Local elasticity of the aorta in patients with type 2 diabetes mellitus.

OBJECTIVE: Arterial elasticity is important for assessing the state of an artery. This cross-sectional study aimed to non-invasively examine stiffness parameters of the ascending aorta in patients with type 2 diabetes mellitus (T2DM). METHODS: We studied 58 patients, including 38 with T2DM and 20 controls. The stiffness of the aorta was evaluated during transthoracic echocardiography. Aortic parameters of stiffness, such as the stiffness index, elasticity index, and compliance index, were calculated using the aortic maximal diameter, aortic minimal diameter, and blood pressure. RESULTS: Pulse pressure values were significantly higher patients with T2DM than in controls. The ß index was significantly higher in patients with T2DM lasting for >7 years compared with those with T2DM lasting for <7 years. Mean aortic compliance was significantly lower in patients with a longer duration of diabetes than in those with a shorter duration of diabetes. Aortic elasticity was significantly lower in patients with diabetes and arterial hypertension compared with patients without diabetes with concomitant arterial hypertension. CONCLUSIONS: Patients with T2DM, especially when T2DM is long-term, have increased stiffness and decreased compliance of the ascending aorta. Pulse pressure, which is a cardiovascular risk factor, is also significantly increased in patients with T2DM.

Circulating Endothelial Microparticles and Aortic Stiffness in Patients with Type 2 Diabetes Mellitus.

Diabetes mellitus represents a metabolic disorder the incidence of which has been on the increase in recent years. The well-known long-term complications of this disease encompass a wide spectrum of renal, neurological and cardiovascular conditions. The aim of the study was to investigate the serum concentration of endothelial microparticles (EMPs) as well as selected noninvasive parameters of the ascending aorta stiffness calculated with echocardiography. In this study, 58 patients were enrolled-38 subjects diagnosed with type 2 diabetes mellitus (T2DM) and 20 healthy controls. The analyzed populations did not differ significantly with respect to age, renal function, systolic and diastolic blood pressure. The patients with diabetes and concomitant hypertension presented higher levels of EMPs in comparison with diabetic normotensive subjects. Among patients with diabetes and hypertension, aortic stiffness assessed with the elasticity index (Ep) was higher and the aortic compliance index (D) lower than in the diabetic normotensive group. No correlation between the amount of EMPs and lipid profile, C-reactive protein (CRP) level and glycemia, was observed in the studied group. There was, however, a statistically significant positive correlation between the creatinine level and amount of EMPs, while the negative relationship was documented for EMPs level and the estimated glomerular filtration rate (eGFR).

The effect of oral contraception on cardiometabolic risk factors in women with elevated androgen levels.

BACKGROUND: In unselected reproductive-aged women, use of combined estrogen-progestin oral contraceptive pills has been linked with an increased risk of vascular disease. The aim of this study was to investigate the effect of oral contraception on cardiometabolic risk factors in a population of women with hyperandrogenism. METHODS: The study included 16 untreated women with elevated testosterone levels and 15 matched healthy women who were then treated with oral contraceptive pills containing ethinyl estradiol (30µg) and drospirenone (3mg). Plasma lipids, glucose homeostasis markers, circulating levels of androgens, uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen and homocysteine, as well as urinary albumin-to-creatinine ratio (UACR) were assessed at baseline and after 12 weeks of treatment. RESULTS: Compared to healthy women, women with elevated androgen levels showed increased plasma levels of hsCRP, fibrinogen and homocysteine, as well as a higher value of UACR. Oral contraception reduced androgen levels only in hyperandrogenic women. In healthy women, ethinyl estradiol plus drospirenone increased plasma levels of insulin, hsCRP, fibrinogen and homocysteine, while in women with elevated androgen levels their effect was limited only to a small increase in hsCRP. CONCLUSIONS: Our results suggest that a deteriorating effect of oral contraceptive pills containing ethinyl estradiol and drospirenone in hyperandrogenic women is weaker than in healthy young women and that ethinyl estradiol/drospirenone combination therapy may be safely used in the former group of patients.

Different cardiometabolic effects of atorvastatin in men with normal vitamin D status and vitamin D insufficiency.

BACKGROUND: Vitamin D is suggested to reduce cardiovascular risk. HYPOTHESIS: Circulating levels of plasma lipids and other cardiovascular risk factors may differ between statin-treated patients with different vitamin D status. METHODS: We studied 3 age- and weight-matched groups of men with elevated low-density lipoprotein cholesterol (LDL-C) levels: vitamin D-naïve men with vitamin D insufficiency (group A, n = 18), men with vitamin D deficiency/insufficiency effectively treated with vitamin D preparations (group B, n = 16), and vitamin D-naïve men with normal vitamin D status (group C, n = 16). All patients were then treated with atorvastatin (20 mg daily) for 4 months. Plasma lipids, glucose homeostasis markers, and plasma levels of uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine, and fibrinogen were assessed before and at the end of atorvastatin therapy. RESULTS: Study groups did not differ in baseline levels of plasma lipids. Men with vitamin D deficiency or insufficiency effectively treated with vitamin D preparations were characterized by decreased insulin sensitivity and higher circulating levels of hsCRP, homocysteine, and fibrinogen in comparison with the remaining groups of patients. Although atorvastatin decreased plasma levels of total cholesterol and LDL-C to a similar extent in all study groups, its effect on uric acid, hsCRP, homocysteine, and fibrinogen was more pronounced in patients from groups B and C than in men from group A. Moreover, in patients with vitamin D insufficiency, atorvastatin impaired insulin sensitivity. CONCLUSIONS: The obtained results indicate that the strength of pleiotropic effects of atorvastatin depends on vitamin D status.

