NEW CLASS OF DRUGS: THERAPEUTIC RNAi INHIBITION OF PCSK9 AS A SPECIFIC LDL-C LOWERING THERAPY.

Hyperlipidemia is a well-known risk factor for coronary heart disease, the leading cause of death for both men and women. Current lipid-lowering treatment is not always efficient, therefore new pharmacological interventions that reduce LDL cholesterol (LDL-C) have been developed. This paper presents new class of specific LDL lipid-lowering drugs under investigation in phase II or III clinical trials. The inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9), a key enzyme in cholesterol homeostasis, improve the liver's ability to clear LDL from the plasma, reducing LDL-C levels. Currently, three monoclonal antibodies PCSK9 inhibitors (alirocumab, evolocumab and bococizumab) are evaluated in clinical outcome trials. ALN-PCSsc, the new first-in- class therapeutic RNA interference (RNAi) inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) is also the first-in-class investigational medicine that acts by turning off PCSK9 synthesis in the liver. The development leadership of ALN-PCSsc has now transferred from Alnylam Pharmaceuticals to The Medicines Company, who has initiated the ORION-1 Phase II study at the beginning of 2016. ALN-PCSsc has significant potential given its highly competitive profile as compared with monoclonal antibodies anti-PCSK9 MAbs, a recently approved class of LDL-C lowering drugs.

Unexpected Coronary Thrombosis Induced By Antiphospholipid Syndrome (Hughes Syndrome): Case Report.

Antiphospholipid syndrome (APS), one of the most common states of acquired hypercoagulability, is diagnosed by the persistent presence of antiphospholipid antibodies and recurrent episodes of vascular thrombosis. We present the case of a 39-year-old man late-presenting for cardiac rehabilitation treatment after primary percutaneous coronary intervention (PCI) performed for anteroseptal myocardial infarction. He was a nonsmoker, with no prior personal history of other cardiovascular diseases (CVD) or cardiometabolic syndrome. The 60% thrombotic occlusion of the left anterior descending artery (LAD) leading to the acute cardiac event was the only abnormality that was found. The only etiological explanation was the late measurement and the positive tests for antiphospholipid antibodies. In young patients with no history of thrombotic disorder, such as cancer, cardiovascular or metabolic diseases, the unexpected onset of myocardial infarction by thrombotic coronary occlusion can be attributed to silent, undiagnosed autoimmune condition.

CHARACTERISTICS OF RESPIRATORY MECHANICS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

UNLABELLED: In chronic obstructive pulmonary disease (COPD) the changes in respiratory thoracoabdominal mechanics result from both hyperinflation and functional and structural skeletal muscle alterations. AIM: Evaluation of the particularities of respiratory movement in COPD and identification of inter-relations between respiratory thoraco-abdominal mechanics and clinical and functional respiratory status. MATERIALS AND METHODS: This study comparatively analyzed the respiratory thoracoabdominal mechanics recorded by polygraphy, using piezoelectric film belts, in 34 COPD patients and 30 healthy subjects, during rest, and during 6-minute walk test. RESULTS: In COPD patients, phase angle between direction of thoracic and abdominal respiratory movements presented significantly higher values compared to the control group, for supine (p = 0.023) and sitting position (p = 0.001), revealing the presence of paradoxical respiratory movements. Furthermore, phase angle dynamics increased significantly during walking test compared to sitting position (p = 0.001). Quantitative difference of end-expiratory pulmonary volume (qDEEL) correlated with pack-years (r = 0.372, p = 0.03) in supine position, and with body mass (r = 0.338, p = 0.05) and St. George activity score (r = 0.353, p = 0.041) during walking test. Rib cage inspiratory contribution to tidal volume ratio (%RCi) inversely correlated with pack-years (r = -0.417, p = 0.014) and body mass index (r = - 0.344, p = 0.047) in supine position, and with St. George activity score (r = 0.345, p = 0.046) in sitting position. CONCLUSIONS: In COPD patient thoracoabdominal mechanics is characterized by paradoxical respiratory movements, more prominent during exercise. The alteration of thoracoabdominal mechanics correlated with St. George activity score, pack-years and body mass.

ST segment depression in asymptomatic male patient with normal coronary arteries.

