Centrinių ir periferinių arterijų struktūrinių ir funkcinių pakitimų ypatumai sergant metaboliniu sindromu

Širdies ir kraujagyslių ligos (ŠKL) yra pagrindinė mirties priežastis visoje Europoje ir Lietuvoje. Literatūroje plačiai, tačiau nevienareikšmiai aptarta MS svarba širdies kraujagyslių ligų atsiradimui. Neatsakyta į vieną iš pagrindinių klausimų: kurie MS sudarantys rizikos veiksniai ar jų grupės daugiausia lemia širdies ir kraujagyslių ligų progresavimą. Mes savo darbe įvertinome arterijų funkcinių ir struktūrinių pokyčių bei kairiojo skilvelio miokardo masės indekso kitimų sąsajas su amžiumi, lytimi ir MS; taip pat atsižvelgėme ne tik į MS, bet ir į atskirų širdies bei kraujagyslių rizikos veiksnių nepriklausomą įtaką kardiovaskuliniam pažeidimui. Be to, bandėme nustatyti, koks MS sudarančių atskirų komponentų skaičius gali daugiausia lemti širdies ir kraujagyslių arterijų funkcinius ir struktūriniais kitimus bei kairiojo skilvelio miokardo masės didėjimą. Darbe nustatyta, kad sergantiesiems metaboliniu sindromu nepriklausomai nuo lyties ir amžiaus yra didesnis intimos medijos storis, šlaunies miego arterijų pulsinės bangos greitis ir kairiojo skilvelio miokardo masės indeksas. Didesnis miego arterijoje aterosklerozinių plokštelių skaičius rastas tik moterims su metaboliniu sindromu. Širdies ir kraujagyslių pažeidimų rizika sergantiems metaboliniu sindromu vyrams ir moterims taip pat buvo skirtinga. Vyrams su MS aptikta 2,14 karto didesnė kairiojo skilvelio hipertrofijos ir 4,9 karto – intimos medijos sustorėjimo tikimybė. Moterims metabolinis sindromas nesukelė intimos medijos storio padidėjimo rizikos, bet akivaizdžiai (1,83 karto) padidino kairiojo skilvelio hipertrofijos ir 1,4 karto – aterosklerozinių plokštelių atsiradimo tikimybę. Moterims ir vyrams metabolinis sindromas nedarė tiesioginės įtakos pulsinės bangos greičiui, intimos medijos storiui, kairiojo skilvelio hipertrofijos ir aterosklerozinių plokštelių atsiradimui. Šių parametrų kitimus daugiausia lemia tradiciniai širdies ir kraujagyslių ligų rizikos veiksniai. Šlaunies miego arterijų pulsinės bangos greitis, kairiojo skilvelio miokardo masės indeksas tiek vyrams, tiek moterims tiesiogiai priklausė nuo metabolinį sindromą sudarančių širdies ir kraujagyslių ligų rizikos veiksnių skaičiaus. Tuo tarpu intimos medijos storio didėjimas tik moterims siejamas su didėjančiu rizikos veiksnių skaičiumi. Metabolinis sindromas skirtingai veikia centrines ir periferines arterijas. Nepriklausomai nuo lyties jis padidina centrinių arterijų pulsinės bangos greitį, tačiau neveikia periferinių arterijų hemodinamikos. Pulsinės bangos greičio apskaičiavimo algoritmas priklauso nuo lyties, amžiaus, širdies susitraukimų dažnio, vidutinio kraujo spaudimo ir juosmens apimties

Peculiarities of structural and functional changes of central and peripheral arteries in metabolic syndrome

Cardiovascular diseases (CVD) are the main cause of death all over the Europe and were the most prevalent disease in Lithuania in 2010. Based on some of the data, MS risk factors have different influence on changes of artery structure and function. MS and its components can influence differently the emergence of cardiovascular diseases and advance of complications in men and women. Furthermore, we tried to estimate the number of separate components constituting MS that can have the most significant influence on functional and structural changes in cardiovascular arteries and increase of the left ventricle myocardial mass index. The particularity of changes in different arterial stiffness indicators in patients with MS has not been determined yet in the literature, as well as prognostic value of MS when initiating early disorders in arterial structure and function and left ventricular hypertrophy. The research showed the following results: in subjects with metabolic syndrome irrespectively their gender and age higher intima-media thickness, femoral-carotid arteries pulse wave velocity and left ventricular myocardial mass index were found. However, higher number of atherosclerotic plaques in carotid artery was found only in females. Risk of cardiovascular disorders in males and females with metabolic syndrome is different. Nor in males, neither in females metabolic syndrome had no direct influence on pulse wave velocity, intima-media thickness, hypertrophy of left ventricle and occurrence of atherosclerotic plaques. Femoral-carotid arteries pulse wave velocity and left ventricular myocardial mass index directly depends on the number of cardiovascular risk factors comprising metabolic syndrome both in males and females. Meanwhile, only in females intima-media thickness is associated with increasing number of risk factors. Metabolic syndrome irrespective of age, increases velocity in central arteries and does not affect peripheral arteries hemodynamic. Pulse wave velocity calculation algorithm depends on gender, age, heart rate, mean blood pressure and waist circumference

