ENDOTHELIAL DYSFUNCTION IN ACROMEGALIC PATIENTS: A CASE-CONTROL STUDY.

PURPOSE: Assessing cardiovascular risk in patients with acromegaly using traditional cardiovascular risk factors is inadequate. Endothelial dysfunction seems to be a much better indicator for assessing cardiovascular risk in acromegaly. The study aims to compare from this point of view two groups of patients, with hypertension and with acromegaly. METHODS: The first group consists of 54 patients with acromegaly and the second group of 64 hypertensive patients. Endothelial dysfunction was evaluated by the FMD method. The relationship between endothelial dysfunction, specific humoral markers of acromegaly and traditional cardiovascular risk factors was analysed in both groups. RESULTS: Although the presence of cardiovascular risk factors was statistically significantly higher in the group of hypertensives (the most important were age, blood pressure, glycemia, hypertriglyceridemia and SCORE), the presence of endothelial dysfunction was higher in the acromegaly group (61.10% vs. 32.10%, p=0.02). The best correlation with endothelial dysfunction in acromegaly group was the level of GH (28.9±28 vs. 11.7±10.3, p=0.003). CONCLUSIONS: The presence of endothelial dysfunction in patients with acromegaly is highly dependent on the level of GH and traditional cardiovascular risk factors are less important. In these patients the cardiovascular risk should not be evaluated in the same way as in normal population.

Circulating microparticles and endothelial progenitor cells in atherosclerosis: pharmacological effects of irbesartan.

AIMS: This study aimed to (i) employ our newly designed model, the hypertensive-hypercholesterolemic hamster (HH), in order to find out whether a correlation exists between circulating microparticles (MPs), endothelial progenitor cells (EPCs) and their contribution to vascular dysfunction and (ii) to assess the effect of irbesartan treatment on HH animals (HHI). METHODS AND RESULTS: The results showed that compared with the control (C) group, HH displayed: (i) a significant increase in plasma cholesterol and triglyceride concentration, and an augmentation of systolic and diastolic arterial blood pressure, and of heart rate; (ii) a marked elevation of MPs and a significant decrease in EPCs; (iii) structural modifications of the arterial wall correlated with altered protein expression of MMP2, MMP9, MMP12, TIMP1, TIMP2 and collagen type I and III; (iv) a considerably altered reactivity of the arterial wall closely correlated with MPs and EPC adherence; and (v) an inflammatory process characterized by augmented expression of P-Selectin, E-Selectin, von Willebrand factor, tissue factor, IL-6, MCP-1 and RANTES. Additionally, the experiments showed the potential of irbesartan to correct all altered parameters in HH and to mobilize EPCs by NO, chemokines and adhesion molecule-dependent mechanisms. CONCLUSIONS: Hypertension associated with hypercholesterolemia is accompanied by structural modifications and expression of pro-inflammatory molecules by the vessel wall, the alteration of vascular tone, enhanced release of MPs and reduced EPCs; the ratio between the latter two may be considered as a marker of vascular dysfunction. Irbesartan, which exhibits a pharmacological control on the levels of MPs and EPCs, has the potential to restore homeostasis of the arterial wall.

Profile of the Romanian hypertensive patient data from SEPHAR II study.

AIM: The objective of this paper is to present the profile of the Romanian hypertensive patient as revealed by the analysis of hypertensive subjects from SEPHAR II survey. METHODS: A total number of 798 hypertensive subjects identified by SEPHAR II survey were analyzed in terms of socio-demographic characteristics, cardiovascular risk factors, subclinical target organ damage, established target organ disease, total CV risk and HT awareness, treatment and control. The profile of the Romanian hypertensive patients was built using the mod of every above mentioned target variables. RESULTS: The majority of hypertensive subjects were females (54.9%), mean age of 57.42 +/- 13.38 years, coming from the South region (17.8%), living in urban areas (59.5%) and aware of their condition (69.5%), associating most often other 4 CV risk factors among which physical inactivity (67.3%), visceral obesity (60.4%) and hypercholesterolemia (61.3%) are the most prevalent, having therefore a very high added CV risk (60.3%). Despite the widespread use of at least 2 antihypertensive drugs (72.3%), an effective treatment was recorded only in a quarter of treated hypertensives. CONCLUSION: The profile of Romanian Hypertensive patient is: middle aged female living in urban area of the South region of the country, with secondary education and a low average income, sedentary lifestyle, nonsmoker and aware of BP values, having visceral obesity, a high total cholesterol and LDL-cholesterol levels and normal HDL-cholesterol and triglyceride levels, having metabolic syndrome, nondiabetic and associating 4 other cardiovascular risk factors and therefore having a high added cardiovascular risk.

