An inverse relationship between plasma glutathione concentration and fasting glycemia in patients with coronary artery disease and concomitant type 2 diabetes: A pilot study.

BACKGROUND: There have been occasional reports indicating that plasma concentrations of reduced glutathione (GSH) may be associated in some way with blood glucose. This relationship, however, has not hitherto been explored in the blood plasma of patients with coronary artery disease (CAD). OBJECTIVES: The aim of this study was to evaluate potential associations of fasting glycemia and peripheral blood plasma GSH concentrations in CAD-free and CAD-affected subjects. MATERIAL AND METHODS: In blood samples obtained from patients with CAD, defined by coronary angiography and/or echocardiography, and from an age-matched control group of patients with a confirmation of no coronary artery occlusion and with no history of cardiovascular events, plasma concentrations of glucose and reduced glutathione were analyzed by routine laboratory diagnostic methods and high performance liquid chromatography (HPLC), respectively. RESULTS: The results showed that in the CAD patients, but not in the non-CAD controls, fasting glycemia is negatively associated with plasma levels of GSH (r = -0.328; p = 0.011). Moreover, in the CAD-affected subjects (but not in the controls) the presence of type 2 diabetes mellitus significantly discriminated plasma levels of GSH (rP = -0.125; p = 0.350, between GSH and glucose adjusted for the occurrence of diabetes). CONCLUSIONS: The study suggests that GSH may be an important factor contributing to glucose metabolism in CAD patients. Hence, it may be considered a significant therapeutic target in strategies aimed at improving glycemic control in CAD-affected subjects.

Iatrogenic left main-stem dissection extending to the circumflex artery and retrogradely involving the left and non-coronary sinuses of Valsalva: iatrogenic aortocoronary dissection.

We present the case of a 57-year-old female who experienced iatrogenic left main-stem (LMS) dissection during elective coronary angiography. The dissection immediately affected the circumflex artery (Cx), causing its total distal occlusion, and the left anterior descending artery (LAD), in which a metal stent, implanted six months earlier, provided blood flow. The dissection spread retrogradely to the left and non-coronary sinuses of Valsalva (SV). Ventricular fibrillation (VF) occurred but the patient was successfully defibrillated. The subsequent introduction of a catheter resulted in recurrent VF, again successfully defibrillated. Total arterial myocardial revascularisation with double skeletonised internal thoracic arteries was performed without complications and SV repair was avoided. At the one-year follow up, a control multi-slice CT (MSCT) angiography was conducted, revealing complete healing of the SV and LMS dissections. It also showed native blood flow, the left internal thoracic artery (LITA) graft to the Cx occlusion, and a patent right internal thoracic artery (RITA) graft implanted to the LAD.

Assessment of the relationship between selected cardiovascular risk factors and the indices of intima-media thickness and coronary artery calcium score in various stages of chronic kidney disease.

Renal diseases pose a growing epidemiological and health problem worldwide. Cardiovascular diseases are the leading cause of deaths among patients with chronic kidney disease. Increased risk of atherosclerosis in these patients results from the occurrence of traditional and non-traditional risk factors. The aim of this study was to assess the relationship between selected risk factors for cardiovascular diseases (age, sex, dyslipidemia, hypertension, etc.), intima-media thickness and coronary artery calcium score in patients with chronic kidney disease stages 2, 3 and 4. This study included 60 patients with chronic kidney disease divided into 3 groups on the basis of disease stage and control group consisting of 20 individuals without diagnosed chronic kidney disease and cardiovascular diseases. Blood analysis and blood pressure measurements were taken. All patients underwent carotid artery ultrasound with the assessment of the intima-media thickness, and heart CT scan in order to assess the index of coronary artery calcification. Logistic regression analysis revealed statistically significant correlation between blood vessels calcification and age--the increase in age by 1 year was associated with the increase in the risk of coronary artery calcification by 6.7 %. The increase in IMT by about 0.1 mm raises the risk of calcification by about 2 %. Second logistic regression model revealed that one-year increase in age was associated with an increase in the risk of intima-media thickening by 6.5 %. Occurrence of hypertension was associated with a ninefold increase in intima-media thickening risk in comparison with patients with normal blood pressure. To sum up, age and hypertension were associated with the growth of IMT in CKD patients, while age and exposure to tobacco smoke were associated with the increase in coronary artery calcium score. The relationship between thickening of IMT and the increase in calcification index in patients was also observed in study group.

