Lucjan Pawlicki

Statin therapy in the elderly: a review.

Cardiovascular morbidity is the leading cause of mortality in the developed nations. Elevated serum cholesterol is a major risk factor for ischemic heart disease, one of the common cardiovascular morbidity in older adults, statins have been shown to be effective in reducing serum cholesterol and improving outcomes. Hypercholesterolemia is common in older adults and is one of the major modifiable risk factors. Yet, these patients have often been excluded from major clinical trials of statins and evidence suggests of their underuse. Data from recent clinical trials of statins indicate that the elderly patients with the highest cardiovascular risk are likely to derive the most benefits from cholesterol lowering. With the aging of the population, the prevalence of hypercholesterolemia and cardiovascular morbidity is likely to increase. In this review we evaluate the evidence for the use of statins in older adults.

Plasma Endothelin-1 Levels in Septic Patients

Dysfunction of the vascular endothelium (ET) causes an increase in serum ET-1 concentration, as observed in septic patients. It was assumed that in this patient population the ET-1 level correlates with the degree of sepsis severity, including the level of organ dysfunction and, in particular, the level of circulatory dysfunction. The aim of the present study was to assess the relationship between levels of ET-1 and levels of N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT), and C-reactive protein (CRP), as well as the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients. PCT and CRP were used to estimate the level of sepsis severity; the SOFA score was used to estimate multiorgan dysfunction; and NT-proBNP was used as a marker of cardiac dysfunction. Twenty patients with sepsis and severe sepsis were included in the study. Blood serum ET-1, NT-proBNP, PCT, and CRP concentrations were determined at specific time intervals, and the SOFA score was calculated. Mean ET-1, NT-proBNP, PCT, and CRP concentrations were 8.39 pg/ml ± 6.39 pg/mL, 140.80 pg/mL ± 84.65 pg/mL, 22.32 ng/mL ± 97.41 ng/mL, and 128.51 mg/L ± 79.05 mg/L, respectively. Correlation between ET-1 levels and levels of NT-proBNP, PCT, and CRP was .3879 (P < .001), .358 (P < .001), and .225 (P = .011), respectively. Mean SOFA score was 6.31 pts ± 3.75 pts. Correlation between the ET-1 levels and SOFA score was .470 (P < .001). Six patients (30%) died during the observation period of 28 days. ET-1 levels correlate with levels of NT-proBNP, PCT, and CRP, as well as the SOFA score in septic patients.

Plasma Total Antioxidant Activity in Comparison With Plasma NO and VEGF Levels in Patients With Metabolic Syndrome

Introduction: The aim of our study was to estimate plasma antioxidant activity as well as plasma nitric oxide (NO) and vascular endothelial growth factor levels in patients with metabolic syndrome compared with healthy participants. Material and Methods: Fifty patients (24 women and 26 men, mean age 55.9 + 11.8 years) with metabolic syndrome were compared with 25 healthy participants (12 women and 13 men, mean age 54.2 + 12.8 years). Plasma total antioxidant activity and plasma levels of NO and VEGF were determined in all participants. Results: In the patients with metabolic syndrome, plasma total antioxidant activity, nitric oxide, and vascular endothelial growth factor were significantly lower (P < .001) than that observed in healthy participants (3.2 + 1.6 vs 6.4 + 2.1 mM/L), (6.3 + 2.2 vs 9.8 + 2.7 μM/L), and 71.0 + 16.9 vs 137.5 + 12.6 pg/mL), respectively. Conclusions: Decreased plasma total antioxidant activity, NO, and VEGF levels in patients with metabolic syndrome reflect significant endothelial dysfunction. This suggests that oxidation—reduction balance disorders might play an important role in this process

Atrial and brain natriuretic peptide and endothelin-1 concentration in patients with idiopathic arterial hypertension: The dependence on the selected morphological parameters

Introduction. The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH). Methods. Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2—control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis. Results. A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH. Conclusions. Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important—especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.

The concentration of uric acid in patients with metabolic syndrome and cardiovascular diseases

The association of elevated serum uric acid (hyperuricemia, gout) with the presence of classical coronary risk factors and coronary artery disease (CAD) or myocardial infarction (MI) has been analysed in many epidemiological studies. Numerous studies have revealed that hypertension, high body mass index (BMI), lipid disorders (especially raised triglyceride (TG) levels and low high dense lipoprotein cholesterol (HDL-C) level), and increased creatinine or insulin levels have caused hyperuricemia. Gout has often occurred with typical disorders for the metabolic syndrome X. Significant correlation of the serum uric level and the CAD presence and severity of coronary atherosclerosis confirmed by coronary angiography has been observed in women. Hyperuricemia has also indirect influence on progress of CAD by physical activity restriction, what causes sedentary mode of life and lead to obesity. Therefore, we conducted our study in order to estimate uric acid levels in patients with metabolic syndrome and coexisting cardiovascular system diseases.

