scholarly journals Independent cardiovascular risk factors: hyperhomocysteinemia and vascular stiffness in patients with hypertension

HYPERTENSION ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 5-16
Author(s):  
O.L. Rekovets ◽  
Yu.M. Sirenko ◽  
O.O. Torbas ◽  
S.M. Kushnir ◽  
H.F. Prymak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Arterial Stiffness ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate

Background. Identification of risk factors and preliminary assessment of overall cardiovascular risk in patients with hypertension is the most important task in clinical practice. Most patients, in addition to high blood pressure (BP), have other cardiovascular risk factors that aggravate each other, leading to an increase in overall cardiovascular risk. One of the cardiovascular risk factors is an increased arterial stiffness. Arterial stiffness is evaluated using pulse wave velocity (PWV). The other independent risk factor for cardiovascular diseases is elevated level of total homocysteine in the blood. The purpose was to evaluate the relationship between hyperhomocysteinemia (HHc) and vascular stiffness in patients with hypertension. Materials and methods. Our research was carried out as a part of the ХІПСТЕР trial in Ukraine. The study included 40 patients with hypertension stage 1 and 2 (average office systolic (SBP)/diasto-lic blood pressure (DBP) was 155.88/92.60 ± 1.63/1.43 mmHg, heart rate — 71.40 ± 1.29 bpm). The average age of the patients was 55.85 ± 2.09 (26–74) years. Individuals with homocysteine levels ≥ 10 μmol/l were referred to as those with HHc (H-type hypertension). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % of patients (30 individuals with mild and moderate hypertension) had H-type hypertension with an increased level of homocysteine. Patients with H-type hypertension (HHc) and hypertension without HHc did not differ in terms of age, duration of hypertension. At the same time, patients with H-type hypertension had higher body weight and body mass index. Office SBP in patients with H-type hypertension at baseline and after 6 months of treatment was higher compared to patients without HHc (156.45 ± 1.04 mmHg and 152.55 ±1.41 mmHg (p < 0.05) at baseline vs 130.65 ± 0.96 mmHg and 126.97 ± 1.08 mmHg (p < 0.05) in 6 months). At the beginning of the study, body mass index was 30.72 ± 0.39 kg/m2 in patients with H-type hypertension vs 28.34 ± 0.69 kg/m2 in those without HHc (p < 0.05). Patients with H-type hypertension less often achieved target blood pressure levels during treatment and initially had higher blood pressure values. Individuals with H-type hypertension compared to patients without HHc had a more severe insulin resistance (according to the homeostatic model assessment), lower glomerular filtration rate, both at baseline and by the end of treatment. According to ambulatory blood pressure monitoring data, before the start of treatment, patients with H-type hypertension compared to those with hypertension without HHc had a significantly higher SBP level. After regression analysis, homocysteine level was associated with PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, b = 0.307, P = 0.001). Conclusions. Male gender, body mass index, glomerular filtration rate, blood glucose, office and central blood pressure were associated with elevated serum homocysteine levels.

scholarly journals Risk Factors for Cardiovascular and Renal Disease in Type 2 Diabetes Mellitus in Patients with Normal and Mildly Reduced Glomerular Filtration Rate

2021 ◽  
Vol 18 (2) ◽  
pp. 61-68
Author(s):  
Marcel Stoiţă ◽  
Amorin Remus Popa
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate

Abstract In this study are investigated the cardiovascular risk factors that as shown in literature also represent risk factors for early glomerular function alteration in type 2 diabetes mellitus patients. The patients were divided according to their glomerular filtration rate in 2 groups, one group of patients with GFR ≥90 mL/min/1.73 m (118 patients) and the other with GFR between 60-89 mL/min/1.73 m2 (126 patients). Older age, hypertension, poor glycemic control, increased BMI, high LDL-cholesterol, high triglyceride level, insulin resistance and high level of apolipoprotein-B appeared to be more prevalent in patients with type 2 diabetes mellitus with mildly reduced kidney function. Even patients with mildly reduced GFR (without confirmed diabetic kidney disease) have an important aggregation of cardiovascular risk factors and their early identification is important for controlling them in order to further prevent glomerular decline.

