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).

Relation between markers of inflammation and estradiol in older men.

BACKGROUND: Inflammation plays a key role in the development of atherosclerosis. Studies in women receiving estrogens show their proinflammatory effects. This study sought to determine relation between sex hormones and 2 inflammation markers: C-reactive protein and fibrinogen. MATERIAL/METHODS: One hundred men of at least age 50 years were enrolled in the study. Plasma levels of total testosterone, estradiol, sex hormone binding globulin, high-sensitivity C-reactive protein, and fibrinogen were measured. Free estradiol and free testosterone were calculated. RESULTS: Estradiol and free estradiol levels were positively correlated with C-reactive protein and fibrinogen. In a subgroup analysis, this association persisted only in patients with stable coronary artery disease. No significant correlations were found between testosterone, free testosterone, sex hormone binding globulin, and markers of inflammation. CONCLUSIONS: This study suggests that estradiol may have proinflammatory effects in older men with coronary artery disease.

[Sex hormones, HDL cholesterol and other lipoproteins in older males]. / Hormony plciowe, HDL cholesterol i inne frakcje lipoproteinowe u starszych mezczyzn.

UNLABELLED: The associations between sex hormones and cardiovascular risk factors in men are controversial. It is well known that testosterone level declines with age and this phenomenon is associated with increased incidence of cardiovascular disease in men. Elevated levels of total cholesterol and LDL cholesterol together with low HDL cholesterol are the important risk factors of coronary heart disease. THE AIM OF STUDY was to investigate the relationships between sex hormones and plasma lipids in aging males. MATERIAL: The study group comprised 107 males over 50 years old. RESULTS: A significant positive correlation was found between testosterone (T) and HDL-cholesterol (r=0.251; p<0.01). Estradiol level was inversely correlated with total cholesterol (r=-0.204; p<0.05). Interestingly, the older age of subjects was associated with increased levels of SHBG (r=0.28; p<0.01) and decreased free testosterone index (T/SHBG) (r=-0.423; p<0.001). CONCLUSION: These data support relationship between sex hormones and plasma lipids and suggest that a low testosterone concentration in aging males may be important in the pathogenesis of atherosclerosis.

[Association of obesity and insulin resistance with serum testosterone, sex hormone binding globulin and estradiol in older males]. / Zwiazek miedzy otyloscia i insulinoopornoscia a stezeniem testosteronu, globuliny wiazacej hormony plciowe i estradiolu u starszych mezczyzn.

UNLABELLED: There is an increased accumulation of fat tissue with subsequent increase of insulin level, insulin resistance and decrease of testosterone level in aging males. AIM OF THE STUDY: Assessment of the relations between obesity, insulin resistance and levels of sex hormones. MATERIAL AND METHODS: Indices of obesity (BMI, WHR, waist circumference), insulin level, insulin resistance (HOMA-IR) and levels of sex hormones (total testosterone, free testosterone, free testosterone index, sex hormone-binding globulin--SHBG, estradiol) were measured in 107 males at the mean age of 60.1 +/- 7 years. RESULTS: Obesity among aging males is associated with insulin resistance and hyperinsulinism. All above factors correlate with decreased serum levels of testosterone and sex hormone binding globulin as well as increased ratio estradiol/testosterone ratio. CONCLUSION: Our data suggest a role of decreased levels of testosterone and SHBG in pathogenesis of visceral obesity and metabolic syndrome in older males.

Hypertension, and not sex hormones or insulin resistance affects left ventricular mass in aging men.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. The aim of the study was to find which factors influence left ventricular mass (LVM) and whether relationships exist between sex hormones: testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG) and insulin resistance (HOMA-IR) and LVM. The study group consisted of 107 males at the age of over 50 years (mean 60.1 +/- 7.0). Positive significant correlations between LVM or left ventricle mass index (LVMI) and hypertension (0.23; p = 0.015 and 0.23; p = 0.019 respectively) as well as between LVM and body weight (0.38; p < 0.001) were observed. LVM and LVMI were higher in hypertensive than in normotensive men (279.9 +/- 82.2 vs. 243.4 +/- 70.3 g, p = 0.015 and 144.6 +/- 41.5 vs. 127.4 +/- 33.1 g/m2, p = 0.019 respectively). Multiple regression analysis showed LVM to be independently associated with hypertension and body weight. For LVMI such correlation was found only with hypertension. No relationships were observed between LVM/LVMI and insulin/insulin resistance.

Dihydrotestosterone treatment in men with coronary artery disease. I. Influence on sex hormones, lipid profile, insulin resistance and fibrinogen.

