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1.
Clin Transplant ; 38(3): e15275, 2024 03.
Artículo en Inglés | MEDLINE | ID: mdl-38477134

RESUMEN

BACKGROUND: There is conflicting evidence on the role of acetylsalicylic acid (ASA) use in the development of cardiac allograft vasculopathy (CAV). METHODS: A nationwide prospective two-center study investigated changes in the coronary artery vasculature by highly automated 3-D optical coherence tomography (OCT) analysis at 1 month and 12 months after heart transplant (HTx). The influence of ASA use on coronary artery microvascular changes was analyzed in the overall study cohort and after propensity score matching for selected clinical CAV risk factors. RESULTS: In total, 175 patients (mean age 52 ± 12 years, 79% male) were recruited. During the 1-year follow-up, both intimal and media thickness progressed, with ASA having no effect on its progression. However, detailed OCT analysis revealed that ASA use was associated with a lower increase in lipid plaque (LP) burden (p = .013), while it did not affect the other observed pathologies. Propensity score matching of 120 patients (60 patient pairs) showed similar results, with ASA use associated with lower progression of LPs (p = .002), while having no impact on layered fibrotic plaque (p = .224), calcification (p = .231), macrophage infiltration (p = .197), or the absolute coronary artery risk score (p = .277). According to Kaplan-Meier analysis, ASA use was not associated with a significant difference in survival (p = .699) CONCLUSION: This study showed a benefit of early ASA use after HTx on LP progression. However, ASA use did not have any impact on the progression of other OCT-observed pathologies or long-term survival.


Asunto(s)
Enfermedad de la Arteria Coronaria , Trasplante de Corazón , Placa Aterosclerótica , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Enfermedad de la Arteria Coronaria/etiología , Estudios Prospectivos , Tomografía de Coherencia Óptica/efectos adversos , Tomografía de Coherencia Óptica/métodos , Aloinjertos/patología , Placa Aterosclerótica/complicaciones , Trasplante de Corazón/efectos adversos , Angiografía Coronaria
2.
Bratisl Lek Listy ; 124(3): 193-200, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36598310

RESUMEN

BACKGROUND: The association between genetic polymorphisms and early cardiac allograft vasculopathy (CAV) development is relatively unexplored. Identification of genes involved in the CAV process may offer new insights into pathophysiology and lead to a wider range of therapeutic options. METHODS: This prospective study of 109 patients investigated 44 single nucleotide polymorphisms (SNPs) within the susceptibility loci potentially related to coronary artery disease, carotid artery intima-media thickness (cIMT), and in nitric oxide synthase gene. Genotyping was done by the Fluidigm SNP Type assays and Fluidigm 48.48 Dynamic Array IFC. The intima thickness progression (IT) was evaluated by coronary optical coherence tomography performed 1 month and 12 months after heart transplantation (HTx). RESULTS: During the first post-HTx year, the mean intima thickness (IT) increased by 24.0 ± 34.2 µm (p < 0.001) and lumen area decreased by ‒0.9 ± 1.8 mm2 (p < 0.001). The rs1570360 (A/G) SNP of the vascular endothelial growth factor A (VEGFA) gene showed the strongest association with intima thickness progression, even in the presence of the traditional CAV risk factors. SNPs previously related to carotid artery intima-media thickness rs11785239 (PRAG1), rs6584389 (PAX2), rs13225723 (LINC02577) and rs17477177 (CCDC71L), were among the five most significantly associated with IT progression but lost their significance once traditional CAV risk factors had been added. CONCLUSION: Results of this study suggest that genetic variability may play an important role in CAV development. The vascular endothelial growth factor A gene SNP rs1570360 showed the strongest association with intima thickness (IT) progression measured by OCT, even in the presence of the traditional CAV risk factors (Tab. 3, Fig. 3, Ref. 36). Text in PDF www.elis.sk Keywords: cardiac allograft vasculopathy, optical coherence tomography, vascular endothelial growth factor A, intimal thickening, genetic polymorphism.