ST segment depression and T waves inversion are electrocardiographic (ECG) repolarization abnormalities often encountered in clinical medical practice that have been proved to predict future cardiovascular events. We present the case of a 62-year-old male patient, asymptomatic, with ST segment depression and inverted T waves discovered incidentally on resting ECG. Echocardiographic and laboratory examinations ruled out multiple causes of ECG abnormalities. Suspecting a silent myocardial ischemia, an ECG exercise stress test was performed; it revealed pseudo normalization of T waves during exercise and early recovery phase. Being inconclusive, a coronary CT was the final election test; it showed normal coronary arteries with no stenosis, the patient being scheduled for regular follow-up. The possible causes of ST segment depression are reviewed since it is important that early cardiovascular signs especially in asymptomatic patients to be prevented and detected.

Inflammatory markers in hypertensive patients and influence of some associated metabolic risk factor.

UNLABELLED: Some epidemiological studies have begun to show a possible correlation between systemic and vascular inflammation and the presence of essential hypertension, especially if it is associated with metabolic risk factors (obesity, dyslipidemia, diabetes mellitus). OBJECTIVES: The objective of this study was to evaluate the levels of C-reactive protein and fibrinogen as markers of inflammation in patients with essential hypertension, with or without associated metabolic risk factors. MATERIAL AND METHODS: The retrospective study included 200 patients separated into five groups (control, hypertension, and respectively hypertension associated with obesity, or diabetes mellitus type II non-obese or obese type II diabetes). Anamnestic and anthropometric data, blood pressure and heart rate, blood glucose, lipid profile, fibrinogen, quantitative C-reactive protein and echocardiographic parameters have been reported and compared between groups. RESULTS: Our study evaluated a total of 110 women and 90 men, each of the five groups comprising a total of 22 (55%) women and 18 (45%) males. Study of the inflammatory syndrome found the highest values of CRP in hypertensive and obese patients: 1.56 +/- 3.08 (p = 0.014) in group 3 and 0.92 +/- 1.11 (p = 0.001) in group 5 versus control group (0.30 +/- 0.36). Fibrinogen values were significantly elevated in all groups of hypertensive, demonstrating the existence of an inflammatory syndrome, even in the absence of obesity or diabetes. CONCLUSIONS: All the patients showed a statistically significant relationship between elevated CRP and fibrinogen levels and the presence of hypertension, isolated, or in combination with obesity and diabetes mellitus.

Differentiation of rheumatoid arthritis from hepatitis C-related arthropathy: case report.

Chronic virus C hepatitis records high prevalence, almost 170 million people worldwide being infected. Systemic involvement is frequent and the implication of the osteoarticular system raises various problems in properly diagnosing and treating it. Rheumatoid arthritis is the most frequent type of inflammatory polyarthritis, with a prevalence of 0.8% in the general population. The rheumatoid factor recorded high values at virus C hepatitis patients (19-80%) even in the absence of articular manifestations, its sensitivity and specificity being reduced for the rheumatoid arthritis diagnosed simultaneous with virus C hepatitis. We report a case of chronic virus C hepatitis patient which, after 30 years of evolution, presents the onset of senile rheumatoid polyarthritis. The authors discuss the usefulness dosage of anti-cyclic citrullinated peptide antibodies for establishing the differential diagnosis between rheumatoid arthritis and hepatitis C-related arthropathy and the particularities of the specific treatment when there is a hepatitis C virus associated infection.

Therapeutical considerations in associated atrial fibrillation and heart failure.

UNLABELLED: Atrial fibrillation is a supraventricular tachyarrhythmia very common in medical practice, often associated with heart failure. Pathophysiological relationship between atrial fibrillation and heart failure is in the attention of numerous case studies, being incomplete elucidated. MATERIAL AND METHODS: We made a retrospective study on patients with both diseases, hospitalized in Cardiovascular Rehabilitation Hospital, Iasi, during 01.01.2013 - 31.12.2013. The obtained data allowed the classification of patients according to gender distribution, age groups, area of origin, clinical aspects, and association with other diseases, instituted treatment and appreciation of CHADS2 score. Data interpretation was performed with appropriate statistical methods. RESULTS: We found a higher frequency of the disease among male patients, male: female ratio being 2:1; the most of the patients lived in urban area. The pick of diseases incidence was in patients over 65 years with a total percentage of 70.84% of cases. We noted that the most common symptoms were exertional dyspnea (in all patients), palpitations, dizziness, headache, fatigue, asthenia, dyspnea at rest and pain/chest pressure. In our study, the majority of patients received the beta-blocker--digoxin combination (46 patients, 40 patients respectively). CONCLUSIONS: The coexistence of the two disorders could be explained by identifying common risk factors. Beta blockers should be the first therapeutic option in patients with chronic heart failure and atrial fibrillation because they have the effect of controlling heart rate and improve survival in patients with these disorders. Meanwhile, digoxin is a drug, only certain conditions of high accuracy monitoring; whose major clinical indications are heart failure and atrial rhythm disturbances.

