Wiesław Bryl

Blood Antioxidant Status, Dysglycemia and Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) patients present increased cardiovascular morbidity and mortality. Oxidative stress is involved in OSA and cardiovascular pathology. The aim of the study was to assess oxidative stress markers in the blood of OSA males during oral glucose tolerance test (OGTT). The study involved OSA-suspected obese males (BMI ≥ 25 kg/m(2)) aged 35-64, with no acute or chronic disorders, appointed for polysomnography to diagnose OSA (AHI ≥ 5). The results of OGTT allowed to select prediabetic (Pre) subjects and normal glucose tolerance (N), excluding newly diagnosed diabetes. Blood was collected at 0 min (fasting) and 120 min of the test. Plasma glucose, total antioxidant status (TAS), thiobarbituric acid-reacting substances (TBARS), and activity of superoxide dismutase-1 (SOD) in erythrocytes, were determined at the two time points and the difference (D) between the 120 and 0 min time points was calculated for either oxidative stress variable (D-TAS, D-SOD and D-TBARS). Fasting serum insulin and lipids also were measured fasting. There were four groups of subjects, each consisting of 22 individuals N-OSA-neg(ative), N-OSA-pos(itive), Pre-OSA-neg and Pre-OSA-pos. The N-OSA-pos and Pre-OSA-pos subjects demonstrated decreased SOD-0 compared with OSA-negative groups. In N-OSA-neg and N-OSA-pos groups, the positive differences D-SOD and D-TAS were observed, while Pre-OSA subjects presented negative differences. In conclusion, prediabetic OSA patients may consume blood antioxidant factors to counter the effects of oxidative stress, more than individuals with normal glucose tolerance.

Aliskiren - an alternative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the therapy of arterial hypertension.

There has been enormous progress in antihypertensive therapy over the last few decades. However, the management of arterial hypertension is still insufficient and more efforts are needed to improve both non-pharmacological and pharmacological treatment of this widely prevalent disease. Renin-angiotensin-aldosterone system (RAAS) inhibition is crucial both for blood pressure (BP) control and for prevention of organ damage or its development in patients with hypertension. Angiotensin-converting enzyme inhibitors and/or sartans block RAAS incompletely. Aliskiren is one of the novel drugs that has been introduced to antihypertensive therapy recently. Up to now no trial has confirmed that aliskiren is efficacious in reducing cardiovascular events. Double RAAS blockade with aliskiren was not always safe. This review article presents the current view on the place of aliskiren in the therapy of arterial hypertension.

The way of serum chromium utilization may contribute to cardiovascular risk factors in centrally obese persons

Introduction Obesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons. Material and methods Fourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0’, G 120’), serum insulin (Ins 0’, Ins 120’) and chromium (Cr 0’, Cr 120’) were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = [(120’ concentration) – (0’ concentration)] was calculated. Contradictory tendencies of Cr 120’ were observed; thus the difference of serum chromium concentrations, DCr = [(Cr 120’) – (Cr 0’)], was used to establish the positive DCr group with DCr > 0 (PosDCr: n= 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n= 24; 8 male/16 female). Results The studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120’ (p= 0.043) and DG (p = 0.048), and lower Cr 120’ (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0’ and systolic and diastolic blood pressure. Conclusions We suggest that the studied centrally obese persons differed in chromium metabolism. In subjects “consuming” Cr during the OGTT, chromium status may be associated with increased risk for CVD.

Managing metastatic bone pain: New perspectives, different solutions

Bone metastases are the most frequent cause of cancer-induced bone pain (CIBP). Although palliative radiotherapy and pharmacotherapy conducted according to World Health Organization (WHO) analgesic ladder are the treatment of choice for CIBP reduction, these methods are not always successful, especially with regard to alleviation of incidental pain. Antiresorptive drugs (bisphosphonates) are able to inhibit bone destruction (loss), proliferation of cancer cells and angiogenesis, but their prolonged use may lead to a spectrum of adverse effects. In this paper, types of bone metastases, their complications, as well as diagnostic and therapeutic implications are presented. Moreover, the paper discusses presently used CIBP treatment methods and research directions for future methods, with special focus on bone metastases.

Economic aspects of hypertension treatment in Poland.

Introduction The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B). Material and methods The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated. Results The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient. Conclusions The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.

The Relationship between Serum Apelin Concentration and Selected Anthropometric Parameters, Serum Lipids and Carotid Intima-Media Thickness in Young Subjects with Primary Arterial Hypertension

Objective: Apelin and its specific receptor, APJ system, seems to be involved in the development of arterial hypertension (HTN). The aim was to estimate plasma apelin concentration in young patients (pts) with primary HTN and to assess the relationship between apelin and selected anthropometric parameters, serum lipids and carotid intima-media thickness (right and left cIMT). Methods: 70 pts (48 males, 22 females) aged 18-33 with newly diagnosed, untreated primary HTN were recruited. There were 15 age- and gender-matched healthy people in the control group. Anthropometric and BP measurements were done. Fasting serum apelin and lipids were evaluated. The cIMT was estimated using ultrasonography. Results: Serum apelin was higher in whole group (but not statistically significant, 98.04 ± 51.82 vs. 79.19 ± 39.51 pg/ml, p >0.05) and in males with HTN (compared to healthy males, 105.86 ± 53.21 vs. 61.42 ± 24.04 pg/ ml, p= 0.04). We observed a statistically significant negative correlation between apelin concentration and left cIMT in normal-weight women (R = -0.74), a negative correlation between triglyceride levels and apelin concentration in overweight subjects (R = -0.49), a negative correlation between apelin concentration and right cIMT (R = -0.99) and a positive correlation between apelin concentration and WHR (R = 0.99) in obese women. Conclusion: In whole examined group with HTN there were no statistically significant differences in serum apelin and no relationships between its concentration and anthropometric parameters, serum lipids or cIMT. However, higher serum apelin concentration in young males with HTN and some statistically significant correlations between serum apelin and analyzed parameters in groups divided by sex and BMI may suggest a possible role of apelin in the development of HTN. Further studies are required to clarify the relationship between apelin, metabolic parameters and the early markers of atherosclerosis in pts with HTN.