The contributions of fasting and postprandial blood glucose increments to oxidative stress and inflammation in dyslipidemic type 2 diabetic patients with stable ischemic heart disease.

BACKGROUND/OBJECTIVES: Contributions of fasting and postprandial blood glucose increments on level of inflammation and oxidative stress biomarkers in patients with stable ischemic heart disease (IHD) and diabetes mellitus type 2 (T2DM) was evaluated. METHODOLOGY: Ninety T2DM patients (60 with IHD and 30 without IHD) treated with metformin and/or sulphonylurea were enrolled in cross-sectional nested case-control clinical study. The areas under the six-point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Malondialdehyde (MDA), protein carbonyl group (PCO), fibrinogen, C-reactive protein (hsCRP), leukocyte count and adhesion molecules ICAM-1 and VCAM-1 were determined. RESULTS: AUCbg-AUCpp 58.2 (95%CI 40.6-75.8) was higher in IHD group compared to non-IHD 36.9 (95%CI 23.5-50.2) mmol*h/L. They had significantly higher ICAM-1 (mean±SD) 72.70±30.6 vs. 60.22±22.6ng/mL and MDA 16.47±4.5 vs. 13.42±4.01µmol/g plasma proteins, but similar PCO, VCAM-1, fibrinogen, hsCRP concentration and leukocyte count. AUCpp positively correlated with MDA (r=0.45) and ICAM-1 (r=0.32) in the presence of IHD, and VCAM-1 (r=0.44) in the absence of IHD. AUCbg-AUCpp positively correlated with PCO (r=0.45) in the absence of IHD. The analysis revealed that AUCpp over turning point of 0mmol*h/L was associated with high MDA and ICAM-1 expression in diabetics with IHD. AUCbg-AUCpp over 30mmol*h/L leads to high oxidative protein modification in diabetics without IHD. CONCLUSION: In T2DM patients with stable IHD, AUCpp at any point, significantly contributes to increasing of MDA and ICAM-1 expression. Fasting blood glucose increment showed significant correlation with carbonyl content in diabetics without IHD.

Association between atherosclerosis and osteoporosis, the role of vitamin D.

The latest data support the correlation of atherosclerosis and osteoporosis, indicating the parallel progression of two tissue destruction processes with increased fatal and non-fatal coronary events, as well as higher fracture risk. Vitamin D inadequacy associated with low bone mineral density increases fall and fracture risk, leads to secondary hyperparathyroidism, calcifies coronary arteries and significantly increases cardiovascular disease. Randomized clinical trial evidence related to extraskeletal vitamin D outcomes was limited and generally uninformative. A recent recommendation on vitamin D dietary requirements for bone health is 600 IU/d for ages 1-70 years and 800 IU/d for 71 years and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l). Further large randomized controlled trials are needed to reassess laboratory ranges for 25-hydroxyvitamin D in both diseases, in order to avoid under- and over-treatment problems, and completely clarify the relationship between atherosclerosis and osteoporosis.

[Acute myocardial infarction incidence and mortality rates in the population of the city of Nis in the period 1974-2000].

INTRODUCTION: The aim of this study was to investigate the annual incidence of hospital morbidity and mortality rates of acute myocardial infarction (AMI) in the population of Nis who were treated at the Cardiology Clinic in Nis during the period 1974-2000. MATERIAL AND METHODS: A retrospective clinical-epidemiological study was carried out in the population of the city of Nis aged 30 years and over. The number of citizens of Nis, aged 30 years and over, was 71,500 in 1974, and 100,000 in 2000, while the male to female ratio was 48%:52%. RESULTS: During the period from 1974 to 2000, 4319 patients of both sexes with AMI received hospital treatment. The average annual incidence rate was 159.92 per 100,000 inhabitants aged 30 years and over. The average annual incidence of AMI showed a trend of progressive increase, and in 2000 it was 274.87 (2.7 times higher than in 1974--102.19). The average annual mortality for both sexes was 1.57% (9.82% for males and 15.89% for females). The female mortality rate was significantly higher (p < 0.001). CONCLUSION: Trends in annual incidence rate of AMI in the population of the city of Nis aged 30 years and over are characterized by progressive increase during the period from 1974 to 2000. The trend line: yt = 159.92 + 6.2432x shows that without primary prevention further increase in the incidence of AMI can be expected.

[The role of physical training in patients after myocardial infarction].

INTRODUCTION: Physical training is an optimal method of rehabilitation of cardiovascular patients, especially in patients with myocardial infarction. The aim of this study was to evaluate the effects of physical training in patients with myocardial infarction during the post-hospital phase and prolonged rehabilitation by determining the test exercise parameters. MATERIAL AND METHODS: This prospective clinical study included 230 patients after myocardial infarction. Group A (180 patients) participated in organized forms of exercise (post-hospital rehabilitation and prolonged rehabilitation at home) for 48 +/- 6.4 months, while the control group was without physical training. The first clinical examination and the exercise test were performed in group A after post-hospital rehabilitation and after 191 +/- 16.4 days in the control group. In all patients the last control was performed 48 +/- 6.4 months after myocardial infarction. RESULTS: After the first control, the mean physical workload in group A was significantly higher compared with the control group (p < 0.05). After a 48 month follow-up period the physical workload was significantly higher in group A (p < 0.01), while in the control group a significant increase of workload was not observed (p > 0.05). Comparing the duration of exercise testing, significant differences were found after the first and last control (p < 0.05; p < 0.01, respectively). The double product was significantly higher in group A than in the control group after the first and last control (p < 0.05; p < 0.01, respectively). CONCLUSION: Prolonged physical training is beneficial for patients after myocardial infarction, because it improves cardiovascular functions and physical work capacity, improves angina threshold and the patient's general health.

[Effects of physical training on the lipid profile of patients after myocardial infarction].

INTRODUCTION: Positive effects of physical training on blood lipoprotein have been clearly demonstrated and they are constituive elements in prevention and treatment of hyperlipoproteinemia. The aim of this study was to evaluate the effects of physical training (PT) on lipid risk factors in patients with myocardial infarction (MI) during posthospital rehabilitation (PHR) and prolonged rehabilitation (48 months). MATERIAL AND METHODS: The prospective clinical study included 230 patients after MI. Patients were divided into two groups: group A (180 patients) participated in organized PT (PHR and prolonged rehabilitation at home) that lasted 48&6.4 months and the control group (50 patients) without PT. The intensity of PT was recommended to be 70% of maximal heart rate obtained during the exercise test (ET). Evaluation of lipid profile was done after the last control (48+/-6.4 months after MI). Parameters in the control group were compared with the parameters in the examined group of patients. RESULTS: Hyperlipidemia, as a risk factor, was present in 39% of patients of group A and in 38% of patients ofthe control group just after MI. A statistically significant difference wasn't established in lipoprotein levels in examined groups of patients before MI (p>0.05). Prolonged PT leads to significant deacrese of total cholesterol (p< 0.01), LDL/cholesterol (p < 0.05) and triglycerides (p<0.01), but increase in HDL/holesterol (p 0.01), in patients after MI with organized rehabilitation in comparison with the control group. CONCLUSION: Prolonged PT has a beneficial effect on hyperlipoproteinemia inl patients after MI. We have to practice PT over the "threshold" of physical activities if we want to achieve optimal results.