Prevalence, Awareness, Treatment, and Control of Hypertension in Romania: Results of the SEPHAR Study.

East European countries have reported high prevalence of Arterial Hypertension (AHT). In order to investigate the data for Romania, we firstly performed a national survey-the Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Adult Population in Romania (SEPHAR). A representative population was selected using stratified proportional sampling, including 2017 adult subjects, ≥18 years old. The general prevalence of AHT was 44,92%, higher in men (50,17%) than in women (41,11%) (P < .0001) and predominant in rural areas (49,47%) in comparison to the urban ones (41,58%) (P < .02). AHT awareness attended 44,26%, rising with age, significantly lower in men (34,58%) than in women (52,8%) (P < .0006). We have found a 38,85% proportion of treated hypertensive persons, worse for men (30,11%) then for women (46,56%) (P < .003). The rate of AHT control was 19,88%, with no significant differences between gender. In conclusion, we estimated for Romania a high prevalence of AHT, a level of awareness and treatment lower than in many European countries and a rate of treatment control at the inferior limit of the European average. Males, characterized by a higher prevalence of AHT, were also less aware and less treated than women.

The management of patients with peripheral arterial disease and intermittent claudication. Actual recommendations.

In the general context of increasing prevalence of cardiovascular risk factors in European population, we face with a significant rise of the incidence of atherothrombotic diseases. Peripheral arterial disease (PAD) represented for a long time a peripheral interest for cardiologist. The epidemiological studies in the latest years determine a reconsideration of the medical attitude in respect of PAD, motivated by an increase in its prevalence and, on the other hand, by the significant cardiovascular risk this disease carries with. Taking into account that fact and aiming at a better medical approach of these patients, we realized a review regarding therapeutic methods in patients with PAD and intermittent claudication based on the latest medical publications and in accord with the guide in force at the moment.

The prevalence of peripheral arterial disease in relationship with cardiovascular risk factors in Romania.

UNLABELLED: Peripheral arterial disease (PAD) represents a disease with high prevalence and related mortality and morbidity. However, there are spearing epidemiological information regarding PAD in Romania. The objective of our study was to evaluate the prevalence of PAD in relationship with cardiovascular risk factors (RF) in Romania. MATERIAL AND METHODS: In the study we randomly enrolled a number of 796 patients aged over 40 from those persons presenting during a 3 month period at the warding rooms in The Emergency Hospital in Bucharest. For every patient a questionnaire was completed containing demographical data, information about personal RF and history of atherothrombotic cardio-vascular disease and also information about patient's treatment. For each patient the height, the weight, waist circumference and ankle-brachial index (ABI) have been measured. RESULTS: The prevalence of PAD was 18.7%, 79.19% from patients being newly diagnosed. Multivascular atherothrombotic disease was noted in 16.1% of PAD patients. FR related with the presence of PAD were age, diabetes mellitus (DM), smoking and former coronary disease. Smoking and DM represented the most unfavourable risk factors association in respect with PAD. CONCLUSIONS: We found a high prevalence of PAD but comparable with that one reported in other European countries. The majority of the patients were newly diagnosed. The RF most frequented encountered have been DM and smoking, their association conducing to further increase in risk of having PAD. We appreciate the necessity of active identification of PAD by means of ABI measurement in patients with RF or other cardiovascular disease.

Total cardiovascular risk estimation in Romania. Data from the SEPHAR study.

OBJECTIVE: of this sub-study was to assess the impact of major CV risk factors on mortality due to CV diseases among Romanian adult subjects using the SCORE System. STUDY DESIGN AND SETTING: In 2005, a survey for CV risk factors (SEPHAR) was performed in Romania involving 2017 subjects aged over 18 yrs, a representative sample for the Romanian adult population. Romania's area was divided into ten regions recommended by The National Commission of Statistics. We evaluated the relationship between gender, age, smoking status, systolic blood pressure and total cholesterol and cardiovascular risk. Ten year risk of fatal cardiovascular disease was estimated according to the SCORE (Systematic COronary Risk Evaluation) System. RESULTS: Average total risk in Romanian adult population was 3.5%. Male population had a significantly higher risk than females (5.4% vs. 1.7%, p<0.01). About one fifth of subjects (20.7%) had a high risk > or = 5%. Four percent of subjects (all males) had a very high risk > or = 15%. The CV risk was relatively homogeneously distributed between Romania's geographic regions. The prevalence of hypercholesterolemia as CV risk factor was high (40%), and also was the prevalence of high systolic blood pressure (36.6%). The prevalence of smoking was similar to other European countries (27%). CONCLUSION: Our study showed Romania as a country with a high cardiovascular risk, being also one of the regions in Europe with the highest CV risk.