Administration of Intravenous Furosemide in Patients with Acute Infection: Patient Characteristics and Impact on In-Hospital Outcome.

Intravenous (IV) fluid is frequently used to treat patients who have been admitted with an acute infection; among these patients, some will experience pulmonary congestion and will need diuretic treatment. Consecutive admissions to the Internal Medicine Department of patients with an acute infection were included. Patients were divided based on IV furosemide treatment within 48 h after admission. A total of 3556 admissions were included: In 1096 (30.8%), furosemide was administered after ≥48 h, and in 2639 (74.2%), IV fluid was administered within <48 h. Mean age was 77.2 ± 15.8 years, and 1802 (50.7%) admissions were females. In a multivariable analysis, older age (OR 1.01 [95% CI, 1.00-1.01]), male gender (OR 0.74 [95% CI, 0.63-0.86]), any cardiovascular disease (OR 1.51 [95% CI, 1.23-1.85]), congestive heart failure (CHF) (OR 2.81 [95% CI, 2.33-3.39), hypertension (OR 1.42 [95% CI, 1.22-1.67]), respiratory infection (OR 1.38 [95% CI, 1.17-1.63]), and any IV fluid administration (OR 3.37 [95% CI, 2.80-4.06]) were independently associated with furosemide treatment >48 h after hospital admission. In-hospital mortality was higher in patients with furosemide treatment (15.9% vs. 6.8%, p < 0.001). Treatment with furosemide in patients admitted with an infection was found to be associated with prolonged hospital stay and increased in-hospital mortality.

Mean Platelet Volume as a Predictor of Coronary Artery Disease Severity and its Association With Coronary Artery Calcification.

Coronary calcium score (CCS) is a highly sensitive marker for estimating coronary artery calcification (CAC) and detecting coronary artery disease (CAD). Mean platelet volume (MPV (is a platelet indicator that represent platelet stimulation and production. The aim of the current study was to examine the association between MPV values and CAC. We examined 290 patients who underwent coronary computerized tomography (CT) exam between the years 2017 and 2020 in a tertiary care medical center. Only patients evaluated for chest pain were included. The Multi-Ethnic Study of Atherosclerosis (MESA) CAC calculator was used to categorize patients CCS by age, gender, and ethnicity to CAC severity percentiles (<50, 50-74, 75-89, ≥90). Thereafter, the association between CAC percentile and MPV on admission was evaluated. Out of 290 patients, 251 (87%) met the inclusion and exclusion criteria. There was a strong association between higher MPV and higher CAC percentile (P = .009). The 90th CAC percentile was associated with the highest prevalence of diabetes mellitus (DM), hypertension, dyslipidemia, and statin therapy (P = .002, .003, .001, and .001, respectively). In a multivariate analysis (including age, gender, DM, hypertension, statin therapy, and low-density lipoprotein level) MPV was found to be an independent predictor of CAC percentile (OR 1.55-2.65, P < .001). Higher MPV was found to be an independent predictor for CAC severity. These findings could further help clinicians detect patients at risk for CAD using a simple and routine blood test.

The accuracy of 8-hour ambulatory blood pressure monitoring, adjusted to seasons.

Ambulatory blood pressure monitoring (ABPM) is considered the most reliable and accurate measurement of blood pressure (BP). However, the use of ABPM has some limitations, which make it difficult to complete for the entire 24 h. We aimed to establish in which part of the day BP measurements are in highest correlation with full ABPM (over 24 h) results. We performed a retrospective cross-sectional study which included 3113 full ABPM. Each ABPM was divided into 6- and 8-hour segments, and mean BP in each time segment was calculated. Linear mix models for describing BP by BP in each time segment were performed. A total of 3113 ABPM measurements carried out on 2676 patients (mean age 57.78 ± 14.74) were included in the study. Linear mix models demonstrated significant association between mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in full ABPM, and SBP and DBP between 2-10 PM, respectively (SBP: ß = 0.902, p < 0.001; DBP: ß = 0.839, p < 0.001), adjusted for gender, age, season, and relevant interactions. This section had higher coefficient correlations than other sections which were examined. The study findings indicate high correlation between BP between 2-10 PM, and BP in full-ABPM, by each season. This time segment may be ideal for short-term BP monitoring as an initial screening test and for patients who are unable to complete full ABPM. However, since this time segment does not include nighttime hours, there is a risk of underdiagnosis of non-dipper.

