Atherosclerotic Background of Cirrhosis in Sickle Cell Patients

Background: We tried to understand the presence of any atherosclerotic background of cirrhosis in patients with sickle cell diseases (SCDs). Methods: The study was performed in the Hematology Service of the Mustafa Kemal University on SCDs patients between March 2007 and June 2012. Results: The study included 256 patients with SCDs (127 females). Their mean age was 29.3 years. Cirrhosis was detected in 5.8% (15) of the SCDs patients without any gender difference (6.2% of females versus 5.4% of males, p>0.05). There were 15 (5.8%) patients with chronic obstructive pulmonary disease with a highly significant male predominance (3.1% versus 8.5%, p<0.001). Digital clubbing and pulmonary hypertension were also higher in males, but the differences were nonsignificant in between (4.7% versus 6.2% and 11.0% versus 12.4%, respectively). Similarly, the leg ulcers were significantly higher in males, too (5.5% versus 16.2%, p<0.001). The significant male predominance was also observed in stroke and smoking (3.1% versus 6.2%, p<0.05 and 3.9% versus 11.6%, p<0.001, respectively). There were 14 (5.4%) mortal patients during the five-year follow-up period (6.2% of females and 4.6% of males, p>0.05), and the mean ages were 31.0 and 26.8 years, respectively (p>0.05). Conclusion: Probably cirrhosis is a systemic inflammatory process prominently affecting the hepatic vasculature, and an eventual accelerated atheroscerotic process is the main underlying cause of characteristics of the disease. SCDs are accelerated systemic atherosclerotic processes, too, and the higher prevalence of cirrhosis in SCDs patients may indicate the underlying atherosclerotic background of cirrhosis. Key words: Atherosclerosis, metabolic syndrome, cirrhosis, sickle cell diseases

Peculiarities of the T-cell response in atherosclerosis. Opportunities in diagnostics and treatment

Резюме Атеросклероз — хроническое воспалительное заболевание крупных артерий, в инициации и прогрессии которого активное участие принимают различные субпопуляции Т7лимфоцитов. T7хелперы 1, 17, 9, 22, CD8+ Т7лимфоциты обладают проатерогенными свойствами, поддерживая воспалительную реакцию в стенке сосуда. Регуляторные Т7лимфоциты подавляют эффекторную активность вышеупомя7 нутых клеток. Экспериментальные иммунотерапевтические подходы, в результате которых модулировались количество и/или функцио7 нальная активность ряда клеток иммунной системы, продемонстрировали антиатерогенный потенциал. В настоящее время активно раз7 рабатываются методики таргетного воздействия на хронический воспалительный процесс в стенке сосуда, и дальнейшее преобразование результатов экспериментальных моделей в эффективные и безопасные методы лечения является высокоперспективной задачей. Summary Atherosclerosis is a chronic inflammatory disease of large arteries, the initiation and progression of which is actively involved in various subpopulations of T7lymphocytes. T7helpers 1, 17, 9, 22, CD8+ T7lymphocytes have proatherogenic properties, supporting an inflammatory reaction in the vessel wall. Regulatory T7lymphocytes inhibit the effector activity of the above cells. Experimental immunotherapeutic approaches, which modulated the number and/or functional activity of a number of immune system cells, demonstrated antiatherogenic potential. At present, methods of targeting the chronic inflammatory process in the vessel wall are being actively developed, and further transformation of the results of experimental models into effective and safe methods of treatment is a highly promising task. Key words: atherosclerosis, coronary heart disease, inflammation, cell immunity, T lymphocytes, atherosclerosis immunotherapy.

The role of level and function of High Density Lipoprotein (HDL) in Cardiovascular Diseases

High-density lipoprotein (HDL) is a set of particles with heterogeneous structures that have different functions due to various compounds including surface charge, size, lipid, and protein compounds. Several prospective epidemiological studies have demonstrated that there is a clear inverse relationship between serum HDL concentration and risk of coronary heart disease, despite this relationship, clinical evidence has only challenged the usefulness of higher levels of HDL-C in predicting the risk of cardiovascular diseases (CVD) and have proven that the structure of HDL is altered and loosed function. Therefore, extensive research is needed to identify new agents and biomarkers to improve HDL function and reduce the risk of cardiovascular disease. Given that the most important function of HDL is to transfer excess cholesterol from peripheral tissues and macrophage cells through a receptor called ABCA1 and direct it to the liver, plays an important role in protecting the formation of atherosclerotic plaque. This molecule can provide a strong protective effect against oxidative damage caused by free radicals with intermittent inhibition of the production of pro-inflammatory oxidized lipids in the intima layer of arteries. There is an inverse relationship between the ability to efflux cholesterol and the prevalence of CVD. The ability to remove cholesterol from macrophages by HDL, it is a crucial criterion for determining HDL performance, and it has a strong inverse relationship with carotid intima-media thickness and coronary artery stenosis in angiography independent of HDL level. Key Words: Atherosclerosis; Cardiovascular Disease; High Density Lipoprotein; Lipoprotein

Radionuclide imaging of arterial inflammation in HIV-infected patients with vascular atherosclerosis

The review examined the role of arterial inflammation in atherogenesis and the pathogenic factors responsible for the high risk of cardiovascular diseases (CVD) among HIV-infected patients. Inflammation has been shown to play an important role in all phases of atherosclerotic CVD. HIV-infected patients have an increased tendency to CVD. The most effective radionuclide method of imaging the inflammatory process in the pathogenesis of CVD among HIV-infected people is F-18 FDG PET/CT. At the present stage, several ligands for visualization were synthesized, which were used to identify vascular inflammation in preclinical and clinical studies. These tracers, in addition to F-18 FDG, have significant potential for future use among HIV-infected patients. Key words: atherosclerosis, cardiovascular disease, positron emission tomography, HIV infection.