Sexual function and depressive symptoms in young women with low vitamin D status: a pilot study.

OBJECTIVE: Although vitamin D deficiency is associated with an increased risk of numerous disorders, no previous study has investigated its association with sexual dysfunction. The aim of this study was to investigate female sexual functioning and depressive symptoms in young women with low vitamin D status. STUDY DESIGN: The study included 14 women with vitamin D deficiency, 14 women with vitamin D insufficiency, as well as 14 matched healthy women. All participants of the study completed questionnaires evaluating female sexual functioning (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II). RESULTS: The total FSFI score was lower while the overall BDI-II score higher in women with vitamin D deficiency, but not in women with vitamin D insufficiency, than in healthy subjects. Compared to women with normal vitamin D status, women with vitamin D deficiency were characterized by lower scores for three domains: sexual desire, orgasm and satisfaction, while women with vitamin D insufficiency were characterized by a lower score only for desire. Desire and in women with vitamin D deficiency also orgasm, sexual satisfaction and the overall FSFI score negatively correlated with 25-hydroxyvitamin D levels. CONCLUSION: The obtained results indicate that low vitamin D status is associated with abnormal female sexual functioning, the severity of which depends on the degree of vitamin D deficiency.

The effect of metformin on the hypothalamic-pituitary-thyroid axis in patients with type 2 diabetes and amiodarone-induced hypothyroidism.

BACKGROUND: Chronic metformin treatment was found to reduce elevated thyrotropin levels. Amiodarone treatment is associated with a range of effects in thyroid function from mild derangements to overt thyroid dysfunction. No previous study has investigated the effect of metformin on hypothalamic-pituitary-thyroid axis activity in patients with amiodarone-induced hypothyroidism. METHODS: The study included three age-, sex- and weight-matched groups of amiodarone-treated patients with type 2 diabetes: patients with treated overt hypothyroidism (group I, n=15), patients with untreated subclinical hypothyroidism (group II, n=15), and subjects without thyroid disorders (group III, n=18). The lipid profile, fasting plasma glucose levels, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, the estimated glomerular filtration rate, as well as serum levels of thyrotropin, thyroid hormones, prolactin, insulin and insulin-like growth factor-1 (IGF-1) were assessed at baseline and after 6 months of metformin treatment (2.55-3g daily). RESULTS: In all groups of patients, metformin reduced plasma glucose and triglycerides, serum insulin, glycated hemoglobin as well as HOMA1-IR. The estimated glomerular filtration rate, thyroid hormones, prolactin and IGF-1 remained at a similar level throughout the study. In patients with untreated amiodarone-induced hypothyroidism, but not in the other groups of patients, metformin reduced serum levels of thyrotropin and this effect correlated weakly with its action on insulin sensitivity. CONCLUSIONS: The obtained results indicate that the effect of metformin on hypothalamic-pituitary-thyroid axis activity is partially related to thyroid function. Metformin treatment may bring clinical benefits to patients with amiodarone-induced hypothyroidism and poor tolerance of exogenous L-thyroxine.

[The rapid progress of heart failure due to systemic amyloidosis with cardiac involvement--case report]. / Gwaltownie postepujaca niewydolnosc krazenia w przebiegu amyloidozy z zajeciem serca-opis przypadku.

UNLABELLED: Amyloidosis is a disease having many different faces. Different symptoms may appear, depending on which organ is involved. That's why correct diagnosis can be difficult. Cardiac involvement must always be considered because of poor prognosis (30 to 68 % patients survive one year). Also in case of rapid progress of cardiac wall thickening, amyloidosis should be taken into account. MATERIAL AND METHODS: we present a case of a female patient with rapid progress of heart failure due to systemic amyloidosis with cardiac involvement. CASE REPORT: 48-old female, with no prior medical history, admitted to cardiology ward because of dyspnea on exertion and leg edema. Couple days before admission hypertrophic cardiomyopathy was diagnosed. Laboratory test revealed elevated troponin I, d-dimers and BNP (natriuretic peptide type B). Electrocardiogram showed low QRS voltage in limb leads. Echocardiography confirmed concentric thickening of left ventricular walls and reduced ejection fraction (40%). We performed cardiac magnetic resonance. Morphology of the delayed enhancement and an increased signal in T2 dependent sequences suggested overlap of general inflammatory process and hypertrophic cardiomyopathy. Because of amyloidosis suspicion, gingival and subcutaneous adipose tissue biopsies were performed. Sirius red stain identified amyloid only in the walls of gingival blood vessels. Diagnosis of amyloidosis was established and further diagnostics planned. Soon after patients condition worsened. Finally, in intensive care unit, after cardiac arrest patient died. CONCLUSION: Amyloidosis with cardiac involvement has a very poor prognosis. Multiple tissue biopsy and histopathological assessment should lead to correct diagnosis and proper treatment.