Serum Levels of Carbamylated LDL and Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Are Associated with Coronary Artery Disease in Patients with Metabolic Syndrome.

Background and objectives: Lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) has been recognized as the primary receptor for carbamylated low-density lipoproteins (cLDL) and is increasingly being viewed as a critical mediator of vascular inflammation and atherosclerosis. The aim of the current study was to evaluate the possible role of circulating cLDL and soluble LOX-1 (sLOX-1) as potential biomarkers of metabolic syndrome (MetS) as well as of coronary artery disease (CAD) among MetS patients. Materials and Methods: The serum levels of cLDL and sLOX-1 were measured by ELISA in 30 MetS patients without CAD, 30 MetS patients with CAD, and 30 healthy controls. Results: Patients with MetS had significantly higher serum levels of both cLDL and sLOX-1 than the healthy controls but lower in comparison to MetS + CAD subjects. Serum sLOX-1 concentration correlated significantly with fasting glucose (rs = 0.414, p = 0.001) and high-density lipoprotein (HDL)-cholesterol (rs = -0.273, p = 0.035) in the whole MetS cohort, whereas it correlated with cLDL only in the MetS + CAD subgroup (rs = 0.396, p = 0.030). The receiver-operating characteristic (ROC) curves of cLDL and sLOX-1 for MetS diagnosis had area under the curve (AUC) values of 0.761 and 0.692, respectively. AUC values of cLDL and sLOX-1 for CAD diagnosis among MetS patients were 0.811 and 0.739. Elevated serum levels of cLDL and sLOX-1 were associated with a higher risk of MetS development [odds ratio (OR) 24.28, 95% confidence interval (CI): 5.86-104.61, p < 0.001 and OR 4.75; 95% CI: 1.58-14.25, p = 0.009] as well as with presence of CAD among MetS subjects (OR 11.23; 95% CI: 3.10-40.71, p < 0.001 and OR 4.03; 95% CI: 1.73-11.84, p = 0.019, respectively). Conclusions: The present study underscores the potential of cLDL and sLOX-1 as promising biomarkers for diagnosis and risk assessment of MetS and CAD among the MetS population.

Real-World Effectiveness and Safety of Lixisenatide as Add-On to Oral Antidiabetic Drugs as Part of Routine Clinical Practice in Bulgaria: LIXODAR Study.

INTRODUCTION: This study aimed to demonstrate the beneficial effect of lixisenatide as add-on therapy to oral antidiabetics (OADs) in type 2 diabetes mellitus (T2DM) patients in routine clinical practice in Bulgaria. METHODS: This was a prospective, observational, multicentre study evaluating the real-life effectiveness and safety of 24-week treatment with lixisenatide in previously uncontrolled T2DM patients on combination therapy with metformin and sulfonylurea on highest tolerable doses. RESULTS: A total of 262 patients were included in the study. The mean (± SD) age in the cohort was 56.2 ± 9.1 years. The mean duration of diabetes was 7.3 ± 6.0 years. The mean body mass index (BMI) was 39.7 ± 4.7 kg/m2. The mean glycated haemoglobin (HbA1c) at baseline was 8.8 ± 1.1%. The mean fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) at baseline were 10.5 ± 3.1 mmol/L and 12.1 ± 3.4 mmol/L respectively. The proportion of patients achieving HbA1c < 7% at study end was 39.0% (95% CI 32.9-45.3). The proportion of patients reaching their individual HbA1c target was 49.0% (95% CI 42.6-55.4). The mean change in HbA1c from baseline was - 1.3 ± 1.2%. The mean change in FPG was - 2.4 ± 3.0 mmol/L and the mean change in PPG was - 3.2 ± 3.6 mmol/L. The mean body weight change from baseline was - 7.2 ± 5.5 kg. The mean BMI change was - 2.6 ± 1.9 kg/m2. The hypoglycaemia incidence was low: 6.1% for all hypoglycaemic events, 3.8% for symptomatic events and 0.4% for severe events. CONCLUSIONS: Lixisenatide as add-on therapy to OADs in a real-life setting led to significant improvements in glycaemic control with low incidence of hypoglycaemia and beneficial weight loss. Lixisenatide was well tolerated with few patients having adverse events or discontinuing therapy. These findings are consistent with lixisenatide's safety and efficacy profile established in randomized controlled trials (RCTs). FUNDING: Sanofi Bulgaria.