scholarly journals Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania

2016 ◽  
Vol 62 (2) ◽  
pp. 225-229
Author(s):  
Carmen Denise Caldararu ◽  
Dorin Tarta ◽  
Raluca Pop ◽  
Mirela Gliga ◽  
Emilian Carasca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate ◽  
Overweight And Obesity ◽  
The Relationship

AbstractObesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors.Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 - December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

Abstract P047: Relation of Body Mass Index to Creatinine Clearance and Glomerular Filtration Rate in Japanese Population Samples in Japan and Hawaii

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Naomi Kitano ◽  
Katsuyuki Miura ◽  
Akira Okayama ◽  
Hideaki Nakagawa ◽  
Kiyomi Sakata ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Glomerular Filtration Rate ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate ◽  
Urine Volume ◽  
Total Serum ◽  
Central Laboratory

Background: Obesity is an established risk factor for hypertension and end stage kidney disease. There is little information on how obesity relates to risk of impaired renal function in apparently healthy individuals. We investigated associations of body mass index (BMI) with timed 24-hour creatinine clearance (Ccr) and glomerular filtration rate (GFR) in the cross-sectional population-based INTERLIPID Study, ancillary study of the International Study on Macro- and Micro-Nutrients and Blood Pressure (INTERMAP). Methods: INTERLIPID participants ages 40-59 y from 5 INTERMAP research samples (4 Japanese and 1 Hawaiian) were investigated. Participants were ethnically all Japanese. Two timed 24-hour urine specimens were collected by each participant and analyses were performed in a central laboratory. Values of serum creatinine (Scr) were assayed by Jaffe’s method in a Japanese central laboratory. Data were analyzed from 1,338 Japanese, 570 men and 563 women in Japan, 100 men and 105 women in Hawaii. Measures of kidney function were 24-hour Ccr (ml/min) and GFR (ml/min/1.73m 2 ). Ccr was calculated by equation (urine creatinine х urine volume)/(Scr х 1440); GFR was calculated as Ccr х (1.73/body surface area (BSA)). BSA was estimated by the DuBois formula. In addition, estimated GFR (eGFR) was calculated by use of the Modification of Diet in Renal Disease (MDRD) Study equation, 186 х Scr -1.154 х age -0.203 х 0.742 (if female). All statistical analyses were stratified by gender. Adjusted mean values of Ccr, GFR, and eGFR in quartiles of BMI were estimated using analysis of covariance. Model 1 was adjusted for age; model 2, for age and urine volume; model 3 for variables in model 2 plus blood pressure, pulse rate, physical activity, smoking habit, alcohol consumption, urinary sodium excretion, HbA1c, and total serum cholesterol. Results: Ccr (mean (SD)) were 107.5 (18.9) in men in Japan, 91.9 (17.0) in women in Japan, 123.4 (25.1) in men in Hawaii, and 98.5 (20.3) in women in Hawaii. BMI quartile ranges were in men Q1 16.8-22.3, Q2 22.3-24.1, Q3 24.1-26.1, and Q4 26.1-42.9; in women Q1 15.9-21.2, Q2 21.2-23.0, Q3 23.0-25.1, and Q4 25.1-47.0. In men, BMI was positively related to multivariate-adjusted Ccr and GFR ( P for trend across BMI quartiles <0.001 and <0.001, respectively), however, multivariate-adjusted eGFR was inversely associated with BMI ( P for trend 0.001). In women, BMI was positively related to multivariate-adjusted Ccr ( P for trend across BMI quartiles <0.001); multivariate-adjusted GFR and eGFR were not significantly associated with BMI. Interactions between age and BMI were not significant in men or women. Conclusions: These results indicate that excess BMI may lead to higher Ccr, and that the MDRD equation may underestimate GFR in middle-aged overweight or obese Japanese men.

scholarly journals Prevalence of obesity and cardiovascular risk among children and adolescents in the municipality of Santa Cruz do Sul, Rio Grande do Sul

2013 ◽  
Vol 131 (5) ◽  
pp. 323-330 ◽  
Author(s):  
Cezane Priscila Reuter ◽  
Leandro Tibirica Burgos ◽  
Marcelo Dias Camargo ◽  
Lia Goncalves Possuelo ◽  
Miriam Beatris Reckziegel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Waist Circumference ◽  
Children And Adolescents ◽  
Cardiovascular Risk Factors ◽  
Diastolic Blood Pressure ◽  
Body Mass ◽  
High Prevalence