Asunto(s)
Enfermedad de la Arteria Coronaria , Factor A de Crecimiento Endotelial Vascular , Humanos , Grosor Intima-Media Carotídeo , Estudios Prospectivos , Vasos Coronarios , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/genética , Aloinjertos
3.
J Card Fail ; 28(1): 13-20, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34324927

RESUMEN

BACKGROUND: Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice. METHODS AND RESULTS: We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P < .001), more likely to have prior stroke (29% vs 17%, P < .001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57). CONCLUSIONS: AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Medición de Resultados Informados por el Paciente , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Persona de Mediana Edad , Calidad de Vida , Volumen Sistólico , Utah/epidemiología , Valina/análogos & derivados
4.
Nutr Metab Cardiovasc Dis ; 32(9): 2137-2146, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35843790

RESUMEN

BACKGROUND AND AIMS: Leptin is an adipocyte-derived peptide involved in energy homeostasis and body weight regulation. The position of leptin in cardiovascular pathophysiology remains controversial. Some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as a neutral or even protective factor. We have explored whether high leptin affects the mortality and morbidity risk in patients with stable coronary heart disease. METHODS AND RESULTS: We followed 975 patients ≥6 months after myocardial infarction or coronary revascularization in a prospective study. All-cause or cardiovascular death, non-fatal cardiovascular events (recurrent myocardial infarction, stroke, or any revascularization), and hospitalizations for heart failure (HF) we used as outcomes. High serum leptin concentrations (≥18.9 ng/mL, i.e., 4th quartile) were associated with worse survival, as well as with a higher incidence of fatal vascular events or hospitalizations for HF. Even after full adjustment for potential covariates, high leptin remained to be associated with a significantly increased 5-years risk of all-cause death [Hazard risk ratio (HRR) 2.10 (95%CIs:1.29-3.42), p < 0.003], CV death [HRR 2.65 (95%CIs:1.48-4.74), p < 0.001], and HF hospitalization [HRR 1.95 (95% CIs:1.11-3.44), p < 0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76-2.13), p = 0.359]. CONCLUSIONS: High leptin concentration entails an increased risk of mortality, apparently driven by fatal CV events and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.


Asunto(s)
Enfermedad de la Arteria Coronaria , Insuficiencia Cardíaca , Infarto del Miocardio , Humanos , Leptina , Estudios Prospectivos , Factores de Riesgo
5.
Vnitr Lek ; 68(8): 532-536, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36575072

RESUMEN

In the Czech Republic, due to the population aging, the prevalence of cognitive dysfunction is increasing. Researchers estimate that by 2050 the number of patients with dementia in the Czech Republic will more than double. Since dementia cannot be cured, it is important to prevent the cognitive dysfunction development by influencing modifiable risk factors. Arterial hypertension (AH) is one of the main risk factors for the development of cognitive dysfunction and dementia. Elevated blood pressure values in youth are associated with a higher risk of cognitive decline in middle age and with the development of dementia in old age. Blood pressure control in low-risk patients with stage I hypertension reduces the risk of dementia development, including Alzheimers disease. Therefore, improving the AH control in the population since younghood will be needed to influence the emerging cognitive dysfunction pandemic.


Asunto(s)
Trastornos del Conocimiento , Disfunción Cognitiva , Demencia , Hipertensión , Persona de Mediana Edad , Humanos , Adolescente , Trastornos del Conocimiento/etiología , Antihipertensivos/uso terapéutico , Pandemias , Autocuidado/efectos adversos , Hipertensión/complicaciones , Disfunción Cognitiva/etiología , Disfunción Cognitiva/complicaciones , Demencia/epidemiología , Demencia/complicaciones , Demencia/tratamiento farmacológico
6.
Microvasc Res ; 134: 104117, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33245956

RESUMEN

Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Our objective has been to establish reference values for major functional and structural parameters of retinal microcirculation in a randomly selected urban population sample. A total of 398 randomly selected individuals from an urban population aged 25 to 65 years, resident in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry (SLDF), with data evaluable in 343 patients. Of this number, complete data were available for 256 individuals free from manifest cardiovascular disease, diabetes and drug treatment for hypertension and/or dyslipidemia, constituting the reference value population. Juxtapapillary retinal capillary blood flow has increased significantly with age whereas vessel and luminal diameters have decreased. No sex differences in retinal microcirculation parameters have been found. Therefore, reference values for retinal microcirculation parameters have been established by age groups. Unattended automated office systolic BP, after adjusting for age, correlated significantly with wall-to-lumen ratio (WLR) and wall thickness (WT). Moreover, after adjusting for age and mean BP, a positive relationship has been found between carotid femoral pulse wave velocity and WT, WLR and wall cross-sectional area, indicating the interaction between micro- and macro-vasculature. In conclusion, our study is the first to provide reference values of retinal microcirculation parameters in a random Caucasian population sample. Our results have shown that, at the population level, the first structural changes in retinal microcirculation are those in lumen diameters. Of note, a close relationship between BP and vascular remodeling of retinal arterioles and between aortic stiffness and WLR of retinal arterioles suggests an interaction between micro- and macro-vasculature.


Asunto(s)
Flujometría por Láser-Doppler , Microcirculación , Vasos Retinianos/fisiopatología , Adulto , Factores de Edad , Anciano , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Estudios Transversales , República Checa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores Raciales , Valores de Referencia , Flujo Sanguíneo Regional , Remodelación Vascular , Rigidez Vascular , Población Blanca
7.
Nutr Metab Cardiovasc Dis ; 31(2): 540-551, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33257192

RESUMEN

BACKGROUND AND AIMS: Matrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). METHODS AND RESULTS: 894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status. Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with "normal" concentrations of both biomarkers [HR 5.51 (95% CI 2.91-10.44), p < 0.0001 and 6.79 (95% CI 3.06-15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. CONCLUSIONS: The individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.


Asunto(s)
Proteínas de Unión al Calcio/sangre , Enfermedad Coronaria/sangre , Proteínas de la Matriz Extracelular/sangre , Factor 15 de Diferenciación de Crecimiento/sangre , Deficiencia de Vitamina D/sangre , Anciano , Biomarcadores/sangre , Enfermedad Crónica , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/terapia , Estudios Transversales , República Checa/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Regulación hacia Arriba , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/mortalidad , Proteína Gla de la Matriz
8.
Horm Metab Res ; 52(12): 861-868, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32746485

RESUMEN

Adiponectin has several beneficial properties, namely, on the level of glucose metabolism, but paradoxically, its high concentrations were associated with increased mortality. We aimed to clarify the impact of high serum adiponectin on mortality and morbidity in patients with stable coronary artery heart disease (CAD). A total of 973 patients after myocardial infarction and/or coronary revascularization were followed in a prospective cohort study. All-cause and cardiovascular (CV) death, non-fatal cardiovascular events, and hospitalizations for heart failure (HF) were registered as outcomes. High serum adiponectin levels (≥8.58 ng/ml, i. e., above median) were independently associated with increased risk of 5-year all-cause, CV mortality or HF [with HRR 1.57 (95% CI: 1.07-2.30), 1.74 (95% CI: 1.08-2.81) or 1.94 (95% CI: 1.20-3.12), respectively] when adjusted just for conventional risk factors. However, its significance disappeared if brain natriuretic peptide (BNP) was included in a regression model. In line with this, we observed strong collinearity of adiponectin and BNP. Additionally, major adverse cardiovascular event (i. e., CV death, non-fatal myocardial infarction or stroke, coronary revascularization) incidence risk was not associated with high adiponectin. In conclusion, the observed inverse association between adiponectin concentrations and mortality risk seems to be attributable to concomitantly increased BNP, rather than high adiponectin being a causal factor.


