia-reoxygenation and changes in intrathoracic pressure that may result in sympathetic nervous system activation, oxidative stress, low-grade inflammation and endothelial dysfunction, among others. This may ultimately lead to vascular injury and development of atherosclerotic lesions. In fact, OSA has been consistently related to both prevalent and incident cardiovascular disease. By preventing the episodes of apneas and hipopneas, the treatment with CPAP could ameliorate or even revert the underlying altered pathophysiologic mechanisms that are present in patients with OSA and, as a result, reduce the vascular risk that this disease may pose on these individuals. Objectives: To assess, in patients with moderate to severe OSA, the effect of treatment with CPAP on different markers of endothelial function and cell damage, as well as on other vascular risk-related conditions such as blood pressure, insulin resistance and lipid levels, C-reactive protein (CRP) and markers of fibrosis. As a secondary aim, we also intended to evaluate whether the presence of a diagnosis of hypertension may influence the effect that the CPAP therapy may have on the aforementioned markers and conditions. Conclusions: In moderate to severe OSA patients the treatment with CPAP, by preventing the episodes of apneas and hipopneas, may improve the vascular risk of such individuals by promoting a reduction in blood pressure and an improvement of the endothelial function and insulin resistance. The effect of the CPAP therapy in each case could be influenced by the OSA severity and the presence of hypertension (even when this condition is well-controlled).Premio Extraordinario de Doctorado U

Role of the Renin-Angiotensin System and Aldosterone on Cardiometabolic Syndrome

Aldosterone facilitates cardiovascular damage by increasing blood pressure and through different mechanisms that are independent of its effects on blood pressure. In this respect, recent evidence involves aldosterone in the pathogenesis of metabolic syndrome. Although this relationship is complex, there is some evidence suggesting that different factors may play an important role, such as insulin resistance, renin-angiotensin-aldosterone system, oxidative stress, sodium retention, increased sympathetic activity, levels of free fatty acids, or inflammatory cytokines and adipokines. In addition to the classical pathway by which aldosterone acts through the mineralocorticoid receptors leading to sodium retention, aldosterone also has other mechanisms that influence cardiovascular tissue remodelling. Finally, overweight and obesity promote the adrenal secretion of aldosterone, increasing the predisposition to type 2 diabetes mellitus. Further studies are needed to better establish therapeutic strategies that act on the blockade of mineralocorticoid receptor in the treatment and prevention of cardiovascular diseases related to the excess of aldosterone and the metabolic syndrome

Physic-chemical study of the marismeña cattle breed meat in different fattening systems

Marismeña cattle breed is a feral population included in a pre-zootechnic agro-ecosystem, the Doñana protected area. In spite of these characteristics so exclusives, the absence of characterization of their products difficults the finding of a way of commercialization differentiated of the typical commerce, adding value to product by way of a differentiated quality. The preliminary results of a meat physic-chemical study are presented. Seventeen animals of the breed have been studied reared in two different systems of fattening: its natural context and a commercial fattening station. Meat shown significant differences between the management systems for the results of the chemical analysis and colour at 24 hours posmortem. Animals belonging to the extensive system shown meat low in fat, with a high percentage of humidity, and colour with lower tone of red (p<0.01) and yellow (p<0.001), when compared with intensive animals. Results demonstrated a differentiation between both systems, together with some arguments to differentiate the products of this breed in the market.El bovino Marismeño es una entidad racial asilvestrada incluida en un sistema agroecológico prezootécnico, el Espacio Natural de Doñana que no encuentra una vía de comercialización adecuada que la diferencie de lo típicamente comercial, y, por tanto, agregue valor para competir mediante una calidad diferenciada. En este trabajo se presentan los resultados preliminares del estudio físico-químico de la carne. Se han estudiado 17 animales de la raza en dos sistemas de terminación diferentes, su entorno natural (extensivo) y un cebadero comercial (intensivo). La carne mostró diferencias significativas entre los sistemas de producción para los resultados de los análisis químicos y el color a las 24 horas postmortem. Los animales del sistema extensivo mostraron carnes magras, con un alto porcentaje de humedad, y una coloración con menores intensidades de rojo (p<0,01) y amarillo (p<0,001), comparada con los animales del intensivo. Los resultados demuestran una diferenciación entre ambos sistemas, a la vez que se hallan algunas características que conducen a la diferenciación del producto de esta raza bovina en el mercado

Obstructive Sleep Apnoea Syndrome, Endothelial Function and Markers of Endothelialization. Changes after CPAP

STUDY OBJECTIVES: This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD) and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA) syndrome at baseline and after three months with CPAP therapy. DESIGN: Observational study, before and after CPAP therapy. SETTING AND PATIENTS: We studied 30 patients with apnoea/hypopnoea index (AHI) >15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA) and microparticles (MPs) were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF) was determined as a marker of endothelial restoration process. MEASUREMENTS AND RESULTS: After three month with CPAP, FMD significantly increased (1072.26 ± 483.21 vs. 1604.38 ± 915.69 PU, p< 0.005) cf-DNA and MPs significantly decreased (187.93 ± 115.81 vs. 121.28 ± 78.98 pg/ml, p<0.01, and 69.60 ± 62.60 vs. 39.82 ± 22.14 U/μL, p<0.05, respectively) and VEGF levels increased (585.02 ± 246.06 vs. 641.11 ± 212.69 pg/ml, p<0.05). These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p<0.005) but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together. CONCLUSIONS: CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage

Cerebrovascular disease and statins

Elevated low-density lipoprotein-cholesterol (LDL-C) is a causal factor for the development of atherosclerotic cardiovascular disease (ASCVD); accordingly, LDL-C lowering is associated with a decreased risk of progression of atherosclerotic plaques and development of complications. Currently, statins play a central role in any ASCVD management and prevention strategies, in relation to their lipid-lowering action and potentially to pleiotropic effects. After coronary artery disease, stroke is the most frequent cause of ASCVD mortality and the leading cause of acquired disability, a major public health problem. There is often a tendency to aggregate all types of stroke (atherothrombotic, cardioembolic, and haemorrhagic), which have, however, different causes and pathophysiology, what may lead to bias when interpreting the results of the studies. Survivors of a first atherothrombotic ischemic stroke are at high risk for coronary events, recurrent stroke, and vascular death. Although epidemiological studies show a weak relationship between cholesterol levels and cerebrovascular disease as a whole compared with other ASCVD types, statin intervention studies have demonstrated a decrease in the risk of stroke in patients with atherosclerosis of other territories and a decrease in all cardiovascular events in patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated the benefit of high doses of atorvastatin in the secondary prevention of ischemic stroke. In this review, we discuss the evidence, use and recommendations of statins in the primary and secondary prevention of stroke, and their role in other scenarios such as the acute phase of ischemic stroke, cerebral hemorrhage, cardioembolic stroke, small vessel disease, and cognitive impairment

Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain

We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017-2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07-1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients

LDL-cholesterol lowering and clinical outcomes in hypercholesterolemic subjects with and without a familial hypercholesterolemia phenotype: Analysis from the secondary prevention 4S trial

Background and aims: Trial evidence for the benefits of cholesterol-lowering is limited for familial hypercho lesterolemia (FH) patients, since they have not been the focus of large outcome trials. We assess statin use in coronary artery disease (CAD) subjects with low-density lipoprotein cholesterol (LDL-C) ≥4.9 mmol/L with or without an FH phenotype. Methods: The 4S trial randomized hypercholesterolemic CAD patients to simvastatin or placebo. We first strat ified participants into baseline LDL-C <4.9 and ≥ 4.9 mmol/L; next, based on the DLCN criteria for FH, the latter group was stratified into four subgroups by presence of none, one or both of “premature CAD” and “family history of CAD”. Participants having both are defined as having an FH phenotype. Results: 2267 and 2164 participants had LDL-C <4.9 and ≥ 4.9 mmol/L, respectively. Mortality endpoints and major coronary events (MCE) were significantly reduced with simvastatin versus placebo in both groups over 5.4 years, but the latter derived greater absolute risk reductions (ARR) (4.1–4.3% for mortality endpoints, versus 2.5–2.8%). LDL-C reductions were similar among the 4 subgroups with levels ≥4.9 mmol/L. Participants with FH phenotype (n = 152) appeared to derive greater relative benefits with simvastatin than the other three subgroups (all-cause death: 84% relative risk reduction, p = 0.046; MCE: 55% reduction, p = 0.0297); statistical interaction was non significant. Participants with FH phenotype derived greater ARR than any other group with simvastatin versus placebo (all-cause mortality: 6.6% ARR; MCE 13.2%; versus 3.8% and 8.3%, respectively, among participants with LDL-C ≥4.9 mmol/L but without features suggestive of FH). Conclusions: The FH phenotype appeared to be associated with greater clinical benefits from a given magnitude of LDL-C reduction as compared to individuals without FH phenotype

Obstructive Sleep Apnoea Syndrome, Endothelial Function and Markers of Endothelialization. Changes after CPAP

Study objectives This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD) and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA) syndrome at baseline and after three months with CPAP therapy. Design Observational study, before and after CPAP therapy. Setting and Patients We studied 30 patients with apnoea/hypopnoea index (AHI) > 15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA) and microparticles (MPs) were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF) was determined as a marker of endothelial restoration process. Measurements and results After three month with CPAP, FMD significantly increased (1072.26 +/- 483.21 vs. 1604.38 +/- 915.69 PU, p<0.005) cf-DNA and MPs significantly decreased (187.93 +/- 115.81 vs. 121.28 +/- 78.98 pg/ml, p<0.01, and 69.60 +/- 62.60 vs. 39.82 +/- 22.14 U/mu L, p<0.05, respectively) and VEGF levels increased (585.02 +/- 246.06 vs. 641.11 +/- 212.69 pg/ml, p<0.05). These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p< 0.005) but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together. Conclusions CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage