scholarly journals Systemic endotoxinemia as a risk factor for atherosclerosis of extracranial brachiocephalic arteries

2020 ◽  
pp. 42-50
Author(s):  
Д.П. Покусаева
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Imaging Techniques ◽  
Experimental Studies ◽  
Diagnostic Procedures ◽  
Maximum Error ◽  
Primary Diagnosis ◽  
Incidence Rates ◽  
Wall Structure ◽  
High Tech

Факторы риска (ФР) развития атеросклероза многочисленны (более двухсот) и связаны с различными подходами к изучению атерогенеза. На уровне изменений в стенке артерии, ведущей является воспалительная концепция атерогенеза, которая находит своё развитие в эндотоксиновой теории атеросклероза, подтвержденной многочисленными экспериментальными исследованиями и клиническими наблюдениями. Однако существующие шкалы оценки риска развития сердечно-сосудистых заболеваний имеют максимальную погрешность для пациентов со средним уровнем риска, что приводит к проведению лишних диагностических процедур, или, наоборот, ведет к ложному занижению риска. Поэтому поиск новых ФР доклинического атеросклероза актуален, что и явилось целью нашего исследования. Материалы и методы. В исследовании участвовало 104 человека, относящиеся к одной группе риска (менее 1-4% по шкале SCORE), не предъявляющие жалоб на момент исследования, и считающие себя здоровыми. Нами были оценены такие показатели, с возможным их отнесением к ФР и применением в практике, как: уровень эндотоксина в плазме крови; уровень антител к гидрофобной и гидрофильной частям молекулы липополисахарида (АТ-ЛПС) в сыворотке. Результаты. Была выявлена значимая разница в концентрации и частоте встречаемости изученных показателей среди пациентов с разной степенью выраженности атеросклеротического поражения сонных артерий. При этом различий по показателям липидного профиля отмечено не было. Также было проведено динамическое наблюдение за лицами, у которых не было значимых изменений в образе жизни, через полтора года, и было выявлено, что только по показателям системной эндотоксинемии отличались обследованные с улучшением структуры стенки от остальных. Заключение. Таким образом, включение таких показателей, как уровень эндотоксина, концентрация АТ-ЛПС может помочь в прогнозировании состояния стенки сонных артерий и, соответственно, в изменении степени риска у пациентов на уровне первичной диагностики без участия высокотехнологичных дорогостоящих визуализирующих методик. Risk factors (RFs) for development of atherosclerosis are numerous, exceeding 200 based on different approaches to studying atherogenesis. The concept of inflammation is the prevailing idea, which focuses on changes in the arterial wall. This concept has developed into the endotoxin theory of atherosclerosis and was supported by multiple experimental studies and clinical observations. However, existing scales for assessing the cardiovascular risk produce a maximum error for patients with an intermediate cardiovascular risk. This leads to unnecessary diagnostic procedures or underestimation of risk. Therefore, searching for new risk factors of preclinical atherosclerosis is relevant and was an objective of this study. Methods. The study included 104 people of the same risk group (less than 1-4% on the SCORE scale). The subjects had no complaints at the time of the study and considered themselves healthy. We evaluated indexes, which could be considered RFs and applicable in practice, including plasma level of endotoxin and serum concentrations of antibodies to hydrophobic and hydrophilic parts of the lipopolysaccharide (AB-LPS) molecule. Results. Significant differences between concentrations and incidence rates of the studied indexes were found in patients with different severity of atherosclerotic lesions in the carotid arteries. At the same time, there were no differences in lipid profiles. A follow-up of subjects who had no significant changes in their lifestyle in 1.5 years showed that the subjects with improved vascular wall structure differed from the others only in parameters of systemic endotoxinemia. Conclusion. Inclusion of such indexes as concentrations of endotoxin and AB-LPS, can help predicting the condition of carotid wall and, thus, modifying the risk in patients at the level of primary diagnosis without involvement of high-tech, expensive imaging techniques.