Asunto(s)
Adiponectina/sangre , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/mortalidad , Anciano , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/genética , Estudios Transversales , República Checa/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia
9.
Blood Press ; 29(5): 308-318, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32425070

RESUMEN

The purpose: To evaluate longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease (CKD) in Czech adults with and without arterial hypertension (HT).Materials and methods: Two independent cross-sectional surveys were performed in 2006-2009 and 2015-2018, each screening involving 1% population random sample of the general population of nine districts of the Czech Republic aged 25-64 years, stratified by age and gender. Hyperuricaemia was defined as serum uric acid ≥ 420 µmol/l in men, and ≥ 360 µmol/l in women. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or albumin/creatinine ratio ≥ 3 mg/mmol.Results: Final analyses included 3504 individuals examined in 2006-2009, and 2309 in 2015-2018. The overall prevalence of hyperuricaemia increased from 16.4% to 25.2% in men (p < 0.001), and from 7.6% to 10.9% in women (p < 0.001), whereas the overall prevalence of CKD declined from 6.8% to 3.6% in men (p = 0.001), and from 7.6% to 4.8% in women (p < 0.001). There was no interaction between HT and hyperuricaemia in either gender; the increase in hyperuricaemia prevalence was observed both in hypertensive and normotensive adults and was accompanied by the increased prevalence of abdominal obesity. Contrarily, there was an interaction between HT and CKD in both men (p < 0.001) and women (p = 0.011); the CKD prevalence declined only in hypertensive individuals, specifically in those using antihypertensive medication and was accompanied by the increased use of renin-angiotensin-aldosterone system (RAS) inhibitors and calcium channel blockers (CCBs).Conclusions: Over the period of 10 years, the overall prevalence of hyperuricaemia increased, while the prevalence of CKD decreased. An increase in the prevalence of hyperuricaemia was observed both in hypertensive and normotensive individuals and was accompanied by an increase in the prevalence of abdominal obesity. A decline in the prevalence of CKD was only observed in hypertensive individuals and was accompanied by the increased use of RAS inhibitors and CCBs.


Asunto(s)
Hipertensión/complicaciones , Hiperuricemia/epidemiología , Insuficiencia Renal Crónica/epidemiología , Adulto , Presión Sanguínea , Estudios Transversales , Femenino , Humanos , Hipertensión/fisiopatología , Hiperuricemia/complicaciones , Hiperuricemia/fisiopatología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/fisiopatología
10.
Blood Press ; 29(3): 191-198, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32036692

RESUMEN

Purpose: Primary aldosteronism (PA) is considered the most common form of secondary hypertension, however, its prevalence, particularly in a general population, is still a matter of debate. The aim of our study was to evaluate the prevalence of PA in a randomly selected general population sample.Materials and methods: A total of 1940 individuals (1% population random sample) aged 25-64 years were screened for major cardiovascular risk factors in six districts of the Czech Republic. Hypertension was defined as a mean of two blood pressure readings ≥140/90 mmHg at one visit or taking antihypertensive medication. Within this population, 740 individuals were labelled as hypertensives and 650 of them sampled for the analysis of direct plasma renin and serum aldosterone. The diagnosis of PA was based on elevated serum aldosterone, low plasma renin and high aldosterone/renin (ARR) ratio and was also verified by a confirmatory test with saline infusion.Results: Positive ARR was found in 52 (8%) individuals (64% women, 36% men, however, due to substatntial proportion of reluctatnt participants to undergo a further work-up (27%), we could confirm the diagnosis of PA only in 13 of them (2%). Aldosterone-producing adenoma was found in one case only, seven patients had idiopathic type and five individuals refused potential surgical treatment therefore, adrenal venous sampling was not performed.Conclusion: Elevated serum aldosterone together with low renin and high ARR were found in 52 (8%) of hypertensives selected from a general population sample, however, the diagnosis of PA was confirmed only in 13 of them (2%). This study based on a general population survey highlighted the difficulty of conducting epidemiological studies on primary aldosteronism in a relatively healthy cohort part of whom did not provide the level of collaboration that is necessary to assess the true prevalence of this condition.


