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1.
Nutr Metab Cardiovasc Dis ; 28(5): 494-500, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29502925

RESUMO

BACKGROUND & AIMS: Gender-related differences represent an emerging investigation field to better understand obesity heterogeneity and paradoxically associated cardiovascular (CV) risk. Here, we investigated if high-sensitivity C-reactive protein (hs-CRP) might differently affect adiposity and predict the clinical response to bariatric surgery in obese males and females. METHODS AND RESULTS: In 110 morbidly obese patients undergoing laparoscopic sleeve gastrectomy, hs-CRP as well as anthropometric assessment of adiposity, completed by electric bioimpedance and ultrasonography quantification of visceral fat area (VFA), were measured before and one year after surgery. As compared to males, obese female showed less severe overweight and prevalent subcutaneous fat deposition, but higher circulating hs-CRP. In obese females, hs-CRP was associated with VFA at baseline, independently of body mass index (BMI) and visceral adiposity index (OR 1.022 [95% CI 1.001-1.044]; p = 0.039). Based on decreases and increases in hs-CRP levels after surgery, two distinct subgroups of females were identified. Post-surgery decreases in hs-CRP was predominantly observed in patients with higher baseline levels of hs-CRP and associated with greater reduction of weight, BMI, fat and lean mass, VFA and visceral to subcutaneous fat ratio. Finally, we observed that high baseline values of hs-CRP were able to predict VFA reduction one-year after surgery, independently of BMI and visceral adiposity index (VAI) loss (OR 1.031 [95% CI 1.009-1.053]; p = 0.005). CONCLUSION: In obese females, hs-CRP levels might be a promising biomarker of visceral fat amount and dysfunction, in addition to predict the effectiveness of bariatric surgery in terms of loss of VFA one-year after surgery.

2.
Horm Metab Res ; 48(12): 847-853, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27300476

RESUMO

The aim of the study was to investigate the involvement of the adipokines eotaxin-3, MIP-1ß, and MCP-4 in obesity and related comorbidities and the modification of their circulating levels after bariatric surgery. Eighty severely obese subjects and 20 normal-weight controls were included in the study. Circulating levels of MCP-4, MIP-1ß, and eotaxin-3, and the main clinical, biochemical, and instrumental parameters for the evaluation of cardiovascular and metabolic profile were determined in controls and in obese subjects at baseline and 10 months after surgery. Within the obese group at baseline, eotaxin-3 levels were higher in males than females and in smokers than non-smokers and showed a positive correlation with LDL-cholesterol, apolipoprotein B, and leptin. MIP-1ß showed a positive correlation with age and leptin and a negative correlation with adiponectin and was an independent predictor of increased carotid artery intima-media thickness. MCP-4 levels were higher in obese subjects than controls and showed a positive correlation with body mass index, eotaxin-3, and MIP-1ß. Bariatric surgery induced a marked decrease in all the 3 adipokines. MCP-4 is a novel biomarker of severe obesity and could have an indirect role in favoring sub-clinical atherosclerosis in obese patients by influencing the circulating levels of eotaxin-3 and MIP-1ß, which are directly related to the main atherosclerosis markers and risk factors. The reduction of circulating levels of MCP-4, eotaxin-3, and MIP-1ß could be one of the mechanisms by which bariatric surgery contributes to the reduction of cardiovascular risk in these patients.


Assuntos
Adipocinas/sangue , Cirurgia Bariátrica , Quimiocina CCL4/sangue , Quimiocinas CC/sangue , Proteínas Quimioatraentes de Monócitos/sangue , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Adiponectina/sangue , Adulto , Antropometria , Espessura Intima-Media Carotídea , Quimiocina CCL26 , Quimiocinas/sangue , Feminino , Humanos , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Análise de Regressão
3.
Nutr Metab Cardiovasc Dis ; 22(3): 231-6, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20708389

