Andrea Komornikova

The effects of atorvastatin treatment on the mean platelet volume and red cell distribution width in patients with dyslipoproteinemia and comparison with plasma atherogenicity indicators—A pilot study

OBJECTIVES The mean platelet volume (MPV) and red cell distribution width (RDW) have recently arisen interest because of their association with an increased cardiovascular risk. The aim of our study was, therefore, to determine whether an association exists between MPV, RDW and lipoprotein sub-fractions, and to show the impact of statin therapy on these new possible biomarkers of atherosclerotic risk. DESIGN AND METHODS A cohort of 40 patients with hypercholesterolaemia (29 females, mean age 62.9±9 years), without previous hypolipidaemic treatment were enrolled. The patients were treated with atorvastatin 40 mg/day for 12 weeks. Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density cholesterol (HDL-C), triglycerides (TG), LDL-C sub-fractions [large LDL-C 1-2 and small dense (sd)-LDL-C 3-7], apolipoproteins (apoA1, apoB), apoB/apoA1 ratio, atherogenic index of plasma (AIP), haematological parameters (including MPV, RDW) and safety parameters (renal, hepatic) were measured before and after 12 weeks of atorvastatin treatment. RESULTS At baseline, a strong correlation between HDL-C, TG, sd-LDL-C, apoB, apoB/apoA1, and AIP with MPV (r=-0.55, p<0.001; r=0.57, p<0.001; r=0.73, p<0.001; r=0.41, p<0.05; r=0.52, p<0.001; r=0.61, p<0.001, respectively) and RDW (r=-0.49, p<0.001; r=0.62, p<0.001; r=0.67, p<0.001; r=0.41, p<0.05; r=0.43, p<0.05; r=0.65, p<0.001, respectively) was found. After 12 weeks of treatment with atorvastatin, MPV and RDW values underwent significant modification only in those patients displaying the strongest lipid-lowering effect. CONCLUSIONS Values of MPV and RDW seem to reflect a pro-atherogenic lipoprotein profile mainly represented by the presence of sd-LDL-C.

Orthostatic hypotension in diabetic patients—10-year follow-up study

INTRODUCTION Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. OBJECTIVES To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. DESIGN AND METHODS We retrospectively analyzed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. RESULTS OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR=10.67) and with prevalence of stroke in DM2 (OR=3.33). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR=14.18) and DM2 (OR=3.26). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR=8.68, DM2 OR=3.24), retinopathy (DM1 OR=8.09, DM2 OR=4.08) and peripheral neuropathy (DM1 OR=17.14, DM2 OR=7.51) Overall 10year mortality rate was higher in diabetic patients with OH. CONCLUSIONS Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality.

Regional differences of vasodilatation and vasomotion response to local heating in human cutaneous microcirculation

BACKGROUND The aim of this study was to evaluate the vasodilatation and vasomotion response to local heating in the cutaneous microcirculation of the ankle, dorsum of foot and forearm. Recently, it has been suggested that this response differs between the forearm and the leg. PROBANDS AND METHODS Twenty-nine young healthy adults were recruited. They underwent measurement by laser Doppler flowmetry (LDF) in three sites of the body (ankle, dorsum of foot, forearm). Percentage change of the median flow of the skin before and after provocation and normalised perfusion flow to maximal dilation (cutaneous vascular conductance--CVC % Max) during short provocation test were monitored. Spectral analysis of laser Doppler flowmetry signals was performed using the fast Fourier transform algorithm. RESULTS Significant differences were found in CVC % Max between ankle/dorsum (45.18±6.38% Max vs. 51.24±6.87% Max, respectively; p<0.05) and between ankle/forearm (45.18±6.38% Max vs. 54.49±5.37% Max, respectively; p<0.05). Percentage change of flux after provocation has revealed significant differences between ankle/dorsum (394.1±204.5% vs. 577.4±273.5%, respectively; p<0.05) and ankle/forearm (394.1±204.5% vs. 637.1±324.7%, respectively; p<0.05). Total spectral activity of vasomotion has differed between ankle/dorsum and ankle/forearm: 69.59 [49.58-96.04] vs. 93.01 [73.15-121.8] (p<0.05) and 69.59 [49.58-96.04] vs. 107.5 [80.55-155.8] (p<0.05), respectively. CONCLUSIONS Cutaneous microcirculation exhibits regional differences. Significant variability of function between ankle and dorsum of foot suggests that leg microcirculation is not uniform.

Effect of short term aerobic exercise on fasting and postprandial lipoprotein subfractions in healthy sedentary men

BackgroundOur goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile.MethodsHealthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75–80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile.Results4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest.ConclusionJust 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.

THE NEED OF BETTER ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION MANAGEMENT IN REDUCING STROKE INCIDENCE

Objective: Strokes are among the most common causes of morbidity and mortality, and in individuals who suffered stroke, subsequent long-term neurological deficit in a larger or smaller range is also an important factor. Arterial hypertension and atrial fibrillation are the most common influencing factors of strokes. Numerous clinical and epidemiological studies have confirmed that elevated systemic blood pressure values are among the major risk factors for both ischemic and hemorrhagic stroke, and the effect of arterial hypertension is complex. Aim of the study was to point out the need to improve the early identification, elimination and treatment of risk factors for stroke, according to the valid recommendations of the European Society of Hypertension and European Society of Cardiology. Design and method: Retrospectively, we analyzed a cohort of patients hospitalized for stroke during a three month period (July - September 2016) at the Ist Department of Neurology in Bratislava. The group consisted of 104 patients, from which ischemic stroke was diagnosed in 88 subjects (84.6 %) and hemorrhagic stroke in 16 subjects (15.4 %). The average age was 70.7 years. A history of previous stroke was in 18 (17.3 %) patients. Results: Among the most important risk factors in addition to age, we found that arterial hypertension as the most common risk factor occured in 96 subjects (92.3 %). Atrial fibrillation occured in 34 patients (32.7 %), but only 14 patients (41.2 %) were treated with anticoagulant therapy before hospitalization. Hemorrhagic stroke during anticoagulant therapy was only in 1 patient, but ischemic stroke in 13 patients. In this group of patients with anticoagulant therapy who have evolved ischemic stroke in spite of this treatment, we found that in 7 patients (53.8 %) the treatment was underdosed and therefore inneffective. Conclusions: Our results from real clinical practice points to the need to improve the effective management of arterial hypertension and atrial fibrillation, the most common influencing factors of stroke. It is necessary to improve the inadequate indication of anticoagulant treatment with consideration of the stroke risk calculation for atrial fibrillation (CHA2DS2-VASc Score) and bleeding risk calculator (HAS-BLED).

[PP.20.05] THE EFFECT OF PROSTAGLANDIN E1 ANALOGUE TREATMENT ON MORTALITY AND AMPUTATION RATE IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Objective: Peripheral arterial disease in advanced stages has severe disabling complications. Major amputations and high-mortality rates are common in patients with critical limb ischemia (CLI). The main option of CLI treatment is revascularization (endovascular, open surgery or hybrid). Patients with CLI and lacking option for revascularization have worse prognosis. The purpose of this retrospective study was to investigate the impact of including prostaglandins in the treatment of patients with CLI lacking the possibility of revascularization. Design and method: This retrospective study cohort includes 67 patients (34 male and 33 female), mean age 71 ± 10.7 years treated for CLI not suitable for revascularization. 13 patients had rest pain and 54 ischemic ulcers or frank gangrene. Mean ankle/brachial pressure index was 0.6. Medial arterial calcification was present in 6 patients (8.9%). Diabetes mellitus type 2 had 37 patients (55.2%). Prostaglandin E1 (alprostadil) was applied by intravenous perfusion with doses of 40 &mgr;g twice a day for 2 weeks. Results: 23 patients (34.3%) underwent amputation - 17 minor and 6 high, and 27 patients (40.3%) died during the total follow-up period (01/2009 - 07/2014). Mortality rate was higher in patients who have undergone an amputation, in diabetics and in patients without statin medication. Conclusions: Our results confirm that therapeutic strategies using prostaglandin treatment in patiíents with CLI lacking option for revascularization do not affect the overal high mortality. Patients with a history of diabetes mellitus, amputation of lower limb and without statin treatment have higher mortality rate. We have confirmed that statin therapy seems to be a protective factor for patients with critical limb ischemia.

[PP.05.05] CLINICAL IMPORTANCE OF ORTHOSTATIC HYPOTENSION IN DIABETIC PATIENTS – 10 YEARS FOLLOW-UP

Objective: Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. The aim of our study was to retrospectively assess the association of orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. Design and method: We retrospectively analysed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. Results: OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR = 10.667) and with prevalence of stroke in DM2 (OR = 3.335). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR = 14.18) and DM2 (OR = 3.263). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR = 8.680, DM2 OR = 3.237), retinopathy (DM1 OR = 8.095, DM2 OR = 4.078) and peripheral neuropathy (DM1 OR = 17.143, DM2 OR = 7.506) Overall 10 year mortality rate was higher in diabetic patients with OH. Conclusions: Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality. Results of our study confirm that OH is a cardiovascular risk factor of significant clinical importance.