Montelukast Use Decreases Cardiovascular Events in Asthmatics.

Cysteinyl leukotrienes are proinflammatory mediators with a clinically established role in asthma and a human genetic and preclinical role in cardiovascular pathology. Given that cardiovascular disease has a critical inflammatory component, the aim of this work was to conduct an observational study to verify whether the use of a cysteinyl leukotriene antagonist, namely, montelukast, may protect asthmatic patients from a major cardiovascular event and, therefore, represent an innovative adjunct therapy to target an inflammatory component in cardiovascular disease. We performed an observational retrospective 3-year study on eight hundred adult asthmatic patients 18 years or older in Albania, equally distributed into two cohorts, exposed or nonexposed to montelukast usage, matched by age and gender according to information reported in the data collection. Patients with a previous history of myocardial infarction or ischemic stroke were excluded. In summary, 37 (4.6%) of the asthmatic patients, 32 nonexposed, and five exposed to montelukast suffered a major cardiovascular event during the 3-year observation period. All the cardiovascular events, in either group, occurred among patients with an increased cardiovascular risk. Our analyses demonstrate that, independent from gender, exposure to montelukast remained a significant protective factor for incident ischemic events (78% or 76% risk reduction depending on type of analysis). The event-free Kaplan-Meier survival curves confirmed the lower cardiovascular event incidence in patients exposed to montelukast. Our data suggest that there is a potential preventative role of montelukast for incident cardiac ischemic events in the older asthmatic population, indicating a comorbidity benefit of montelukast usage in asthmatics by targeting cysteinyl leukotriene-driven cardiac disease inflammation.

A potential role of PUFAs and COXIBs in cancer chemoprevention.

Polyunsaturated fatty acids (PUFAs), particularly the ω-3 PUFAs and COXIBs have been associated with decreased inflammation and the prevention of tumorigenesis. ω-3 PUFAs have shown to display multiple antitumour actions, while ω-6 PUFAs and its derived eicosanoids promote the effects in cancer cell growth, angiogenesis, and invasion. ω-3 PUFAs may act by suppressing the metabolism of arachidonic acid to form proinflammatory mediators or as a precursors of novel lipid mediators with pro-resolving activity, while COXIBs are able to modulate inflammatory response by inhibiting cyclooxygenase 2 (COX-2), an inducible prostaglandin synthase overexpressed in several human cancers. As recently has been postulated, the anti-inflammation and pro-resolution processes are not equivalent. A family of lipid mediators from ω-3 PUFAs can act as agonist promoting resolution, while antinflammatory agents such as COXIBs may act as antagonists limiting the inflammatory response. The present paper reviews the current knowledge about the role of PUFAs and its derivatives (metabolites), as well as the COXIBs activity in cancer process as a sinergic therapeutic alternative for cancer treatment.

Measurement of carotid artery intima-media thickness in dyslipidemic patients increases the power of traditional risk factors to predict cardiovascular events.

A longitudinal observational study investigated whether the measurement, in clinical practice, of carotid maximum intima-media thickness (Max-IMT) could be combined with the Framingham risk score (FRS) to improve the predictability of cardiovascular events in dyslipidemic patients who are at low or intermediate risk. Max-IMT was measured by ultrasound in 1969 patients attending a lipid clinic. The "best threshold values" (BTVs) above which we considered the Max-IMT to be abnormally high were calculated for our dyslipdemic population for each 10-year age interval in men and women. Two hundred and forty-two patients (age 54+/-10 years; 43.8% women) with an FRS <20%, i.e. at low or intermediate risk, were monitored for more than 5 years. Twenty-four of these patients suffered a cardiovascular event within 5.1+/-2.3 years. Both FRS and Max-IMT proved to be independent outcome predictors (p<0.04, both), with a hazard ratio (HR) of 6.7 (95% CI 1.43, 31.04; p=0.015) in patients in whom FRS was 10-20% and Max-IMT was above the BTV (60th percentile of Max-IMT distribution for men or 80th for women). In Kaplan-Meier analysis, the Max-IMT significantly improved the predictive value of the FRS (chi(2)=8.13, p=0.04). Patients with FRS 10-20% (currently considered intermediate-risk) and also elevated Max-IMT values came into the same high-risk category as patients with FRS 20-30%. The combination of FRS with Max-IMT measurement can be used in routine clinical practice to greatly enhance the predictability of cardiovascular events in the large number of patients who fall into the intermediate-risk category, which currently does not call for aggressive preventive measures.