RESUMO

BACKGROUND AND AIMS: We investigated the behaviour of non-cholesterol sterols, surrogate markers of cholesterol absorption (campesterol and sitosterol) and synthesis (lathosterol), in primary hyperlipemias. METHODS AND RESULTS: We studied 53 patients with polygenic hypercholesterolemia (PH), 38 patients with familial combined hyperlipemia (FCH), and 19 age- and sex-matched healthy control subjects. In all participants, plasma sitosterol, campesterol and lathosterol were determined by gas chromatography coupled to mass spectrometry. To correct for the effect of plasma lipid levels, non-cholesterol sterol concentrations were adjusted for plasma cholesterol (10² µmol/mmol cholesterol). Patients with FCH were more frequently men, and had higher body mass index (BMI), fasting glucose, insulin and HOMA-IR. Lathosterol was higher in FCH than in pH or controls (p < 0.05). Campesterol was significantly lower in FCH (p < 0.05), while no differences were found between pH and controls. Sitosterol displayed higher values in pH compared to FCH (p < 0.001) and controls (p < 0.05). Spearman's rank correlations showed positive correlations of lathosterol with BMI, waist circumference, HOMA-IR, triglycerides, apoprotein B, and a negative one with HDL-cholesterol. Sitosterol had a negative correlation with BMI, waist circumference, HOMA-IR, triglycerides, and a positive one with HDL-cholesterol and apoprotein AI. Multivariate regression analyses showed that cholesterol absorption markers predicted higher HDL-cholesterol levels, while HOMA-IR was a negative predictor of sitosterol and BMI a positive predictor of lathosterol. CONCLUSIONS: Our findings suggest the occurrence of an increased cholesterol synthesis in FCH, and an increased cholesterol absorption in pH. Markers of cholesterol synthesis cluster with clinical and laboratory markers of obesity and insulin resistance.


Assuntos
Hipercolesterolemia/sangue , Hiperlipidemia Familiar Combinada/sangue , Esteróis/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Colesterol/análogos & derivados , Colesterol/sangue , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Hiperlipidemia Familiar Combinada/epidemiologia , Hiperlipidemia Familiar Combinada/genética , Absorção Intestinal , Itália/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Herança Multifatorial , Análise Multivariada , Fitosteróis/sangue , Medição de Risco , Fatores de Risco , Sitosteroides/sangue , Adulto Jovem
5.
J Intern Med ; 262(6): 668-77, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17908164

RESUMO

BACKGROUND: Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy. OBJECTIVES AND DESIGN: This prospective study investigated the relation between renal dysfunction and long-term all-cause and cardiovascular mortality in a population of nonsurgical patients with lower extremity arterial disease (LEAD). SUBJECTS AND METHODS: A total of 357 patients with symptomatic LEAD underwent baseline glomerular filtration rate (GFR) estimation by the 4-variable Modification Diet in Renal Diseases equation, and were then followed for 4.2 years (range: 1-17). RESULTS: During follow-up, 131 patients died (8.6 deaths per 100 patient-years), 79 of whom (60%) from cardiovascular causes. All-cause death rates were 3.8, 6.6, and 15.5 per 100 patient-years, respectively, in the groups with normal GFR, mild reduction in GFR (60-89 mL min(-1) per 1.73 m2) and chronic kidney disease (CKD; <60 mL min(-1) per 1.73 m2; P < 0.001 by log-rank test). Compared to patients with normal renal function, the risk of all-cause and cardiovascular death was significantly higher in patients with CKD [hazard ratio, respectively, 2.23, 95% confidence interval (CI): 1.16-4.34, P = 0.017; 2.15, 95% CI: 1.05-4.43, P = 0.03]. The association of CKD with all-cause and cardiovascular mortality were independent of age, LEAD severity, cardiovascular risk factors and treatment with angiotensin-converting enzyme (ACE)-inhibitors, hypolipidaemic and antiplatelet drugs. The power of GFR in predicting all-cause death was higher than that of ankle-brachial pressure index (P = 0.029) and Framingham risk score (P < 0.0001). CONCLUSION: Chronic kidney disease strongly predicts long-term mortality in patients with symptomatic LEAD irrespective of disease severity, cardiovascular risk factors and concomitant treatments.


Assuntos
Doenças Vasculares Periféricas/complicações , Insuficiência Renal/complicações , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Doença Crônica , Creatinina/sangue , Eletrocardiografia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Rim/fisiopatologia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/mortalidade , Doenças Vasculares Periféricas/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Medição de Risco/métodos , Fumar/efeitos adversos , Taxa de Sobrevida
6.
J Clin Pharm Ther ; 32(5): 477-82, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17875114

