Lowered postoperative ldl-c/hdl-C ratio reduces later cardiovascular events after abdominal aortic aneurysm surgery.

PURPOSE: To examine the relationship between the incidence of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery and postoperative lipid levels. METHODS: Atherosclerotic risk factors including postoperative serum lipid levels were examined in 116 patients aged 70 or less undergoing an elective AAA surgery. Later cardiovascular events after AAA surgery occurred in 21 patients, including cerebral infarction (n = 4), catheter intervention or surgery for coronary artery disease (CAD) (n = 10) and other vascular disease. RESULTS: Postoperative cholesterol levels during the average follow-up period of 55.6 ± 44.3 (months) were 49.0 ± 15.7 (mg/dL) for high-density lipoprotein cholesterol (HDL-C), 97.9 ± 31.2 (mg/dL) for low-density lipoprotein cholesterol (LDL-C), which were both significantly improved compared to preoperative values (p <0.001). Cox hazard analysis indicated that preexistent CAD significantly increased in the risk for later cardiovascular events (hazard ratio 5.67; 95%CI 1.92-16.8; p = 0.002) and lowered postoperative LDL-C/HDL-C ratio <1.5 decreased in the risk after AAA surgery (hazard ratio 0.10; 95%CI 0.01-0.83; p = 0.033). Patients with postoperative LDL-C/HDL-C ratio <1.5 (n = 22) had a significantly better cardiovascular event-free rate than those with that ratio ≥1.5 (n = 94) (p = 0.014). CONCLUSION: Lowered postoperative LDL-C/HDL-C ratio <1.5 can decrease in the risk for later cardiovascular events after AAA surgery. These results may support the rationale for postoperative aggressive lipid-modifying therapy.

Lowered LDL-C Levels Reduce Later Local Vascular Events after Surgical or Endovascular Treatment of Peripheral Artery Disease.

PURPOSE: To examine the relationship between incidence of later, local vascular events (restenosis and occlusion) and clinical factors including lipid levels after surgical or endovascular treatment of peripheral artery disease (PAD). METHODS: Consecutive 418 PAD lesions (in 308 patients under the age of 70) treated with surgical (n = 188) or endovascular (n = 230) repair for iliac (n = 228) and infrainguinal (n = 190) lesions were retrospectively analyzed. Clinical features and lipid levels were compared between patients who developed vascular events (n = 51; VE group) and those who did not (n = 257; NoVE group). RESULTS: Among assessed factors, post-therapeutic low-density lipoprotein cholesterol (LDL-C) levels (mg/dL) were significantly higher in the VE group (120.4 ± 31.2) than in the NoVE group (108.2 ± 25.1) (P = 0.01). Infrainguinal lesions were more common in the VE than in the NoVE group (P <0.001). Cox hazard analysis indicated that infrainguinal lesions relative to iliac lesions significantly increased the risk of vascular events (hazard ratio (HR) 3.35; 95% CI 1.63-6.90; P = 0.001) and post-therapeutic LDL-C levels <130 (mg/dL) decreased the risk (HR 0.34; 95%CI 0.17-0.67; P = 0.002). CONCLUSION: Lowered post-therapeutic LDL-C levels can decrease the risk of later, local vascular events after PAD treatment. These results may support the rationale for aggressive lipid-modifying therapy for PAD.

Preoperative HDL-C Predicts Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery.

PURPOSE: To determine the predictive value of serum lipid levels on the development of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery. METHODS: A total of 101 patients under 70 undergoing an elective AAA surgery were divided into the following two groups: 1) those who developed later cardiovascular events after AAA surgery, including cerebral infarction (n = 4), catheter intervention (PCI) or surgery for coronary artery disease (CAD) (n = 9) and other vascular disease. (CVE group; n = 19); 2) those without later events (NoCVE group: n = 82). Preoperative atherosclerotic risk factors including serum lipid levels were subjected to univariate and multivariate analysis. RESULTS: The CVE group showed a significantly lower high-density lipoprotein cholesterol (HDL-C) level (32.9 ± 6.6 vs 41.6 ± 12.1 mg/dL; p <0.001), higher low-density lipoprotein cholesterol (LDL-C) / HDL-C ratio (4.30 ± 1.01 vs 3.24 ± 1.15; p = 0.001), and higher prevalence of mild CAD (without an indication of PCI) (p = 0.029) preoperatively. Cox hazard analysis indicated that preexistent mild CAD (hazard ratio 4.70) and preoperative HDL-C <35 mg/dL (hazard ratio 3.07) were significant predictors for later cardiovascular events after AAA surgery. CONCLUSION: Patients at high risk for later cardiovascular events should require a careful follow-up and may also require an aggressive lipid-modifying therapy.

Sucralfate protects intestinal epithelial cells from radiation-induced apoptosis in rats.

Radiotherapy for malignant pelvic disease is often followed by acute radiation colitis (ARC). It has been reported that sucralfate treatment has a protective effect against ARC, though the mechanisms of action are unknown. The effects of sucralfate on X-ray radiation-induced apoptosis was studied at 4 Gy in the colonic crypt cells of rats. Sucralfate enemas given prior to radiation resulted in the following: (1) reduction in number of apoptotic colonic crypt cells; (2) reduction in number of caspase-3 positive cells; (3) decreases in p53 accumulation and p21 expression; (4) decreases of Bax/Bcl-2 ratio. The protective effects of sucralfate against ARC may be partially due to the suppression of radiation-induced apoptosis by way of p53 in the colon and the protection of the colonic epithelial stem cell region.

Real-time cerebral monitoring using multichannel near-infrared spectroscopy in total arch replacement.

Multichannel near-infrared spectroscopy (NIRS) could detect change in the regional cerebral oxygenation by following animated pictures of oxy-hemoglobin (OxyHb), deoxy-hemoglobin (DeoxyHb) and total hemoglobin in operations for three surgical cases of thoracic aortic aneurysm with selective cerebral perfusion (SCP). Simultaneously measured jugular venous oxygen saturation (SjO2) showed no change in parallel to OxyHb or DeoxyHb of NIRS. It was concluded that SjO2 represented the entire rather than the local findings of the cerebral oxidative metabolism. Assessment of the intra cranial oxidative metabolism using a multichannel NIRS provided real-time information about the efficacy of SCP, while SjO2 had a comprehensive limited value. The animation enabled the detection of regional hypoperfusion visually and instantly during SCP. This multichannel NIRS was a new real-time monitoring method and was useful to prevent cerebral neurological complication due to hypoperfusion during SCP.