The relationship between visceral fat depots and markers of renal dysfunction in patients with borderline arterial hypertension and obesity

Introduction Obesity is a potent risk factor for the development of kidney disease (CKD). The localization of adipose tissue and its hormonal activity plays an important role in the formation of the cardiorenal relationship. Purpose of work To assess the relationship between visceral fat stores with hormonal activity of adipose tissue, metabolic parameters and markers of renal dysfunction in patients with borderline arterial hypertension (AH) and obesity. Materials and methods The study included 100 people aged 44.8±6.4 years. Group 1 – patients with borderline hypertension – SBP 134.1±4.7 mm Hg; DBP – 84.3±5.9 mm Hg, BMI 36.1±3.2kg/m2. Group 2 was patients with BMI 35.5±3.9 kg/m2, SBP level 120.6±10.1 mm Hg and DBP 70.1±8.4 mm Hg. Albumin/creatinine ratio urine (ACRU), β2 microglobulin, tumor necrosis factor (TNF), interleukin 6 (IL6), monocytechemoattractant protein (MCP-1) was determined in a single portion of morning urine, the level of leptin, resistin and cystatin C was determined by ELISA. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula and cystatin C (Hoek's formula). The examination of visceral adipose tissue (VAT) was using an ultrasound method of investigation: the epi- and pericardial fat depots were assessed; VAT 1 – measurement at the level of the navel from the inner surface of the rectus abdominis to the posterior wall of the aorta and L4; VAT 2 – measurement at the level of the navel from the inner surface of the rectus abdominis to L4; the thickness of the posterior perirenal VAT on the right and left and the area of perirenal fat on both sides. Result The amount of fat depots in the groups is shown in Table 1. Indicators of hormonal activity of adipose tissue and renal markers are presented in Table 2. In the group with borderline hypertension the relationship between VAT 1 and 2 with ALT levels (r=0.40) and (r=0.42) was established, AST (r=0.52) and (r=0.47); HDL (r=−0.67) and (r=−0.70), TG (r=0.38) and (r=0, 39), HOMA index (r=0.45) and (r=0.39), MCP-1 (r=0.28) and (r=0.36). Perineal fat depot located to the right and left is correlated with LDL (r=0.40) and (r=0.37), glucose (r=0.49) and (r=0.50), ACRU (r=0.43) and (r=0.57), urinary excretion of cystatin C (r=0.28) and (r=0, 39). The connection with the optimal blood pressure level in control group was established between the perineal adipose tissue on the right and the left with the level of TG (r=0.35) and (r=0.29), GFR according to Hoek (r=0.29) and (r=0, 38), MCP-1 (r=0.36) and (r=0.29). Findings The increase of perinephral adipose tissue in obese patients is associated with an increase in cytokine excretion in the urine, an increase in VAT is accompanied by a deterioration in metabolic parameters. FUNDunding Acknowledgement Type of funding sources: None.

Genotypic analysis of the female BPH/5 mouse, a model of superimposed preeclampsia

Animal models that recapitulate human diseases and disorders are widely used to investigate etiology, diagnosis, and treatment of those conditions in people. Disorders during pregnancy are particularly difficult to explore as interventions in pregnant women are not easily performed. Therefore, models that allow for pre-conception investigations are advantageous for elucidating the mechanisms involved in adverse pregnancy outcomes that are responsible for both maternal and fetal morbidity, such as preeclampsia. The Blood Pressure High (BPH)/5 mouse model has been used extensively to study the pathogenesis of preeclampsia. The female BPH/5 mouse is obese with increased adiposity and borderline hypertension, both of which are exacerbated with pregnancy making it a model of superimposed preeclampsia. Thus, the BPH/5 model shares traits with a large majority of women with pre-existing conditions that predisposes them to preeclampsia. We sought to explore the genome of the BPH/5 female mouse and determine the genetic underpinnings that may contribute to preeclampsia-associated phenotypes in this model. Using a whole genome sequencing approach, we are the first to characterize the genetic mutations in BPH/5 female mice that make it unique from the closely related BPH/2 model and the normotensive background strain, C57Bl/6. We found the BPH/5 female mouse to be uniquely different from BPH/2 and C57Bl/6 mice with a genetically complex landscape. The majority of non-synonymous consequences within the coding region of BPH/5 females were missense mutations found most abundant on chromosome X when comparing BPH/5 and BPH/2, and on chromosome 8 when comparing BPH/5 to C57Bl/6. Genetic mutations in BPH/5 females largely belong to immune system-related processes, with overlap between BPH/5 and BPH/2 models. Further studies examining each gene mutation during pregnancy are warranted to determine key contributors to the BPH/5 preeclamptic-like phenotype and to identify genetic similarities to women that develop preeclampsia.

Mammography screening disparities in Asian American women: Findings from the California Health Interview Survey 2015-2016.

e18568 Background: Foreign-born Asians were less likely to utilize preventive care due to medicine beliefs, language barriers, insurance coverage, and more. Their perceptions of breast cancer risks and screening benefits for asymptomatic conditions may differ from individuals born in the United States. It is urgent for preventive health professionals to understand screening disparities in Asian Americans. Methods: Data from the California Health Interview Survey (CHIS) 2015-2016 were used. Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening in relation to socioeconomic, chronic health condition/health behavior, and preventive care utilization, stratified by race. Results: Of NH-White and Asian American women aged 40 and above (unweighted N = 13,451), 78.41% were NH-White, 25.38% were foreign-born, 56.88% spoke only English at home, and 6.44% were not currently insured. The prevalence for self-reported mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. Among Asian American women, the lowest rate of mammograms was in Koreans (55.29%) and Chinese (72.19%) had the highest rate (p = 0.6438). In NH-White women, place of birth, smoking status, borderline diabetes, high blood pressure, is currently insured, and having a preventive care visit in the past 12 months were significant factors. Within Asian American women, borderline hypertension and having a preventive care visit were significant factors, but not ethnicity. Conclusions: The findings indicate that mammogram disparity in relation to socioeconomics, health behaviors, preventive care utilization, and race. Further development of ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should target Asian American women with borderline hypertension and no preventive care visits.

