Value of D-dimer and HDL cholesterol concentrations in predicting the occurrence of acute pulmonary embolism.

UNLABELLED: Pulmonary embolism (PE) usually is a clinical manifestation of venous thromboembolism. The lack of simple and safe laboratory test to confirm or exclude PE is a problem that slows down the diagnosis. AIM: The aim of the study was the assessment the usefulness of D-dimer and HDL cholesterol concentration in predicting the occurrence of acute pulmonary embolism. MATERIALS AND METHODS: The study group comprised 86 patients. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were measured by catalase HDL-C and LDLC assay. The D-dimer level was assessed using immunoenzymatic method with high sensitivity test (VIDAS D-Dimer Exclusion). Pulmonary embolism was diagnosed using contrast-enhanced multidetector computer tomography (16-row GE Light Speed Pro and 64-row Toshiba Aquilion Systems). RESULTS: In all patients with PE, higher D-dimer concentration was found. Odds ratio (OR) calculated for the D-dimer indicates that the concentration of D-dimer ≥859,5 ng/ml increases the risk of PE 612 times, compared with those with levels below 859,5 ng/ml. HDL cholesterol level in patients with PE was significantly lower compared with the control group (p < 0,05). Odds ratio (OR) calculated for the HDL cholesterol indicates that the risk of PE in subjects with the concentration of HDL-C ≤44 mg/dl is 26,89 times higher, compared with individuals with HDL-C >44 mg/dl. CONCLUSIONS: According the studies, increase D-dimer and decrease HDL levels are an independent risk factors for occurrence of acute pulmonary embolism.

Wheal and flare reactions in skin prick tests of patients treated with montelukast alone or in combination with antihistamines.

BACKGROUND: Because antileukotrienes may inhibit inflammation, it is plausible that montelukast administered for a long time could suppress skin wheal and flare reaction, and thus, it should be discarded prior to the tests. This study assessed the effect of long-lasting treatment with montelukast alone or in combination with antihistamines on wheal and flare in skin pricks tests (SPT) in patients sensitized to perennial allergens. METHODS: We conducted a 32-week, double-blind, placebo-controlled, cross-over and randomized trial that implicated two arms: arm A, 20 patients received levocetirizine, montelukast with or without levocetirizine or placebo; arm B, 20 patients received desloratadine, montelukast with or without desloratadine or placebo. All treatment periods lasted 6 weeks and were separated by 2-week washouts. At baseline and on the last day of each treatment period, SPT were performed in all participants. RESULTS: Both levocetirizine and desloratadine in monotherapy, or in combination with montelukast, were effective in reducing wheal and flare in SPT. Monotherapy with montelukast did not change the size of the wheal for either histamine or for house dust mites, in either arm of the study, but significantly reduced the size of flare for histamine in arm A. Addition of montelukast to antihistamine did not exceed efficacy of monotherapy with antihistamine in both arms of the study. CONCLUSIONS: Since the size of wheal determines the results of SPT, montelukast, even taken for a long time, does not have to be discarded prior to the tests.

Oxygen uptake efficiency plateau is unaffected by fitness level - the NOODLE study.

