[Effect of hormone replacement therapy on the cardiovascular system]. / Vliv hormonální substitucní terapie na kardiovaskulární systém.

OBJECTIVE: Analysis of contemporary knowledge of influences of hormone replacement therapy on cardiovascular system. DESIGN: Literary review. SETTING: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague. METHOD: Informations were collected from full-texts which were chosen in database Medline and Ovid. CONCLUSION: Hormone replacement therapy (HRT) has positive influence on some risk factors of cardiovascular disease. Changes in the lipoprotein spectrum are well known. Oral estrogens cause a decrease of low density lipoprotein cholesterol (LDL-C) and, especially an increase of high density lipoprotein cholesterol (HDL-C) levels, which both have potentially favourable effects; they also cause a triglyceride level increase, which probably has no clinical relevance except in cases with basal hypertriglyceridemia. Transdermal estradiol causes generally a minor decrease in LDL-C and minor increase HDL-C levels, with no increase or even decrease in triglyceride levels. The addition of androgenic progestins at conventionally used doses, while not interfering with LDL-C variations, causes a HDL-C decrease, which contrasts he effect of oral estrogens and completely reverses the effect of transdermal estradiol. On the contrary, the addition of a non-adrogenic progestin does not interfere with any of the estrogen induced lipid profile modifications. Transdermal estradiol does not cause change of insulinoresistance. Estrogen substitution protects gynoid distribution of body fat that is connected with lower risk of ischemic heart disease. Estrogens have possibility to dilate vessels. Decreasing of levels of cytoadhesive molecules was verify during HRT so as lowering of homocysteine level to premenopausal levels. Newly uncovered changes like the significant increase of CRP connected with oral estrogen therapy could explain increasing of cardiovascular risk on the beginning of HRT especially in group of women with history of ischemic heart disease.

Serum ferritin levels in subjects at high risk of atherosclerosis.

Serum ferritin levels were determined in a group of 148 subjects drawn from a community study who were found to be at high risk of atherosclerosis (evaluated on the basis of the following data: levels of non-HDL cholesterol, arterial pressure, smoking status, cardiovascular or cerebrovascular disease in a subject's history, diabetes mellitus, a positive family predisposition to, or accumulation of the above factors) and compared with the levels obtained in a control group of 148 examined age- and sex-matched subjects from the same community with non-significant risk factors. Mean serum ferritin levels were higher in the whole risk group and in the subgroups of risk men and postmenopausal women than in the corresponding controls (the whole risk group: 263.4 +/- 218.5 micrograms/l vs. 198.3 +/- 179.5 micrograms/l, p < 0.05; the subgroup of men 361.8 +/- 235.7 micrograms/l vs. 286.4 +/- 194.6 micrograms/l, p < 0.05 and the subgroup of postmenopausal women 184.1 +/- 143.1 vs. 126.7 +/- 108.4 micrograms/l, p < 0.05).

Birth weight of neonates as an indicator of morbidity and mortality in adult age and factors which influence it.

In 28 neonates born by spontaneous delivery to healthy mothers with a normal course of gestation venous umbilical blood was examined to assess the immunoreactive insulin concentration. Moreover, the birth weight of the neonates was recorded, the weight increment of the mother during pregnancy and the body mass index at the end of gestation. By means of a questionnaire and the computer programme Progana the dietary intake of the mothers at the end of pregnancy was assessed and compared with recommended allowances. The assembled data were evaluated statistically by assessment of the correlation coefficient. The investigation revealed that the birth weight of the neonates in the group does not correlate with the immunoreactive insulin concentration in umbilical venous blood. Although the dietary intake of the mothers at the end of pregnancy is not ideal (fat and cholesterol intake predominates over carbohydrate and protein intake), it does not correlate with the birth weight of the neonates nor with the immunoreactive insulin concentration in umbilical venous blood. From these results the conclusion is drawn that neonates with a low birth weight do not have a higher plasma insulin concentration after delivery and that the mother's diet at the end of pregnancy does not influence the birth weight and insulin level in neonates.

Fasting plasma insulin levels in an unselected Prague suburban population.