Effects of two serotoninergic agents on the behavioral manifestations in rats.

AIM: To investigate the effects of two serotonin receptor antagonists on spontaneous behavior in rats. MATERIAL AND METHOD: The experiment was carried out on white male Wistar rats (150-200g) divided into 3 groups of 6 animals each, treated intraperitoneally with the same volume of solution as follows: Group I (Control): saline solution 0.1 ml/10 g weight; Group II (SB-269970): SB-269970 1 mg/kbw; Group III (NAN-190): NAN-190 1 mg/kbw. The effects of serotonin receptor antagonists on the spontaneous psychomotor skills of rats were tested in Actimeter LE-8811 (PanLab). The data were presented as mean +/- standard deviation and significance was tested by SPSS Statistics for Windows version 17.0 and ANOVA method. The experimental protocol was implemented according to the guidelines for handling and use of experimental animals of the Research Ethics Committee of the Iasi "Grigore T. Popa" University and ethical standards of the European Community. RESULTS: The 5HT1 serotonin receptor antagonist NAN-190 determined a statistically significant reduction (p < 0.01) in both horizontal and vertical movements as compared with the control group, whereas the 5HT7 serotonin receptor antagonist SB269970 had no influence on rat behavioral manifestations. CONCLUSIONS: In our experimental conditions 1 mg/kbw NAN-190 decreased the total escape attempts, corresponding to a significant diminution of exploratory and self-maintenance spontaneous behavior in this experimental animal model. These manifestations may be correlated with the anxiolytic effect of 5HT1 serotonin receptor antagonist NAN-190 in rats. The administration of 5HT7 serotonin receptor antagonist SB-269970 did not alter the spontaneous activity in this behavioral experimental model in rats.

Predictive value of a positive exercise stress testing and correlations with cardiovascular risk factors.

UNLABELLED: Electrocardiogram exercise stress test (EST) is a widespread technique in assessment of coronary artery disease, stratifying cardiovascular risk and prognosis. AIM: Evaluation of the impact of cardiovascular risk factors upon the results of EST. METHODS: The 2-year retrospective study included 294 patients referred to an EST. All patients were assessed according to: presence of typical angina chest pain at admission, medical history of angina or myocardial infarction, resting electrocardiogram, global ejection fraction at echocardiographic exam and traditional cardiovascular risk factors. We compared the results between two groups: positive and negative EST. RESULTS: The patients were age- and sex-matched. 160 patients (54.42%) had a positive EST. Positive EST was associated with typical angina chest pain at admission (88.12% vs. 76.11%, p = 0.008), coronary artery disease history (61.87% vs. 41.04%, p = 0.0003), resting ECG abnormalities (49.37% vs. 36.56%, p = 0.026), arterial hypertension (85.62% vs. 74.62%, p = 0.019). Ejection fraction was higher in the negative EST group (63.34 +/- 8.57% vs. 61.18 +/- 11.34%, p = 0.035). Type 2 diabetes mellitus, smoking, obesity, dyslipidemia and inflammatory syndrome did not significantly influence the results of the EST. CONCLUSIONS: Typical angina, medical history of coronary artery disease, arterial hypertension, and reduced ejection fraction are strong predictors for a positive exercise stress test.

The correlation between the ankle-brachial index and the metabolic syndrome. .