Aspirin dose increase from 75 to 150 mg suppresses red blood cell contribution to suboptimal platelet response to aspirin in patients with CAD.

PURPOSE: To verify the hypothesis that erythrocytes play a role in suboptimal blood platelet response to acetylsalicylic acid (ASA, aspirin) in subjects with coronary artery disease (CAD). METHODS: In a cross-over randomized controlled intervention study we evaluated blood platelet response to 30-day treatment with 75 mg/d or 150 mg/d of ASA (enteric coated) in CAD patients (n = 125). In vitro platelet response to collagen or arachidonic acid was monitored with impedance aggregometry and plasma thromboxane B2 was assayed immunoenzymatically. Blood morphology and several plasma biochemical parameters were determined using routine diagnostic procedures. RESULTS: CAD patients demonstrated lower blood platelet responsiveness to 75 mg/d of ASA compared to healthy subjects. The improved platelet responsiveness to 150 mg/d of ASA was particularly evident in "poor" responding patients. Positive correlations between platelet "poor" response to lower (75 mg/d) ASA dose and red blood cell count (Rs = 0.215; p < 0.04), haemoglobin (Rs = 0.232; p < 0.02) and haematocrit (Rs = 0.239; p < 0.02) were found in CAD patients. Association between "poor" platelet response with lower ASA dose was confirmed by conditional maximum likelihood logistic regression, which showed the independency between erythrocyte-derived parameters, as the risk factors for suboptimal platelet response to ASA, and other risk factors, like CRP or LDL-cholesterol. In "poor" ASA responders taking the higher ASA dose (150 mg/d) the correlation between platelets' response to ASA and erythrocyte-derived parameters was not significant. CONCLUSIONS: Red blood cell parameters are associated with suboptimal blood platelet response to ASA in patients with CAD. Such a platelet refractoriness to ASA may be effectively overcome by increasing the ASA dose.

Role of preprocedural glutathione concentrations in the prediction of major adverse cardiac events in patients with acute coronary syndrome treated with percutaneous coronary intervention.

INTRODUCTION: Poor antioxidant protection of cardiomyocytes due to cardiac ischemia and low serum levels of reduced glutathione (GSH) may be associated with enhanced risk of coronary restenosis after primary percutaneous coronary intervention (pPCI). OBJECTIVES: The aim of this study was to investigate whether preprocedural serum reduced GSH, reflecting the antioxidant status, may be predictive of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) treated with pPCI. PATIENTS AND METHODS: Preprocedural serum GSH level was evaluated in 141 patients with ACS treated with pPCI with bare-metal stent (BMS) deployment. During a 15-month follow-up, 30 patients (mean age, 61 ±10 years) experienced a MACE. The remaining 111 subjects constituted the non-MACE group (mean age, 63 ±10 years). RESULTS: The MACE group had significantly lower GSH levels compared with the non-MACE group (P <0.001); significant differences were also observed in a subgroup of type 2 diabetic patients (P <0.001). All patients were arbitrarily classified as having low (median, ≤1.39; 1.04-1.55 µmol/l) or high serum GSH (median, >2.26; 2.09-2.99 µmol/l; P <0.001). The Kaplan-Meier analysis showed a significantly longer MACE-free survival in patients with higher serum GSH (P <0.004). The Cox proportional hazards regression indicated that patients with lower GSH were 2.2 times more likely to experience MACE (95% confidence interval [CI], 1.2-3.9; P <0.02 for the whole group and 1.8-11.8 for diabetic patients; P <0.002). CONCLUSIONS: Preprocedural GSH levels may be useful in the prediction of MACE in patients with ACS scheduled for pPCI and BMS deployment, especially in diabetic subjects.

[Long term regular physical activity as a factor modifying the incidence of subclinical atherosclerosis in occupationally active men]. / Wieloletni systematyczny wysilek fizyczny jako czynnik modyfikujacy wystepowanie miazdzycy subklinicznej u mezczyzn aktywnych zawodowo.

