Egidija Rinkuniene

Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularisation

BACKGROUND Exercise electrocardiography is a long-standing method for the evaluation of coronary artery disease (CAD), and it remains the initial test for most patients who can exercise adequately with a baseline interpretable electrocardiogram. However, there is little information about the relationship between Duke treadmill test score (DTS) and severity of coronary artery lesion, as well as estimating the need for revascularisation. AIM The aim of the study was to ascertain whether the DTS could be an efficient parameter in choosing coronary revascularisation in different DTS groups. METHODS Two hundred and fifty-eight (n = 258) patients had positive exercise testing for CAD and underwent coronary angiography. The patients were divided into three groups according to the DTS: low-risk (with a score of ≥ +5), moderate-risk (with scores ranging from -10 to +4), and high-risk (with a score of ≤ -11). Coronary angiography was done by the Judkins technique. A coronary lesion was considered significant when stenosis of the coronary artery was ≥ 70% and stenosis of the trunk was ≥ 50%. The SYNTAX score was determined. RESULTS The study group included 258 patients with mean age 62.66 ± 9.6 years, and most of them were men (72.8%). Patients with high- and intermediate-risk DTS had the same SYNTAX score (16.35 ± 7.3, 15.09 ± 10.08 and 11.80 ± 9.88, respectively; p = 0.064) compared to low-risk DTS. A negative correlation between DTS and significant coronary artery stenosis (r = -0.181; p = 0.005), SYNTAX score (r = -0.173; p = 0.007), and cardiac revascularisations (r = -0.213; p = 0.001) were found. In multiple linear regressions to predict coronary revascularisation the SYNTAX score (B = 0.018; p = 0.0001), DTS (B = -0.014, p = 0.008) and previous myocardial infarction (B = -0.143; p = 0.047) were significant predictors. CONCLUSIONS The DTS alone is a useful tool in suspecting a significant coronary artery stenosis, but it is not accurate enough for revascularisation. Thus, by adding clinical information, its value may be maximised.

Lipid profile evaluation and severe hypercholesterolaemia screening in the middle-aged population according to nationwide primary prevention programme in Lithuania

BACKGROUND AND AIMS Cardiovascular disease (CVD) is a major cause of premature death in Lithuania where abnormal lipid levels are very common among middle-aged adults. The aim of this study was to evaluate lipid profile in middle-aged Lithuanians and perform population-based severe hypercholesterolaemia (SH) screening. METHODS This study included men aged 40-54 and women aged 50-64 years without overt CVD, participating in the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme during the period 2009-2016. Lipidograms of 92,373 adults (58.4% women and 41.6% men) included in the database were analysed and screening for SH was performed. RESULTS The mean levels of total cholesterol, LDL cholesterol (LDL-C) and triglycerides (TG) among participants were 6.08 mmol/l, 3.87 mmol/l, and 1.59 mmol/l, respectively. Any type of dyslipidaemia was present in 89.7%, and severe dyslipidaemia in 13.4% of the study population. 80.2% of adults without overt CVD had LDL-C ≥3 mmol/l. SH (LDL-C ≥6 mmol/l) was detected in 3.2% of study participants. Prevalence of SH decreased from 2.91% to 2.82% during the period 2009-2016 (p for trend = 0.003). LDL-C ≥6.5 mmol/l was observed in 1.5% of subjects while both LDL-C ≥6.5 mmol/l, and TG ≤ 1.7 mmol/l was found in 0.6% of subjects. CONCLUSIONS SH was present in 3.2% of the middle-aged population without overt CVD. Slightly decreasing prevalence of SH was observed during the period 2009-2016 in Lithuania. Likely phenotypic familial hypercholesterolaemia was observed in 1.5% of middle-aged Lithuanians. Further clinical and genetic evaluation of people with SH is needed to detect familial forms of SH.