BACKGROUND: Endurance athletes (EA) are an emerging population of focus for cardiovascular health. The oxygen uptake efficiency plateau (OUEP) is the levelling-off period of ratio between oxygen uptake (VO2) and ventilation (VE). In the cohort of EA, we externally validated prediction models for OUEP and derived with internal validation a new equation. METHODS: 140 EA underwent a medical assessment and maximal cycling cardiopulmonary exercise test. Participants were 55% male (N = 77, age = 21.4 ± 4.8 years, BMI = 22.6 ± 1.7 kg·m- 2, peak VO2 = 4.40 ± 0.64 L·min- 1) and 45% female (N = 63, age = 23.4 ± 4.3 years, BMI = 22.1 ± 1.6 kg·m- 2, peak VO2 = 3.21 ± 0.48 L·min- 1). OUEP was defined as the highest 90-second continuous value of the ratio between VO2 and VE. We used the multivariable stepwise linear regression to develop a new prediction equation for OUEP. RESULTS: OUEP was 44.2 ± 4.2 mL·L- 1 and 41.0 ± 4.8 mL·L- 1 for males and females, respectively. In external validation, OUEP was comparable to directly measured and did not differ significantly. The prediction error for males was - 0.42 mL·L- 1 (0.94%, p = 0.39), and for females was + 0.33 mL·L- 1 (0.81%, p = 0.59). The developed new prediction equation was: 61.37-0.12·height (in cm) + 5.08 (for males). The developed model outperformed the previous. However, the equation explained up to 12.9% of the variance (R = 0.377, R2 = 0.129, RMSE = 4.39 mL·L- 1). CONCLUSION: OUEP is a stable and transferable cardiorespiratory index. OUEP is minimally affected by fitness level and demographic factors. The predicted OUEP provided promising but limited accuracy among EA. The derived new model is tailored for EA. OUEP could be used to stratify the cardiorespiratory response to exercise and guide training.

Below or all the way to the peak? Oxygen uptake efficiency slope as the index of cardiorespiratory response to exercise-the NOODLE study.

Background: The ratio of oxygen uptake (VO2) to minute ventilation (VE) is described as the oxygen uptake efficiency slope (OUES). OUES has been suggested as a valuable submaximal cardiorespiratory index; however, its characteristics in endurance athletes remain unknown. In this study, we a) investigated OUES between different time intervals, b) assessed their prediction power for VO2peak, and c) derived new prediction equations for OUES tailored for well-trained individuals. Materials and Methods: A total of 77 male (age = 21.4 ± 4.8 yrs; BMI = 22.1 ± 1.6 kg·m-2; peak oxygen uptake = 4.40 ± 0.64 L·min-1) and 63 female individuals (age = 23.4 ± 4.3 yrs; BMI = 23.1 ± 1.6 kg·m-2; peak oxygen uptake = 3.21 ± 0.48 L·min-1) underwent the cycling cardiopulmonary exercise test. OUES was measured at 75%, 90%, and 100% of exercise duration. Prediction power and new models were derived with the multiple linear regression method. Results: In male subjects, OUES [mL·min-1/L·min-1] from 75% = 4.53 ± 0.90, from 90% = 4.52 ± 0.91, and from 100% = 4.41 ± 0.87. In female subjects, OUES [mL·min-1/L·min-1] from 75% = 3.50 ± 0.65, from 90% = 3.49 ± 0.62, and from 100% = 3.41 ± 0.58. OUES did not differ between time intervals in male (p = 0.65) and female individuals (p = 0.69). OUES strongly predicts peak VO2 independently from the measuring interval (ß = 0.71-0.80; R 2 = 0.50-0.63). The prediction model designed for elite athletes was OUES [mL·min-1/L·min-1] = -1.54 + 2.99; BSA [m2]-0.0014; (age [in years]; sex [1 = male, 2 = female]) (R 2 = 0.36). Conclusion: OUES enables an accurate prediction of peak cardiorespiratory fitness in elite endurance athletes. OUES is a feasible alternative to maximal exercise testing. A new prediction equation should be used for highly trained individuals. Physicians should understand OUES physiology to properly assess the cardiorespiratory response to exercise in athletic cohorts.

Is the Ventilatory Efficiency in Endurance Athletes Different?-Findings from the NOODLE Study.

