Inflammatory markers 10 weeks after myocardial infarction predict future cardiovascular events

Background: The prognostic value of chronic inflammation markers in patients after myocardial infarction (MI) in the era of interventional treatment, statin and aspirin use is still unclear. Methods: The study was carried out on 107 patients with a first MI who were followed up for 18 months. The end points were cardiac death, reinfarction or unstable angina pectoris. At 10 days and at 10 weeks we measured C-reactive protein (CRP), fibrinogen, soluble intercellular adhesion molecule 1 (sICAM-1), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and Chlamydia preumoniae antibodies. Results: During the follow-up period there were 22 events. The patients were divided into two subgroups: those with recurrent episodes and those without coronary events. Patients with recurrent episodes had significantly higher values of CRP (7.07 vs. 3.77 mg/l, p = 0.02), ESR at 1 h (24.3 vs. 13.3 mm; p = 0.01) and sICAM-1 (287.9 vs. 260.9 ng/ml, p = 0.04) at 10 weeks following infarction. Statistical analysis showed that sICAM-1 > 270 ng/ml, CRP > 1.83 mg/l and ESR at 1 h > 14 mm measured at 10 weeks were independent risk factors for recurrent cardiovascular events. In patients with coronary events between the 10th day and 10th week there was no decrease in inflammatory indices (WBC, ESR) and a tendency towards increasing sICAM-1. Conclusions: Increased inflammatory markers (CRP, ESR, sICAM-1) at 10 weeks after MI are independent risk factors for recurrent cardiovascular events. Measuring CRP, ESR and sICAM-1 at this time point is useful in long-term prognosis after MI. Changes in inflammatory indices (ESR, WBC, sICAM-1) measured at 10 days and 10 weeks following infarction show a different pattern in patients with and without recurrent cardiovascular events. (Cardiol J 2007; 14: 50–58

The use of selected neutrophil protein plasma concentrations in the diagnosis of Crohn's disease and ulcerative colitis : a preliminary report

Background: Difficulties in diagnosis of inflammatory bowel disease (IBD) motivate the search for new diagnostic tools, including laboratory tests. The aim of this study was to evaluate concentrations of the neutrophil (NEU) proteins leukocyte elastase (HLE-α1AT), lactoferrin and calprotectin as potential biomarkers used in the diagnosis and assessment of clinical activity of Crohn’s disease (CD) and ulcerative colitis (UC).Material/Methods: The study included 27 patients with CD, 33 patients with UC and 20 healthy controls. Plasma concentrations of calprotectin, lactoferrin and HLE-α1AT were measured using ELISA.Results: In patients with CD higher concentrations of HLE-α1AT (64.3±43.1 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (151.6±97.8 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (243.2±102.0 vs. 129.7±32.7 ng/l, P<0.001) than in the control group were found. In patients with UC higher plasma concentrations of HLE-α1AT (62.0±30.9 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (149.6±72.3 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (242.6±107.5 vs 129.7±32.7 ng/l, P<0.001) than in the control group were found. HLE-α1AT/NEU and lactoferrin/NEU ratios in patients with UC were significantly higher compared with patients with CD. Calprotectin (P=0.010) and lactoferrin (P=0.023) levels were higher in patients with the active compared with inactive phase of CD.Conclusions: The diagnostic characteristics of plasma granulocyte protein concentrations indicate the usefulness of these tests in the diagnosis of IBD. Higher HLE-α1AT and lactoferrin/NEU ratios in patients with UC than with CD may suggest the usefulness of these ratios in differential diagnostics. Plasma calprotectin and lactoferrin levels may be useful in CD activity assessment

The effect of antihypertensive treatment on arterial stiffness and serum concentration of selected matrix metalloproteinases