BACKGROUND: Optimal dose of physical activity in the prevention of atherosclerosis remains unclear. The purpose of the study was to investigate the influence of leisure-time physical activity (LTPA) on selected indices of atherosclerosis in the working-age population of men. MATERIALS AND METHODS: The study was carried out in a cohort of asymptomatic men participating in follow-up examinations in the Healthy Men Clinic, Medical University of Lodz. Of the 132 men who responded to the invitation to participate in this study, 101 men were eligible for the non-invasive assessment of subclinical atherosclerosis indices. Self-reported PA was assessed by interviewer-administered validated questionnaires. During the latest follow-up subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC), the carotid inti ma-media thickness (IMT) and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). RESULTS: Preliminary results have been elaborated in the group of 60 men (mean age: 61.3 +/- 8.85 years). The participants were predominantly white collar workers with low occupational LTPA. The cohort was divided into 3 groups according to the LTPA level. Both dose and energy expenditure of recreational PA significantly correlated with CA, IMT and RHI in the whole cohort. The majority of men maintained their baseline PA throughout the observation period. Men with the highest LTPA level had significantly lower mean CAC, IMT (p < 0.01), and significantly higher mean RHI (p < 0.05) compared to the least active group. On final examination men with high PA had also the most favorable cardiovascular profile. CONCLUSIONS: The preliminary results indicate the protective effect of high LTPA level in the context of subclinical atherosclerosis in men.

[Glycosylated hemoglobin and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus]. / Zaleznosc miedzy stezeniem hemoglobiny glikowanej a stopniem niewydolnosci rozkurczowej serca u chorych na cukrzyce typu 2.

UNLABELLED: Glycosylated hemoglobin (HbA1c) is a confirmed prognostic factor of cardiovascular complications in diabetic patients. The relative odds of cardiovascular disease (CD) increase by 20% for 1% increase of HbA1c above HbA1c 5%. The aim of the study was to assess relationship between diastolic dysfunction and HbA1c in patients with diabetes mellitus 2 (DM 2) without critical coronary stenosis in coronarography. MATERIAL AND METHODS: The study comprised 57 subjects (35 men and 22 women) with DM 2, without coronary stenosis in coronarography, with normal and elevated HbA1c levels. The subjects were divided into two groups depending on HbA1c level: with HbA1c < or = 6.1% and HbA1c >6.1%. Parameters of left ventricular diastolic function were assessed in echocardiography according to criterions of European Society of Cardiology. Subjects with decreased systolic function (EF<50%) were excluded from the study. RESULTS: Diastolic dysfunction of the left ventricle was observed in 43% of patients with HbA1c >6.1% comparing to 4.5% of patients in the group with HbA1 < or = 6.1%. In the group with HbA1c >6.1% in 38% of the patients abnormal relaxation in early filling phase and in 5% abnormal isovolumetric relaxation were observed. In the group with HbA1 < or = 6.1% in only 1 patient (4.5%) abnormal relaxation in early filling phase was observed. CONCLUSION: Diastolic function of the left ventricle in patients with diabetes is dependent on HbA1c levels.

[High sensivity C-reactive protein as a complement to classical methods in the evaluation of coronary event's risk]. / HsCRP (bialko C-reaktywne oznaczane metoda o duzej czulosci) jako uzupelnienie klasycznych metod oceny ryzyka wystapienia epizodu wiencowego.

Recent years have brought many new advances concerning etiology and pathology of atherosclerosis and cardiovascular risk. However, there are still researches taking place to improve currently used Scales of Cardiovascular Risk, which introduce novel biomarkers of inflammatory process, hemostasis or oxidative stress in order to identify individuals who are the most endangered group of cardiovascular event. This study's aim was to review existing cardiovascular risk factors and risk assessment scales and to confront their clinical usefulness with novel biomarkers emerging in this field with special respect to high sensivity C-reactive protein (hsCRP). Existing cardiovascular risk assessment scales seem not to be endangered in their prognostic role mainly due to crucial role of individual medical history in diagnosis ischaemic heart disease and evaluating the cardiovascular risk. For the time being, despite many novelties appearing in cardiovascular risk evaluation, only hsCRP has unarguably proven prognostic ability in terms of coronary events and may have addictive informative power towards existing cardiovascular risk scales. The level of hsCRP < 1 mg/l should be interpreted as low cardiovascular risk (CVR), 1-3 mg/I as moderate CVR and > 3 mg/I as high CVR. Unfortunately, hsCRP is unpopular and not widely used in standard biochemical tests in Polish hospitals in patients with ischaemic heart disease.