RESUMO

BACKGROUND: Adipose tissue is not an inert deposit of fat; in the truncal area, it seems to be metabolically active, due to the adipokines produced locally. These substances are related to insulin resistance, inflammation and atherosclerotic damage to the vascular system. The development of ultrasound methodologies enable better estimation of fat distribution and more detailed investigation of the metabolic aspects of the fat depots and their impact on the initial stages of atherosclerosis. AIM OF THE STUDY: To investigate the influence of abdominal fat on endothelial function, the initial stages of atherosclerotic vascular damage and its relationship with inflammatory status in normal-overweight subjects [n. 162, body mass index (BMI) >25 kg/m(2) to <30 kg/m(2)]. METHODS: A total of 162 Caucasian postmenopausal women (mean age 54 +/- 4 years, menopausal age 8 +/- 4 years) were subdivided on the basis of the median value of the visceral fat distribution and associations with brachial flow-mediated vasoactivity (FMV), BMI, intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), total and LDL cholesterol investigated. RESULTS: Subjects with lower levels of visceral fat had a higher brachial FMV (7.9 +/- 4.3 vs. 5.1 +/- 3.2%, P < 0.05) and lower BMI, waist, sICAM-1, sVCAM-1, total and LDL cholesterol. In univariate analyses, abdominal visceral fat showed a direct correlation with sICAM-1 (r = 0.43, P < 0.001), and an inverse correlation with FMV (r = -0.49, P < 0.01). Moreover an indirect relationship emerged between brachial FMV and sICAM-levels (r = -0.36, P < 0.05). In a multivariate analysis the predictive variables for brachial FMV were LDL cholesterol (beta = -0.22, P < 0.05), visceral fat (beta = -0.32, P < 0.05), sICAM-1 (beta = -0.18, P < 0.05), HDL cholesterol (beta = 0.25, P < 0.05) and brachial diameter (beta = -0.27, P < 0.05). Subcutaneous fat and triglycerides were also included in the model. CONCLUSIONS: In Caucasian normal-overweight women, visceral fat thickness was directly associated with the level of soluble ICAM-1 and inversely with FMV, thereby showing its relevance to endothelial function and the inflammatory state.


Assuntos
Gordura Abdominal/fisiopatologia , Endotélio Vascular/fisiopatologia , Obesidade/metabolismo , Pós-Menopausa , Análise de Variância , Antropometria , Distribuição da Gordura Corporal , Índice de Massa Corporal , Artéria Braquial/fisiopatologia , LDL-Colesterol/sangue , Feminino , Humanos , Molécula 1 de Adesão Intercelular/sangue , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Fluxo Sanguíneo Regional , Molécula 1 de Adesão de Célula Vascular/sangue
7.
J Clin Pharm Ther ; 32(4): 373-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17635339

RESUMO

BACKGROUND: Resistin could be the linkage between the adipose tissue and the insulin resistance. In humans, the role of resistin on metabolic and vascular homeostasis is not well defined. The aim of this study was to investigate the possible association between resistin expression and insulin resistance. METHODS AND RESULTS: We evaluated the relationship between monocyte expression of mRNA and anthropometric and metabolic parameters of insulin resistance. We focused on the potential role of resistin on endothelial function. Thirty-nine patients with metabolic syndrome (MS) and clinically free from cardiovascular disease, and 15 healthy subjects were included in this study. All subjects underwent clinical examination, assessment of haematochemical parameters, bioimpedentiometry, measurement of monocyte resistin mRNA and of brachial-artery flow-mediated vasodilation (FMV). Patients with MS showed higher levels of interleukin-6 (IL; 2.1 +/- 1.2 vs. 1.2 +/- 0.9 pg/mL, P < 0.05) and reduced FMV (5.4 +/- 3.9 vs. 8.3 +/- 3.1%, P < 0.05). The subjects were divided into two groups: (i) subjects with high expression mRNA resistin levels and (ii) subjects with low or not detectable; Group 1 was younger (50 +/- 13 vs. 59 +/- 11 years, P = 0.01), showed higher IL-6 values (2.3 +/- 1.2 vs. 1.6 +/- 1.2, P = 0.03) and lower values of FMV (4.3 +/- 2.8 vs. 7.4 +/- 3.9%, P = 0.003). With univariate analysis monocyte mRNA showed a significant positive correlation with waist circumference (r = 0.27, P < 0.05) and IL-6 (r = 0.26, P < 0.05) and a negative correlation with FMV (r = -0.38, P < 0.005). With multivariate regression analysis brachial-artery diameter, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, IL-6 and RNAm resistin expression were independent predictors of reduced FMV. CONCLUSIONS: mRNA resistin negatively influences FMV, and is a possible in vivo index of endothelial dysfunction.


Assuntos
Expressão Gênica , Resistência à Insulina/genética , RNA Mensageiro/metabolismo , Resistina/metabolismo , Adulto , Idoso , Pesos e Medidas Corporais , Artéria Braquial , HDL-Colesterol , LDL-Colesterol , Endotélio Vascular , Feminino , Humanos , Interleucina-6/metabolismo , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Monócitos , Fluxo Sanguíneo Regional , Resistina/genética , Vasodilatação/fisiologia
8.
Lupus ; 16(4): 259-64, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17439932