Background: Ventilatory efficiency (VE/VCO2) is a strong predictor of cardiovascular diseases and defines individuals' responses to exercise. Its characteristics among endurance athletes (EA) remain understudied. In a cohort of EA, we aimed to (1) investigate the relationship between different methods of calculation of VE/VCO2 and (2) externally validate prediction equations for VE/VCO2. Methods: In total, 140 EA (55% males; age = 22.7 ± 4.6 yrs; BMI = 22.6 ± 1.7 kg·m-2; peak oxygen uptake = 3.86 ± 0.82 L·min-1) underwent an effort-limited cycling cardiopulmonary exercise test. VE/VCO2 was first calculated to ventilatory threshold (VE/VCO2-slope), as the lowest 30-s average (VE/VCO2-Nadir) and from whole exercises (VE/VCO2-Total). Twelve prediction equations for VE/VCO2-slope were externally validated. Results: VE/VCO2-slope was higher in females than males (27.7 ± 2.6 vs. 26.1 ± 2.0, p < 0.001). Measuring methods for VE/VCO2 differed significantly in males and females. VE/VCO2 increased in EA with age independently from its type or sex (ß = 0.066-0.127). Eleven equations underestimated VE/VCO2-slope (from -0.5 to -3.6). One equation overestimated VE/VCO2-slope (+0.2). Predicted and observed measurements differed significantly in nine models. Models explained a low amount of variance in the VE/VCO2-slope (R2 = 0.003-0.031). Conclusions: VE/VCO2-slope, VE/VCO2-Nadir, and VE/VCO2-Total were significantly different in EA. Prediction equations for the VE/VCO2-slope were inaccurate in EA. Physicians should be acknowledged to properly assess cardiorespiratory fitness in EA.

Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy--a meta-analysis of 11 randomized controlled trials involving 21,295 participants.

The available studies have reported the benefits of statins on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients. However studies in end-stage renal disease patients on dialysis yielded conflicting results. Therefore, we performed a meta-analysis and provide the most reliable trial data to date on the impact of statin therapy on cardiovascular events and death from all causes in CKD patients. Data from PubMed, Web of Science, Cochrane Library, and Scopus for the years 1966 to October 2012 were searched. The final meta-analysis included 11 randomized controlled trials involving 21,295 participants with CKD. Among them 6857 were on dialysis. The use of statins in subjects with non-dialysis-dependent CKD resulted in a marked reduction in death from all causes (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.79; p<0.0001), cardiac causes (RR: 0.69; 95%CI: 0.55-0.68; p=0.0012), cardiovascular events (RR: 0.55; 95%CI: 0.4-0.75; p=0.0001) and stroke (RR: 0.66; 95%CI: 0.5-0.88; p=0.0022). The use of statins in dialysis-dependent CKD patients resulted in a non-significant effect on death from all causes (RR: 0.99; 95%CI: 0.88-1.11; p=0.85) and stroke (RR: 1.31; 95%CI: 0.9-1.89; p>0.05), but had the effect of reducing death from cardiac causes (RR: 0.79; 95%CI: 0.64-0.98; p<0.05) and cardiovascular events (RR: 0.81; 95%CI: 0.7-0.94; p<0.05). In conclusion, the use of statins should be indicated in cardiovascular disease prevention especially in patients with non-dialysis-dependent CKD. According to the very limited data the obtained results suggest caution in expecting a reduction in cardiovascular events in patients on dialysis.

Validity of the Maximal Heart Rate Prediction Models among Runners and Cyclists.

Maximal heart rate (HRmax) is a widely used measure of cardiorespiratory fitness. Prediction of HRmax is an alternative to cardiopulmonary exercise testing (CPET), but its accuracy among endurance athletes (EA) requires evaluation. This study aimed to externally validate HRmax prediction models in the EA independently for running and cycling CPET. A total of 4043 runners (age = 33.6 (8.1) years; 83.5% males; BMI = 23.7 (2.5) kg·m-2) and 1026 cyclists (age = 36.9 (9.0) years; 89.7% males; BMI = 24.0 (2.7) kg·m-2) underwent maximum CPET. Student t-test, mean absolute percentage error (MAPE), and root mean square error (RMSE) were applied to validate eight running and five cycling HRmax equations externally. HRmax was 184.6 (9.8) beats·min-1 and 182.7 (10.3) beats·min-1, respectively, for running and cycling, p = 0.001. Measured and predicted HRmax differed significantly (p = 0.001) for 9 of 13 (69.2%) models. HRmax was overestimated by eight (61.5%) and underestimated by five (38.5%) formulae. Overestimated HRmax amounted to 4.9 beats·min-1 and underestimated HRmax was in the range up to 4.9 beats·min-1. RMSE was 9.1-10.5. MAPE ranged to 4.7%. Prediction models allow for limited precision of HRmax estimation and present inaccuracies. HRmax was more often underestimated than overestimated. Predicted HRmax can be implemented for EA as a supplemental method, but CPET is the preferable method.