The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain.

Background: Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to patients with stable chest pain (SCP). Since it is known that ACP differs in many ways from SCP, the aim of this study was to compare the predictive value of a high CACS for the diagnosis of severe CAD between ACP and SCP patients. Methods: This single center observational retrospective study included consecutive patients who underwent cardiac CT for chest pain and were found to have a CACS of >200 Agatston units. Patients were divided into two groups, ACP and SCP. Severe CAD was defined as ≥70% stenosis on coronary CT angiography or invasive coronary angiography. Baseline characteristics and final diagnosis of severe CAD were compared. Results: The cohort included 220 patients, 106 with ACP and 114 with SCP. ACP patients had higher severe CAD rates (60.4% vs. 36.8%; p < 0.001). On multivariate analysis including cardiac risk factors, CACS > 400 au (OR = 2.34 95% CI [1.32−4.15]; p = 0.004) and ACP (OR = 2.54 95% CI [1.45−4.45]; p = 0.001) were independent predictors of severe CAD. The addition of the clinical setting of ACP added significant incremental predictive value for severe stenosis. Conclusion: A high CACS is more associated with severe CAD in patients presenting with ACP than SCP. The findings suggest that the CACS could impact the management of patients during the scan.

Routine blood tests during pregnancy for predicting future increases in risk of cardiovascular morbidity.

OBJECTIVE: To examine the association between routine blood tests during pregnancy and future risk of cardiovascular morbidity. METHODS: The present case-control study was conducted among women who delivered at a teaching hospital in Israel between January 1, 2000, and December 31, 2012. The cohort comprised women who were subsequently hospitalized owing to cardiovascular morbidity (case group) and age-matched non-hospitalized women (control group). Blood levels of creatinine, glucose, potassium, urea, and uric acid were measured during pregnancy. Only women with at least one test result available for all five measurements were included. The relationship between upper quartile blood test values and cardiovascular hospitalization was assessed. RESULTS: The study included 4115 women (212 in the case group and 3903 in the control group). Three measures were associated with a future risk of cardiovascular morbidity requiring hospitalization: creatinine (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.37-2.53; P<0.001); potassium (HR 1.48, 95% CI 1.09-2.01; P=0.013), and urea (HR 1.60, 95% CI 1.17-2.19; P=0.003). The number of blood test results in the upper quartile also increased such risk. The HRs for two tests and at least three tests were 1.65 (95% CI 1.06-2.56; P=0.026) and 3.32 (95% CI 2.19-5.04; P<0.001), respectively. CONCLUSIONS: Future cardiovascular morbidity was predicted by routine blood tests during pregnancy.

Red alga polysaccharides attenuate angiotensin II-induced inflammation in coronary endothelial cells.

The pro-inflammatory vasoconstrictor Angiotensin II can cause endothelial dysfunction and is considered to be one of the mediators of atherosclerosis. Our former results demonstrated that polysaccharides derived from the red alga Porphyridium sp. attenuate inflammatory processes by interfering with tumor necrosis factor-alpha-induced inflammation, in human coronary artery endothelial cells. However, the anti-inflammatory effect of these polysaccharides on inflammation processes occurring under Angiotensin II stimulation is yet unknown. Herein, we studied the polysaccharide's anti-inflammatory effect by quantification of inflammatory markers in Angiotensin II- stimulated Human Coronary Artery Endothelial Cells following pre-treatment with polysaccharides. Inflammatory atherosclerotic pathways up-regulated by Angiotensin II, including adhesion molecule expression and nuclear factor kappa-light-chain-enhancer of activated B cells translocation, were significantly attenuated or diminished in cells pre-treated with the polysaccharides. In addition, the polysaccharides increased the antioxidant response elements activity through the nuclear factor-E2-related factor 2- antioxidant protection system. These polysaccharide's promising abilities may be considered as a basis for future use as a therapeutic agent aimed at improving vascular health by attenuation of the inflammatory atherosclerotic process.