PERKEMBANGAN KONSEP PATOGENESIS ATEROSKLEROSIS

Nowadays, the concept of the pathogenesis of atherosclerosis is called a response to injury hypothesis. This is based on the fact that atherosclerosis is a chronic inflammatory disease induced by endothelial injury (endothelial dysfunction). This chronic inflammatory disease consists of sequences of cellular and molecular responses, and is induced and accelerated mainly by endothelial injury. Furthermore, this injury causes compensatory responses which change the endothelial homeostasis, and increases the endothelial permeability and adhesion of leucocytes or platelets to endothelial cells. Many factors can trigger this endothelial injury, but the most important ones are haemodynamic imbalance and hypercholesterolemia. Besides these, vascular myocytes, together with extracellular matrix, play some significant roles in developing fatty streaks to become atheroma plaques. Key words: atherosclerosis, endothelial injury, lipid, chronic inflammation, vascular myocytes. Abstrak: Konsep patogenesis aterosklerosis saat ini disebut hipotesis respons terha-dap cedera. Konsep ini mengacu pada aterosklerosis sebagai penyakit radang kronik yang diinduksi oleh cedera endotel (disfungsi endotel). Proses radang kronik pada aterosklerosis terdiri dari rangkaian respons seluler dan molekuler. Sebagai faktor utama yang dapat menginduksi dan memacu proses radang disini adalah cedera endotel. Adanya cedera endotel menyebabkan terjadinya respons kompensatorik yang mengubah homeostasis endotel serta meningkatkan permeabilitas endotel dan adhesi lekosit atau trombosit terhadap endotel. Banyak faktor dapat mencetuskan terjadinya cedera endotel namun yang terpenting adalah gangguan hemodinamik dan hiperkolesterolemia. Selain itu sel otot polos pembuluh darah juga turut berperan dalam aterogenesis yang bersama-sama dengan matriks ekstrasel mengubah fatty streak menjadi bercak ateroma. Kata kunci: aterosklerosis, cedera endotel, lemak, radang kronis, otot polos pembuluh darah.

Exercise, Postprandial Triacylglyceridemia, and Cardiovascular Disease Risk

An elevation of plasma triacylglycerides (TAG) is a well recognized cardiovascular risk factor. Less appreciated is that high and prolonged elevations in TAG in the postprandial (PP) phase is also a risk factor. Given that we spend approximately 18 hrs a day in the PP state, this is particularly critical. The elevation is due to both cylomicron and very low density lipoprotein TAG. It is thought that enhancing the concentrations of these lipoproprotein fractions increases the production of smaller, more dense low density lipoprotein and that this leads to increased cardiovascular disease risk. The PP TAG response is greater in men, in obese individuals, and in type 2 diabetics. It has been reported repeatedly that exercise the day before ingestion of a high fat meal is associated with a marked dampening of the PP TAG rise. The mechanisms for this are not clear and do not appear to be due to changes in the exercised muscle itself. There is some speculation that the production of plasma TAG may be decreased. The exercise benefits are lost within 3 days. The minimum exercise required has not been determined, but even 30 min of intermittent aerobic exercise or mild resistance exercise has a positive effect. This demonstrates a clear benefit from an active lifestyle and one that does not require intense exercise or months of training. Key words: atherosclerosis, type 2 diabetes, dietary fats, carbohydrates, VLDL, LDL, triglycerides, sex differences

Identification of Potential Predisposition to Clinical Atherosclerosis: A Clinical Concept Based on Integration of Significant Blood Parameters with Platelet Aggregation Scores

We sought to develop a predictive method, based on the integration of blood parameters found to be significantly associated with thrombosis and progression of atherosclerosis, that would be more accurate than primary reliance on elevation of separate risk factors. The study involved 1,034 male subjects. Lipid profiles and fibrinogen levels were determined for 123 men with documented clinical atherosclerosis and 123 apparently healthy volunteers. There were significant differences between these groups for fibrinogen, triglycerides, and HDL cholesterol. An algebraic expression was then developed which combined normalized values of fibrinogen, HDL cholesterol, and triglycerides with platelet count and aggregation data to yield a numerical value, the clinical atheroscterosis predisposition (CAP) factor. We then tested this CAP factor with a validation group of 788 men, 372 of whom were patients with documented clinical atherosclerosis; the rest were apparently healthy. A 3-year prospective evaluation was done for 72 of the 123 apparently healthy volunteers. The CAP factor was 90% indicative of patient status for the 372 men with documented complications of atherosclerosis and appeared to predict severe coronary disease in the 3-year prospective evaluation. This initial study suggests that integrated analysis of thrombotic factors in white males. provides a useful estimate of an individual's risk for subsequent development of clinical atherosclerosis. Key Words: Atherosclerosis-Prevention and control-Blood-Platelets-Cholesterol-Triglycerides--Fibrinogen.