Impact of COVID-19 Infection on Cardiorespiratory Fitness, Sleep, and Psychology of Endurance Athletes-CAESAR Study.

COVID-19 has a deteriorating impact on health which is especially important for endurance athletes (EAs) who need to maintain continuity of training. The illness affects sleep and psychology, which influence sport performance. The aims of this study were: (1) to assess the consequences of mild COVID-19 on sleep and psychology and (2) to assess the consequences of mild COVID-19 on cardiopulmonary exercise test (CPET) results. A total of 49 EAs (males = 43, 87.76%; females = 6, 12.24%; age = 39.9 ± 7.8 years; height = 178.4 ± 6.8 cm; weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m-2) underwent a maximal cycling or running CPET pre- and post-COVID-19 and completed an original survey. Exercise performance deteriorated after COVID-19 (maximal oxygen uptake, VO2max = 47.81 ± 7.81 vs. 44.97 ± 7.00 mL·kg·min-1 pre- and post-infection, respectively; p < 0.001). Waking up at night affected the heart rate (HR) at the respiratory compensation point (RCP) (p = 0.028). Sleep time influenced pulmonary ventilation (p = 0.013), breathing frequency (p = 0.010), and blood lactate concentration (Lac) (p = 0.013) at the RCP. The maximal power/speed (p = 0.046) and HR (p = 0.070) were linked to the quality of sleep. Stress management and relaxation techniques were linked with VO2max (p = 0.046), maximal power/speed (p = 0.033), and maximal Lac (p = 0.045). Cardiorespiratory fitness deteriorated after mild COVID-19 and was correlated with sleep and psychological indices. Medical professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Metabolic associated fatty liver disease and cardiovascular risk: The expert opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society.

The diagnosis of metabolic associated fatty liver disease (MAFLD) is significant for patients' prognosis, as the disease accelerates the development of cardiovascular complications and, on the other hand, cardiometabolic conditions are risk factors for the development of fatty liver diseases. This expert opinion presents principles of MAFLD diagnosis and standards of management to reduce cardiovascular risks in patients with MAFLD.

Examining the Nutrition of Cardiological Patients in Hospitals: Evaluating the Discrepancy between Received Diets and Reference Diet Based on ESC 2021 Guidelines-Hospital Diet Medical Investigation) (HDMI) Study.

Cardiovascular diseases (CVDs) are the leading causes of death worldwide. CVDs have become the dominant cause of death and have been a significant health challenge since the second half of the 20th century in the Polish population. The aim of our HDMI (hospital diet medical investigation) study was to examine the quality of the hospital diets given to cardiac patients and assess how much they adhere to the European Society of Cardiology (ESC) 2021 guidelines. By comparing the diets received by patients with the recommended dietary patterns outlined in the ESC 2021 guidelines, we sought to identify discrepancies. The study was conducted in two steps: creating a 7-day model menu and comparing it with the received diets and then making comparisons with ESC 2021 guidelines. Additionally, we designed a survey to obtain the characteristics of the hospitals. The results show that the nutrition in hospitals remains substandard. None of the diets had an appropriate salt supply or predominance of plant-based food patterns. Only 1/7 diets avoided sweetened beverages, and 2/7 diets had an appropriate amount of fiber. This underscores a gap in the healthcare system to improve patients' health by implementing dietary interventions that foster the development of healthy eating habits.

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed.

[Estimation of pulse pressure in subjects with carbohydrate disorders]. / Ocena cisnienia tetna u osób z zaburzeniami gospodarki weglowodanowej.