Early Postpartum Hemoglobin Less Than 10 g/dL Is Associated with Future Maternal Atherosclerotic Morbidity.

OBJECTIVE: Anemia is associated with increased cardiovascular morbidity in the general population. Anemia is common during pregnancy. We examined the association between anemia at the very early postpartum period and long-term atherosclerotic-related morbidity. PATIENTS AND METHODS: A retrospective study including women who gave birth between 1988 and 2013 was conducted. The women were divided into two groups according to hemoglobin (Hb) value on the first day after delivery: Hb <10 g/dL and Hb ≥10 g/dL. We examined the rates of hospitalization due to atherosclerotic-related morbidity, which were classified into minor and major events. The follow-up period was from the index birth until either hospitalization or the end of study period. Survival estimates were calculated by Kaplan-Meier survival analysis. Cox proportional hazards models were used to evaluate whether Hb <10 gr/dL is an independent risk factor for long-term atherosclerotic events. RESULTS: The study population included 30,088 (37.40%) women with Hb <10 g/dL and 50,354 (63%) women with Hb ≥10 g/dL at the index birth. The hospitalization incidence density was higher in the Hb <10 g/dL group versus the Hb ≥10 g/dL group, for total atherosclerotic- related hospitalizations (4.35 vs. 3.76, p < 0.001), and hospitalization for major events (1.83 vs. 1.51, p < 0.001) and minor events (2.60 vs. 2.31, p < 0.001). In Cox proportional hazards models, it was demonstrated that Hb <10 g/dL was independently associated with total hospitalizations (HR 1.13; CI: 1.04-1.24 p = 0.004) and hospitalizations for major events (HR 1.16; CI: 1.01-1.34 p = 0.034) Conclusions: Hb <10 g/dL at the very early postpartum period might be a marker for long-term atherosclerotic-related morbidity.

Benzodiazepine Consumption Is Associated With Lower Blood Pressure in Ambulatory Blood Pressure Monitoring (ABPM): Retrospective Analysis of 4938 ABPMs.

BACKGROUND: The effect of chronic benzodiazepine use on blood pressure has not been documented. We aimed to evaluate whether regular benzodiazepine use can be associated to the results of ambulatory blood pressure monitoring (ABPM). METHODS: A retrospective analysis of the ABPM database between 2009 and 2015 was performed. The study groups were divided according to benzodiazepine treatment at least 3 months before ABPM. Generalized estimating equation (GEE) model analysis was conducted to estimate the association between benzodiazepine treatment and ABPM test measurements. Multivariable COX regression survival analysis model for mortality and cardiovascular (CV) events was performed. RESULTS: A total of 4,938 ABPM studies were included in final analysis, 670 ABPMs of benzodiazepine-treated patients, and 4,268 of untreated patients. The benzodiazepine-treated group was significantly older, with a predominance of female patients, comprised more diabetic patients and consumed more antihypertensive medications. Adjustment for age, gender, diabetes mellitus, and number of antihypertensive medications, showed an association between benzodiazepine treatment and significantly lower ABPM measurements. When the analysis was split into those ≥60 years old and the other <60 years old, regular benzodiazepine consumption was associated with lower ABPM measurements only among ≥60 years old. Multivariable Cox regression survival analysis showed that regular benzodiazepine consumption was not associated with increased mortality or CV events (mean follow-up period of 42.4 ± 19.8 and 42.1 ± 20.0 months, respectively). CONCLUSIONS: Long-term use of benzodiazepines by ≥60 years old was independently associated with lower diastolic and systolic blood pressure in all parameters of ABPM, but not among younger patients.

Angiotensin 1-7, but not the thrombin-cleaved osteopontin C-terminal fragment, attenuates osteopontin-mediated macrophage-induced endothelial-cell inflammation.

