Adipocytokines, neuropeptide Y and insulin resistance in overweight women with gynoid and android type of adipose tissue distribution.

UNLABELLED: The AIM of the study was to compare the levels of certain adipose tissue hormones in women with the two main morphological types of obesity - android and gynoid obesity. MATERIALS AND METHODS: The study included 2 groups of age- and weight-matched women with android (n = 32) and gynoid (n = 27) type of obesity, and a group of age-matched healthy women (n = 24) with normal weight and body constitution. Leptin, resistin, tumour necrosis factor alpha (TNFalpha), neuropeptide Y (NPY), glucose and insulin were measured. HOMA index was calculated. RESULTS: Leptin levels in the women with gynoid obesity did not differ significantly from those in the controls and the women with android obesity. The controls had significantly lower leptin levels compared with the android obesity women. NPY was significantly higher in the control women compared to the women with android obesity and did not differ significantly between the two groups of obese women. TNFalpha levels in all groups were very similar. Resistin did not show significant differences between all groups but tended to have the lowest levels in the controls. In the women with android obesity, insulin was significantly higher than that in the women with gynoid obesity and the controls. Insulin resistance was found in the women with android obesity only. Basal insulin and HOMA index in the women with gynoid obesity did not differ significantly from the values in the control group. CONCLUSION: The results from this study contribute to understanding the association of adipose tissue hormones and insulin resistance in obesity. When adipose tissue is predominantly distributed in the abdominal area at similar amount and percentage of body fats, leptin production is higher and insulin resistance develops. In the gynoid type of adipose tissue predisposition, overt insulin resistance is not found, leptin levels does not differ significantly from those in the control group.

Effect of short-term standard therapeutic regimens on neuropeptide Y and adipose tissue hormones in overweight insulin-resistant women with polycystic ovary syndrome.

AIM: The study was aimed at elucidating the influence of a 3-month treatment with routine therapeutic regimens--oral hormonal contraceptives (OHC) with antiandrogenic activity (a standard combination of ethynil estradiol 35 microg plus cyproterone acetate 2 mg) in combination with insulin sensitizing agents--metformin (Group I) and rosiglitazone (Group II) on adipose tissue hormones and hypothalamic neuropeptide Y (NPY) in women with polycystic ovary syndrome. PATIENTS AND METHODS: The study included 66 overweight insulin resistant women with PCOS according to the recent ESHRE-ASRM criteria randomized into 2 age-matched therapeutic groups. RESULTS: Significant decrease of leptin (P < 0.01; P = 0.001, resp.), resistin (P < 0.01; P < 0.01, resp.), tumour necrosis factor alpha (TNF alpha) (P = 0.001; P < 0.001, resp.), and NPY (P < 0.05; P < 0.001, resp.) was observed in both groups after treatment. These findings were in parallel with a significant decrease in the anthropometric parameters of body weight in the metformin group only. No significant changes in hormonal characteristics of the groups were found except for a significant decrease in androstenedione and DHEA-S (P < 0.05) in the metformin group and in 17-OH-progesterone (P < 0.05) in the rosiglitazone group. HDL-cholesterol rose and diastolic blood pressure fell significantly (P < 0.05) in the metformin group. CONCLUSION: Our data suggest beneficial effects of the treatment on potential cardiovascular risk in insulin resistant PCOS women.

Blood flow velocity in donor coronary artery depends on the degree and pattern of collateral vessel development: a study using thrombolysis in myocardial infarction frame count method.

To understand the influence of collateral vessels on the coronary flow, TIMI frame count (TFC) method was applied as a measure of mean coronary blood flow velocity in artery giving collateral blood supply to the other artery in angiograms of 76 patients with single occluded coronary artery: RCA giving collaterals to occluded LAD or LAD giving collaterals to occluded RCA. As a control group, TFC was applied in angiograms of 30 patients with mild or no coronary artery disease. TFC was lower (faster blood flow) in LAD giving collaterals to occluded RCA (43 patients) than in LAD in control group (21.8 +/- 10.5 vs. 33.9 +/- 20.8 frames; P < 0.01). Higher degree of collateral vessels (Rentrop classification) and mixed- and distal-type collaterals (through the interventricular septum and heart apex) was associated with lower TFC. There was no difference in TFC in the RCA giving collaterals to an occluded LAD (33 patients) compared to the TFC in RCA in control group (16.6 +/- 9.0 vs. 18.5 +/- 6.0; P = NS), even in angiograms with higher degree of collateral vessel development. TFC was lower (faster blood flow) only in subgroups with mixed (proximal and distal types together in the same patient) and distal (through the interventricular septum and the apex of the heart) collateral types. A delayed contrast appearance in occluded LAD compared to occluded RCA has been found (35.1 +/- 16.1 vs. 20.2 +/- 7.3 frames; P < 0.001) with earlier contrast appearance in occluded LAD when proximal collateral vessels (through the conal and acute marginal branches of RCA) were presented. The coronary flow in donor arteries depends not only on the degree but also on the pattern of collateral vessels. The simple TFC method may facilitate the study of collateral filling pattern and offer insight into the influence of collaterals on the ventricular function.