UNLABELLED: Carbohydrate disorders are important and independent risk factor for cardiovascular system diseases. Increased values of pulse pressure are an independent risk factor for cardiovascular complications and total mortality. The aim of the study was to evaluate the pulse pressure in subjects with carbohydrate disorders. MATERIAL AND METHODS: The study comprised 112 subjects with carbohydrate disorders (54 females and 58 males), aged 30-78 (57.4 +/- 9.6) years. Carbohydrate disorders were diagnosed according to the Polish Diabetes Association criteria from 2007 (group 1). 56 subjects had impaired fasting glucose (IFG), 36--impaired glucose tolerance (IGT) and 20--type 2 diabetes. Comparative group comprised 30 subjects without cardiovascular diseases and carbohydrate disorders (15 females and 15 males), aged 29-64 (52.7,4 +/- 8.8) years (group II). The fasting serum glucose level was evaluated using an enzymatic method, Kone-Pro biochemical analyzer and bioMérieux Glucose RTU kit. In subjects with fasting glucose level > or = 100 mg/dl, an oral glucose tolerance test (OGTT) was performed. In all subjects 24-h ambulatory blood pressure monitoring with oscillometric method, using boso-TM-2430PL system (Bosch+Sohn, Germany). Pulse pressure (pp) was evaluated as a mean difference between the systolic and diastolic pressure. RESULTS: In subjects with carbohydrate disorders the mean value of pp was 56.79 +/- 16.28 mmHg and it was significantly higher (p < 0.05) than in comparative group (49.0 +/- 11.1 mmHg). Increased value of pp (> 63 mmHg) was found significantly more often in group with carbohydrate disorders (46% vs 10%) (p < 0.05). On the basis of ROC curve analysis and OR (odds ratio) it was shown that pp > or = 52.5 mmHg results in a threefold increased risk of carbohydrate disorders. CONCLUSIONS: Increased values of pulse pressure are found significantly more often in subjects with carbohydrate disorders. The risk of carbohydrate disorders increases threefold in subjects with pp > or = 52.5 mmHg.

[Resting heart rate in subjects with carbohydrate disorders]. / Spoczynkowa czynnosc serca u osób z zaburzeniami gospodarki weglowodanowej.

UNLABELLED: Large epidemiological studies conducted during last 25 years confirmed the importance of resting heart rate as an independent risk factor for total and cardiovascular mortality in females and males, both in overall population and in subjects with cardiovascular diseases such as arterial hypertension, myocardial infarction, coronary heart disease, heart failure or left ventricular dysfunction. The aim of the study was to evaluate the resting heart rate (HR) in subjects with carbohydrate disorders. MATERIAL AND METHODS: The study comprised 112 subjects with carbohydrate disorders (54 females and 58 males), aged 30-78 (57.4 +/- 9.6) years. Carbohydrate disorders were diagnosed according to the Polish Diabetes Association criteria from 2007 (group I). 56 subjects had impaired fasting glucose (IFG), 36 - impaired glucose tolerance (IGT) and 20 - type 2 diabetes. Comparative group comprised 30 subjects without cardiovascular diseases and carbohydrate disorders (15 females and 15 males), aged 29-64 (52.7 +/- 8.8) years (group II). The fasting serum glucose level was evaluated using an enzymatic method, Kone Pro biochemical analyzer and bioMérieux Glucose RTU kit. In subjects with fasting glucose level > or = 100 mg/dl, an oral glucose tolerance test (OGTT) was performed. Additionally, in all subjects resting heart rate (HR) was measured, after 10-minute rest, at a room temperature of about 20 degrees C. The measurements were made threefold, every 5 minutes and mean value was assessed. RESULTS: In subjects with carbohydrate disorders HR was significantly higher than in comparative group (82.79 +/- 12.1 vs 69.9 +/- 9.56/min; p < 0.05). In group of subjects with carbohydrate disorders in comparison to comparative group, resting heart rate < 60/min occurred in 1.79 vs 13.33%, in intervals: 60-70/min in 14.29 vs 50%. 71-80/min in 33.93 vs 23.33%, 81-90/min in 25% vs 13.33%, and above 90/min in 25% of studied group (p < 0.05). On the basis of ROC curve analysis and odds ratio (OR) it was shown that HR > or = 72.5/min is an independent risk factor for carbohydrate disorders. CONCLUSIONS: Resting heart rate > or = 72.5/min is an independent risk factor for carbohydrate disorders and increases its risk more than ninefold.