scholarly journals The role of lipopolisaccharide and antibodies to the lipopolysaccharide in the systemic circulation to the cardiovascular risk group determination

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Pokusaeva
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Lipid Profile ◽  
Experimental Studies ◽  
Duplex Scanning ◽  
High Tech ◽  
Wall Thickening ◽  
P Value ◽  
Specificity And Sensitivity ◽  
Significant Difference

Abstract   The inflammatory concept of atherogenesis is the leading one. Its finds development in the endotoxin theory of atherosclerosis, confirmed by numerous experimental studies and a several of clinical observations. But the involvement of lipopolysaccharide (LPS) in atherogenesis in humans has been studied without assessing the morphological changes in the structure of the vascular wall and not included an antibodies response. Existing scales for assessing the risk of developing cardiovascular diseases have a maximum error for patients with an average level risk. We examined 113 patients belonging to one group of cardiovascular risk (<5% on the SCORE scale). We evaluated such indicators, which can be attribution to risk factors and can be application in practice, as the level of LPS in blood plasma, the level of antibodies to the LPS Salmonella minnnesota RE 595 (AB-LPS-1) and LPS Escherichia coli O55 (AB-LPS-2) in serum. A duplex scanning of extracranial brachiocephalic arteries (BCA) and a testing for lipid profile were made. It was revealed that the lipid profile do not allow to evaluate the condition of the BCA wall prior duplex scanning. A significant difference was found in the concentration and frequency of occurrence of LPS and AB-LPS indicators among patients with varying degrees of severity of atherosclerotic lesions of BCA (table). Thus, the inclusion of as risk factors the level of LPS, the concentration of AB-LPS can help in predicting the condition of the carotid arteries wall and, accordingly, in changing the degree of risk in patients at the primary diagnosis level without the participation of high-tech expensive imaging techniques. Simple binary models with high specificity and sensitivity were constructed using cluster analysis to predict the severity of BCA atherosclerosis using concentration of LPS and AB-LPS adapted for practical (figure). Comparison risk factors between groups Parameter Group (by arterial wall state) p-value Intact wall Thickening of TIM ASP Cholesterol, mmol/L 6.43 [6.04; 6.82] 5.81 [4.75; 8.28] 6.63 [5.68; 7.51] 0.2750 LDL, mmol/L 4.43 [4.03; 4.78] 3.64 [3.04; 4.98] 4.74 [3.74; 5.28] 0.0558 HDL, mmol/L 1.09 [0.94; 1.29] 1.21 [1.07; 1.51] 1.13 [0.98; 1.35] 0.3198 Triglycerides, mmol/L 1.72 [1.23; 2.54] 1.21 [0.91; 1.92] 1.48 [0.99; 2.07] 0.2752 Atherogenicity index 4.23 [3.45; 6.32] 3.67 [2.91; 4.48] 4.93 [3.92; 5.68] 0.3532 LPS, EU/ml 0.90 [0.60; 1.52] 0.60 [0.41; 0.98]* 1.20 [0.60; 1.8]* 0.0067* AB-LPS-1, c.o.u.d. 216.0 [132.5; 248.5]* 127.5 [105.75; 221.5] 123.0 [91.00; 187.0]* 0.0444* AB-LPS-2, c.o.u.d. 374.0 [199.0; 481.0] 399.5 [195.75; 451.0] 265.0 [200.0; 399.0] 0.1991 *Result was significant at p<0.05 at post-hoc pairwise comparisons. “Decision tree” for a group of patients Funding Acknowledgement Type of funding source: None

scholarly journals Sex differences in the association between major cardiovascular risk factors in midlife and dementia: a cohort study using data from the UK Biobank

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jessica Gong ◽  
Katie Harris ◽  
Sanne A. E. Peters ◽  
Mark Woodward
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Sex Differences ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Sex Difference ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Uk Biobank ◽  
The Uk