RESUMO

Antiphospholipid and anti-oxidized LDL (anti-oxLDL) antibodies are associated with thrombosis and atherosclerosis. Rheumatoid arthritis (RA) is characterized by excess atherosclerosis and cardiovascular diseases. Our aim was to determine whether antiphospholipid and anti-oxLDL antibodies are associated with early atherosclerotic changes in RA. The levels of IgG and IgM anticardiolipin, IgG and IgM anti-beta-2-glycoprotein-I and anti-oxLDL autoantibodies have been evaluated in 82 patients having RA. Carotid artery intima-media thickness (IMT) was measured in the carotid arteries in the common carotid, bifurcation and internal carotid arteries. Elevated levels of IgG anticardiolipin antibodies were detected in 17 of 82 (21%) RA patients, including 7 with medium-to-high levels considered being clinically relevant. These patients had significantly elevated mean carotid and carotid bifurcation IMT compared with RA patients without elevated anticardiolipin. No such association was found regarding other autoantibodies tested. Anticardiolipin antibodies are prevalent in RA and are associated with early atherosclerotic changes, supporting a rational for measuring them in RA, and upon detection treat the patients in order to decrease chances of atherosclerosis progression and thrombosis.


Assuntos
Anticorpos Anticardiolipina/sangue , Artrite Reumatoide/complicações , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/patologia , Lipoproteínas LDL/imunologia , Túnica Íntima/patologia , Idoso , Artrite Reumatoide/imunologia , Artrite Reumatoide/patologia , Aterosclerose/sangue , Aterosclerose/complicações , Aterosclerose/imunologia , Doenças das Artérias Carótidas/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Vasa ; 35(4): 215-20, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17109362

RESUMO

BACKGROUND: The natriuretic peptides, Brain Natriuretic Peptide (BNP), C-type Natriuretic Peptide (CNP), are mediators of cardiovascular homeostasis. The impairment of arterial ability to vasodilate, also known as endothelial dysfunction, represents the first stage of atherosclerotic damage and may be assessed as brachial flow mediated vasodilation (FMV) in human. Generally an altered brachial FMV is documented in association to several cardiovascular risk factors as hypercholesterolemia. Aim of the study was to evaluate the behaviour of BNP and CNP in hyperlipemia and the potential relationship to FMV. PATIENTS AND METHODS: Forty-four hyperlipemic patients (LDL-cholesterol > 130 mg/dl and/or triglycerides > 150, age 35-60 y) of both genders and 20 normolipemic patients, matched for age and sex were investigated. RESULTS: Patients had lower values of brachial FMV in comparison to controls (3.9 +/- 3.5 vs 7.5 +/- 0.5%, p < 0.005), no differences were observed in BNP (4.6 +/- 4.6 vs 5.9 +/- 3.4 ng/mL, p = n.s) and CNP (4.1 +/- 5.8 vs 5.7 +/- 3.3 ng/mL, p = n.s). Univariate analysis showed a positive correlation between BNP and HDL-cholesterol values (r = 0.36, p = 0.001). In the multivariate analysis, LDL-cholesterol (beta = -0.57), HDL-cholesterol (beta = 0.26) and brachial artery diameter (beta = -0.33) were predictors of brachial FMV. The only predictive variable for CNP was HDL-cholesterol (beta = 0.37). CONCLUSIONS: The present study suggested that natriuretic peptides, BNP and CNP, are not altered in patients affected by hypercholesterolemia. Nevertheless, the levels of HDL-cholesterol are strictly related to the values of CNP. This observation, in humans, adds another mechanism to the vascular control exerted by HDL.


Assuntos
Aterosclerose/sangue , HDL-Colesterol/sangue , Endotélio Vascular/fisiopatologia , Hipercolesterolemia/sangue , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Tipo C/sangue , Vasodilatação/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Braquial/fisiopatologia , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estatística como Assunto , Triglicerídeos/sangue
11.
Reumatismo ; 57(1): 16-21, 2005 Jan-Mar.
Artigo em Italiano | MEDLINE | ID: mdl-15776142

RESUMO

BACKGROUND: There is an increasing body of evidence suggesting that subjects with rheumatoid arthritis (RA) are characterized by acceleration of atherosclerotic process of arterial wall. However, all investigations performed so far to evaluate subclinical atherosclerosis in RA included subjects without selection for age and degree of disease activity that may represent confounding factors in such an evaluation. OBJECTIVES: To verify signs of accelerated subclinical atherosclerosis in young subject suffering from RA but with low disease activity. METHODS: Thirty-two patients with RA and 28 age- and sex-matched control subjects with non-inflammatory rheumatic diseases were enrolled. Inclusion criteria were age less than 60 and low disease activity with score < or =3.2 according to DAS28, while subjects with traditional risk factors for and/or overt cardiovascular disease were ruled out from the study. Both patients and controls underwent evaluation of carotid and femoral artery intima-media thickness by ultrasounds. RESULTS: Patients had higher intima-media thickness than controls of all the sites evaluated at carotid artery level, whereas there were no differences at the comparison of the superficial and common femoral artery wall. At the univariate analysis, a positive correlation between LDL cholesterol levels and intima-media thickness at the carotid bifurcation was found. CONCLUSIONS: Young patients with RA and low disease activity have acceleration of atherosclerosis development as shown by increased intima-media thickness of carotid artery with respect to subjects without inflammatory rheumatic disease. It is conceivable that the organic damage of arterial wall could be the result of persistent endothelial dysfunction induced by chronic inflammation and immune dysregulation which characterize RA.