OBJECTIVE: The aim of the study was to determine the levels of fasting plasma insulin in an unselected population of a Prague suburban community and correlate the levels of insulin with other metabolic and anthropometric parameters which could be directly or indirectly associated with insulin levels. RESEARCH DESIGN AND METHODS: A total of 835 adult inhabitants, the Prague suburban community, were examined. Mean age of examined people was 44.9 +/- 16.9 years, the group included 370 men and 465 women, 189 of the latter were in the menopause. The parameters examined included the fasting plasma levels of insulin, glycaemia, total cholesterol, HDL cholesterol and triacylglycerols; LDL cholesterol and, using the basic anthropometric data, the body mass index (BMI) and the waist/hip ratio (WHR) were calculated. RESULTS: The levels of all parameters were divided in ten-year groups of men and women. The average levels of fasting plasma insulin in all ten-year groups of men and women were normal. We found in the men small but constant rise of fasting insulinaemia in the decades. This was not observed in women, where the insulin levels were similar up to the time after menopause, then the level of average plasma insulin rose significantly. We found the positive correlation of plasma insulin levels with triacylglycerol levels (p < or = 0.001), BMI (p < or = 0.001) and WHR (p < or = 0.001) and a negative correlation with plasma HDL cholesterol (p < or = 0.001) in the whole group of probands. No significant correlation was demonstrated between fasting insulinaemia and total or LDL cholesterol. When dividing the group by age and sex, the strongest positive correlations were seen between insulin and triacylglycerols, glycaemia, BMI, and WHR, and negative correlations between insulin and HDL cholesterol. CONCLUSION: Fasting plasma insulin levels in an unselected population were within the normal range, but follow a continuous and steady upward course in men while did not change until after the menopause when they bounce in women; compared to insulin levels in younger women, insulinaemia does not increase up to 55 years of age. The strongest positive correlations were demonstrated between plasma insulin and triacylglycerols, and between insulin and BMI and WHR in men and postmenopausal but not premenopausal women whereas a negative correlation was observed between fasting plasma insulin and HDL cholesterol.

A program to reduce cardiovascular and cerebrovascular disease in the czech republic: design and methods of the healthy dubec project.

Cardiovascular Disease (CVD) morbidity and mortality rates in the Czech Republic are among the highest in the industrialized world. Due to the substantial burden CVD plays on the health and well being of the Czech society, a variety of health promotion/disease management strategies to reduce CVD risk need to be designed and implemented. A project that combined community-based health education programs designed to address pervasive perceptions and cultural traditions that influence lifestyle factors, with secondary and tertiary prevention clinical strategies to aggressively treat high-risk individuals was recently conducted in Dubec, a small Czech community. This article describes the methods used in this project (i.e., the Healthy Dubec Project) which took American-based technology and experiences in community risk reduction methods and clinical management strategies for high risk patients and adapted them to fit the Czech people and their attitudes about CVD risk behaviors.

[Hyperinsulinemia--the common denominator in type II diabetes mellitus,obesity, hypertension, hypertriglyceridemia and atherosclerosis]. / Hyperinzulinémie--spolecný jmenovatel pro diabetes mellitus II. typu, obezitu, hypertenzi, hypertriglyceridémii a aterosklerózu.

During the last twenty years we witnessed a remarkable increase in knowledge of the mechanism as regards insulin action, the central hormone of metabolic regulations. Interest in cellular and molecular mechanisms of action was conditioned by a high prevalence of insulin resistance and the fact that insulin resistance holds a key position in the pathogenesis of many diseases, in particular atherosclerosis, obesity, hypertension, diabetes mellitus type II, ovarian hyperandrogenism and others. The syndrome of hyperinsulinaemia/insulin resistance is the basic component of the so-called X syndrome defined in 1988 by Reaven. It is encountered in subjects with a normal glucose tolerance but a predisposition for diabetes type II. If this disposition, probably genetic by nature, is potentiated by the central type of obesity and a sedentary lifestyle it can influence the development of hypertension and dyslipidemia. The sum of these factors promotes acceleration of atherosclerosis and frequently its premature manifestations: myocardial infarction and other cardiovascular diseases which hold the first place as regards causes of death on a world wide scale. It is important to identify but also to treat this complex not only metabolic risk factors for macrovascular diseases. It is a paradox that some drugs used as antihypertensives can cause deterioration of insulin resistance, subsequently influence in an adverse manner dyslipidemia and thus increase the metabolic risk of cardiovascular diseases. In the submitted paper the authors tried to summarize hitherto expressed views on the syndrome of hyperinsulinaemia and insulin resistance, using as a basic the results of their own work.