A New Grape Seed Extract Pharma Standard Supplement (ECOVITIS TM) Prevents and Controls Borderline Hypertension and Endothelial Dysfunction

This registry evaluates the effect of ECOVITIS™ (grape seeds extract) in borderline hypertension (also evaluating endothelialmediated vasodilatation). The main targets of the registry were the normalization of blood pressure and of an altered endothelial function (EF); 3 groups of 15 subjects used: Standard Management (SM) (GROUP 1); GROUP 2: SM+ECOVITIS™ (150 mg/day); GROUP 3: SM+ECOVITIS™ (300 mg/day+SM). Results. The groups were comparable. Tolerability/safety were optimal. Blood tests, urines and ECG were normal at 4 and 12 weeks. BMI showed, minimal variations (<26) in 3 months. Blood pressure (systolic, diastolic) and heart rate indicate a progressive improvement in Group 3 (p<0.05) with better values at 4 and 12 weeks. The lower dose improved (p<0.05) blood pressure and heart rate better than SM. Lipids and oxidative stress were improved better with the high dose (p<0.05). The lower dose resulted better than SM (<0.05). Other metabolic parameters (blood sugar and glycosylated hemoglobin) followed the same patterns (G3 resulted better that the other two groups) (p<0.05). Laser Doppler measurements (skin flux) and strain gauge plethysmography measured an improvement in post-occlusive flow (EF) at the level of the arm (p<0.65). This was confirmed by artery ultrasound measurements showing a larger increase in size in the brachial artery after occlusion with ECOVITIS TM (subjects in Group 3 had the best results (p<0.025); the lower dose (Group 2) was superior to SM (p<0.05). Tc PO2 increased more in group 3 (p<0.05); PCO2 was decreased. Results in the lower dose group were better (p<0.05) than results in the SM patients. In conclusion, this pilot registry shows that ECOVITIS™ is safe, well tolerated and may control and improve blood pressure and EF in borderline subjects. More studies may be needed for a longer period of time.

Characteristics and outcomes of atrial fibrillation in patients without traditional risk factors: an RE-LY AF registry analysis

Aims Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled ‘lone AF’, are sparse. Methods and results The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130–140/80–90 mmHg; 47%), chronic kidney disease (eGFR &lt; 60 mL/min; 57%), obesity (body mass index &gt; 30; 19%), diabetes (5%), excessive alcohol intake (&gt;14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P &lt; 0.001) had paroxysmal AF (55% vs. 37%, P &lt; 0.001) and less AF persistence after 1 year (21% vs. 49%, P &lt; 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P &lt; 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). Conclusion Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.

Estimating risk and cost: An analysis of patients with risk factors for Type 2 Diabetes in rural Jalisco, Mexico

The global age standardized prevalence of type 2 diabetes (T2DM) has doubled (4.7% to 8.5%) over the last three decades and is increasing more rapidly in low and middle-income countries (LMICs). The global economic burden of diabetes affects individuals and health care systems and is estimated to cost $825 billion USD a year. Within Mexico, T2DM is the second leading cause of mortality and the leading cause of morbidity using disability associated life years (DALYs). A retrospective chart review and cost analysis, analyzing those at risk of diabetes, was conducted at a rural community health clinic in Jalisco, Mexico. The goal was to project the cost of providing an appropriate scope of care and plan prevention-based population health programs. The results demonstrated that out of 264 charts reviewed, 218 (83%) had one or more diabetic risk factor. The estimated per patient per visit cost is $127.22 MP (Mexican Peso, 2018) and as the number of diabetes risk factors increases for an individual patient, the mean cost of their care to the system increases (p < .001). Those with at least one risk factor comprise the majority in both males and females with a median age of 36 and median BMI of 28, and this group also has the highest percentage of borderline hypertension (46%). This data demonstrates an opportunity to intervene in a group of young adults (ages 27-46) with a cluster of high-risk borderline risk factors and preventing them from developing obesity, hypertension and diabetes later in life.

High urate concentration is associated with elevated blood pressure in schoolchildren

Background Studies in adults have shown a relationship between high blood pressure and hyperuricemia, but few studies have investigated this association in children and adolescents. The aim of the present study was to associate urate concentration with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in schoolchildren. Methods This cross-sectional study used a sample of 2335 schoolchildren in basic education between 7 and 17 years old. Blood pressure was classified by percentile according to Brazilian parameters for sex and age, reclassified into two categories: normal and borderline/hypertension. Blood collection to obtain serum for urate concentration analysis was performed after a 12-h fast. Values above 5.5 mg/dL were considered hyperuricemia. Descriptive data were presented in frequency and percentage. Linear regression and Poisson regression (prevalence ratio [PR]) was used to test the association between urate concentration and blood pressure. Results Urate concentration was weakly associated with SBP (β: 0.05; 95% CI: 0.02–0.08) and DBP (β: 0.03; 95% CI: 0.01–0.05) z-scores. Schoolchildren with hyperuricemia had a higher prevalence of high SBP (PR: 1.12; p<0.001) and DBP (PR: 1.08; p<0.001). Conclusions Elevated urate concentration is associated with altered blood pressure in schoolchildren.