Assuntos
Artrite Reumatoide/complicações , Aterosclerose/complicações , Aterosclerose/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Eur J Clin Invest ; 35(2): 93-8, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15667579

RESUMO

BACKGROUND: The role of blood viscosity as a marker for discriminating cardiovascular risk in essential hypertension remains uncertain. The aim of this study was to assess whether whole blood viscosity (WBV) could be useful in assessing cardiovascular risk in men with a first diagnosis of hypertension. DESIGN: A total of 331 middle-aged men with newly diagnosed essential hypertension (age at entry 40-64 years, average blood pressure 151/95 mmHg) underwent low-shear-rate (0.94 s(-1)) and high-shear-rate (94.5 s(-1)) WBV determination and were then followed for a mean of 4.8 +/- 3 years (range 0-12 years). RESULTS: Cardiovascular event rates in the bottom, middle and top tertiles of the distribution of low-shear WBV were 1.10, 2.13 and 4.43 per 100 patient-years, respectively (log-rank test, P < 0.001). After taking into account several established cardiovascular risk factors in a Cox survival analysis, a raised low-shear WBV conferred an increased risk for cardiovascular events (top vs. bottom tertile hazard ratio = 3.42, 95% confidence interval = 1.4-8.4, P = 0.006; middle vs. bottom tertile hazard ratio = 2.25, 95% confidence interval = 0.9-5.6, P = 0.09). The independent association between high-shear-rate WBV and cardiovascular events bordered statistical significance (P = 0.07). Inclusion in the survival model of low-shear-rate resulted in a significantly greater chi(2) improvement (P < 0.05) than inclusion of high-shear-rate WBV. CONCLUSIONS: In hypertensive men, an increased WBV at low shear rate is a predictor of cardiovascular events independently from the effect of several traditional risk factors. Low-shear WBV is a better discriminator of cardiovascular risk than high-shear WBV.


Assuntos
Viscosidade Sanguínea/fisiologia , Hipertensão/sangue , Adulto , Angina Instável/sangue , Angina Instável/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
13.
Eur J Clin Invest ; 34(5): 335-41, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15147330

RESUMO

BACKGROUND: Excess of cardiovascular risk among patients with chronic inflammatory diseases has been attributed to increased arterial stiffness. Hypercholesterolaemia has been demonstrated to promote a low-grade inflammatory status. The objective of the present study was to define, in hypercholesterolaemia, the influence of plasma lipids, low-grade inflammation, and indices of adiposity on aortic pulse wave velocity, a measure of arterial stiffness and cardiovascular risk. MATERIALS AND METHODS: Anthropometric characteristics, plasma lipids, C-reactive protein and aortic pulse wave velocity were measured in 85 subjects (60 patients with newly diagnosed never-treated hypercholesterolaemia and 25 age- and sex-matched normocholesterolaemic controls). RESULTS: Plasma C-reactive protein and aortic pulse wave velocity were significantly higher among hypercholesterolaemic patients than in controls (P < 0.05 for both). Aortic pulse wave velocity was associated with age (r = 0.24, P = 0.04), body mass index (r = 0.33, P = 0.006), waist (r = 0.42, P < 0.001) and hip (r = 0.32, P = 0.007) circumferences, as well as with systolic (r = 0.34, P = 0.003) and diastolic (r = 0.30, P = 0.01) blood pressures, plasma C-reactive protein (r = 0.51, P < 0.001), total cholesterol (r = 0.45, P < 0.001), and low-density lipoprotein cholesterol (r = 0.46, P < 0.001). In the multivariate analysis, waist circumference and C-reactive protein levels predicted increased aortic stiffness, independently of traditional cardiovascular risk factors. The degree of independent association between cholesterol, systolic blood pressure and aortic stiffness increased when indices of adiposity and inflammation were excluded from the multivariate analysis. Comparable results were obtained when the analyses were restricted to hypercholesterolaemic patients. CONCLUSIONS: Low-grade systemic inflammation and abdominal fat, more than traditional risk factors, are major determinants of reduced arterial distensibility in hypercholesterolaemia.