Introduction: The aim of the study was to assess the arterial stiffness and serum levels of selected metalloproteinases (MMPs) in hypertensive patients and their changes following antihypertensive therapy. Material and methods: The study group consisted of 95 patients with essential arterial hypertension (HT) stage 1 or 2 (mean age: 53.1 ±13.0 years). The control group consisted of 31 normotensives of the same age range. Hypertension patients were randomized to one of the following monotherapies for 6 months: quinapril, losartan, amlodipine, hydrochlorothiazide or bisoprolol. Carotid-femoral pulse wave velocity (PWV) was measured using a Complior device. Serum concentrations of MMPs (proMMP-1, MMP-2, MMP-3, MMP-9) and plasma concentration of tissue inhibitor of MMPs (TIMP-1) were measured using ELISA. Results: Pulse wave velocity and serum concentrations of MMP-2 and MMP-9 were higher in HT patients than in the control group. In HT patients PWV was significantly associated (R2 = 0.41) with age (B = 0.408, p = 0.00027), systolic blood pressure (SBP) (B = 0.441, p = 0.0011), and MMP-3 (B = 0.204, p = 0.0459). After 6 months of treatment, regardless of the agent used, we observed a significant decrease of PWV, SBP, MMP-2 and MMP-3 and an increase of TIMP-1 plasma concentration. The decrease of PWV was significantly associated with a decrease of SBP (R2 = 0.07, B = 0.260, p = 0.015) only. Conclusions: In patients with arterial hypertension, beside age and systolic blood pressure, the determinants of arterial stiffness include serum MMP-3 concentration. For drugs compared in the study with the same hypotensive effect obtained, the arterial stiffness reduction effect is not dependent on the drug used. Systolic blood pressure is one of the independent factors responsible for the reduction of arterial stiffness in the course of antihypertensive treatment

Markery zapalne 10 tygodni po zawale serca: czynniki prognostyczne przyszłych zdarzeń sercowo-naczyniowych

Wstęp: Wartość prognostyczna markerów przewlekłego stanu zapalnego u pacjentów po zawale serca (MI) w epoce leczenia interwencyjnego oraz używania statyn i kwasu acetylosalicylowego nadal pozostaje niejasna. Materiał i metody: Badaniem objęto 107 pacjentów z pierwszym MI i poddano ich obserwacji przez 18 miesięcy. Punkty końcowe stanowiły: śmierć z przyczyn sercowo-naczyniowych, ponowny MI lub niestabilna dławica piersiowa. Po 10 dniach i po 10 tygodniach zmierzono stężenie białka C-reaktywnego (CRP), fibrynogenu, rozpuszczalnej międzykomórkowej cząsteczki adhezyjnej 1 (sICAM-1), odczyn Biernackiego (OB), leukocytozę (WBC) i przeciwciała przeciw Chlamydia pneumoniae. Wyniki: W trakcie obserwacji odnotowano 22 zdarzenia. Pacjentów podzielono na dwie podgrupy: z nawracającymi incydentami sercowo-naczyniowymi oraz bez zdarzeń sercowo-naczyniowych. U osób z nawracającymi zdarzeniami stwierdzono znamiennie wyższe wartości CRP (7,07 vs. 3,77 mg/l; p = 0,002), OB po 1 h (24,3 vs. 13,3 mm; p = 0,01) oraz sICAM-1 (287,9 vs. 260,9 ng/ml; p = 0,04) 10 tygodni po zawale. W analizie statystycznej wykazano, że sICAM-1 > 270 ng/ml, CRP > 1,83 mg/l, OB po 1 h > 14 mm mierzone po 10 tygodniach były niezależnymi czynnikami ryzyka nawracających zdarzeń sercowo-naczyniowych. U pacjentów ze zdarzeniami sercowo-naczyniowymi między 10. dniem a 10. tygodniem nie obserwowano spadku wartości wskaźników zapalenia (WBC, OB); odnotowano tendencję do zwiększenia stężenia sICAM-1. Wnioski: Podwy¿szone markery stanu zapalnego (CRP, OB, sICAM-1) 10 tygodni po MI są niezależnymi czynnikami ryzyka nawracających zdarzeń sercowo-naczyniowych. Pomiar CRP, OB oraz sICAM po tym czasie jest przydatny w ocenie długotrwałego rokowania po MI. Zmiany wartości wskaźników stanu zapalnego (OB, WBC, sICAM-1) mierzone 10 dni i 10 tygodni po MI mają różny przebieg u pacjentów z nawracającymi zdarzeniami sercowo-naczyniowych i bez nich. (Folia Cardiologica Excerpta 2007; 2: 65–74

Brain natriuretic peptide in women with mild hypertension in perimenopausal period