Abstract Background Sex differences in major cardiovascular risk factors for incident (fatal or non-fatal) all-cause dementia were assessed in the UK Biobank. The effects of these risk factors on all-cause dementia were explored by age and socioeconomic status (SES). Methods Cox proportional hazards models were used to estimate hazard ratios (HRs) and women-to-men ratio of HRs (RHR) with 95% confidence intervals (CIs) for systolic blood pressure (SBP) and diastolic blood pressure (DBP), smoking, diabetes, adiposity, stroke, SES and lipids with dementia. Poisson regression was used to estimate the sex-specific incidence rate of dementia for these risk factors. Results 502,226 individuals in midlife (54.4% women, mean age 56.5 years) with no prevalent dementia were included in the analyses. Over 11.8 years (median), 4068 participants (45.9% women) developed dementia. The crude incidence rates were 5.88 [95% CI 5.62–6.16] for women and 8.42 [8.07–8.78] for men, per 10,000 person-years. Sex was associated with the risk of dementia, where the risk was lower in women than men (HR = 0.83 [0.77–0.89]). Current smoking, diabetes, high adiposity, prior stroke and low SES were associated with a greater risk of dementia, similarly in women and men. The relationship between blood pressure (BP) and dementia was U-shaped in men but had a dose-response relationship in women: the HR for SBP per 20 mmHg was 1.08 [1.02–1.13] in women and 0.98 [0.93–1.03] in men. This sex difference was not affected by the use of antihypertensive medication at baseline. The sex difference in the effect of raised BP was consistent for dementia subtypes (vascular dementia and Alzheimer’s disease). Conclusions Several mid-life cardiovascular risk factors were associated with dementia similarly in women and men, but not raised BP. Future bespoke BP-lowering trials are necessary to understand its role in restricting cognitive decline and to clarify any sex difference.

scholarly journals Angiopoietin-like protein 3, 4 and 8 are linked to cardiovascular function in naïve sub-clinical and overt hypothyroid patients receiving levothyroxine therapy

2021 ◽  
Author(s):  
Sahar Hossam El Hini ◽  
Yehia Zakaria Mahmoud ◽  
Ahmed Abdelfadel Saedii ◽  
Sayed Shehata Mahmoud ◽  
Mohamed Ahmed Amin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Healthy Subjects ◽  
Experimental Studies ◽  
Cardiovascular Function ◽  
Stiffness Index ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Cardiovascular Functions

Objective: Angiopoietin-like protein (ANGPTL) 3,4,8 are upcoming cardiovascular biomarkers. Experimental studies showed thyroid hormones altered their levels. We assessed: ANGPTL3,4,8 as predictor of cardiovascular functions among naïve-subclinical and naïve-overt hypothyroidism [SCH and OH]; and altered ANGPTL levels with levothyroxine replacement (LT4) and their association with improved cardiovascular risk factors and cardiovascular function. Design and Methods: Prospective follow-up study assessed ANGPTL3,4,8 levels, vascular status (flow mediated dilation% of brachial artery (FMD%), carotid intima media thickness (CIMT), aortic stiffness index (ASI)), left ventricle (LV) parameters (ejection fraction (EF), myocardial performance index (MPI), LV mass), well-known cardiovascular risk factors and HOMA-IR, at two time points: among naïve -SCH, naïve-OH and healthy subjects groups; and at six months after achieved euthyroid state with LT4 with calculating their increased or decreased delta changes (∆↑ or ∆↓) in longitudinal arm among LT4- hypothyroid groups. Results: Significantly elevated ANGPTL3,4 and 8 among hypothyroid groups than healthy subjects were reduced with LT4. Multivariate analysis revealed ANGPTLs as independent predictors of cardiovascular functions and the contributors for ANGPTL levels: ANGPTL3,4 for impaired FMD% and ANGPTL8 for LVmass among naïve-SCH; ANGPTL3 for EF% and ANGPTL8 for CIMT in naïve-OH; ∆↓ ANGPTL3 for ∆↓ ASI meanwhile ∆↑ freeT4 for ∆↓ ANGPTL3, ∆↓ fasting glucose, ∆↓ triglyceride and ∆↓ thyroid peroxidase antibody for ∆↓ ANGPTL4 among LT4-SCH. ∆↓ ANGPTL4 for ∆↓ MPI and ∆↓ LVmass meanwhile ∆↓ TSH and ∆↓ triglyceride for ∆↓ ntributors for ANGPTL level: ANGPTL3,4 for impaired FMD% and ANGPTL8 for LVmass among naïve-SCH; ANGPTL3 for EF% and g LT4-OH. Conclusion: Elevated ANGPTL3,4,8 levels are differentially independent predictors of endothelial and cardiac function and reduced with LT4 in SCH and OH.