CONTEXT AND OBJECTIVE: Studies have demonstrated that metabolic complications from child obesity, although silent, increase the risk of development of cardiovascular diseases in adulthood. The present paper sought to describe the prevalence of overweight/obesity and analyze the possible relationship between obesity and other cardiovascular risk factors among children and adolescents. DESIGN AND SETTING: Cross-sectional study, conducted in a university. METHODS: The study included 564 children and adolescents, aged 8 to 17 years. Body mass index and waist circumference were used to evaluate obesity. Other cardiovascular risk factors were evaluated, like systolic and diastolic blood pressure, glycemia, triglycerides and total cholesterol. Descriptive analysis was used for sample characterization, the chi-square test for categorical variables and Pearson's linear correlation for evaluating the relationship between obesity indicators and other cardiovascular risk factors. RESULTS: High prevalence of overweight/obesity was found among the schoolchildren (25.3% among the boys and 25.6% among the girls), along with abdominal obesity (19.0%). The overweight/obese schoolchildren presented higher percentages for the pressure and biochemical indicators, compared with underweight and normal-weight schoolchildren. Body mass index and waist circumference showed a weak correlation with the variables of age and systolic and diastolic blood pressure (P < 0.001), but there was no correlation between these obesity indices and biochemical variables. CONCLUSION: The high prevalence of overweight/obesity and its relationship with other cardiovascular risk factors demonstrate that it is necessary to develop intervention and prevention strategies from childhood onwards, in order to avoid development of chronic-degenerative diseases in adulthood.

scholarly journals The absence of standard modifiable cardiovascular risk factors does not predict better outcomes in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.I Gonzalez Del Hoyo ◽  
O.M Peiro Ibanez ◽  
K Vaquez-Nunez ◽  
F Dominguez Benito ◽  
M Ferrero ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Cox Regression ◽  
Coronary Syndrome

Abstract Introduction The standard modifiable cardiovascular risk factors (SMuRFs), like diabetes mellitus, hyperlipidemia,hypertension and smoking, are central elements of the well-established European Society of Cardiology SCORE calculator. However, acute coronary syndromes (ACS) in SMuRF-less individuals are not uncommon. Purpose Our study aimed to describe the population with and without SMuRFs attended for an ACS and study prognostic factors associated with mortality. Methods We identified 1347 ACS patients without prior history of cardiovascular disease (ACS, cerebrovascular or peripheral artery disease)attended in our university hospital between 2009 and 2012 and examined the proportion of SMuRF-less patients as well as outcomes.The primary outcome was 5-year all-cause death. Results Overall, the median age was 63 years, 73.4% were male and 52 patients (7%)had no SMuRFs. The most common SMuRF was hypertension (60%), followed by smoking (47%), dyslipidemia (48%) and diabetes mellitus (27%). In patients with and without SMuRFs there were no differences in the proportion of females (27% vs 28%), age (63.7 years [IQR 54–75] vs 62 years [IQR 53–71]), renal failure (4.7% vs 0%, p=0.159), prior heart failure (1.6% vs 1.9%, p=0.590) and pulmonary obstructive disease (11.3% vs 9.6%, p=0.707). SMuRF-less patients had substantially less angina in the previously month (1.9% vs 19.1%, p&lt;0.001), were less treated previously with aspirin (3.9% vs 18.9%, p=0.006), betablockers (5.8% vs 16.6%, p=0.039)and ACEI/ARAII (0% vs 38.1%, p&lt;0.001). Patients with SMuRFs presented significantly more frequently with a NSTEMI (63.1% vs 48.1%) and less frequently with STEMI (32.3% vs 44.2%) or a non-classifiable ACS (2.7% vs 7.7%), compared to those without SMurFS. In patients with and without SMuRFs, there were no significant differences in Killip I class (95.4% vs 98%, p=0.370)and GRACE risk score (105 vs 103, p=0.694). Patients with SMuRFS compared to those without had a higher systolic blood pressure (141 mmHg vs 131 mmHg, p=0,03) and a lower glomerular filtration rate (81.8 ml/min/m2 vs 94 ml/min/m2, p=0.04). There were no differences in those with and without SMuRFs in performance of angiography (83% vs 90%, p=0.160), but SMurF-less patients had lower proportion of multivessel disease (18.6% vs 38.2%, p=0.011), higher tendency to percutaneous angioplasty (70.6% vs 57.8%, p=0.073) or performance of CABG (6.1% vs 1.1%, p=0.028).At 5-year follow up (IQR 3–7),SMuRF-less patients had a lower mortality (11.5% vs 23.4%, p=0.049).On multivariable Cox Regression age, chronic renal failure, glomerular filtration rate and GRACE score were independent predictors of death. Coronary angioplasty was a strong protective risk factor of death.However, being SMuRF-less was not protective against mortality. Conclusion The absence of SMuRFs was not an independent predictor of mortality. Our study highlights the importance of the often-overlooked subgroup of ACS patients with atherosclerosis not predicted by SMuRFs. Funding Acknowledgement Type of funding source: None