Serum Levels of Carbamylated LDL, Nitrotyrosine and Soluble Lectin-like Oxidized Low-density Lipoprotein Receptor-1 in Poorly Controlled Type 2 Diabetes Mellitus.

INTRODUCTION: Carbamylated low-density lipoprotein (cLDL) has profound proatherogenic properties. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) has been identified as the primary cLDL receptor. The soluble form of LOX-1 (sLOX-1) and 3-nitrotyrosine (NT) have recently been suggested as biomarkers of vascular disease. Although type 2 diabetes mellitus (T2DM) is characterised by an increased atherosclerotic risk, the clinical data on cLDL, NT and sLOX-1 levels in T2DM are limited. AIM: To explore the possible role of cLDL, NT and sLOX-1 as potential biomarkers for disease progression and complications in poorly controlled T2DM patients with and without microalbuminuria. MATERIALS AND METHODS: The serum concentrations of cLDL, NT and sLOX-1 were measured by ELISA in a cross-sectional study of 60 T2DM patients and 35 nondiabetic controls. RESULTS: Both the normoalbuminuric (n = 34) and the microalbuminuric (n = 26) patients had significantly higher serum levels of cLDL and NT than the healthy controls, but sLOX-1 was only elevated in the microalbuminuric subgroup (p < 0.05). Carbamylated LDL correlated positively with NT in the diabetic subjects (rs = 0.266, p = 0.04) while it correlated with urea only in the control group (rs = 0.475, p = 0.004). The serum concentration of sLOX-1 correlated significantly with fasting glucose (rs = 0.441, p < 0.001), HbA1c (rs = 0.328, p = 0.01) and microalbuminuria (rs = 0.272, p = 0.035) in the whole diabetic cohort. CONCLUSIONS: The present study highlights the potential of cLDL, NT and sLOX-1 as possible markers of diabetic complications.

Anthropological Characteristic of the Distribution of Adipose Tissue in Bulgarian Females with Type 2 Diabetes Mellitus.

BACKGROUND: The complex study of adipose tissue in women with type 2 diabetes mellitus (T2DM) is of importance for the clinical course and prognosis of the disease. AIM: To study the distribution of adipose tissue in Bulgarian females with T2DM. PATIENTS AND METHODS: The study included 92 women with T2DM (age range 40-60 years). The control group consisted of 40 age-matched women. Measurement parameters: height, weight, 9 skinfolds (sf) - sfTriceps, sfBiceps brachii, sfForearm, sfSubscapular, sfXrib, sfAbdomen, sfSuprailiaca, sfThigh, and sfCalf; bioelectrical impedance analysis - % body fat tissue and visceral fat tissue. Calculated indexes: body mass index (BMI), the ratio sfTrunk to sfLimbs, the ratio skin folds upper half of body/skin folds lower half of body, fat mass and subcutaneous fat mass. RESULTS: Statistically significant differences were found in the means of sfTriceps, sfXrib, sfThigh, sfCalf, % body fat tissue, visceral fat tissue, and fat mass and subcutaneous fat mass between the diabetic and healthy women. The body composition of diabetic females aged 40-60 years contained a larger adipose component than controls. Visceral adipose tissue which determines the body composition is a reliable indicator of the health risks in diabetic women. CONCLUSION: The pattern of subcutaneous adipose tissue distribution in diabetic females aged 40-60 yrs was primarily in the upper torso region and less so in the limbs. In the controls adipose tissue is accumulated primarily in the limbs and in the lower part of the body.

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease.

