Association of intima-media thickness of carotid arteries with remnant lipoproteins in men and women.

The subclass of triglyceride-rich lipoproteins - remnant-like particles (RLP) seems to be strong and independent risk factor for cardiovascular disease. We evaluated the role of RLP and other risk factors (RF) with sonographically measured intima-media thickness of carotid arteries (IMT CCA) in a cohort of Czech population including women defined according to the time after menopause. We investigated relation of IMT CCA to age, weight, central obesity, plasma lipids including remnant-like particles cholesterol (RLP-C) and triglycerides (RLP-TG) in 136 men and 160 women. Using multiple linear regression analysis, significant association between IMT CCA and RLP-C was found in women 1-7 years after menopause. In the whole group of women, only age and fasting blood glucose were independently associated with IMT CCA. In men only age significantly correlated with IMT CCA. Significant decrease of all plasma lipids between 1988 and 1996 in men was detected, while in women significant increase in triglycerides and no change in non-HDL cholesterol was observed. RLP-C was the strongest independent RF for atherosclerosis in postmenopausal women but its association with IMT CCA was limited to several years after menopause. In conclusion, women changing reproductive status could be more sensitive to atherogenic impact of remnant lipoproteins.

Preclinical atherosclerosis and other determinants of venous thromboembolism in patients with thrombophilias.

At present, the supposed association between venous thromboembolism and atherosclerosis has yet to be proven. However, no data are available from patients with thrombophilias. We evaluated the association between preclinical atherosclerosis and prevalence of thromboembolic events in patients with thrombophilias. Presence of preclinical atherosclerosis in common carotid and femoral arteries measured by ultrasound was assessed by Belcaro score (based mainly on the presence of plaques) and by measurements of intima media thickness in the same location in 109 patients (43 men, mean age 41.5+/-13 years) with established thrombophilias. Other parameters under the study were age, presence of traditional cardiovascular risk factors, anthropometric and clinical data including blood pressure measurements and medication. The differences between patients with (n=47) and without (n=62) thromboembolic events were assessed by paired t-test and chi square tests. In patients with a history of venous thromboembolism, body mass index and the prevalence of antihypertensive treatment (AT) were significantly higher than in patients without history of thromboembolism (BMI: 26.5+/-5.0 vs. 24.4+/-3.7 kg/m2; p=0.04, AT: 25.5 % vs. 8.1 %; p=0.013). No significant differences between groups were found regarding preclinical atherosclerosis. Overweight and hypertension, but not preclinical atherosclerosis, were more prevalent in patients with thrombophilias suffering from thromboembolism.

The effect of fluvastatin on cICAM-1 as a biomarker of endothelial dysfunction in patients with dyslipidemia.

AIM: Upregulation of intercellular adhesion molecule-1 (ICAM-1) expression has been suggested to play an important role in the pathogenesis of atherosclerosis. Lipid-lowering therapy with 3-hydroxy-methylglutaryl-coenzyme A reductase inhibitors reduces the incidence of atherosclerosis-related cardiovascular events. The aim of this study was to establish the effect of a 3-month treatment of fluvastatin on circulating (c)ICAM-1 and standard lipid parameters. METHODS: A total of 14 patients (6 men and 8 women), 59.7+/-11 years old, with mean systolic and diastolic blood pressure 135+/-16.3 and 81+/-9.3 mmHg, respectively, fasting plasma cholesterol 6.2+/-1 mmol/L and plasma triglycerides 2.6+/-1 mmol/L, took part in the study. The observed parameters were measured before and after 3 months of therapy. RESULTS: When comparing total cholesterolemia, low-density lipoprotein (LDL) cholesterol, and apolipoprotein B, there were significant decreases after a 3-month treatment. By contrast, no significant difference was observed when we compared the values of triglycerides, high-density lipoprotein (HDL) cholesterol, apolipoprotein A1 and, especially, of cICAM-1. Our results demonstrate the well-known capacity of fluvastatin to lower LDL- and total cholesterol; however, it failed to reduce cICAM after a 3-month treatment. CONCLUSIONS: It can be concluded that a 3-month therapy with fluvastatin does not decrease cICAM-1 levels, despite normalization of cholesterol levels. The implication is that cholesterol may not induce endothelial activation by the initial upregulation of this adhesive molecule.

The effect of an acute fat load on endothelial function after different dietary regimens in young healthy volunteers.

Attention has recently been focused on endothelial function after a single high-fat meal, i.e. on the anticipated direct atherogenic effect of triglyceride-rich lipoproteins. Our study was designed to investigate the effect of a low-fat diet given for four weeks followed by a high-fat diet for another four weeks. At the end of each dietary period, a noninvasive ultrasound investigation of endothelial function of the brachial artery was performed along with laboratory tests. Endothelial function was measured immediately before the dietary load and after three and six hours in 11 healthy volunteers. The results were expressed as percentage of the changes in artery diameter at rest and during hyperemia; the data were processed using computer technology. When compared to the low-fat regimen, the total cholesterol content rose after the high-fat diet from 4.28 mmol/l to 5.15 mmol/l (p<0.05) in the whole group of volunteers. There was no difference between both dietary regimens in baseline triglycerides. The brachial artery dilatation under basal conditions was 5.26+/-2.88 mm after the high-fat diet compared with the value of 3.13+/-3.01 mm (p<0.05) after the low-fat diet. When measured individually endothelial function in the whole group of volunteers in the course of the day, the degree of arterial dilatation after one month on low-fat diet was 3.13+/-3.0%, 3.88+/-2.5% and 5.23+/-3.3% at single measurement. When comparing arterial dilatation at two closest measurements, a non-significant trend, p>0.05 was seen in either case. The following values were obtained after one month on the high-fat diet: 5.26+/-2.9%, 4.47+/-1.7%, and 6.2+/-3.6%; again showing a non-significant trend of p>0.05. In this study, a single high-fat meal at the different dietary regimen did not significantly influence the vasoreactivity of the brachial artery in young volunteers.

[Vascular endothelial dysfunctions, possible detection and treatment]. / Cévní endoteliální dysfunkce, moznosti detekce a ovlivnení.

The basic physiological functions of the endothelium are functions of a semipermeable membrane, control of optimal vascular patency and safeguarding of the vascular integrity. Endothelial dysfunction may be considered the first functionally important stage of atherosclerosis. The most frequent evoking factors include hyperlipoproteinaemia, arterial hypertension, smoking and diabetes mellitus. The clinically most important manifestations of impaired endothelial function are disorders in the coronary circulation and transient cerebral ischaemias. Ways of detection of endothelial dysfunctions include invasive methods and at present non-invasive ultrasonic methods. Treatment of endothelial dysfunction is based on elimination of the basic risk factors of atherosclerosis, i.e. elimination of active and passive smoking, in indicated cases strict dietetetic and pharmacological hypolipidaemic treatment, effective antihypertensive treatment and compensation of DM.