Maria Pia Costa

High circulating levels of cytokines (IL-6 and TNFa), adhesion molecules (VCAM-1 and ICAM-1) and selectins in patients with peripheral arterial disease at rest and after a treadmill test:

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis that is associated with systemic inflammation. The aim of our study was to assess whether plasma markers of inflammation increased after exercise in patients with PAD. The study was conducted on two groups of 20 subjects each: one group (mean age 68.4 6 5.09 years) was affected by PAD with claudication, while the other group consisted of healthy controls (66.9 6 6.1 years). Concentrations of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNFa) were determined in plasma, in supernatants and in cells stimulated with 1 mg lipopolysaccharide in all patients. E-selectin (ES), L-selectin (LS) and P-selectin (PS) concentrations and plasma concentrations of VCAM-1 and ICAM-I were also determined. All determinations were performed in patients at rest and after the treadmill exercise. Resting values of soluble mediators were greater in PAD patients than in controls. They increased in both groups after the treadmill test, even if post-treadmill concentrations were signifi cantly higher in PAD patients (PAD p < 0.001 or 0.0001, controls p < 0.05 or 0.001). These results confi rm that white blood cell activation is characteristic of systemic atherosclerosis and that these inflammation markers increase in conditions of hemodynamic stress.

Duration of menopause and behavior of malondialdehyde, lipids, lipoproteins and carotid wall artery intima-media thickness

AIM our study assessed whether minor or major hormonal deficiency influenced oxidative status and vascular wall structure in menopausal women. METHODS the study series was made up of 62 non hypertensive non diabetic menopausal women (mean age 52.3+/-4.7 years) divided into two groups depending on duration of menopause (group 1 duration 0-5 years; group 2 duration over 5 years). Total cholesterol (TC), LDL cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), malondialdehyde (MDA) and common carotid artery wall intima-media thickness (IMT) were determined in the entire series. RESULTS mean TC, LDL-C, TG, MDA and IMT values were higher in group 2 than group 1. The intergroup difference between MDA (P<0.007) and IMT values (P<0.006) values was statistically significant. CONCLUSIONS the study revealed a close temporal correlation between plasma oxidative stress and carotid wall IMT, jeopardizes vascular wall status as menopause proceeds.

Oxidative stress and endothelial damage in patients with asymptomatic carotid atherosclerosis.

Abstract It is know that oxidative stress can be able to induce cytotoxicity of blood cells, stimulate release of inflammatory cytokines, and induce the production of growth factors. The aim of this study was to investigate oxidative stress and endothelial dysfunction in patients with asymptomatic carotid artery disease and healthy controls. Native low-density lipoproteins, oxidised low-density lipoproteins, malondialdehyde, nitrates, glutathione peroxidase activity and endothelin-1 were determined in patients without severe (range between 30% and 50%) carotid artery stenosis. Native low-density lipoproteins, oxidized low-density lipoproteins, malondialdehyde, glutathione peroxydase, and endothelin-1 concentrations were higher in patients than in health controls (P<0.001). No difference was observed in nitrate values (P<0.8). Our results revealed oxidative stress in patients without severe carotid artery stenosis and clinical symptoms. This was shown by the elevated malondialdehyde and oxidized low-density lipoprotein levels.

Efficacy of L-Propionyl Carnitine in the Treatment of Chronic Critical Limb Ischaemia