Plasma cysteine and glutathione are independent markers of postmethionine load endothelial dysfunction.

OBJECTIVES: Oxidative stress caused by acute hyperhomocysteinemia impairs endothelial function in human arteries. We sought to identify markers of endothelial dysfunction during methionine-induced hyperhomocysteinemia. DESIGN AND METHODS: 35 subjects underwent flow-mediated dilation (FMD) of the brachial artery by high-resolution ultrasonography and fasting blood samples before and 3 h postmethionine load (PML). Clinical, conventional biochemical, and redox status (plasma total and reduced homocysteine, glutathione, cysteine, cysteinylglycine, ascorbic acid, alpha-tocopherol, free malondialdehyde, blood glutathione) data were sequentially entered into an univariate and multivariate stepwise linear regression analysis to evaluate their relation with the dependent variable FMD. RESULTS: Median [interquartile range] FMD decreased from 4.1% [2.8-6.3] to 3.2% [0.7-4.3] PML (P=0.02). At the multivariate analysis PML total cysteine (beta=-0.008, P=0.002) and glutathione (beta=0.21, P=0.005) were the only independent variables associated with FMD after methionine, adjusted for baseline FMD. CONCLUSIONS: Elevated plasma total cysteine and decreased plasma total glutathione levels were associated with abnormal FMD PML. Cysteine and glutathione are stronger markers of endothelial dysfunction than clinical and all other biochemical variables explored.

Correlation of parents' longevity with carotid intima-media thickness in patients attending a Lipid Clinic.

The relationship between carotid intima-media thickness (IMT) and the subject's parents' longevity has been investigated. The association between parents' age at death and IMT was estimated in 593 consecutive patients attending a Lipid Clinic by survival-analysis methods. Average maximum IMT (Avg-IMT), maximum IMT (Max-IMT), clinical and laboratory variables and parental age at death, were assessed. Kaplan-Meier analyses showed significant differences in survival curves, low IMTs being associated with long-lived parents (p=0.0003 and 0.001 by log-rank test for fathers and mothers, respectively). A Cox proportional hazards regression model showed that higher carotid IMT values were associated with father's and mother's deaths at an early age, even after adjusting for conventional cardiovascular risk factors. These data were confirmed after the stratification of patients into younger (<65 y) and older (>/=65 y) or into subjects with and without a family history of dyslipidemia or vascular diseases. In addition, by stratifying subjects into those with no, one or two long-lived parents, we observed a significant trend for the combination of father's and mother's longevity on their offspring's IMTs (p<0.01 and 0.05 for Avg-IMT and Max-IMT, respectively). These data highlight a significant relationship between carotid artery IMT and a familial predisposition to be long-lived that is independent of the individual's vascular risk profile.

Recognition of patients with cardiovascular disease by artificial neural networks.