[Exercise testing to estimate dysfunction of the autonomic nervous system in subjects with carbohydrate disorders]. / Test wysilkowy w ocenie dysfunkcji autonomicznego ukladu nerwowego u osób z zaburzeniami gospodarki weglowodanowej.

UNLABELLED: Slow heart rate recovery (HRR) 2 minutes after exercise testing is a predictor of cardiovascular mortality and index of decreased parasympathetic activity. The aim of the study was to evaluate the heart rate recovery in subjects with carbohydrate disorders. MATERIAL AND METHODS: The study comprised 112 subjects with carbohydrate disorders (54 females and 58 males), aged 30-78 (57.4 +/- 9.6) years. Carbohydrate disorders were diagnosed according to the Polish Diabetes Association criteria from 2007 (group I). 56 subjects had impaired fasting glucose (IFG), 36 - impaired glucose tolerance (IGT) and 20 - type 2 diabetes. Comparative group comprised 30 subjects without cardiovascular diseases and carbohydrate disorders (15 females and 15 males), aged 29-64 (52.70 +/- 8.8) years (group II). The fasting serum glucose level was evaluated using an enzymatic method, Kone-Pro biochemical analyzer and bioMérieux Glucose RTU kit. In subjects with fasting glucose level > or = 100 mg/dl, an oral glucose tolerance test (OGTT) was performed. In all subjects submaximal exercise treadmill testing was performed. Heart rate recovery was defined as a difference between the peak heart rate and that after 2 minutes of recovery in sitting position. RESULTS: In subjects with carbohydrate disorders the mean value of HRR was 38.93 +/- 12.08/min and it was significantly lower (p < 0.05) than in comparative group (57.0 +/- 11.44/min). In subjects with carbohydrate disorders negative correlation between HRR and patients' age as well as between HRR and fasting glucose level in males. On the basis of ROC curve analysis and OR (odds ratio) it was shown that HRR < or = 43.5/min results in almost threefold increased risk of carbohydrate disorders. CONCLUSIONS: In subjects with carbohydrate disorders the value of HRR is lowered, what stands for decreased parasympathetic activity and increased cardiovascular risk. HRR < or = 43.5/min results in almost threefold increased risk of carbohydrate disorders.

An expert opinion of the Association of Cardiovascular Interventions and the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society related to the place of prasugrel in the prevention of cardiovascular events in patients with acute coronary syndromes.

Based on many randomized clinical trials, it can be concluded that dual antiplatelet therapy is one of the best-studied treatments in the field of cardiovascular medicine. For many years prasugrel and ticagrelor have been preferred inhibitors of the platelet P2Y12 receptor in patients with acute coronary syndromes. These drugs enable faster, stronger, and more consistent inhibition of platelets and lead to better clinical outcomes than clopidogrel. The following document is an expert group opinion summarizing the latest knowledge in the field of antiplatelet therapy in the prevention of cardiovascular events in patients with acute coronary syndromes, with a special focus on prasugrel.

[Tissue inhibitor of metalloproteinases-1 level in patients with metabolic syndrome qualified for cardiac rehabilitation]. / Ocena stezenia tkankowego inhibitora metaloproteinaz u chorych na zespól metaboliczny zakwalifikowanych do rehabilitacji kardiologicznej.