Background Morbidity and mortality from cardiovascular diseases increase rapidly in women after menopause. Relationship between menopause and hypertension has been a topic of investigation for several years. There are no evidences about the influence of menopause on brain natriuretic peptide level. Present studies indicate the important prognostic value of this parameter in this group of patients. The aim of this study was to assess the level of N-terminal part of brain natriuretic peptide as well as the correlation of this factor with values of blood pressure in hypertensive women in relation to post- and premenopausal hormonal status. Material and methods The study included 112 women aged 45 to 55 years (mean age 50.73 ± 1.82 years) with mild essential hypertension confirmed by conventional blood pressure measurements and 24 h ABP monitoring (SpaceLabs 90207). The study population was stratified according to hormonal status: postmenopausal (group A; n = 61; age 51.03 ± 1.39 years) and premenopausal (group B; n = 51; age 50.37 ± 2.19 years). Fasting plasma level of NT-proBNP, was measured by immunochemical method. Results The level of NT-proBNP was significantly higher in women after menopause (1.88 ± 0.27 [75.86] vs. 1.75 ± 0.28 [56.23] log pg/ml; p = 0.016), in the whole group 1.82 ± 0.28 (66.07) log pg/ml. Conclusions The women after menopause are characterized by higher level of NT-proBNP than premenopausal ones. Furthure investigations are required to explain this phenomenon.Background Morbidity and mortality from cardiovascular diseases increase rapidly in women after menopause. Relationship between menopause and hypertension has been a topic of investigation for several years. There are no evidences about the influence of menopause on brain natriuretic peptide level. Present studies indicate the important prognostic value of this parameter in this group of patients. The aim of this study was to assess the level of N-terminal part of brain natriuretic peptide as well as the correlation of this factor with values of blood pressure in hypertensive women in relation to post- and premenopausal hormonal status. Material and methods The study included 112 women aged 45 to 55 years (mean age 50.73 ± 1.82 years) with mild essential hypertension confirmed by conventional blood pressure measurements and 24 h ABP monitoring (SpaceLabs 90207). The study population was stratified according to hormonal status: postmenopausal (group A; n = 61; age 51.03 ± 1.39 years) and premenopausal (group B; n = 51; age 50.37 ± 2.19 years). Fasting plasma level of NT-proBNP, was measured by immunochemical method. Results The level of NT-proBNP was significantly higher in women after menopause (1.88 ± 0.27 [75.86] vs. 1.75 ± 0.28 [56.23] log pg/ml; p = 0.016), in the whole group 1.82 ± 0.28 (66.07) log pg/ml. Conclusions The women after menopause are characterized by higher level of NT-proBNP than premenopausal ones. Furthure investigations are required to explain this phenomenon

Brain natriuretic peptide in women with mild hypertension in perimenopausal period

Wstęp Związek pomiędzy menopauzą a rozwojem nadciśnienia tętniczego jest przedmiotem badań od wielu lat. U kobiet po menopauzie zapadalność na chorobę niedokrwienną serca gwałtownie wzrasta, podobnie jak związana z nią śmiertelność. Dotychczas brakuje danych klinicznych charakteryzujących wpływ menopauzy na stężenie mózgowego peptydu natriuretycznego (BNP). Wydaje się jednak, że może on stanowić istotny czynnik prognostyczny u kobiet z nadciśnieniem tętniczym w okresie pomenopauzalnym. Celem badania było określenie stężenia N-końcowej części mózgowego peptydu natriuretycznego (NT-proBNP) u kobiet przed i po menopauzie z łagodnym nadciśnieniem tętniczym oraz ocena korelacji tych stężeń ze stanem hormonalnym i wartościami ciśnienia tętniczego krwi. Materiał i metody Badaniem objęto 112 kobiet w wieku 45–55 lat (50,73 ± 1,82 roku) z pierwotnym łagodnym nadciśnieniem tętniczym, rozpoznanym na podstawie pomiarów gabinetowyche i potwierdzonym całodobową automatyczną rejestracją ciśnienia tętniczego (SpaceLabs 90207), bez leczenia farmakologicznego co najmniej przez ostatnie 4 tygodnie. Badaną grupę podzielono na 2 podgrupy: kobiety w okresie pomenopauzalnym (grupa A; n = 61, wiek 51,03 ± 1,39 roku) oraz regularnie miesiączkujące (grupa B; n = 51; wiek 50,37 ± 2,19 roku). NT-proBNP oznaczono metodą immunochemiczną. Wyniki Stężenie NT-proBNP po menopauzie było wyższe niż u kobiet regularnie miesiączkujących (1,88 ± 0,27 [75,86] vs. 1,75 ± 0,28 [56,23] log pg/ /ml; p = 0,016) i wynosiło w całej badanej grupie 1,82 ± 0,28 (66,07) log pg/ml. Wnioski Kobiety po menopauzie z łagodnym pierwotnym nadciśnieniem tętniczym charakteryzują się wyższymi stężeniami NT-proBNP w porównaniu z kobietami regularnie miesiączkującymi. Wyjaśnienie tego zjawiska wymaga dalszych badań.Background Morbidity and mortality from cardiovascular diseases increase rapidly in women after menopause. Relationship between menopause and hypertension has been a topic of investigation for several years. There are no evidences about the influence of menopause on brain natriuretic peptide level. Present studies indicate the important prognostic value of this parameter in this group of patients. The aim of this study was to assess the level of N-terminal part of brain natriuretic peptide as well as the correlation of this factor with values of blood pressure in hypertensive women in relation to post- and premenopausal hormonal status. Material and methods The study included 112 women aged 45 to 55 years (mean age 50.73 ± 1.82 years) with mild essential hypertension confirmed by conventional blood pressure measurements and 24 h ABP monitoring (SpaceLabs 90207). The study population was stratified according to hormonal status: postmenopausal (group A; n = 61; age 51.03 ± 1.39 years) and premenopausal (group B; n = 51; age 50.37 ± 2.19 years). Fasting plasma level of NT-proBNP, was measured by immunochemical method. Results The level of NT-proBNP was significantly higher in women after menopause (1.88 ± 0.27 [75.86] vs. 1.75 ± 0.28 [56.23] log pg/ml; p = 0.016), in the whole group 1.82 ± 0.28 (66.07) log pg/ml.Conclusions The women after menopause are characterized by higher level of NT-proBNP than premenopausal ones. Furthure investigations are required to explain this phenomenon