OBJECTIVE AND DESIGN: Evaluating the pro-/anti-inflammatory activity of the C-terminal cleavage product of osteopontin in comparison to angiotensin 1-7. MATERIAL AND SUBJECTS: Human coronary endothelial cells (hcEC) treated with conditioned media from human U937 macrophages. TREATMENT: Macrophages were (pre)treated with C-terminal, full-length or N-terminal osteopontin (OPN-C, OPN-FL, OPN-N, respectively), angiotensin II, angiotensin 1-7 or TNF-α. OPN-C modulatory capacity was compared to that of Ang1-7 in inhibiting subsequent Ag II, OPN-FL or OPN-N-induced macrophage-mediated endothelial inflammation. METHODS: Protein expression of NFκB, IκB, vCAM-1 and iCAM-1 was assessed using western blot. Promotor activation by NFκB was also assessed by dual-luciferase reporter assay. RESULTS: Conditioned media of macrophages treated with OPN-C induced hcECs' NfκB activation to a lower degree than OPN-FL or OPN-N. Priming of macrophages with angiotensin 1-7 attenuated the endothelial pro-inflammatory effect induced by subsequent exposure of the macrophages to angiotensin II, OPN-FL or OPN-N. This was evidenced by both NfκB activation and vCAM and iCAM expression. In contrast, priming macrophages with OPN-C did not significantly attenuate the subsequent response to the pro-inflammatory cytokines. CONCLUSIONS: OPN-C induces lower macrophage-induced endothelial inflammation compared to OPN-FL or OPN-N, but unlike angiotensin 1-7, fails to prevent endothelial inflammation induced by subsequent pro-inflammatory macrophage stimulation.

An anti-inflammatory effect of red microalga polysaccharides in coronary artery endothelial cells.

BACKGROUND AND AIMS: Polysaccharides (PSs) produced by the red microalga Porphyridium sp. were reported to exhibit anti-inflammatory bioactivities in the human skin. The primary goal of the present research was to assess whether PSs attenuate inflammatory processes by interfering with tumour necrosis factor-alpha (TNF-α)-induced inflammation, in human coronary artery endothelial cells (HCAECs). METHODS: Functional and inflammatory markers were quantified in TNF-α-stimulated HCAECs, with and without pre-treatment with PSs. The expression/activation of these markers was assessed by Western immunoblotting and a luciferase reporter assay. NO levels were measured using the Griess method and intracellular reactive oxygen stress (ROS) was determined with the fluorescent probe 2',7'-dichlorodihydro-fluorescein diacetate (H2DCFDA). RESULTS: The TNF-α-induced up-regulation of inter-cellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) translocation, as well as IκB degradation were significantly attenuated in cells pre-treated with PSs. In addition, PSs were able to inhibit NF-κB activation as well as TNF-α-induced oxidative stress in HCAECs. Endothelial function was also improved, as measured by increased nitric oxide (NO) formation and decreased endothelin (ET-1) protein expression. CONCLUSIONS: This is the first report that demonstrates the anti-inflammatory effect and vaso-relaxing property of red microalgae PSs in a HCAEC-TNF-α induced system. This study lays the foundation for basic research concerning the PS mode of action in biochemical processes involving endothelial dysfunction, and it also holds potential for applied research, possibly promoting the use of PSs as a therapeutic agent or food additive to improve vascular health.

Assessment of aortic stiffness among patients with systemic lupus erythematosus and rheumatoid arthritis by magnetic resonance imaging.

To evaluate aortic stiffness by MRI in female patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) in comparison to controls. We measured aortic strain, distensibility and pulse wave velocity (PWV) by MRI in 30 SLE patients, 31 RA patients and 53 matched controls. Mean PWV in SLE and RA patients were higher in comparison to controls (9.2 ± 4.4 vs. 7.6 ± 3.0 m/s, p = 0.04) and (6.2 ± 2.3 vs. 5.4 ± 1.7, p = 0.04) respectively. Aortic distensibility among RA patients was significantly lower in comparison to controls (4.4 ± 4.6 vs. 5.8 ± 4.9 kPa(-1) × 10(-3), p = 0.04). A significant correlation was found between PWV and age (r = 0.67, p < 0.001), Framingham risk score (r = 0.61, p < 0.001), waist to hip ratio (r = 0.45, p < 0.001), systolic blood pressure (r = 0.37, p = 0.01), diabetes (r = 0.32, p = 0.001) and dyslipidemia (r = 0.32, p = 0.001). In multivariate analysis for the prediction of PWV, variables which were found significant included: RA (p = 0.01), age (p < 0.001) and hypertension (p = 0.01) for patients with RA and SLE (p = 0.02), waist to hip ratio (p < 0.001) and total cholesterol (p < 0.001) for patients with SLE. Arterial stiffness, characterized by metrics of aortic distensibility and pulse wave velocity derived from MRI, is increased in SLE and RA female patients.