UNLABELLED: Each year in Poland, the number of patients treated by PCI and CABG increases. Many of them have metabolic syndrome. After these procedures patients are qualified for cardiac rehabilitation. It is preceded by risk stratification for cardiac events. Metalloproteinases belong to the enzymes responsible for destabilization of atheroma plaques. The activity of metalloproteinases is tightly regulated by their inhibitors. The aim of the study was to estimate plasma tissue inhibitor of metalloproteinases-1 (TIMP-1) level in patients with metabolic syndrome qualified for cardiac rehabilitation after PCI procedures. MATERIAL AND METHODS: The study comprised of 50 subjects with metabolic syndrome (26 males, 24 females) aged 18-65 (mean 50.9+/-11.8) years, qualified for cardiac rehabilitation after PCI procedures and 25 healthy participants (13 males, 12 females) aged 21-55 (mean 50.2+/-12.8) years. The estimation of plasma TIMP-1 level was determined with use of R&D Systems kit. RESULTS: Plasma level of tissue inhibitor of metalloproteinases-1 in subjects with metabolic syndrome was 119.1+/-15.3 ng/ml and it was significantly lower than in group of healthy participants (188.5+/-14.7 ng/ml (p<0.001). CONCLUSIONS: Decreased plasma level of tissue inhibitor of metalloproteinases-1 in subjects with metabolic syndrome qualified for cardiac rehabilitation indicates disturbances of metalloproteinases activity control which take part in destabilization of atheroma plaque. In cardiac rehabilitation of subjects with metabolic syndrome we should pay attention to the type, time and intensity of exercise, because of increased risk of cardiovascular events.

[Vascular complications in patients with metabolic syndrome]. / Powiklania naczyniowe u chorych na zespól metaboliczny.

UNLABELLED: All risk factors of metabolic syndrome (MS) are responsible for endothelial dysfunction what accelerate the development of atherosclerosis. It causes increased cardiovascular risk and development of cardiovascular complications in these subjects. The aim of the study was to assess the presence of vascular complications in subjects with MS. MATERIAL AND METHODS: The study comprised of 108 patients with metabolic syndrome (36 males and 72 females), aged 46-67 (57+/-8.5) years. MS was diagnosed according to the International Diabetes Federation criteria from 2005. Ischaemic heart disease was diagnosed according to the coronarography or patient care documentation. The assessment of nephrological complications was conducted with use of glomerular filtration rate (eGFR) calculated by using the simplified Modification of Diet in Renal Disease Study (MDRD) equation. The occurrence of brain strokes and diabetic foot was estimated basing on medical history and documentation. Vascular complications in the bottom of the eye were assessed with ophtalmoscopic examination and fluorescein angiography. RESULTS: The frequency of vascular complications in subjects with MS was: vascular complications in the bottom of the eye - 72.7% (symptoms of vascular angiopathy without retinopathy - 41.2%, retinopathy - 31.5%), ischaemic heart disease - 54.9%, eGFR < 90 m/min. - 38.9%, diabetic foot - 5.55%. brain stroke - 3.7%. Ischaemic heart disease was present in all subjects with MS qualified to the second and higher class of retinopathy. CONCLUSIONS: In patients with MS, ischaemic heart disease was the most common macroangiopathic complication, with increasing in the frequency together with retinopathy intensification. Changes in the bottom of the eye were the most common microangiopathic complications. Early identification and treatment of metabolic syndrome may have important value in prophylaxis and delay of vascular complications.

[Plasma nitric oxide and vascular endothelial growth factor levels in patients with metabolic syndrome and co-existing vascular complications]. / Stezenie tlenku azotu i naczyniowo-sródblonkowego czynnika wzrostu w osoczu chorych na zespól metaboliczny ze wspólistniejacymi powiklaniami naczyniowymi.