scholarly journals Identifying Novel Causes of Cancers to Enhance Cancer Prevention: New Strategies are Needed

2021 ◽  
Author(s):  
Paul Brennan ◽  
George Davey Smith
Keyword(s):  
Risk Factors ◽  
Bacterial Infections ◽  
Experimental Studies ◽  
Population Based ◽  
Incidence Rates ◽  
High Income ◽  
Laboratory Research ◽  
Research Strategies ◽  
Cancer Burden ◽  
Cancer Statistics

Abstract The burden of cancer from a clinical, societal, and economic viewpoint continues to increase in all parts of the world, along with much debate regarding how to confront this. Projected increases in cancer indicate a 50% increase in the numbers of cases over the next two decades, with the greatest proportional increase in low- and medium-income settings. In contrast to the historic high cancer burden due to viral and bacterial infections in these regions, future increases are expected to be due to cancers linked to ‘westernization’ including breast, colorectum, lung, and prostate cancer. Identifying the reasons underlying these increases will be paramount to informing prevention efforts. Evidence from epidemiological and laboratory studies conducted in high income countries over the last 70 years have led to the conclusion that about 40% of the cancer burden is explained by known risk factors, the two most important being tobacco and obesity in that order, raising the question of what is driving the rest of the cancer burden. International cancer statistics continue to show that about 80% of the cancer burden in high income countries could be preventable in principle, implying that there are important environmental or lifestyle risk factors for cancer that have not yet been discovered. Emerging genomic evidence from population and experimental studies points to an important role for non-mutagenic promoters in driving cancer incidence rates. New research strategies and infrastructures that combine population-based and laboratory research at a global level are required to break this deadlock.

scholarly journals Cardiovascular safety of nintedanib in subgroups by cardiovascular risk at baseline in the TOMORROW and INPULSIS trials

2019 ◽  
Vol 54 (3) ◽  
pp. 1801797 ◽  
Author(s):  
Imre Noth ◽  
Marlies Wijsenbeek ◽  
Martin Kolb ◽  
Francesco Bonella ◽  
Lizette Moros ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Events ◽  
Kinase Inhibitor ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiovascular Safety ◽  
History Of