Assuntos
Artérias/fisiopatologia , Hipercolesterolemia/fisiopatologia , Abdome , Tecido Adiposo/metabolismo , Aorta , Arteriosclerose/etiologia , Arteriosclerose/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Constituição Corporal , Índice de Massa Corporal , Proteína C-Reativa/análise , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Hipercolesterolemia/metabolismo , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
14.
Ann Rheum Dis ; 63(1): 31-5, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14672888

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. Endothelial dysfunction represents the earliest stage of atherosclerosis. OBJECTIVE: To evaluate the influence of chronic inflammatory state on endothelial function in patients with RA by measuring endothelial reactivity in young patients with RA with low disease activity and without traditional cardiovascular risk factors. METHODS: Brachial flow mediated vasodilatation (FMV), assessed by non-invasive ultrasound, was evaluated in 32 young to middle aged patients with RA (age /=4 determinations multiplied by the disease duration (r = -0.40, p<0.05). In a multivariate regression model, a lower brachial flow mediated vasodilatation was independently predicted by low density lipoprotein cholesterol (beta = -0.40, p<0.05), average CRP levels multiplied by the disease duration (beta = -0.44, p<0.05), and brachial artery diameter (beta = -0.28, p<0.05). CONCLUSIONS: Young to middle aged patients with RA with low disease activity, free from cardiovascular risk factors and overt cardiovascular disease, have an altered endothelial reactivity that seems to be primarily related to the disease associated chronic inflammatory condition.


Assuntos
Artrite Reumatoide/fisiopatologia , Endotélio Vascular/fisiopatologia , Adulto , Análise de Variância , Artrite Reumatoide/complicações , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Fatores de Risco , Vasodilatação
15.
J Clin Pharm Ther ; 28(5): 419-24, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14632967

RESUMO

BACKGROUND: Fasting and post-prandial hypertriglyceridemia have been associated with endothelial dysfunction. OBJECTIVE: To investigate the effects of a 3-month treatment with fenofibrate (200 mg daily) on endothelial reactivity and inflammatory state in hypertriglyceridemic patients at fast and after an oral fat load. METHODS: Brachial flow-mediated vasodilation (FMV) and the circulating levels of intercellular adhesion molecule (ICAM) and vascular cellular adhesion molecule (VCAM) were determined in 10 hypertriglyceridemic patients. RESULTS: Before treatment, post-prandial phase was characterized by an increase in triglycerides (3.7 +/- 1 mmol/L at baseline vs. 4.2 +/- 1, 6.5 +/- 1, 6.6 +/- 2, and 5.3 +/- 2 mmol/L after 2, 4, 6, and 8 h), a decrease in FMV (4.3 +/- 2% at baseline vs. 2.8 +/- 1, 2.2 +/- 1, and 1.3 +/- 1% after 2, 4, and 6 h), and an increase in ICAM and VCAM. After fenofibrate there was a significant reduction in fasting triglycerides (3.7 +/- 1.3 vs. 2.1 +/- 0.8 mmol/L), ICAM (480 +/- 113 vs. 269 +/- 65 ng/mL) and VCAM (1821 +/- 570 vs. 1104 +/- 376 ng/mL), and an increase in FMV (4.3 +/- 2 vs. 7.1 +/- 2%). Post-prandially triglycerides increased (2.1 +/- 1 at baseline vs. 2.4 +/- 2 and 3.6 +/- 1 mmol/L after 4 and 6 h), FMV decreased (7.1 +/- 2 at baseline vs. 5.8 +/- 2, 5.5 +/- 2, 5.9 +/- 2, 6.4 +/- 2% after 2, 4, 6, and 8 h), and there was an increase of ICAM and VCAM. Before therapy post-prandial changes in FMV had an inverse correlation with the changes in triglycerides (r = -0.34; P < 0.05) and ICAM (r = -0.66; P < 0.001). CONCLUSIONS: The transient endothelial dysfunction observed in hypertriglyceridemic subjects during post-prandial lipemia is mediated by post-prandial triglyceride increase and by the activation of inflammatory response. The anti-inflammatory activity of fenofibrate may represent an additional mechanism of its favorable action on the endothelial function during fasting and the post-prandial phase.