Asunto(s)
Hiperaldosteronismo/epidemiología , Hipertensión/epidemiología , Adulto , Aldosterona/sangre , Antihipertensivos/uso terapéutico , Biomarcadores/sangre , Presión Sanguínea/efectos de los fármacos , Estudios Transversales , República Checa/epidemiología , Femenino , Humanos , Hiperaldosteronismo/sangre , Hiperaldosteronismo/diagnóstico , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Renina/sangre
11.
Heart Fail Clin ; 16(4): 409-420, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32888636

RESUMEN

Heart failure is a chronic disease with a multitude of different clinical manifestations. Empowering people living with heart failure requires education, support structure, understanding the needs of patients, and reimaging the care delivery systems currently offered to patients. In this article, the authors discuss practical approaches to activate and empower people with heart failure and enable patient-provider dialogue and shared decision making.


Asunto(s)
Toma de Decisiones , Insuficiencia Cardíaca/psicología , Poder Psicológico , Humanos
12.
Vnitr Lek ; 65(11): 698-697, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31906675

RESUMEN

Currently, there is a change in the algorithm of hypertension treatment, introducing its simplification. While in the past a careful stepwise titration of antihypertensive drugs was used, the current European Society of Hypertension Guidelines prefer a more aggressive and rapid approach to combination treatment as the initial step with the aim to achieve the goal blood pressure within three months. This review summarizes changes in recommendations and evidence supporting a more aggressive treatment of hypertension.


Asunto(s)
Antihipertensivos/administración & dosificación , Hipertensión/tratamiento farmacológico , Algoritmos , Presión Sanguínea/efectos de los fármacos , Determinación de la Presión Sanguínea , Objetivos , Humanos , Hipertensión/diagnóstico , Factores de Tiempo
13.
Horm Metab Res ; 50(1): 56-64, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29183090

RESUMEN

Low vitamin D status has been frequently associated with impaired glucose metabolism. We examined associations between 25-hydroxyvitamin D (25-OH-D) and several parameters of glucose homeostasis in virtually healthy subjects, and explored possible interaction with vitamin D receptor (VDR) polymorphism. Nondiabetic subjects without chronic medication or any known significant manifest disease were selected from large general-population based population survey. Insulin sensitivity and ß cell secretion were calculated by homeostasis model assessment (HOMA) and soluble isoform of receptor for advanced glycation end-products (sRAGE) using commercial ELISA. Subjects were also genotyped for rs2228570 polymorphism of VDR. After adjustment for potential confounders, we observed a significant relationship between 25-OH-D and fasting glycemia (ß coefficient=-5.904; p=0.002) or insulin sensitivity (ß=0.042; p=0.001), but not with ß cell secretion or sRAGE. We found also an interaction with VDR polymorphism. Subjects with low 25-OH-D and AA genotype had significantly lower insulin sensitivity than those with GG genotype plus highest 25-OH-D concentrations (107.3% vs. 183.9%, p=0.021). In conclusion, low vitamin D status was in virtually healthy subjects associated with decreased insulin sensitivity, namely in those with GG genotype of rs2228570 VDR polymorphism.