ObjectiveTo compare the therapeutic benefits of L-propionyl carnitine (LPC) with those of pentoxifylline in the clinical treatment of patients with chronic critical limb ischaemia.DesignRandomised, single-blind study.Patients188 patients, 85 with a recent (within the previous 15 days) reduction in pain-free walking distance (PWD), 59 with rest pain lasting for ≥2 weeks, and 44 patients with skin ulcers that had appeared during the previous 15 days.InterventionsIntravenous infusion with LPC 1.2 g/day or pentoxifylline 1.2 g/day In both groups, patients also received calcium heparin 25 000 U/day (12 500U twice daily) subcutaneously. Treatment duration was 2 weeks.Main Outcome Measures and ResultsWith both treatments, an increase in the PWD, a reduction in the use of analgesics for pain relief and a reduction in the diameter (in cm) of skin ulcers were observed; all changes were significant versus baseline for both groups. However, a statistically significant difference was observed between the results obtained with LPC and those obtained with pentoxifylline, which was in favour of LPC. Mean PWD increased by 78% in the LPC group vs 30% in the pentoxifylline group (p < 0.001), mean pain score decreased by 83 vs 46% (p < 0.001), and mean ulcer size decreased by 48 vs 25% (p < 0.001).ConclusionsLPC, which has already been shown to produce beneficial effects in the treatment of the chronic phase of peripheral vascular disease, was also found in this study to have greater effects in delaying disease progression than pentoxifylline, a drug that has been extensively tested for this indication. LPC, therefore, appears to be a promising treatment option in patients with peripheral arterial disease and should be further explored in large randomised, long-term controlled trials.

Effects of long-term hormone replacement therapy on arterial wall thickness ,lipids and lipoproteins ,fibrinogen and antithrombin III

We aimed to study the effects of hormone replacement therapy (HRT) in menopausal women on lipoproteins ,blood coagulation ,arterial blood pressure and markers of atherosclerosis. A total of 186 postmenopausal women were studied; 98 used HRT (0.625 mg 17 β-estradiol plus 10 mg progestin) and were followed for 48 months ,and were matched with 98 women without therapy. Low-density lipoproteins ,high-density lipoproteins ,triglycerides ,antithrombin III ,systolic and diastolic arterial pressure and intima–media thickness were measured at 6 ,12 ,24 ,38 and 48 months. In users of HRT ,we found a significant reduction of the lipoproteins ,triglycerides ,systolic and diastolic pressures and intima–media thickness; however ,we found an increase in high-density lipoproteins and anthitrombin III in comparison with non-users. This study has shown a protective effect of HRT on such risk factors and on certain markers of atherosclerosis.

Behaviour of the carotid wall in menopausal women with and without arterial hypertension

OBJECTIVE A study was conducted on the carotid vascular wall to evaluate its behaviour in postmenopausal women suffering from arterial hypertension compared to normotensive postmenopausal women. METHOD Intima-media thickness(IMT) of carotid artery was determined by ecoduplex scanner in 182 postmenopausal women (age range 40-60 years) divided in four age classes (40-45, 46-50, 51-55, 55-60 years). Ninety-one women presented normal arterial blood pressure (SBP 136.6+/-11.7 and DBP 82.3+/-8.9 mmHg) and 91 were hypertensive (SBP 172.6+/-11.7 and DBP 97.4+/-6.6 mmHg). RESULTS The normotensive women presented the following IMT values: 1.19+/-0.21 mm (40-45 years), 1.21+/-0.25 mm (46-50 years), 1.25+/-0.20 mm (51-55 years), 1.25+/-0.20 mm (55-60 years). IMT values in hypertensive women were: 1.75+/-0.25 mm (40-45 years), 1.77+/-0.30 mm (45-50 years), 1.91+/-0.28 mm (51-55 years), 2.02+/-0.33 mm (55-60 years). ANOVA test was performed in both groups of women and did not show any significant difference in the four age classes of normotensive women. On the other hand it revealed a statistical significance between 40-45 and 46-50-year-old hypertensive classes (P<0.001) and between 51-55 and 55-60-year-old hypertensive clases (P<0.02). CONCLUSIONS There was a correlation between age and IMT in the arterial hypertensives, especially in two older classes, and between the duration of menopause and IMT values. The results indicated that carotid wall thickening was constantly higher in hypertensive women compared with normotensive ones.

Effects of a Micronized Flavonoid Fraction (Daflon 500) on the Clinical, Haemodynamic and Cytokine Alterations of Patients with Varicose Disease

The pathogenetic role performed by venous stasis and hypertension has long been emphatized (1,2 ) on the other hand a less importnace has been given to the performance of plasmatic cells, regarding the chronic venous insufficiency (C.V.I.).