Association Between Erectile Dysfunction and Asymptomatic Cardiovascular Damage in Middle-Aged Men

Background and Objective. It has been proposed that the same cardiovascular risk (CV) factors predispose middle-aged men to the development of both coronary artery disease and erectile dysfunction (ED). Moreover, several recently published studies have identified ED as a possible early marker of CV disease. The aim of this particular study was to evaluate the association between ED and early asymptomatic heart and vascular damage in middle-aged men with CV risk factors. Material and Methods. In this case-control study, the International Index of Erectile Function (IIEF) questionnaire was employed to assess the erectile function of the study participants and to allocate them either into the ED group (N=21; mean IIEF score, 18.15 [SD, 2.54]; mean age, 48.2 years [SD, 4.4]) or the control group (N=24; mean IIEF score, 23.45 [SD, 0.99]; mean age, 46.8 years [SD, 3.1]). Additionally, pulse wave velocity, augmentation index, pulse pressure, carotid intima media thickness (IMT), and atherosclerotic plaque count were determined, and echocardiography was performed in every subject. Results. The mean IMT and left ventricular mass index (LVMI) of both carotid arteries in the ED group were significantly higher when compared with controls (598.57 vs. 535.54 mm·10–3, P=0.03, and 107.26 vs. 98.67 g/m2, P=0.04, respectively). Using multiple regression analysis, an independent association between the IIEF score and the LVMI was found (P=0.002). No significant differences in the results of pulse wave velocity, atherosclerotic plaque count, and other laboratory tests were found between the 2 study groups. Conclusions. The study suggests that ED is associated with a higher LVMI and may be an early marker of CV disease

The importance of inflammatory and angiogenic markers in the evaluation of early cardiovascular disease risk in women with hypertensive disorders of pregnancy /

Background: Women with hypertensive disorders of pregnancy (HDP) have a significantly higher risk of developing cardiovascular diseases later in life. The stratification of this risk using biomarkers during pregnancy can help to identify these women and apply early prevention. Objective: We aimed to determine proinflammatory cytokines and angiogenic markers, echocardiographic parameter changes after delivery and predict early cardiovascular disease risk in women with arterial hypertension and its complications during pregnancy. Methods: We conducted a literature search using the PubMed database for the last ten years. A total of 17 articles were included to our study and full text reviewed. Results: Four out of six studies found higher postpartum Interleukin-6 (IL-6) levels in women with HDP. IL–6 correlated positively with waist circumference, body mass index, and triglycerides, and negatively with high density lipoproteins (HDL). Two out of four studies found higher postpartum tumor necrosis factor alpha (TNF-α) levels in women with HDP but later concentration equalizes. One out of eight studies found higher placental growth factor (PlGF) and two out of eight found more elevated soluble fms-like tyrosine kinase-1 (sFlt-1) in women with HDP. With decreasing PlGF and increasing sFlt-1, common carotid artery intima and media thickness, aortic root diameter, left atrial diameter, left ventricle mass, systolic, diastolic, and mean blood pressure increased, whereas HDL decreased. One out of four studies found higher sFlt-1/PlGF. Conclusion: IL-6 remains significantly higher after delivery. Few studies found higher TNF-α, sFlt-1, PlGF and their ratio postpartum. All studies found a correlation between angiogenic factors, IL-6, and cardiovascular disease risk factors

The Prevalence of Erectile Dysfunction and Its Association with Cardiovascular Risk Factors in Patients after Myocardial Infarction

Background and Objectives: This study estimates the prevalence and severity of erectile dysfunction and its association with cardiovascular risk factors in patients after a myocardial infarction. Materials and Methods: This study included men aged 35–80 years, diagnosed with myocardial infarction and examined in the Department of Preventive Cardiology of Vilnius University Hospital Santaros Klinikos between 2016 and 2020. Anthropometric characteristics, blood pressure, lipid profile, blood glucose levels and prevalence of cardiovascular risk factors were evaluated. The International Index of Erectile Function-5 was used to assess patients’ erectile function. Results: A total of 171 patients were analysed. The mean age was 57.6 ± 8.8 years. Of the patients, 42.1, 25.1 and 11.7% had three, four and five established cardiovascular risk factors, respectively. Of the patients, 100% were diagnosed with dyslipidaemia, 90.0%—arterial hypertension, 14.6%—diabetes, 23.3%—smoking, 43.7%—positive familial history and 54.5%—insufficient physical activity. The overall prevalence of erectile dysfunction was 62%. It was scored mild in 37.4%, mild-to-moderate—15.2%, moderate—5.3% and severe in 4.1% of the patients. The mean age was significantly different between severity groups (p < 0.001). The study demonstrated a negative correlation between age and total score of the questionnaire (r = −0.308, p < 0.001). Arterial hypertension was more frequent in the patients with erectile dysfunction (p = 0.02). Other cardiovascular risk factors were distributed similarly. Conclusions: Erectile dysfunction is common in patients after a myocardial infarction and its severity is age dependent. The prevalence of cardiovascular risk factors is high, with arterial hypertension significantly more frequent in patients with erectile dysfunction