Vitamin D, cardiovascular and bone healthin postmenopausal women with metabolic syndrome

BACKGROUND The evidence highlights the importance of improving vitamin D levels in the general population for the prevention of adverse long-term health risks, including cardiovascular events, metabolic syndrome, cancer, anxiety and depression, and overall mortality, although controversies in the research are common. OBJECTIVES The purpose of this study was to investigate the relationship between vitamin D and vascular and bone health among postmenopausal metabolic women, controlling for traditional cardiovascular factors, and thus seeking to explore their plausible relation. The secondary aim was to look specifically for the relation between artery stiffness and bone health. MATERIAL AND METHODS This is a cross-sectional study designed to evaluate the relation between vitamin D level and vascular and bone health among women with metabolic syndrome. Two hundred and ten women visiting a cardiologist were recruited consecutively into the study. The study variables included clinical examination, laboratory findings, measurements of vascular stiffness, and bone turnover markers. RESULTS We found 126 (60%) metabolic women with a vitamin D deficiency (50 nmol/L) among the study group. We discovered no statistically significant correlation between vitamin D and vascular stiffness. Vitamin D was not associated neither with femoral neck bone mineral density (BMD) and T score, nor with lumbar spine BMD and T score. Nevertheless, there was an indirect weak correlation between vascular stiffness, in particular the augmentation index (AIx), and all bone health markers, including BMD and T score in both the femur head and lumbar spine. CONCLUSIONS We showed a high proportion of postmenopausal metabolic women with a vitamin D deficiency, but there was no relation between vitamin D and vascular health or vitamin D and bone health. Nevertheless, the relation between vascular health and bone health exists, although the role of vitamin D in this link has not yet been established.

Cardiorenal Determinants of Erectile Dysfunction in Primary Prevention: A Cross-Sectional Study

Objective: The aim of this study was to investigate the association between the severity of erectile dysfunction (ED), cardiovascular risk, and target organ damage (heart, renal, vascular) in men free of cardiovascular diseases (CVD). Subjects and Methods: ED was assessed using the International Index of Erectile Function (IIEF-5). The study included 182 men: 100 with ED (IIEF mean score ≤21) and 82 without ED (IIEF mean score >21). Ultrasound was used to evaluate carotid plaques and left ventricular mass, geometry, and diastolic function. Cardiovascular anamnesis, CVD risk factors, and anthropometric and biochemical parameters were obtained. The European Society of Cardiology-Systematic Coronary Risk Evaluation Score (ESC-SCORE) was used to calculate total patient cardiovascular risk. Continuous variables between groups were compared using the Student t test and Mann-Whitney U test, while categorical data were compared using the χ2 test. Multiple linear regression was used to test the association between the severity of ED and presence of target organ damage. Results: The following parameters were significantly higher in the ED group compared to the controls: family history of coronary heart disease (43.7 vs. 26.7%, p = 0.047), ESC-SCORE (2.27 ± 1.79 vs. 1.61 ± 1.13, p = 0.012), and waist circumference (109.28 ± 10.82 vs. 106.17 ± 10.07, p = 0.047). Impaired renal function (p = 0.081), albuminuria (p = 0.545), vascular damage (p = 0.602), and diastolic function (p = 0.724) were similar in both groups. However, left ventricular hypertrophy (LVH; odds ratio 2.231, 95% CI 1.069-4.655, p = 0.22) was more frequent in the ED group (29.9 vs. 16.0%). The multiple linear regression analysis revealed that LVH (β = 1.761, p = 0.002) and impaired renal function assessed using the estimated glomerular filtration rate (<60 mL/min/1.73 m2; β = 6.207, p = 0.0001) were the independent risk factors for severity of ED. Conclusion: This study showed that LVH and impaired renal function are associated with ED severity.

Pregnancy-related severe hypertriglyceridemia

Abstract The increase in plasma triglyceride level in pregnancy is modest, but in those who have deficiencies in lipoprotein lipase or apolipoprotein C-II (i.e., familial hyperlipidemia), the increase in very LDL concentration cannot be controlled and results in severe hypertriglyceridemia. This case is related to severe primary hypertriglyceridemia (types V) detected on the 25th week of gestation and treated with regular therapeutic plasma exchange and later on with alternate plasmapheresis with donated plasma. No complications were observed. A healthy male baby was delivered on the 39th week of pregnancy. After giving birth, the maternal triglyceride levels showed a remarkable reduction.