Markers of antioxidant defense in patients with type 2 diabetes

Aims. Diabetes is considered a state of increased oxidative stress. This study evaluates blood concentrations of selected markers of antioxidant defense in patients with type 2 diabetes. Methods. The study included 80 type 2 diabetes patients and 79 apparently healthy controls. Measured markers included ferric reducing ability of plasma (FRAP), reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), γ-glutamyltransferase (GGT) and uric acid serum, and plasma and/or hemolysate levels. Results. FRAP, uric acid, CRP, and GGT levels were significantly higher in patients with diabetes. Plasma and hemolysate GR was significantly higher whereas GPx activity was significantly lower in patients with diabetes. There were no significant differences in antioxidant defense markers between patients with and without chronic diabetes complications. Fasting serum glucose correlated with plasma GPx, plasma and hemolysate GR, FRAP, and serum GGT, and HbA1c correlated with serum GGT. Only FRAP and serum uric acid were significantly higher in obese (BMI>30 kg/m2) patients with diabetes than in nonobese patients. Conclusions. Some components of antioxidant defense such as GR, uric acid, and GGT are increased in patients with type 2 diabetes. However, the whole system cannot compensate for an enhanced production of ROS as reflected by the trend toward decreased erythrocytes GSH

Cardiovascular risk in chronic kidney disease patients : intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries

BACKGROUND: The objective of the study was to determine the relationship between common carotid artery intima-media thickness (CCA-IMT) and histologically assessed calcification of radial artery in relation to clinical features and laboratory markers of bone and mineral metabolism, inflammation, and oxidative stress in patients with stage 5 chronic kidney disease (CKD). METHODS: The study comprised 59 patients (36 hemodialyzed, 23 predialysis). CCA-IMT was measured by ultrasonography; the biochemical parameters examined were assessed using routine laboratory methods, ELISA micro-plate immunoassays and spectrophotometry. Fragments of radial artery obtained during creation of hemodialysis access were cryosectioned and stained for calcifications using von Kossa method and alizarin red. RESULTS: Glucose, osteoprotegerin, pentraxin 3 and Framingham risk score significantly correlated with CCA-IMT. In multiple regression analysis, OPG positively predicted CCA-IMT. Radial artery calcifications were found in 34 patients who showed higher CCA-IMT (0.98 ± 0.13 vs 0.86 ± 0.14 mm; P = 0.006). Higher CCA-IMT values were also associated with more advanced calcifications. CCA-IMT and the presence of plaques in common carotid artery were positive predictors of radial artery calcifications, independent of dialysis status, Framingham risk score, CRP and Ca x Pi [OR for calcifications 2.19 (1.08-4.45) per 0.1 mm increase in CCA-IMT]. The presence of radial artery calcifications was a significant predictor of mortality, independent of dialysis status and Framingham risk score [HR 3.16 (1.03-9.64)]. CONCLUSIONS: In CKD patients, CCA-IMT examination can be used as a surrogate measure to assess the incidence and severity of arterial medial calcification which is associated with poor clinical outcome in these patients