Body mass index and waist-to-height ratio among schoolchildren with visual impairment: A cross-sectional study.

AbstractChildren and adolescents with visual impairments may be predisposed to excessive body mass due to restrictions in everyday functioning and the ability to take part in physical activity. This study aimed to estimate the prevalence of obesity, overweight, and abdominal obesity (AO) among blind and partially sighted schoolchildren and to determine whether sociodemographic factors and participation in physical education classes (PEC) are associated with excessive body weight or AO in this group.A cross-sectional sample of 141 partially sighted or blind schoolchildren aged 7 to 18.9 years were included in this study. Anthropometric measurements were performed, and sociodemographic variables and ability to attend PEC were recorded. Overweight and obesity were noted among 21.3% and 14.9% of students, respectively. Although more males than females had excessive body weight (39.2% vs 32.3%), the difference was not significant (chi square test [ch2] = 3.197; probability value [P] = 0.362). There was a significant association between mean body mass index standard deviation score and age (results of ANOVA analysis [F] = 5.620; P = 0.0045). A waist-to-height ratio (WHtR) ≥0.50 was observed among 27.7% of pupils. The prevalence of AO in boys and girls was 32.9% and 21.0%, respectively; this difference was not significant (ch2 = 2.48; P = 0.12). There was a significant relationship between mean WHtR and age (7–9 years: 0.477 ± 0.050; 10–13 years: 0.484 ± 0.065; ≥14 years: 0.454 ± 0.061; results of Kruskal–Wallis test [H] = 8.729; P = 0.023, respectively).Multivariate logistic regression analysis showed that none of the sociodemographic variables examined (except “having siblings”) were significantly associated with the occurrence of overweight, obesity, and AO. Subjects with no siblings were 4 times more likely to have WHtR ≥ 0.5 (odds ratio [OR] = 4.22; 95% confidence interval [CI] = 1.33–17.8; P = 0.01).Overweight and obesity were almost 4 times more frequent (OR = 3.74; 95% CI 0.81–17.4) and AO 3 times more frequent (OR = 3.18, 95% CI 0.71–14.2) among students not participating in PEC. Excessive body mass and AO represent an urgent health problem among schoolchildren with visual impairments. Health education concerning healthy eating habits and physical activity should be provided to this group to reduce potential future health costs.

Cardiac rehabilitation improves the blood plasma properties of cardiac patients

Cardiac rehabilitation (CR) improves exercise tolerance and general function. However, its effects on blood plasma in cardiac patients remain uncertain. Our aim was to examine the effect of comprehensive CR on the oxidative stress parameters and antioxidant plasma status in patients with coronary artery disease (CAD) after cardiac interventions. Exercise-based rehabilitation was established as ergometer training, adjusted for individual patients’ physical efficiency. Training was repeated three times a week for two months. The standard biochemical (total cholesterol, HDL, LDL, triglycerides and erythrocyte sedimentation rate) and metabolic parameters (peak oxygen uptake [VO2] and peak workload) were determined. We assessed plasma viscosity, lipid peroxidation, carbonyl compounds levels, glutathione (GSH) and ascorbate (ASC) levels and the non-enzymatic antioxidant capacity of plasma in 12 patients with CAD before and after CR. Parameters were examined before exercise, immediately after exercise, and 1 h later. We also compared morphological and biochemical parameters of blood, as well as other parameters such as heart rate and blood pressure (resting and exercise), VO2max and peak workload (W) before and after CR. Before CR, a significant decrease in GSH concentration was observed 1 h after exercise. Conversely, after CR, GSH, and ASC levels remained unchanged immediately after exercise. However, ASC increased after CR after exercise and 1 h later in comparison to before CR. There was a significant increase in ferric reduction ability of plasma immediately after exercise after CR, when compared with before CR. CR improved several blood biochemical parameters, peak VO2, induced an increase in systolic blood pressure peak, and patients’ peak workload. After CR, improvements were detected in oxidative stress parameters, except in the level of carbonyls. These changes may contribute to the increased functional heart capacity and better tolerance to exercise and functional capacity of the patients. These improvements could indicate better prognosis of future cardiac events and hospitalization and better quality of life.