[Risk factors for ischemic heart disease in healthy persons with hyperinsulinemia and normal glucose tolerance]. / Rizikové faktory pro ischemickou chorobu srdecní u zdravých osob s hyperinzulinémií a normální glukózovou tolerancí.

The authors investigated the relationship of plasma insulin to some risk factors of ischaemic heart disease (IHD). They examined 79 healthy men--drivers of international truck transport with a normal glucose tolerance. The group comprised 21 men with hyperinsulinaemia. This group was compared with 21 men from the same group with normal insulin levels. The two groups were comparable (matched pairs) for age, occupation, cigarette and alcohol consumption and education. Significantly higher values of the body mass index (BMI), systolic and diastolic blood pressure were found in the group with hyperinsulinaemia. The latter group had a significantly more frequent positive family-history as regards cardiovascular diseases. After 48 months all subjects were checked. Two men from the entire group had died (43 and 48 years) from fatal myocardial infarction, both had hyperinsulinaemia. Manifestations of cardiovascular diseases (IHD and hypertension) developed in 12 subjects from the group with hyperinsulinaemia, as compared with two subjects with hypertension but normal insulin levels. To conclude, it may be stated that healthy subjects with hyperinsulinaemia and a normal glucose tolerance have a higher level of some risk factors of coronary heart disease (hypertension, obesity, positive family-history), as compared with the normoinsulinaemic group, and a poorer prognosis as regards cardiovascular morbidity and mortality.

Essential hypertension and insulin resistance.

Insulin resistance (IR) appears to be an important risk factor of both hypertension and atherosclerosis. Moreover, it is present also in obesity, dyslipoproteinaemia and non-insulin dependent diabetes. IR could be found in untreated hypertension and even in normotensive children of hypertensive parents. It alters carbohydrate, lipid and protein metabolism and participates directly in the development of hypertension. The diagnosis of IR is possible by simple determination of insulin and glyceamia during glucose tolerance test. The differential diagnosis is obligatory because IR is not specific just for hypertension. Treatment, with the exception of nonpharmacological measures, is unsatisfactory. However, results of newest research are highly promising.

Isolation of mycobacterial phage from the laboratory strain Mycobacterium leprae murium "Douglas".

The colony microstructure of the laboratory strain Mycobacterium leprae murium "Douglas" cultivated on Ogawa's egg medium was examined. A bioptical sample from the liver of a white mouse subcutaneously infected and observed for ten months was used as inoculum. The inoculum contained 5.2 X 10(9) acidfast rods. The Ogawa's media were incubated in 5% atmosphere of CO2 at 33 degrees C to 37 degrees C for 6 to 10 months. The outgrown colonies were killed with a formol solution, then embedded into the agarparaffin and cut out with the aid of Reichert's microtom. In thin sections there was an apparent vacuolisation of colonies proving the presence of the temperate phage, which was isolated from the bacterial suspension inoculated on the host non lysogenic strain Mycobacterium smegmatis ATCC 607. On the simple agar medium N-4 the number of 2.4 X 10(9) living particles was achieved, which shows the possible use of this phage for differential diagnostic purposes in the taxonomy studies of mycobacteria.

The microscopical pattern of growth of Mycobacterium leprae-murium "Douglas" in microcolonies.

A thin section technique of Ogawa egg yolk culture medium inoculated with Mycobacterium leprae-murium was found to reveal microscopical growth of the strain which could not be demonstrated by macroscopical examination. A peculiar structure of the growth, characterized by many lytic spots different in size, was observed indicating the possible presence of a temperate phage which may interfere with the synthesis of nucleic acids needed for the active multiplication of M. leprae-murium.