BACKGROUND: Road traffic noise (RTN) is a risk factor for cardiovascular disease (CVD) and hypertension; however, few studies have looked into its association with blood pressure (BP) and renal function in patients with prior CVD. AIM: This study aimed to explore the effect of residential RTN exposure on BP and renal function in patients with CVD from Plovdiv Province. MATERIALS AND METHODS: We included 217 patients with ischemic heart disease and/or hypertension from three tertiary hospitals in the city of Plovdiv (March - May 2016). Patients' medical history, medical documentation, and medication regimen were reviewed, and blood pressure and anthropometric measurements were taken. Blood samples were analyzed for creatinine, total cholesterol, and blood glucose. Participants also filled a questionnaire. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. All participants were asked about their annoyance by different noise sources at home, and those living in the city of Plovdiv (n = 132) were assigned noise map Lden and Lnight exposure. The effects of noise exposure on systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular filtration rate (eGFR) were explored using mixed linear models. RESULTS: Traffic noise annoyance was associated with higher SBP in the total sample. The other noise indicators were associated with non-significant elevation in SBP and reduction in eGFR. The effect of Lden was more pronounced in patients with prior ischemic heart disease/stroke, diabetes, obesity, not taking Ca-channel blockers, and using solid fuel/gas at home. Lnight had stronger effect among those not taking statins, sleeping in a bedroom with noisy façade, having a living room with quiet façade, and spending more time at home. The increase in Lden was associated with a significant decrease in eGFR among men, patients with ischemic heart disease/stroke, and those exposed to lower air pollution. Regarding Lnight, there was significant effect modification by gender, diabetes, obesity, and time spent at home. In some subgroups, the effect of RTN was statistically significant. CONCLUSIONS: Given that generic risk factors for poor progression of cardiovascular diseases cannot be controlled sufficiently at individual level, environmental interventions to reduce residential noise exposure might result in some improvement in the management of blood pressure and kidney function in patients with CVD.

Association between community noise and adiposity in patients with cardiovascular disease.

INTRODUCTION: This study aimed to explore the effect of community noise on body mass index (BMI) and waist circumference (WC) in patients with cardiovascular disease (CVD). MATERIALS AND METHODS: A representative sample of 132 patients from three tertiary hospitals in the city of Plovdiv, Bulgaria was collected. Anthropometric measurements were linked to global noise annoyance (GNA) based on different residential noise annoyances, day-evening-night (Lden), and nighttime (Lnight) road traffic noise exposure. Noise map Lden and Lnight were determined at the living room and bedroom façades, respectively, and further corrected to indoor exposure based on the window-opening frequency and soundproofing insulation. RESULTS AND DISCUSSION: Results showed that BMI and WC increased (non-significantly) per 5 dB. The effect of indoor noise was stronger in comparison with that of outdoor noise. For indoor Lden, the effect was more pronounced in men, those with diabetes, family history of diabetes, high noise sensitivity, using solid fuel/gas for domestic heating/cooking, and living on the first floor. As regards indoor Lnight, its effect was more pronounced in those with low socioeconomic status, hearing loss, and using solid fuel/gas for domestic heating/cooking. GNA was associated with lower BMI and WC. CONCLUSION: Road traffic noise was associated with an increase in adiposity in some potentially vulnerable patients with CVD.

Correlations between human somatotype components and some anthropometric parameters in male patients with type 2 diabetes mellitus.