Asunto(s)
Glucosa/metabolismo , Homeostasis , Polimorfismo de Nucleótido Simple/genética , Receptores de Calcitriol/genética , Vitamina D/sangre , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Resistencia a la Insulina/genética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Vitamina D/análogos & derivados
14.
Curr Hypertens Rep ; 18(8): 62, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27372446

RESUMEN

The aim of this paper was to critically evaluate recent publications on hypertension treatment and control in regions by income. Prevalence of hypertension is increasing worldwide, most prominently in low-income countries. Awareness, treatment, and control are most successful in North America while remaining a challenge in middle- and low-income countries. Easy access to medical care and aggressive use of pharmacotherapy are the key strategies which have proved to be successful in reducing the burden of hypertension on the population level.


Asunto(s)
Comparación Transcultural , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Pobreza , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Antihipertensivos/uso terapéutico , Estudios Transversales , Femenino , Estilo de Vida Saludable , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
15.
Vnitr Lek ; 62(11): 863-867, 2016.
Artículo en Checo | MEDLINE | ID: mdl-28128571

RESUMEN

INTRODUCTION: Hypertension and hypercholesterolemia are inter-related ad mutually potentiating cardiovascular risk factors, which, when occurring together, strongly accelerate atherosclerosis and significantly increase cardiovascular risk.The aim of our study was to assess the prevalence and control of both risk factors in the Czech population. METHODS: A 1 % population random sample aged 40-64 years was examined within the Czech post-MONICA in 2006-2009. Hypertension was defined as systolic blood pressure 140 mm Hg and/or diastolic BP 90 mm Hg or use of antihypertensive medication. Hypercholesterolemia was defined according to cardiovascular risk and LDL-cholesterol levels or use of lipid-lowering drugs. RESULTS: In a group of 2 508 persons (51 % of females), hypertension was found in 52 % and hypercholesterolemia in 40 % of examined individuals. Both risk factors occurred together in 30 % of subjects. While lipid-lowering drugs were used by 39 % of individuals with hypertension and hypercholesterolemia, target LDL-cholesterol were achieved by only 42 % of treated individuals. Only a total of 10 % individuals with both hypertension and hypercholesterolemia achieved target levels for both risk factors. CONCLUSION: Treatment and control of hypercholesterolemia in patients with hypertension remains unsatisfactory in the Czech Republic. Taking into account the high prevalence of hypercholesterolemia and the substantial increase in cardiovascular risk, lipid-lowering drugs should be considered in each patient with hypertension.Key words: antihypertensive drugs - Czech post-MONICA - lipid-lowering drugs - SCORE - target values - total cardiovascular risk.


Asunto(s)
Hipercolesterolemia/epidemiología , Hipertensión/epidemiología , Adulto , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Enfermedades Cardiovasculares/epidemiología , LDL-Colesterol/sangre , República Checa/epidemiología , Femenino , Humanos , Hipercolesterolemia/sangre , Hipercolesterolemia/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
16.
BMC Nephrol ; 16: 146, 2015 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-26286066

RESUMEN

BACKGROUND: Induction therapy can improve kidney transplantation (KTx) outcomes, but little is known about the mechanisms underlying its effects. METHODS: The mRNA levels of T cell-related genes associated with tolerance or rejection (CD247, GZMB, PRF1, FOXP3, MAN1A1, TCAIM, and TLR5) and lymphocyte subpopulations were monitored prospectively in the peripheral blood of 60 kidney transplant recipients before and 7, 14, 21, 28, 60, 90 days, 6 months, and 12 months after KTx. Patients were treated with calcineurin inhibitor-based triple immunosuppression and induction with rabbit anti-thymocyte globulin (rATG, n = 24), basiliximab (n = 17), or without induction (no-induction, n = 19). A generalized linear mixed model with gamma distribution for repeated measures, adjusted for rejection, recipient/donor age and delayed graft function, was used for statistical analysis. RESULTS: rATG treatment caused an intense reduction in all T cell type population and natural killer (NK) cells within 7 days, then a slow increase and repopulation was observed. This was also noticed in the expression levels of CD247, FOXP3, GZMB, and PRF1. The basiliximab group exhibited higher CD247, GZMB, FOXP3 and TCAIM mRNA levels and regulatory T cell (Treg) counts than the no-induction group. The levels of MAN1A1 and TLR5 mRNA expressions were increased, whereas TCAIM decreased in the rATG group as compared with those in the no-induction group. CONCLUSION: The rATG induction therapy was associated with decreased T and NK cell-related transcript levels and with upregulation of two rejection-associated transcripts (MAN1A1 and TLR5) shortly after KTx. Basiliximab treatment was associated with increased absolute number of Treg cells, and increased level of FOXP3 and TCAIM expression.