Relationship of arterial wall parameters to cardiovascular risk factors and cardiovascular risk assessed by SCORE system

Tuberculosis is one of the biggest global health problems. One-third of the world’s population (2 billion) is latently infected with tuberculosis. The tuberculin skin test is commonly used to diagnose tuberculosis infection. This test has poor specificity and sensitivity, cross-reactivity with bacille Calmette-Guérin vaccination and many environmental mycobacteria, and poor sensitivity (only 75–90% in active tuberculosis). Mycobacterium tuberculosis activates a strong T cell-mediated immune response. That is why, a better marker for tuberculosis infection could be the presence of mycobacteria specific interferon-γ-secreting T cells. These cells can be identified in blood or any other sample, which contains T cells. The test specificity is 99.9% (in low-risk control groups), and the sensitivity is 97.2% (in subjects with culture-confirmed active disease). New in vitro diagnostic test of tuberculosis, based on tuberculosis-induced immunological mechanisms, seems to be more specific and useful as previous methods

Prevalence of Cardiovascular Risk Factors in Middle-Aged Lithuanian Men Based on Body Mass Index and Waist Circumference Group Results from the 2006–2016 Lithuanian High Cardiovascular Risk Prevention Program

Background and aims: This study aimed to estimate the prevalence of cardiovascular risk factors in middle-aged Lithuanian men categorized according to body mass index and waist circumference results. Methods and results: The data were from the Lithuanian High Cardiovascular Risk primary prevention program between 2009 and 2016. This community-based cross-sectional study comprised 38,412 men aged 40 to 54 years old. We compared the prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, and metabolic syndrome in body mass index (BMI) and waist circumference (WC) groups. Regarding the allometric anthropometrics for WC, A Body Shape Indices (ABSIs) were analyzed with respect to mortality risk and smoking status. The most prevalent risk factor in men was dyslipidaemia, followed by arterial hypertension and smoking (86.96%, 47.94%, and 40.52%, respectively). All risk factors except for smoking were more prevalent in men with overweight or obesity as measured by BMI compared to men with normal weight. Similarly, smoking was the only cardiovascular risk factor that was more prevalent among subjects with normal WC compared to those with increased WC or abdominal obesity. Elevated ABSI, which is associated with higher mortality risk, was more prevalent in smokers. Conclusion: The most prevalent cardiovascular risk factor among middle-aged Lithuanian men was dyslipidaemia, with a surprisingly high prevalence in all BMI and WC groups. Smoking was the only risk factor most prevalent in subjects with low or normal weight according to BMI. It was also more prevalent in the normal WC group compared to the increased WC or abdominal obesity groups, but ABSI values associated with higher mortality were more prevalent among smokers than non-smokers

Trends in Cigarette Smoking among Middle-Aged Lithuanian Subjects Participating in the Primary Prevention Program between 2009 and 2016

Background and Objectives: The aim of the study was to evaluate trends in smoking among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. Materials and Methods: A community-based cross-sectional study comprised 92373 Lithuanian adults (41.6% men and 58.4% women). We compared the prevalence of smoking, smoking cessation activity and smoking intensity by gender and age groups. Results: There was a statistically significant upward trend in the number of smoking subjects (average annual percent change (AAPC) 2.99%, p < 0.001). The number of smoking male subjects remained much higher than the number of smoking female subjects during the 2009–2016 period. The study showed a significant increase in the percentage of smoking quitters in the whole group (AAPC 7.22%, p < 0.001) and among men and women separately. There was no significant change in smoking intensity in groups of male and female smokers separately. Conclusions: The analysis showed that the prevalence of smoking in Lithuania is still increasing due to women smoking despite all the governmental tobacco control efforts to reduce it

Hypertriglyceridemia impact on arterial parameters in patients with metabolic syndrome

BACKGROUND: The development of metabolic syndrome (MS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MS and different triglycerides levels. METHODS: Patients (aged 40-65 years) were divided into two groups: patients with MS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters-aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (cIMT) were performed. RESULTS: Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR 1.150; CI 95% 1.04-1.28), cfPWV (OR 1.283; CI 95% 1.14-1.42) and cIMT (OR 1.13; CI 95% 1.02-1.25) were significantly associated with hTG (p < 0.05), while AIxHR75 did not show significant association. CONCLUSION: Increased triglycerides are independently associated with a cfPWV, crPWV, and cIMT and may modify CVD risk in patients with MS