UNLABELLED: The aim of the present study was to find and compare the correlations between somatotype and some anthropological parameters in Bulgarian male patients with type 2 diabetes mellitus. PATIENTS AND METHODS: Anthropometric measurements were taken from 165 male patients with type 2 diabetes mellitus. All patients were ethnic Bulgarians. They were divided into two age groups: a 40-60-year group (58 patients, mean age 52.05 ± 0.73 yrs), and a 61-80-year group (111 patients, mean age 68.02 ± 0.53 yrs). The controls were allocated into similar age-matched groups. Direct anthropometric measurements were body height and weight, biepicondylar breadth of the humerus and biepicondylar breadth of the femur. Circumferential measurements were taken from the relaxed and contracted upper arm, the forearm, the waist, the hip, the thigh and the medial calf. Skin folds were measured below the inferior angle of the scapula, above the X rib, above the crista iliaca, at the abdomen, triceps brachii, forearm, thigh and the medial calf. The components of human somatotype according to the criteria of Heath-Carter, body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. RESULTS: We found very strong positive correlations (PC > 0.70) between BMI and the endomorphic and mesomorphic components of somatotype in 40-60-year-old male diabetic patients. The correlation between the endomorphic and mesomorphic components of somatotype and the anthropometric measurements characterizing the central accumulation of adipose tissue (waist circumference, hip circumference, WHR) was very strong positive (PC = 0.5-0.7). Male diabetic patients aged 61-80 years: we found a very strong positive correlation between endomorphic and mesomorphic components and BMI, a strong correlation between these components and the waist circumference, and a good correlation between the components and the circumferences of the waist and hip and WHR. CONCLUSIONS: In male patients with type 2 diabetes aged 40-60 years, the endomorphic and mesomorphic components of somatotype are strongly positively correlated with the parameters which characterize the total adipose tissue accumulation in the human body (BMI). There is a good positive correlation between the two components of somatotype and the parameters showing visceral adipose tissue accumulation (circumferences of waist, hip, thigh and WHR). In male patients with type 2 diabetes aged 61-80 years we found a strong positive correlation of the endomorphic and mesomorphic components of somatotype with BMI and a good positive correlation with the circumferences of the waist, hip, thigh and WHR.

Evaluation of endemic goiter prevalence in Bulgarian schoolchildren: results from national strategies for prevention and control of iodine-deficiency disorders.

Iodine deficiency is a major health problem worldwide. The environment of the Balkan countries, including Bulgaria, is distinguished for its low iodine content. In 1994, the strategies for the prevention and control of iodinedeficiency disorders were actualized in Bulgaria and universal salt iodization and supplementation for the risk population groups (schoolchildren, pregnant women) were introduced. The aim of this study was to assess the effectiveness of the iodine prophylaxis in schoolchildren, living in an endemic for goiter area after the introduction of salt iodization in Bulgaria. For this purpose, the goiter prevalence and iodine status in 483 schoolchildren (274 boys and 209 girls) aged between 8 and 15 yr, living in an endemic for goiter area in Bulgaria were evaluated. Despite the normalization of iodine supply, mild iodine deficiency on the basis of goiter prevalence (16.15%) and urinary iodine excretion was found. These data indicate the need for reevaluation of the national strategy for prevention of iodine deficiency.

Effect of chromium on the insulin resistance in patients with type II diabetes mellitus.

INTRODUCTION: Chromium deficiency in diabetic patients is a debatable problem. The prevailing opinion suggests the presence of low serum concentrations in such patients and therefore an early, long-term addition of chromium to the standard therapy is recommended. PURPOSE: The aim of the present study was to evaluate the effect of chromium on the insulin resistance in diabetic patients with type II diabetes mellitus. MATERIAL AND METHODS: We have studied a total of 34 overweight patients with type II diabetes mellitus, who were distributed in two study sub-groups--patients with very good metabolic control and patients with bad control. For sixty days the patients of both groups received 30 microg of chromium picolinate as food additive. We measured the serum concentration of chromium (using atom-absorption methods), immune-reactive insulin and the insulin resistance index at baseline and at the end of the two-month period. RESULTS: The serum concentrations of chromium was significantly lower in diabetic patients than in the healthy individuals used as controls (2.18 +/- 0.87 nmol/l versus 4.03 +/- 0.96 nmol/l; p < 0.001). We found a significant decrease of the immune-reactive insulin and the insulin resistance index after a two-month application of chromium 30 microg daily (1 tablet of chrome picolinate). The effects of this trace element are analysed in the light of an improved first phase of secretion of insulin or facilitated post-receptor insulin sensibility as a way of potentiating the insulin action. CONCLUSION: Chromium included early in the complex therapy of diabetes is beneficial in the reduction of the degree of insulin resistance.