Asunto(s)
Expresión Génica/efectos de los fármacos , Rechazo de Injerto/inmunología , Quimioterapia de Inducción/métodos , Trasplante de Riñón/métodos , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Suero Antilinfocítico/uso terapéutico , Basiliximab , Complejo CD3/genética , Inhibidores de la Calcineurina/uso terapéutico , Femenino , Factores de Transcripción Forkhead/genética , Rechazo de Injerto/genética , Rechazo de Injerto/prevención & control , Granzimas/genética , Humanos , Tolerancia Inmunológica/efectos de los fármacos , Tolerancia Inmunológica/genética , Terapia de Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Recuento de Linfocitos , Masculino , Manosidasas/genética , Persona de Mediana Edad , Células T Asesinas Naturales/efectos de los fármacos , Células T Asesinas Naturales/inmunología , Perforina/genética , Estudios Prospectivos , ARN Mensajero/sangre , Proteínas Recombinantes de Fusión/uso terapéutico , Linfocitos T Reguladores/efectos de los fármacos , Linfocitos T Reguladores/inmunología , Adulto Joven
17.
Blood Press ; 24(4): 206-11, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26018462

RESUMEN

Metabolic syndrome (MetSy) is associated with a high risk of cardiovascular complications. Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. This study investigated the effect of individual MetSy risk factors on central and peripheral parameters of aortic stiffness. In the Czech post-MONICA study, we measured aortic pulse-wave velocity (aPWV), lower extremity pulse-wave velocity (lePWV), augmentation index (AIx) and central augmentation pressure (cAP) in 936 subjects. Based on the definition of MetSy, we divided subjects according to number of risk factors. We used univariate and multivariate linear regression analysis to assess the association between number of risk factors and aPWV, lePWV, AIx and cAP. In analyses adjusted for age, gender, heart rate and mean arterial pressure, aPWV was higher in subjects with MetSy (MetSy+ group) than in those without (MetSy + group) (8.3 vs. 7.7 m/s; p < 0.0001), but lePWV was not significantly different between the groups (11.0 vs. 11.2 m/s; p = 0.2037). After adjustment for covariates, AIx in MetSy+ was lower than in MetSy- respondents (143.2 vs. 146.8; p = 0.014). In adjusted analysis, aPWV rose with increasing number of MetSy risk factors (7.3 ± 0.1 vs. 9.0 ± 0.1 m/s; p for trend < 0.0001). The number of MetSy risk factors did not affect lePWV (p = 0.11). AIx decreased with higher number of MetSy risk factors (148.3 vs. 141.5; p = 0.020). This finding confirms the fact that PWV and AIx may have different associations with risk factors and AIx should not be used as an isolated parameter of arterial stiffness. The individual MetSy risk factors have only a small effect on lower extremity arterial stiffness.


Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Síndrome Metabólico/fisiopatología , Obesidad/complicaciones , Rigidez Vascular/fisiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
18.
J Stroke Cerebrovasc Dis ; 24(6): 1443-50, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25866318