Low Osteopontin N-Terminal Fragment and Carotid Plaque Stability Associated with Statin or Antiplatelet Therapy.

INTRODUCTION: Full-length osteopontin (OPN-FL), whose levels are elevated in association with atherosclerosis, is cleaved by thrombin, resulting in the formation of a putatively biologically-active N-terminal cleavage product (OPNN). This study addresses the hypothesis that statin and antiplatelet therapy in hypertensive patients specifically reduces OPN-N, rather than OPN-FL, in carotid plaques. METHODS: Seventy-four carotid plaques were collected from patients who underwent carotid endarterectomy (CEA). Plaque tissue was used to measure OPN proteins and for histological and immunohistochemical characterization. RESULTS: There were 22 statin-negative and 52 statin-treated patients. In the carotid plaque, immunohistochemical staining for macrophages was higher in statin-negative vs. statin-treated patients (high CD68 immunostaining was in 61.9 vs. 28.6%, p=.03, respectively). OPN-FL staining had a similar trend, but without statistical significance (78.7 vs. 47.8%, p=.08, respectively). Western blot analysis of plaque OPN-FL showed that statin treatment was not associated with significant alteration of its abundance, but with a significantly lower plaque content of OPN-N [median 0.08 (IQR 0.05-1.01) vs. 0.81 (IQR 0.27-2.86), respectively, p=.015]. Comparable pattern of association between OPN proteins and antiplatelet therapy was found: the abundance of OPN-FL was not different in plaques from untreated or treated patients, while the abundance of OPN-N was significantly reduced in antiplatelet treated vs. non-treated patients [0.08, (IQR 0.05-0.66) vs. 0.89, (IQR 0.13-1.94), p=0.004]. CONCLUSION: The effect of anti-atherosclerotic treatment on carotid plaques of hypertensive patients more readily associates with OPN-N than with OPN-FL expression, suggesting that anti-atherosclerotic treatment including statins and antiplatelet drugs modulates the "OPN system".

High potassium level during pregnancy is associated with future cardiovascular morbidity.

OBJECTIVE: The present study was aimed to determine whether high potassium level during pregnancy is an independent risk factor for future atherosclerotic morbidity. PATIENTS AND METHODS: A case-control study was conducted including women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity after their last delivery (n = 653) and matched controls (n = 4101). The mean follow-up duration was 57.7 ± 36.5 and 78.5 ± 42.3 months, respectively. The cases were further divided into: major events (severe atherosclerotic morbidity; n = 363), minor events (i.e. cardiovascular risk factors; n = 201) and cardiovascular evaluation tests (n = 89). The Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for hospitalizations while controlling for confounders. RESULTS: A Cox proportional hazard model, controlling for confounders such as gestational hypertension, gestational diabetes mellitus, obesity, maternal age, creatinine level and gestational week at index pregnancy showed that K(+ )≥ 5.0 mEq/L during pregnancy was significantly associated with hospitalizations due to severe atherosclerotic morbidity (adjusted HR = 1.55; 95% CI 1.02-2.35; p = 0.039). A non-significant trend was also noted with long-term total hospitalizations for atherosclerotic (adjusted HR = 1.39; 95% CI 0.99-1.94; p = 0.052). CONCLUSION: High potassium level during pregnancy is associated with a significant risk for severe atherosclerotic morbidity, as it might be an indication for occult metabolic and renal dysfunction.

Renal function during pregnancy may predict risk of future hospitalization due to atherosclerotic-related morbidity.