Assuntos
Moléculas de Adesão Celular/sangue , Gorduras na Dieta/sangue , Jejum/sangue , Fenofibrato/uso terapêutico , Hipertrigliceridemia/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Período Pós-Prandial/efeitos dos fármacos , Adulto , Endotélio Vascular/efeitos dos fármacos , Feminino , Fenofibrato/farmacologia , Humanos , Hipolipemiantes/farmacologia , Masculino , Pessoa de Meia-Idade , Vasodilatação/efeitos dos fármacos
16.
Vasa ; 32(3): 139-43, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-14524033

RESUMO

BACKGROUND: Patients with peripheral arterial disease (PAD) are characterized by a high mortality for cardiovascular events. An impairment of endothelial function, expressed as brachial-artery flow-mediated vasodilation (FMV), has been described in PAD patients. Aim of this study was to investigate the association between FMV and cardiovascular events in patients with PAD. PATIENTS AND METHODS: Thirty-eight patients with intermittent claudication (71% men, mean age 71 years) were divided into two groups according to the presence or absence of previous major cardiovascular events (myocardial infarction or stroke). RESULTS: Brachial FMV was significantly lower in patients with a history of myocardial infarction or stroke (n = 16) than in patients without cardiovascular events (3.2 +/- 3.6% vs. 5.7 +/- 3.6%; p = 0.042). In the group with cardiovascular events there was a significantly higher proportion of subjects in the lower FMV tertile (56% vs. 18%), and a lower proportion of subjects in the upper tertile (25% vs. 41%; chi 2 test, p = 0.047). CONCLUSION: We conclude that FMV of the brachial artery is significantly reduced in PAD patients with a history of stroke and myocardial infarction. These cross-sectional results suggest a potential role of FMV as a marker of major cardiovascular events.


Assuntos
Arteriopatias Oclusivas/fisiopatologia , Infarto Cerebral/fisiopatologia , Endotélio Vascular/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Infarto Cerebral/diagnóstico por imagem , Endotélio Vascular/diagnóstico por imagem , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Recidiva , Valores de Referência , Medição de Risco , Ultrassonografia Doppler , Vasodilatação/fisiologia
17.
Ann Nutr Metab ; 46(1): 32-7, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-11914513

RESUMO

BACKGROUND/AIM: Postmenopausal age is characterized by a higher risk for coronary heart disease (CHD) and postprandial lipemia is strictly related with the evidence of CHD. The aim of the study was to clarify the vascular effects of postprandial state in postmenopausal women. METHODS: Ten postmenopausal women (mean age 57 +/- 8 years) without vascular risk factors and history of cardiovascular disease underwent an oral fat load test. Endothelial function, expressed as brachial flow-mediated vasodilation (FMV), lipid parameters and reduced glutathione (GSH) were evaluated at baseline and 2, 4 and 6 h after the load. RESULTS: FMV showed a significant decrease at the 2nd hour (2.3 +/- 2.6%, vs. baseline 7.7 +/- 2.8%, p < 0.05) and overlapping to the basal value after 4 h. Triglycerides increased postprandially at the 2nd and 4th hour (1.6 +/- 0.6 micromol/l, 1.8 +/- 0.5 micromol/l vs. baseline 0.9 +/- 0.4 micromol/l, p < 0.05), decreasing thereafter. GSH decreased at the 2nd hour of the postprandial phase (5.1 +/- 1.9 micromol/l vs. baseline 8.4 +/- 1.9 micromol/l, p < 0.05), normalizing successively. At the univariate analysis a negative correlation was found between FMV and triglyceride changes (r = -0.37, p < 0.05) and a positive one between FMV and GSH modifications (r = 0.40, p < 0.05). CONCLUSION: These data demonstrated that postprandial lipemia transiently impairs endothelial reactivity by an oxidative burden, partly dependent to triglyceride increase.


Assuntos
Gorduras na Dieta/farmacologia , Endotélio Vascular/efeitos dos fármacos , Glutationa/metabolismo , Lipídeos/sangue , Período Pós-Prandial/fisiologia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiologia , Doença das Coronárias/etiologia , Gorduras na Dieta/administração & dosagem , Endotélio Vascular/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/metabolismo , Fatores de Risco , Triglicerídeos/sangue , Ultrassonografia , Vasodilatação/efeitos dos fármacos
18.
J Hum Hypertens ; 16(2): 117-22, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11850769