The effects of three months' transdermal dihydrotestosterone treatment were assessed in eleven men with coronary artery disease. Concentration of total testosterone level significantly decreased (p < 0.01) as well as free testosterone (p < 0.05) and estradiol levels (p < 0.01), without changes of sex hormone binding globuline and estradiol/testosterone ratio. DHT regimen did not alter the parameters of lipid profile. No changes of blood glucose, insulin, insulin resistance (HOMA) and fibrinogen were observed in this group. The tendency towards higher levels of hemoglobin, erythrocyte count and hematocrit did not reach statistical significance. Short term DHT administration in aging males was safe for prostate.

Dihydrotestosterone treatment in men with coronary artery disease. II. Influence on myocardial ischemia and left ventricle.

The effect of transdermal dihydrotestosterone on left ventricle mass and its systolic and diastolic function as well as on the results of treadmill stress test was assessed in eleven males with coronary artery disease. DHT treatment for 3 months resulted in significant decrease in isovolumetric relaxation time (0.150+/-0.37 s vs. 0.135+/-0.03 s; p < 0.05) indicating the improvement of left ventricle diastolic function. Left ventricle mass and systolic function indices remained unchanged. There was improvement in myocardial ischemia, time to 1 mm ST segment depression increased (p < 0.05) and ST/HR slope decreased (p < 0.01). Correlation coefficients between testosterone concentration at the beginning of the study and differences in selected parameters of ECG stress test were as follows: for T and increased total exercise time (r= -0.83, p=0.002), for T and increased maximum workload (r= -0.84, p=0.001), for T and increased time to 1 mm ST segment depression (r= -0.75, p=0.009) and for T and decreased ST/HR slope (r=0.68, p=0.02).

[Echocardiographic evaluation of right ventricular structure and diastolic function in patients with overweight and arterial hypertension]. / Echokardiograficzna ocena budowy i czynnosci rozkurczowej prawej komory serca u chorych z nadwaga i nadcisnieniem tetniczym.

The accelerated development of the left ventricular dysfunction due to increased preload and afterload is often observed in patients with systemic hypertension and concurrent overweight/obesity. Right ventricle is also influenced by systemic hypertension. The aim of the study was the echocardiographic assessment of the right ventricular structure and diastolic function in patients with systemic hypertension and overweight. The study group consisted of 31 subjects with untreated, mild to moderate systemic hypertension and overweight defined as a body mass index (BMI) above 26 kg/m2. Right ventricular diastolic diameter and right ventricular wall thickness were similar in study and control groups. In comparison with the controls patients with overweight demonstrated significantly shortened acceleration time of systolic flow in pulmonary artery, increased mean pulmonary artery pressure and decreased early to late filling wave velocity time integrals. These findings indicate that systemic hypertension associated with obesity does not cause additional morphological changes of the right ventricle compared to hypertensives with normal weight. Impaired right ventricular diastolic filling and pulmonary artery systolic flow indicate the presence of mild right ventricular dysfunction in subjects with overweight, however, diastolic and systolic parameters are within normal range both in patients with normal weight and overweight.

Prognostic value of the atrial pulsed Doppler recordings of transmitral flow in the assessment of left ventricular diastolic dysfunction.

Volume sample location is the most important factor influencing pulsed Doppler recordings of left ventricular (LV) diastolic filling. Transmitral diastolic flow velocities measured at the tips of mitral valve leaflets are usually higher than those obtained from atrial location. Nevertheless, independently of volume sample location, differences between early to late velocities ratio (E/A) are nonsignificant, so E/A became the most useful index of ventricular diastolic performance. In some patients, however, with E/A > 1 measured between the tips of mitral leaflets, the pattern of delayed LV relaxation, with diminished E and predominant A wave (E/A < 1), is often obtained from left atrial volume sample location. The aim of our study was to compare LV dimensions and wall thickness between patients with E/A > 1 recorded both at the tips of mitral valve leaflets and in the left atrium and patients with E/A > 1 at the tips of mitral valve leaflets and E/A < 1 in the left atrium. The study population consisted of 51 patients with E/A > 1 recorded between the tips of mitral valve (E/Avent) and excluded pseudonormalized filling pattern. The study population was divided into two groups based on Doppler profile recorded in the left atrium: group A--26 patients with E/A < 1 (E/Aatr) and group B--25 patients with E/Aatr > 1. Patients from group A were significantly older (55.6 +/- 12.8 vs 43.5 +/- 10.5 yrs, p < 0.001) and had increased body mass index (28.8 +/- 4.4 vs 25 +/- 4.1 kg/m2, p < 0.01) compared to subjects from group B. The average thickness of intraventricular septum was 13.5 +/- 2.8 mm in group A and 9.7 +/- 1.6 mm in group B, the average thickness of LV posterior wall was 11.6 +/- 1.7 and 9.2 +/- 1.8 mm, respectively. The results of this study suggest that abnormal atrial recordings of diastolic flows may reflect the earliest stage of left ventricular diastolic dysfunction in asymptomatic patients with echocardiographic signs of mild cardiac damage.