Metabolic disturbances in women with polycystic ovary syndrome.

The AIM of the study was to characterize the metabolic syndrome in lean and overweight women with polycystic ovary syndrome (PCOS). The study included 142 premenopausal women distributed into 2 subgroups according to the body mass index: Group 1 with normal weight (n = 39) and Group 2 with overweight (n = 103). The following parameters were measured: basal and oral glucose tolerance test (oGTT)-induced glucose, insulin and triglycerides (TG1), glycated hemoglobin, total, HDL- and LDL-cholesterol; HOMA index and 2 indices of atherogenic risk (total/HDL-cholesterol and atherogenic index) were calculated. The results were compared with those of 35 clinically healthy women allocated also to 2 subgroups: Group 3 with normal weight (n = 18) and Group 4 with overweight (n = 17). Group 1 differed from group 3 in significantly higher fasting, 120-minute insulin, 180-minute insulin during the oGTT, fasting and stimulated TG1, and atherogenic index. Group 2 did not differ from group 4 in the lipid parameters, but 60-minute, and 120-minute glucose, the area under the curve (AUC) of glucose, and stimulated insulin were significantly higher at similar levels of fasting insulin, homeostasis model assessment (HOMA) index and glucose-to-insulin ratio. Fasting glucose did not differ between the two subgroups of PCOS women, but 60-minute, and 120-minute glucose, AUC glu, fasting, 60-minute, and 180-minute insulin, AUC ins and HOMA index were significantly higher in group 2 where the lipid parameters were significantly unfavourable. Our data confirmed the presence of insulin resistance of various degree and an increased lipid atherogenic risk in PCOS while obesity appeared as an additional factor aggravating the metabolic disturbances.

Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is associated with higher risk of developing cardiovascular diseases including higher incidence of hypertension later in life. Absence of circadian blood pressure fluctuations is considered as a marker of pre-hypertensive state and correlates highly with target organ damage in hypertension. AIM: Characterization of the circadian blood pressure rhythms as well as comparison of the results from the clinical measurements and Holter-monitored blood pressure data in women with PCOS. MATERIALS AND METHODS: The study comprised 35 women (mean age 22.6 +/- 5.9 years, mean BMI 31.4 +/- 7.1 kg/m2) with proven diagnosis. 24-hour ambulatory Holter-monitoring using Oscar device (Sun Tech Medical Instruments, USA) was performed in parallel with clinical measurements of blood pressure. RESULTS: There were 25.7% of the subjects diagnosed with hypertension according to the criteria of ambulatory monitoring observing discrepancy with the criteria for normal clinically measured blood pressure in 7 cases (20%). The "white coat" effect was observed in 11.4%. Physiological nocturnal drop in the systolic pressure was not observed in 51.4% of the patients and in the diastolic pressure - in 22.9% of the cases. CONCLUSIONS: The results confirm the advantages and the importance of the 24-hour monitoring as a diagnostic and predictive method for assessment of blood pressure alterations even in the absence of overt hypertension. PCOS is characterized by higher incidence of unstable blood pressure that is an additional risk factor for further development of cardiovascular diseases in this relatively young age group.

Bulgarian population in transitional period.

In the transition period from a communist to market-oriented economy, Bulgaria faces several public health challenges. One of them is the decline in population (estimated fall from current 8.25 million to around 6 million in 2045), mainly due to emigration and pronounced fall in fertility. Infant mortality is still relatively high (over 15/1,000 live births), and the incidence of tuberculosis is on the rise. Total mortality shows a steady upward trend from 12.1/1,000 in 1990 to 14.3/1,000 in 1998. Trends in ischemic heart disease are comparable to those in other Central and Eastern European countries, but stroke mortality is notably higher. This calls for detailed epidemiological studies of risk factors, such as salt consumption, as well as preventive programs for detection and control of high blood pressure. The problems of smoking and alcohol abuse should be addressed by a coordinated public health and legal measures.