Subjects with familial hypercholesterolemia have lower aortic valve area and higher levels of inflammatory biomarkers.

BACKGROUND: Reduction of the aortic valve area (AVA) may lead to aortic valve stenosis with considerable impact on morbidity and mortality if not identified and treated. Lipoprotein (a) [Lp(a)] and also inflammatory biomarkers, including platelet derived biomarkers, have been considered risk factor for aortic stenosis; however, the association between Lp(a), inflammatory biomarkers and AVA among patients with familial hypercholesterolemia (FH) is not clear. OBJECTIVE: We aimed to investigate the relation between concentration of Lp(a), measurements of the aortic valve including velocities and valve area and circulating inflammatory biomarkers in adult FH subjects and controls. METHODS: In this cross-sectional study aortic valve measures were examined by cardiac ultrasound and inflammatory markers were analyzed in non-fasting blood samples. The study participants were 64 FH subjects with high (n = 29) or low (n = 35) Lp(a), and 14 healthy controls. RESULTS: Aortic valve peak velocity was higher (p = 0.02), and AVA was lower (p = 0.04) in the FH patients compared to controls; however, when performing multivariable linear regression, there were no significant differences. Furthermore, there were no significant differences between the high and low FH Lp(a) groups regarding the aortic valve. FH subjects had higher levels of platelet-derived markers CD40L, PF4, NAP2 and RANTES compared to controls (0.003 ≤ P ≤ 0.03). This result persisted after multiple linear regression. CONCLUSIONS: Middle-aged, intensively treated FH subjects have higher aortic valve velocity, lower AVA, and higher levels of the platelet-derived markers CD40L, PF4, NAP2 and RANTES compared to healthy control subjects. The aortic valve findings were not significant after multiple linear regression, whereas the higher levels of platelet-derived markers were maintained.

No evidence of impaired endothelial function or altered inflammatory state in patients with familial hypercholesterolemia treated with statins.

BACKGROUND: Familial hypercholesterolemia (FH) is associated with an increased risk of premature atherosclerosis. Central in this aspect is enhanced inflammation and endothelial dysfunction. OBJECTIVE: We sought to examine inflammatory cytokines and endothelial dysfunction in patients with FH treated with statins (n = 14) compared with healthy control patients (n = 11). METHODS: Endothelial function was evaluated by the use of the Endo-PAT® system which measured mean reactive hyperemia index. Fasting blood samples were drawn, and 27 biomarkers in addition to standard laboratory tests were analyzed. RESULTS: There were no statistically significant differences between the FH group and the control group regarding age, weight, blood pressure, or body mass index. Endothelial function given as RHI was 1.58 and 1.93 (P = NS) in the control and FH groups, respectively. There were no differences between the groups in tumor necrosis factor-alpha, interleukin (IL-1) beta, IL-1 receptor antagonist, IL-6, IL-10, monocyte chemoattractant protein 1, high-sensitivity C-reactive protein, or any of the other inflammatory markers tested. Furthermore, no significant differences between the groups in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein A, apolipoprotein B, lipoprotein (a), homocysteine, HbA(1c), platelets, and fibrinogen were found. CONCLUSION: Endothelial function assessed by reactive hyperemia index-peripheral arterial tonometry or inflammatory state assessed by soluble inflammatory biomarkers were not different in FH patients on statins compared with healthy control patients.

[Postoperative cardiovascular complications]. / Postoperative kardiovaskulaere komplikasjoner.

BACKGROUND: It has been estimated that up to 25% of non-cardiac surgical procedures carry a significant risk of perioperative cardiovascular morbidity and mortality. A thorough preoperative evaluation with subsequent relevant diagnostic or therapeutic action can reduce the risk of postoperative complications in high-risk patients. The purpose of the present study was to compare clinical practice in a medium-sized Norwegian hospital with international recommendations regarding perioperative evaluation and care. PATIENTS AND METHODS: We performed a registration of all patients transferred to the coronary care unit after surgery--retrospectively for 2002, prospectively for 2003. RESULTS: A total of 55 patients with one or more postoperative complication were identified, out of which 28 had been through elective surgery. Forty-four of the patients suffered an acute myocardial infarction. At 30 days, 15 of the patients had died and a further 13 had sequelae. At 90 days, 22 patients were dead. The patients with complications were characterised by advanced age and high risk of cardiovascular disease. Out of the 55 patients, 8 were incorrectly scored for preoperative risk with American Society of Anaesthesiology's system for classification. For another 3, the score was missing. At discharge from the coronary care unit, only 1 out of 55 patients received a diagnosis of a postoperative complication. INTERPRETATION: The registration indicates that there is a potential for improving clinical practice in order to reduce the number of postoperative complications.