scholarly journals Association between genetic determinants of clopidogel metabolism and clinical cardiovascular risk indicators in Buryat patients

2019 ◽  
Vol 23 (3) ◽  
pp. 39
Author(s):  
E. M. Zelenskaya ◽  
K. Y. Nikolaev ◽  
O. S. Donirova ◽  
V. D. Altayev ◽  
K. V. Protasov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Conflict Of Interest ◽  
Filtration Rate ◽  
Coronary Syndrome ◽  
Polymorphic Variants

<p><strong>Background. </strong>In some patients, the metabolism of clopidogrel is altered because of the presence of polymorphic variants rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17) in the <em>CYP2C19 </em>gene. There is also evidence of decreased efficacy of clopidogrel in individuals with the T/T genotype in the variant rs2305948 of the <em>VEGFR-2 </em>gene. Nevertheless, this medication is used widely in Russia due to the availability of generic anticoagulants.</p><p><strong>Aim. </strong>To assess the prevalence of the following polymorphic variants of <em>CYP2C19</em>: rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17); assess the prevalence of the rs2305948 variant of <em>VEGFR-2</em>, and determine cardiovascular risk factors in patients of Buryat nationality.</p><p><strong>Methods. </strong>The study included 113 patients of Buryat nationality who underwent coronary stent placement due to acute coronary syndrome. Patients were stratified by the presence of the following alleles: <em>CYP2C19 </em>* 2, *3, *17 and <em>VEGFR-2 </em>rs2305948. The following laboratory parameters were measured for all patients: blood glucose, lipid spectrum, creatinine, and glomerular filtration rate. The severity of coronary atherosclerosis was evaluated.</p><p><strong>Results. </strong>The frequencies of the alleles and halotypes (<em>CYP2C19 </em>* 2, * 3 and *17) were determined. An association between the carriage of the C/C genotype in rs2305948 and a &lt;60 ml/min/1.73 m<!-- x-tinymce/html --><sup>2</sup> decrease in glomerular filtration rate (χ<!-- x-tinymce/html --><sup>2</sup> = 4.185, p = 0.032) were found. Additionally, the C/C genotype in rs2305948 was associated with higher blood pressure (χ<!-- x-tinymce/html --><sup>2</sup> = 12.593, p = 0.001). For men, we identified a positive correlation between the rs2305948 C/C allele and the number of significant coronary stenoses (R = 0.227, p &lt; 0.05).</p><p><strong>Conclusion. </strong>Among Buryat patients with acute coronary syndrome and percutaneous coronary intervention, the CYP2C19*2,*3 polymorphic variants were associated with a 46.0% decrease in the metabolic rate for clopidogrel. Furthermore, we identified several associations between the C/C genotype in the rs2305948 variant of VEGFR-2 with a number of cardiovascular risk factors.</p><p>Received 2 September 2019. Revised 24 October 2019. Accepted 30 October 2019.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><strong></strong></p><p>Conception and study design: V.D. Altayev, K.V. Protasov, G.I. Lifshits</p><p>Data collection and analysis: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. Lifshits</p><p>Drafting the article: Е.М. Zelenskaya</p><p>Critical revision of the article: Е.М. Zelenskaya</p><p>Final approval of the version to be published: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. Lifshits</p>

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