Ewa Podolecka

Exercise-induced mobilisation of endothelial progenitor cells in patients with premature coronary heart disease

BACKGROUND Endothelial progenitor cells (EPC) derive from bone marrow and participate in both endothelial regeneration and development of new blood vessels. EPC also play a role in the atherosclerotic process, and their number correlates negatively with the presence of classical risk factors. AIM To evaluate circulating EPC count and their exercise-induced mobilisation in patients with premature coronary artery disease (CAD). METHODS The study group included 60 patients with stable CAD diagnosed before 45 years of age. The control group consisted of 33 healthy age- and gender-matched volunteers. Venous blood was sampled 3 times in order to assess circulating EPC count immediately before an exercise test (EPC 0) and at 15 min (EPC 15) and 60 min (EPC 60) after the exercise test. RESULTS Circulating EPC count in the study group at rest and at 15 min after exercise was comparable (2.1 vs. 2.1 cell/μL, p = 0.35) and increased significantly at 60 min after exercise in comparison to resting values (2.1 vs. 3.2 cell/μL, p < 0.00001). In the control group, circulating EPC count increased significantly at 15 min after exercise (2.0 vs. 3.5 cell/μL, p < 0.0001) but later decreased at 60 min after exercise, although it remained greater than at rest (2.7 vs. 2.0 cell/μL, p < 0.0002). Circulating EPC count at rest and at 60 min after exercise was comparable in the two groups (2.1 vs. 2.0 cell/μL, p = 0.96; and 3.2 vs. 2.7 cell/μL, p = 0.13, respectively) but it was significantly lower in the study group compared to the control group at 15 min after exercise (2.1 vs. 3.5 cell/μL, p < 0.00001). Circulating EPC count at rest and at 15 min after exercise did not correlate with the number of stenosed coronary arteries but at 60 min after exercise it was greater in patients with one-vessel disease compared to those with two- or three-vessel disease (4.2 vs. 3.4 cell/μL, p = 0.01; and 4.2 vs. 2.3 cell/μL, p = 0.00003). However, no difference in circulating EPC count was seen at 60 min after exercise between patients with two- or three-vessel disease (3.4 vs. 2.3 cell/μL, p = 0.3). CONCLUSIONS 1. Circulating EPC count at rest is comparable between subjects with premature atherosclerosis and healthy volunteers. 2. A single bout of physical exercise causes a significant increase in circulating EPC count in both groups, but the dynamics of exercise-induced EPC mobilisation is different, with delayed exercise-induced EPC mobilisation in subjects with premature CAD. 3. The extent of atherosclerotic coronary lesions does not influence circulating EPC count at rest.

The correlation between LDL-cholesterol and arterial wall elasticity indices

BACKGROUND Elevated serum low-density lipoprotein cholesterol (LDL-C) concentration is a risk factor for atherosclerosis, which involves remodelling of the arterial walls with their subsequent stiffening. AIM We sought to evaluate the relationship between serum lipid levels and the elastic properties of the arterial wall. METHODS The study group comprised 315 men and women aged 55.84 ± 9.44 years. Serum glucose and lipid concentrations were determited. All subjects underwent blood pressure (BP) measurement, transthoracic echocardiography, and assessment of vascular compliance of large (C1) and small arteries (C2) using the HDI/Pulse Wave™ CR-2000 Research CardioVascular Profiling System (Hypertension Diagnostics Inc., Eagan, MN, USA). The subjects were divided into three groups: group I - LDL-C < 2.6 mmol/L, group II - LDL-C ≥ 2.6 mmol/L and < 4.0 mmol/L, and group III - LDL-C ≥ 4.0 mmol/L. RESULTS There were no intergroup differences with regard to smoking status (p = 0.56), serum glucose concentration (p = 0.13), body mass index (p = 0.96), systolic (p = 0.17) and diastolic BP (p = 0.29), or C1 (p = 0.09). However, C2 was higher in groups I and II than in group III (5.12 ± 2.57 vs. 5.18 ± 2.75 vs. 4.20 ± 1.58 mL/mmHg × 100, respectively, p < 0.01). Multivariate regression analysis negated the independent associations between C1 and serum lipid levels. In contrast, C2 was independently inversely associated with serum LDL-C concentration (r = -0.15, p < 0.01). CONCLUSIONS Higher serum LDL-C concentration seems to contribute independently to stiffening of small arterial vasculature in otherwise healthy adults. Screening for dyslipidaemia in the general population and its prompt treatment are highly recom-mended.

Socioeconomic status and cardiovascular risk SCORE

BACKGROUND Cardiovascular diseases (CVD) are one of the most frequent causes of morbidity and death both in men and women. The influence of the following factors on the occurrence and progression of atherosclerosis is well known: hyperten-sion, hypercholesterolaemia, tobacco smoking, obesity, diabetes, age, and sex. As well as the typical risk factors of CVD, there is also a significant association between the incidence of those diseases and socioeconomic status (SES). AIM The aim of this study was to establish the correlation between SES status and CVD risk assessed according to the SCORE algorithm. METHODS The study encompassed 516 participants (207 men and 309 women) aged 40-74 years, who had never been diagnosed with any CVD. The SES was calculated by multiplying the patients education and net monthly income. The cor-relation between the SES and SCORE was established using linear and logistic regression analysis. RESULTS After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p = 0.006) and in the mens group (p = 0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55-59-year-olds (p = 0.011), 60-64-year-olds (p = 0.014), and 65-69-year olds (p = 0.034). A similar relationship was established in men aged 65-69 years (p = 0.038) and women aged 40-44 years (p = 0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being ≥ 10% were becoming smaller along with the increase in the SES index value in the entire group (p = 0.048) and in the mens group (p = 0.011). The odds ratio (OR) for the SCORE risk value being ≥ 10% depending on the SES index value was OR = 0.978 (95% confidence interval [CI] 0.956-0.999) in the entire group and OR = 0.964 (95% CI 0.938-0.992) in men. Furthermore, we also established that the risk of SCORE ≥ 5% decreased with the increase in the SES index value in the womens group (OR = 0.970; 95% CI 0.941-0.999; p = 0.042). CONCLUSIONS 1. We demonstrated a statistically significant correlation between the SES and the CVD risk assessed according to the SCORE algorithm. 2. The value of the CVD risk according to SCORE was inversely correlated with SES status.

How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition

BACKGROUND Socioeconomic status (SES) is an important factor of cardiovascular diseases (CVD) development. A decline in death from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk between socioeconomic classes in Poland, a country currently in transition. METHODS A sample of 15200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001-2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). RESULTS Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower HDL-cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49-0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67-0.99; p = 0.04). CONCLUSIONS SES is an independent predictor of high cardiovascular (CV) risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.