Nintedanib is a tyrosine kinase inhibitor used to treat idiopathic pulmonary fibrosis (IPF). We investigated the cardiovascular safety of nintedanib using pooled data from the TOMORROW and INPULSIS trials.Cardiovascular events were assessed post hoc in patients with a history of atherosclerotic cardiovascular disease (CVD) and/or one or more cardiovascular risk factors at baseline (“higher cardiovascular risk”) and patients with no history of atherosclerotic CVD and no cardiovascular risk factors at baseline (“lower cardiovascular risk”).Incidence rates were calculated for 1231 patients (n=723 nintedanib and n=508 placebo), of whom 89.9% had higher cardiovascular risk. Incidence rates of major adverse cardiovascular events were similar in the nintedanib and placebo groups in patients with higher cardiovascular risk (3.88 (95% CI 2.58–5.84) and 3.49 (95% CI 2.10–5.79) per 100 patient-years, respectively) and lower cardiovascular risk (4.78 (95% CI 1.54–14.82) and 5.37 (95% CI 1.73–16.65) per 100 patient-years, respectively). Incidence rates of myocardial infarction in the nintedanib and placebo groups, respectively, were 3.03 (95% CI 1.91–4.81) and 1.16 (95% CI 0.48–2.79) per 100 patient-years in patients with higher cardiovascular risk and 1.59 (95% CI 0.22–11.29) and 1.78 (95% CI 0.25–12.64) per 100 patient-years in patients with lower cardiovascular risk. Incidence rates of other ischaemic heart disease in the nintedanib and placebo groups, respectively, were 1.85 (95% CI 1.02–3.34) and 3.28 (95% CI 1.94–5.54) per 100 patient-years in patients with higher cardiovascular risk and 0 and 1.80 (95% CI 0.25–12.78) per 100 patient-years in patients with lower cardiovascular risk.These data help to establish the cardiovascular safety profile of nintedanib in IPF.

scholarly journals COVID-19 in Chronic Kidney Disease: The Impact of Old and Novel Cardiovascular Risk Factors

2021 ◽  
pp. 1-10
Author(s):  
Manuel Alfredo Podestà ◽  
Federica Valli ◽  
Andrea Galassi ◽  
Matthias A. Cassia ◽  
Paola Ciceri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Events ◽  
Experimental Studies ◽  
Cardiovascular Complications ◽  
High Risk Population ◽  
High Prevalence ◽  
The Impact

Cardiovascular disease is a frequent complication and the most common cause of death in patients with CKD. Despite landmark medical advancements, mortality due to cardiovascular disease is still 20 times higher in CKD patients than in the general population, which is mainly due to the high prevalence of risk factors in this group. Indeed, in addition to traditional cardiovascular risk factors, CKD patients are exposed to nontraditional ones, which include metabolic, hormonal, and inflammatory alterations. The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought novel challenges for both cardiologists and nephrologists alike. Emerging evidence indicates that coronavirus disease 2019 (COVID-19) increases the risk of cardiovascular events and that several aspects of the disease may synergize with pre-existing cardiovascular risk factors in CKD patients. A better understanding of these mechanisms is pivotal for the prevention and treatment of cardiovascular events in this context, and we believe that additional clinical and experimental studies are needed to improve cardiovascular outcomes in CKD patients with COVID-19. In this review, we provide a summary of traditional and nontraditional cardiovascular risk factors in CKD patients, discussing their interaction with SARS-CoV-2 infection and focusing on CO­VID-19-related cardiovascular complications that may severely affect short- and long-term outcomes in this high-risk population.

scholarly journals The risk of cardiovascular disease in systemic sclerosis: a population-based cohort study

2012 ◽  
Vol 72 (7) ◽  
pp. 1188-1193 ◽  
Author(s):  
Ada Man ◽  
Yanyan Zhu ◽  
Yuqing Zhang ◽  
Maureen Dubreuil ◽  
Young Hee Rho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Systemic Sclerosis ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Population Based ◽  
Incidence Rates ◽  
Increased Risk ◽  
Comparison Cohort

ObjectivesTo evaluate the risk of incident myocardial infarction (MI), stroke and peripheral vascular disease (PVD) in individuals with systemic sclerosis (SSc) in a general population context.MethodsWe conducted a cohort study using a UK primary care database containing records from 1986 to 2011. SSc diagnoses, outcomes and cardiovascular risk factors were identified from electronic medical records. We conducted two cohort analyses: (1) MI and stroke, and (2) PVD, excluding individuals with prevalent disease at baseline for each analysis. We estimated HRs comparing SSc with age-, sex- and entry time-matched comparison cohorts, adjusting for potential cardiovascular risk factors.ResultsAmong 865 individuals with SSc (85.8% women, mean age 58.7 years), the incidence rates (IRs) of MI and stroke were 4.4 and 4.8 per 1000 person-years (PY), versus 2.5 and 2.5 per 1000 PY in the comparison cohort. The corresponding adjusted HRs were 1.80 (95% CI 1.07 to 3.05) for MI and 2.61 (95% CI 1.54 to 4.44) for stroke. Among 858 individuals with SSc (85.3% female, mean age 58.9 years), the IR of PVD was 7.6 per 1000 PY versus 1.9 per 1000 PY in the comparison cohort, with an adjusted HR of 4.35 (95% CI 2.74 to 6.93).ConclusionsThese findings provide the first general population-based evidence that SSc is associated with an increased risk of developing MI, stroke and PVD. Further insight into disease mechanisms, as well as how disease subtype, organ involvement and medication use may alter these increased risks, is needed.