AIM: This study aims to examine whether renal function during pregnancy can serve as a surrogate marker for the risk of developing atherosclerotic-related morbidity. METHODS: A case-control study, including women who gave birth at a tertiary referral medical centre during 2000-2012. This population was divided into cases of women who were subsequently hospitalized for atherosclerotic morbidity during the study period and age-matched controls. From the study population, we retrieved two groups: the creatinine (Cr) group: women who had at least one Cr measurement (4945 women) and the urea group: women who had at least one urea measurement (4932 women) during their pregnancies. In the Cr and urea group, there were 572 and 571 cases and 4373 and 4361 controls, respectively. The mean follow-up period in the Cr and urea group was 61.7 ± 37.0 and 57.3 ± 36.0 months, respectively. Cox proportional hazards models (controlling for confounders: gestational hypertension, gestational diabetes, obesity, maternal age, creatinine level (for urea), and gestational week) were used to estimate the adjusted hazard ratios (HR) for hospitalizations. RESULTS: A significant association was documented between renal function during pregnancy and long-term atherosclerotic morbidity. Multivariate analysis, showed that Cr at pregnancy index of ≥89 µmol/L was associated with a significant increased risk for hospitalization due to cardiovascular (CVS) events (adjusted HR = 2.91 CI 1.37-6.19 P = 0.005) and urea level ≤7 mmol/L was independently associated with reduced prevalence of CVS hospitalization (adjusted HR = 0.62 CI 0.57-0.86 P = 0.001). CONCLUSION: Renal function abnormality during pregnancy may reveal occult predisposition to atherosclerotic morbidity years after childbirth.

High Uric Acid Levels During Pregnancy Linked to Increased Risk for Future Atherosclerotic-Related Hospitalization.

The aim of this study was to examine the association between uric acid (UA) level during pregnancy and future maternal hospitalization for atherosclerotic-related morbidity. A case-control study was conducted including women who delivered between the years 2000 to 2012 and subsequently developed atherosclerotic morbidity at least 1 year after their last delivery (n=588) and controls (n=3645). The mean follow-up duration was 57.8±35.6 months and 77±43.4 months, respectively. Cox proportional hazards models were used to estimate the adjusted hazard ratios for hospitalizations. A significant linear association was documented between UA during pregnancy and long-term maternal-related atherosclerotic morbidity. A Cox proportional hazard model, controlling for the confounders gestational hypertension, gestational diabetes mellitus, obesity, maternal age, creatinine level, and gestational week at index pregnancy showed that UA ≥5.6 mg/dL during pregnancy remained independently associated with long-term total hospitalization (adjusted hazard ratio, 1.47; 95% confidence interval, 1.16-1.86; P<.001). High UA level during pregnancy may predict maternal atherosclerotic morbidity.

Osteopontin - a multi-modal marker and mediator in atherosclerotic vascular disease.

Atherosclerosis is a chronic inflammatory process of the vessel wall with systemic correlates. It is now well established that patients' outcome is tightly linked to atherosclerotic plaque stability, potentially more so than to the mere plaque size. Osteopontin (OPN) is an integrin-binding ligand, N-linked glycoprotein, which was recognized as a significant participant in the atherosclerotic inflammatory milieu. Evidence from several genetic mouse models suggests that OPN is an enhancer of atherosclerosis. This may be mediated by its capacity to enhance inflammation in the atherosclerotic plaque. Interestingly, OPN may also possess potentially protective vascular effects, such as attenuation of vascular calcification. In humans circulating levels of OPN were found to be independently associated with the severity of coronary atherosclerosis. Moreover, several studies report that high plasma OPN levels were associated with increased risk for major adverse cardiac events. This review aims to critically assess current understanding of the role of OPN in the atherosclerotic process, from animal models to clinical practice. Specific focus is given to evaluating whether OPN could serve as a marker for monitoring coronary atherosclerosis severity, and in parallel, assess the evidence for its role as a mediator in the pathogenic pathways leading to atherosclerotic vascular disease.

Doxazosin to treat hypertension: it's time to take it personally--a retrospective analysis of 19, 495 patients.