BACKGROUND: Artificial neural networks (ANNs) are computer algorithms inspired by the highly interactive processing of the human brain. When exposed to complex data sets, ANNs can learn the mechanisms that correlate different variables and perform complex classification tasks. AIMS: A database, of 949 patients and 54 variables, was analysed to evaluate the capacity of ANNs to recognise patients with (VE+, n = 196) or without (VE-, n = 753) a history of vascular events on the basis of vascular risk factors (VRFs), carotid ultrasound variables (UVs) or both. METHOD: The performance of ANN was assessed by calculating the percentage of correct identifications of VE+ and VE- patients (sensitivity and specificity, respectively) and the prediction accuracy (weighted mean between sensitivity and specificity). RESULTS: The results showed that ANNs can be trained to identify VE+ and VE- subjects more accurately than discriminant analyses. When VRFs and UVs were used as input variables, the prediction accuracies of the ANN providing the best results were 80.8% and 79.2%, respectively. The addition of gender, age, weight, height and body mass index to UVs increased accuracy of prediction to 83.0%. When the ANNs were allowed to choose the relevant input data automatically (I.S. system-Semeion), 37 variables were selected among 54, five of which were UVs. Using this set of variables as input data, the performance of the ANNs in the classification task reached a prediction accuracy of 85.0%. with the 92.0% correct classification of VE+ patients. CONCLUSIONS: Artificial neural network technology is highly promising in the development of accurate diagnostic tools designed to recognize patients at high risk of cardiovascular diseases.

A new noninvasive method for the accurate and precise assessment of varicose vein diameters.

The feasibility and reproducibility of a new ultrasonic method for the direct assessment of maximal varicose vein diameter (VVD) were evaluated. A study was also performed to demonstrate the capacity of the method to detect changes in venous diameter induced by a pharmacologic treatment. Patients with varicose vein disease were recruited. A method that allows the precise positioning of patient and transducer and performance of scans in a gel-bath was developed. Maximal VVD was recorded both in the standing and supine positions. The intraassay reproducibility was determined by replicate scans made within 15 minutes in both positions. The interobserver variability was assessed by comparing VVDs measured during the first phase baseline examination with those obtained during baseline examinations in the second phase of the study. The error in reproducibility of VVD determinations was 5.3% when diameters were evaluated in the standing position and 6.4% when assessed in the supine position. The intramethod agreement was high, with a bias between readings of 0.06 +/- 0.18 mm and of -0.02 +/- 0.19 mm, respectively, in standing and supine positions. Correlation coefficients were better than 0.99 in both positions. The method appears to be sensitive enough to detect small changes in VVDs induced by treatments. The proposed technique provides a tool of potential valid use in the detection and in vivo monitoring of VVD changes in patients with varicose vein disease. The method offers an innovative approach to obtain a quantitative assessment of varicose vein progression and of treatment effects, thus providing a basis for epidemiologic surveys.

Increased carotid artery intima-media thickness in subjects with primary hypoalphalipoproteinemia.

The plasma concentration of high-density lipoprotein cholesterol (HDL-C) is inversely correlated with the incidence of atherosclerotic vascular events. In the present study, we evaluated pre-intrusive atherosclerosis in subjects with plasma HDL-C at the extremities of normal distribution. Fifty-five subjects with primary hypoalphalipoproteinemia (HypoALP) or hyperalphalipoproteinemia (HyperALP) were compared with fifty-five control subjects with average HDL-C levels, matched for sex, age, and plasma cholesterol. The average and maximal intima-media thicknesses (Avg-IMT and Max-IMT) of 48 carotid segments for each subject were approximately 40% greater in HypoALP than in control subjects (0.94 +/- 0.06 versus 0.69 +/- 0.04 mm, P=0.004, and 1.86 +/- 0.16 versus 1.35 +/- 0.10 mm, P=0.025, respectively). The IMT values in HyperALP subjects (Avg-IMT, 0.71 +/- 0.04 and Max-IMT, 1.38 +/- 0.14 mm) were the same as in controls. In a large cohort of hyperlipidemic subjects (n=559), significantly greater Avg-IMT and Max-IMT were found in subjects belonging to the first HDL-C quintile (<42 mg/dL) than in all the others. The measurement of carotid IMT in cases with HypoALP and HyperALP, and in a large series of hyperlipidemic patients, thus indicates that a low HDL-C is associated with significant pre-intrusive atherosclerosis, whereas a HDL-C level above average values does not lead to a further reduction of arterial wall thickening.