What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction?

2007 ◽  
Vol 112 (10) ◽  
pp. 507-516 ◽  
Author(s):  
Ewoud ter Avest ◽  
Anton F. H. Stalenhoef ◽  
Jacqueline de Graaf
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Risk Prediction ◽  
Pulse Wave ◽  
Imaging Techniques ◽  
Non Invasive ◽  
Cardiovascular Risk Prediction

Primary prevention of CVD (cardiovascular disease) is mainly based on the assessment of individual cardiovascular risk factors. However, often, only the most important (conventional) cardiovascular risk factors are determined, and every level of risk factor exposure is associated with a substantial variation in the amount of atherosclerosis. Measuring the effect of risk factor exposure over time directly in the vessel might (partially) overcome these shortcomings. Several non-invasive imaging techniques have the potential to accomplish this, each of these techniques focusing on a different stage of the atherosclerotic process. In this review, we aim to define the current role of various of these non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction, taking into account the most recent insights about validity and reproducibility of these techniques and the results of recent prospective outcome trials. We conclude that, although the clinical application of FMD (flow-mediated dilation) and PWA (pulse wave analysis) in individual cardiovascular risk prediction seems far away, there may be a role for PWV (pulse wave velocity) and IMT (intima-media thickness) measurements in the near future.

scholarly journals Primary Cardiovascular Disease Prevention: Risk Factors Control vs. Imaging Subclinical Atherosclerosis

2020 ◽  
Vol 19 ◽  
Author(s):  
Federico Vancheri ◽  
Pompilio Faggiano ◽  
Michael Y Henein
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Imaging Techniques ◽  
Subclinical Atherosclerosis ◽  
Developed Countries ◽  
Incidence Rates ◽  
Arterial System ◽  
Risk Scores ◽  
Intermediate Risk ◽  
Obesity And Diabetes

The burden of cardiovascular disease in developed countries has shown dramatic improvements over the last 50 years, largely due the identification and control of major risk factors including, smoking hypertension and high cholesterol.   However, due to the significant increase in obesity and diabetes CVD incidence rates will not reduce as far over over the next years. Risk prediction in asymptomatic individuals remains a major challenge. Primary preventive treatment is currently based on the assessment of individual’s global risk mainly through screening of conventional risk factors and their treatment with lifestyle intervention and pharmacotherapy, often based on multivariate risk equations, and yet  a large proportion of CVD still occurs in individuals who are classified as carrying low- or intermediate-risk according to the risk scores. Atherosclerosis is the most common pathophysiologic process underlying CVD, often after a prolonged asymptomatic phase during which it may be possible to modify the course of the disease. Unlike conventional probabilistic risk scores, non-invasive imaging techniques such as carotid intima-media thickness (CIMT) along with plaque assessment (Figure 2), measured by B-mode ultrasound, and coronary calcium scoring (CAC) detected by CT scan have the advantage of direct visualization of the consequences of atherosclerosis on the arterial system. We consider the proposal that imaging of subclinical atherosclerosis is superior to risk equations as it directly identifies the disease and can effectively predict the risk of future CV events in low- and intermediate-risk individuals. In addition, imaging can improve the adherence to guidelines based treatment in patients and their physicians.

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