RESUMEN

BACKGROUND: Although obesity is a risk factor for stroke and achieving normal weight is advocated to decrease stroke risk, the risk associated with obesity and weight loss after stroke has not been well established. The aim of this study was to assess the association of obesity at the time of stroke admission and weight loss after stroke with total mortality. METHODS: We analyzed 736 consecutive patients (mean age, 66 ± 11 years; 58% men) hospitalized for their first ischemic stroke. Body weight at hospital admission and at the outpatient visit during follow-up was used in the analysis. RESULTS: After multivariate adjustment, obesity at admission was associated with lower mortality risk as compared with normal weight (hazard ratio [HR], .50, P = .03). At the outpatient visit, with a median follow-up time of 16 months, 21% of patients had lost more than 3 kg of weight. Stroke severity, heart failure, transient ischemic attack, and depression after stroke were independently associated with significant weight loss. Weight loss of more than 3 kg was associated with increased mortality risk (HR, 5.87; P = .001) independently of other factors. Similar results were seen when weight loss was defined as losing more than 3% of baseline weight (HR, 4.97; P = .004). Weight gain of more than 5% of the baseline weight tended to be associated with better survival when compared with no weight change (log-rank test, P = .07). CONCLUSIONS: Normal weight at hospital admission and weight loss after ischemic stroke are independently associated with increased mortality. Overweight and obesity at baseline do not decrease the risk associated with weight loss.


Asunto(s)
Obesidad/complicaciones , Accidente Cerebrovascular/complicaciones , Pérdida de Peso/fisiología , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología
19.
Eur J Prev Cardiol ; 2024 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-38497201

RESUMEN

AIMS: While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients' stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended GRACE score. METHODS: A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. RESULTS: Data from 1,135 patients (aged 64±12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) questionnaire and clinical variables were used as possible predictors. The best model included the following variables - age, heart failure history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months (AUC 90.1, 95% CI 81.8-98.4 vs. 77.4, 95% CI 62.2-92.5, p=0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5-96.0 vs. 76.2, 95% CI 64.7-87.7, p=0.004). CONCLUSION: The PragueMi score combining heart failure symptoms and clinical variables performs better than the currently recommended GRACE score.


The prognosis of patients after myocardial infarction is heterogeneous. Thus, risk stratification is needed to identify and intervene patients at increased risk. While heart failure (HF) symptoms are associated with adverse prognosis, they are not used for patients' stratification. We have developed and internally validated the PragueMi score, which integrates clinical risk factors at the time of hospitalization and HF symptoms determined remotely by a questionnaire 1 month after hospital discharge. PragueMi score was able to better stratify patients' risk as compared to the currently recommended GRACE score.

20.
Eur J Intern Med ; 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38697863

RESUMEN

BACKGROUND: Data on the clinical significance of iron deficiency (ID) in patients with myocardial infarction (MI) are conflicting. This may be related to the use of various ID criteria. We aimed to compare the association of different ID criteria with all-cause mortality after MI. METHODS: Consecutive patients hospitalized for their first MI at a large tertiary heart center were included. We evaluated the association of different iron metabolism parameters measured on the first day after hospital admission with all-cause mortality. RESULTS: From the 1,156 patients included (aged 64±12 years, 25 % women), 194 (16.8 %) patients died during the median follow-up of 3.4 years. After multivariate adjustment, iron level ≤13 µmol/L (HR 1.67, 95 % CI 1.19-2.34) and the combination of iron level ≤12.8 µmol/L and soluble transferrin receptor (sTfR) ≥3 mg/L (HR 2.56, 95 % CI 1.64-3.99) termed as PragueID criteria were associated with increased mortality risk and had additional predictive value to the GRACE score. Compared to the model including iron level, the addition of sTfR improved risk stratification (net reclassification improvement 0.61, 95 % CI 0.52-0.69) by reclassifying patients into a higher-risk group. No association between ferritin level and mortality was found. 51 % of patients had low iron levels, and 58 % fulfilled the PragueID criteria. CONCLUSION: Iron deficiency is common among patients with the first MI. The PragueID criteria based on iron and soluble transferrin receptor levels provide the best prediction of mortality and should be evaluated in future interventional studies for the identification of patients potentially benefiting from intravenous iron therapy.

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