OBJECTIVE: The aim of the current study was to evaluate the effect of α blockers on the cardiac outcomes of hypertensive patients who underwent myocardial perfusion imaging (MPI). METHODS: A retrospective analysis of the nuclear cardiology laboratory database was performed. The study group included only hypertensive patients (n = 19 ,495). The cohort was divided into three groups - a reference group of no α-blocker therapy (n = 17 ,053), α blockers for benign prostatic hypertrophy (BPH) (n = 1164), and doxazosin for hypertension (HTN) (n = 1258). We used Cox proportional regression models to examine the patient cardiac outcomes (composite of cardiovascular mortality and myocardial infarction) adjusted for the myocardial perfusion study results. The mean age was 65 ±â€Š11.1 years, 55% were men, and the average follow-up was 79.2 ±â€Š37.3 months. RESULTS: In univariate analysis, the doxazosin for HTN group had the highest rate of adverse cardiac events in comparison to the BPH and reference groups (14.1 vs. 11.3% and 8.9%, respectively, P < 0.001). After stratifying for the degree of reversibility of perfusion defect, only individuals with a moderate-to-severe perfusion defect in the doxazosin for HTN group had a significant increase in adverse cardiac events [hazard ratio 1.50 95% confidence interval (1.14-1.98)]. CONCLUSION: Our data show that doxazosin treatment for HTN is associated with adverse cardiac outcome only among patients with moderate-to-severe ischemia on myocardial perfusion imaging. Doxazosin and other α blockers appear to be safe in the vast majority of patients with a lesser degree of ischemia.

Can carotenoids attenuate vascular aging?

One of the main manifestations of vascular aging is the development of atherosclerotic lesions. These lesions become unstable and prone to rupture due to the formation of reactive oxygen species (ROS) that are produced by the inflammatory milieu in the atherosclerotic plaque. The carotenoids are a group of red, orange, or yellow pigmented polyisoprenoid hydrocarbons synthesized by prokaryotes and higher plants. Lycopene, lutein, and other carotenoids have anti-oxidant activity that attenuates the inflammatory atherosclerotic process and delays vascular aging. This ability improves endothelial function due to the increase in bioavailability of NO. Carotenoid consumption also improves the metabolic profile, decreasing the incidence of diabetes, lowering LDL levels, and improving blood pressure control. The beneficial metabolic effect is translated to improvement in atherosclerosis, which is characterized by a decrease in carotid intima-media thickness. The favorable anti-atherosclerotic effect of carotenoids was also demonstrated in cross-sectional population studies showing a positive correlation between low carotenoid levels and adverse cardiovascular outcome. However, carotenoid utilization failed to decrease major cardiovascular and cerebrovascular events in randomized control double blind trials. The main still unanswered question is: What is the therapeutic role of carotenoids in atherosclerotic disease? Is their anti-atherosclerotic effect restricted to primary prevention or can it alter the prognosis of existing cardiovascular and cerebrovascular diseases?

Is it possible to shorten ambulatory blood pressure monitoring?

The aim of this investigation was to find a time segment in which average blood pressure (BP) has the best correlation with 24-hour BP control. A total of 240 patients with full ambulatory BP monitoring (ABPM) were included; 120 had controlled BP (systolic BP [SBP] ≤135 mm Hg and diastolic BP [DBP] ≤85 mm Hg) and 120 had uncontrolled BP (SBP >135 mm Hg and/or DBP >85 mm Hg). Each ABPM was divided into 6- and 8-hour segments. Evaluation for correlation between mean BP for each time segment and 24-hour BP control was performed using receiver operating characteristic curve analysis and Youden's index for threshold with the best sensitivity and specificity. The mean BP in the following segments showed the highest area under the curve (AUC) compared with average controlled 24-hour BP: SBP 2 am to 8 am (AUC, 0.918; threshold value of 133.5 mm Hg, sensitivity-0.752 and specificity-0.904); SBP 2 pm to 10 pm (AUC, 0.911; threshold value of 138.5 mm Hg, sensitivity-0.803 and specificity-0.878); and SBP 6 am to 2 pm (AUC, 0.903; threshold value of 140.5 mm Hg, sensitivity-0.778 and specificity-0.888). The time segment 2 pm to 10 pm was shown to have good correlation with 24-hour BP control (AUC >0.9; sensitivity and specificity >80%). This time segment might replace full ABPM as a screening measure for BP control or as abbreviated ABPM for patients with difficulty in performing full ABPM.