RESUMO

A relation between left ventricular (LV) hypertrophy and depressed midwall systolic function has been described in hypertensive subjects. However, a strong confounding factor in this relation is concentric geometry, which is both a powerful determinant of depressed midwall systolic function and a correlate of LV mass in hypertension. To evaluate the independent contribution of LV mass to depressed systolic function, 1827 patients with never-treated essential hypertension (age 48 +/- 12 years, men 58%) underwent M-mode echocardiography under two-dimensional guidance. Relative wall thickness was the strongest determinant of low midwall fractional shortening (r = -0.63, P < 0.0001). The significant inverse relation observed between LV mass and midwall fractional shortening (r = -0.43, P < 0.0001) persisted after taking into account the effect of relative wall thickness (partial r = -0.27, P < 0.0001). Within each sex-specific quintile of relative wall thickness, prevalence of subnormal afterload-corrected midwall systolic function was greater in subjects with, than in subjects without, LV hypertrophy (P < 0.05 for the first, third, fourth and fifth quintile). In a multiple linear regression analysis, both LV mass (P < 0.0001) and relative wall thickness (P < 0.0001) were independent predictors of a reduced midwall fractional shortening. In conclusion, the inverse association between LV mass and midwall systolic function is partly independent from the effect of relative wall thickness. LV hypertrophy is a determinant of subclinical LV dysfunction independently of the concomitant changes in chamber geometry.


Assuntos
Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Adulto , Distribuição por Idade , Idoso , Determinação da Pressão Arterial , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Intervalos de Confiança , Fatores de Confusão (Epidemiologia) , Ecocardiografia , Feminino , Testes de Função Cardíaca , Humanos , Hipertensão/diagnóstico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Sístole/fisiologia
19.
J Hypertens ; 19(12): 2265-70, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11725172

RESUMO

OBJECTIVE: The proportion of left ventricular (LV) mass variability explained by blood pressure in essential hypertension is small, and several non-haemodynamic determinants of LV mass have been identified or hypothesized. This study examines the possible relation between blood lipids and LV mass in hypertension. DESIGN: Never-treated non-diabetic hypertensive patients. SETTING: Hospital hypertension outpatient clinics in Umbria, Italy. PATIENTS: We investigated the association between high-density lipoprotein (HDL)-cholesterol and echocardiographic LV mass in 1306 never-treated subjects with essential hypertension. Subjects with previous cardiovascular events, diabetes and current or previous antihypertensive or lipid-lowering therapy were excluded. RESULTS: HDL-cholesterol showed an inverse association with LV mass (r = -0.30, P < 0.001). No association was found between LV mass and total or low-density lipoprotein cholesterol. With multiple linear regression analysis we tested the independent contribution of several potential determinants of LV mass in women and in men. Average 24 h blood pressure (both pulse and mean), body mass index, height, stroke volume, age (all P < 0.01) and low HDL-cholesterol (P < 0.0001 in women, P < 0.001 in men) were associated with a greater LV mass in both sexes. Triglycerides showed a weak univariate association with LV mass in women (r = 0.11, P < 0.02), which did not hold in a multivariate analysis. CONCLUSIONS: Low HDL-cholesterol is an independent predictor of LV mass in untreated hypertensive subjects. Common hormonal and metabolic mechanisms, including insulin resistance, could explain this association, which may contribute to the adverse prognostic significance of low HDL-cholesterol levels.


Assuntos
HDL-Colesterol/sangue , Hipertensão/sangue , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/etiologia , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Ecocardiografia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Caracteres Sexuais , Volume Sistólico
20.
Am J Hypertens ; 14(10): 1025-31, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11710781

RESUMO

Large artery intima-media thickness (IMT) is considered an integrated marker for the total individual burden of arteriosclerosis, and a graded index for cardiovascular risk. However, several different aggregate indexes of IMT on B-mode ultrasound have been used by various investigators, and the optimal number of IMT readings is currently unsettled. In 128 newly diagnosed, never treated, uncomplicated hypertensive subjects aged <55 years (43 +/- 9 years, blood pressure [BP] 152/99 mm Hg), we measured left ventricular mass (M-mode echocardiography, average of five or more measurements) and IMT of common carotid and common femoral arteries. For each segment, 12 IMT measurements were performed, and the average of 1 and 3 readings (right far wall), 6 readings (right side), and 12 readings (right and left side, far and near wall, 3 sampling points) was analyzed. The relation of IMT with left ventricular mass increased progressively with increasing number of readings, from 0.35 (1 reading) to 0.51 (12 readings) for common carotid artery, and from 0.31 to 0.56 for common femoral artery (both P <.001). For each 0.2-mm increase in common femoral IMT, the age-adjusted relative risk of having left ventricular hypertrophy was 1.31 for 1 reading, and increased up to 3.59 for the average of 12 readings. In summary, the association of IMT with left ventricular mass depends strongly on the number of IMT readings. The average of several readings in each segment, including right and left side and far and near wall, carries the closest association to left ventricular mass, and should be preferred for clinical purposes in hypertensive subjects.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/patologia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Adulto , Arteriosclerose/etiologia , Biomarcadores , Doenças Cardiovasculares/etiologia , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Hipertensão/complicações , Hipertrofia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ultrassonografia/métodos
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