UNLABELLED: Subjects with metabolic syndrome (MS) are especially exposed to co-existing several cardiovascular risk factors. It's aggregated action leads to the endothelial damage. Tissue hipoxaemia increases VEGF synthesis. NO may also play the crucial role in VEGF synthesis The balance between factors increasing and decreasing VEGF synthesis has special importance in development of vascular complications. The aim of the study was to estimate plasma nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels in patients with metabolic syndrome and vascular complications. MATERIAL AND METHODS: The study was conducted in two groups of patients. I Group--54 patients with metabolic syndrome (diagnosed according to the IDF criteria from 2005) and macro- and microvascular complications, aged 46-67 (58 +/- 6.7) years. II Group--20 healthy subjects, aged 40-61 (51 +/- 5.1) years. Plasma levels of NO and VEGF were determined in all participants. RESULTS: Plasma level of nitric oxide in subjects with metabolic syndrome and vascular complications was 6.48 +/- 1.5 micromol/l and in healthy participants 10.08 +/- 1.09 micromol/l (p < 0.05). Plasma level of vascular endothelial growth factor in subjects with metabolic syndrome and vascular complications was 193.45 +/- 131.0 pg/ml and in healthy participants 71.09 +/- 14.49 pg/ml (p < 0.05). CONCLUSIONS: Endothelial dysfunction seems to be the substantial factor responsible for the vascular complications in subjects with metabolic syndrome, which manifests in increased plasma level of VEGF and decreased plasma level of NO.

[Characteristic of metabolic syndrome in subjects with or without cardiovascular diseases]. / Charakterystyka zespolu metabolicznego u osób bez chorób i z chorobami ukladu sercowo-naczynlowego.

UNLABELLED: Identification of risk factors of metabolic syndrome (MS) as a part of primary prophylaxis allows early diagnosis and appropriate treatment. Secondary prophylaxis may lead to decreased number of complications and deaths resulting from cardiovascular diseases in subjects with MS. THE AIM OF THE STUDY: To assess the risk factors of MS and incidence of MS in subjects with or without cardiovascular diseases. MATERIAL AND METHODS: There were two groups of patients. I group--600 patients with primary prophylaxis, without cardiovascular diseases, aged 35-60 (49.57 +/- 8.5) and II group--231 patients with cardiovascular diseases (hypertension, ischaemic heart disease, type 2 diabetes), aged 27-69 (56.5 +/- 11.3). MS was diagnosed according to the IDF criteria from 2005. RESULTS: MS was diagnosed in 141 cases of 600 patients with primary prevention what gives 23.5% out of whole study group. In the I group the most common were: abdominal obesity (100%), hypertriglyceridemia (80.2%), hypertension (64.7%) and fasting hyperglycemia (55.2%). MS was diagnosed in 158 cases of 231 patients with cardiovascular disease what gives 68.4% out of whole study group. MS was the most frequent in patients with type 2 diabetes (90.32%), in patients with hypertension (71.58%) and the least common in patients with cardiovascular disease (59.05%). In the II group the most frequent were: abdominal obesity (100%), hypertension (89.24%), fasting hyperglycemia (75.32%). CONCLUSIONS: MS occurs more often in patients with cardiovascular diseases than in the total population. Cardiovascular diseases are connected with fasting hyperglycemia, systolic hypertension and high WHR.

[Assessment of the periodontal state in subjects with metabolic syndrome]. / Ocena stanu przyzebia u chorych na zespól metaboliczny.

UNLABELLED: Occurrence of metabolic syndrome (MS) increases cardiovascular risk in comparison with healthy subjects. In many studies the role of infection in pathogenesis of atherosclerosis is emphasised. The aim of the study was to assess the periodontal state in subjects with metabolic syndrome. MATERIAL AND METHODS: The study comprised 300 subjects with MS (mean age 42.0 +/- 9.5 years)--group I. 80 subjects (mean age 36 +/- 7.8 years) without MS were enrolled into the control group--group II. Metabolic syndrome was defined according to IDF criteria. To assess the periodontal state we evaluated: the depth of periodontal pocket, Russel index, gingival index, Aproximal Plaque Index (API) and alveolar process radiography. RESULTS: In patients with MS periodontal diseases were more frequent than in the control group (p < 0.05). CONCLUSIONS: Periodontal diseases are more frequent in subjects with metabolic syndrome than in the population of subjects without metabolic syndrome. Prophylaxis and treatment of periodontal diseases should be the crucial element of therapy in subjects with metabolic syndrome.