UNLABELLED: On a global scale, the cardiovascular diseases constitute the prime factor of death and invalidity. The premature mortality percentage caused by these varies from 4% in high developed countries to 40% in underdeveloped countries. Atherosclerosis is the most important etiological factor. The presence of various degrees of atherosclerosis in a certain vascular area (in our case, the lower limb arteries), increases the probability of affecting other areas as well (coronary, cerebral, renal, mesenteric arteries). AIM: The evaluation and description of the correlations between the ankle-brachial index levels and the cardiovascular risk factors, taken individually or as part of the metabolic syndrome. MATERIAL AND METHOD: The values of the ankle-brachial index were divided in normal and abnormal. The evaluated cardiovascular risk factors were: age, sex, arterial hypertension, obesity, smoking, high levels of cholesterol and basal glucose, low levels of HDL-cholesterol. RESULTS: There were significant statistical differences between the normal ankle-brachial index lot and the one with abnormal values, specifically in patients with diabetes mellitus and metabolic syndrome. More so, the study demonstrates that the ankle-brachial index is considerably smaller in patients with metabolic syndrome. CONCLUSIONS: The simple measurement of the afore mentioned index, as a atherosclerosis marker for the lower limb arteries, represents an independent prediction over the metabolic syndrome and the conventional risk factors, in the development of the cardiovascular diseases. The routine measurement of this parameter in medical practice might imply the early diagnosis of high risk manifested cardiovascular disease patients.

Influence of metabolic syndrome profile on cardiovascular risk.

AIM: The trial was conducted on patients with metabolic syndrome hospitalized between 01.01.2012-31.12.2012 at Cardiovascular Rehabilitation Clinic of the Rehabilitation Hospital Iasi. MATERIAL AND METHODS: Patients included in the study were analyzed according to age and sex, criteria for the clinical definition of the metabolic syndrome, known cardiovascular diseases, diabetes mellitus type 2 or type 1. RESULTS: Metabolic syndrome components analysis showed statistical differences between the sexes, in case of certain cardiovascular risk factors. The frequency of cardiovascular risk factors (obesity, hypertriglyceridemia, hypertension, glycemic profile modification) was higher among women, the only risk factor most common in males was the decrease of HDL cholesterol. The statistically significant difference occurs in hypertriglyceridemia (p = 0.001) and HDL-Cholesterol (p = 0.000). Patients included in the study were studied depending on the frequency of the main cardiovascular diseases, secondary to the metabolic syndrome: ischemic heart disease, stroke, peripheral arterial disease of the lower extremities. CONCLUSIONS: Association of impaired glucose tolerance/diabetes mellitus, arterial hypertension and hypertriglyceridemia recorded an additional risk of developing CIC or ischemic stroke, independent of sex.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some comorbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

The clinical-epidemological study of drugs used to treat arterial hypertension and associated comorbidities.

AIM: The objective of this study was to investigate the drug treatment of AHT according to the grade and associated comorbidities: diabetes, chronic kidney disease, angina pectoris. MATERIAL AND METHODS: This study is a retrospective one, comprising a total of 1064 patients admitted to the Clinical Rehabilitation Hospital lasi, Cardiovascular Rehabilitation Clinic between 01.01.2011 - 31.12.2012. We noted the epidemiological data on the distribution of AHT according to area of origin, sex, age, and the pharmacological treatment according to the AHT grade and related diseases. RESULTS: The results obtained were statistically analyzed by comparing drugs used together, their number depending on the AHT grade and associated comorbidities in order to achieve target values of blood pressure and reduce cardiovascular risk. The strategies used to control blood pressure were the gradual increase of the dose of drug or its replacement, switching from monotherapy to combination therapy, starting treatment with two drugs or administration of fixed combinations. CONCLUSIONS: The most used antihypertensive drugs were the angiotensin receptor blockers, ACE inhibitors, calcium blockers, diuretics and beta blockers. Some patients have even received triple therapy.

Heart rate variations in chronic obstructive pulmonary disease.

UNLABELLED: Autonomic nervous system dysfunction proved in chronic obstructive pulmonary disease (COPD) patients might determine an elevated cardiovascular risk by heart rate alteration. AIM: To assess the particularities of heart rate as a possible cardiovascular risk factor in COPD patients. MATERIALS AND METHODS: This prospective, case-control study comparatively analyzed the pulse rate continuously recorded with a polygraph in 32 COPD patients and 29 healthy subjects during rest (supine and sitting position) and during submaximal exercise (6-minute walk test). The relation between pulse rate and respiratory, functional or clinical alterations was analyzed in COPD patients. RESULTS: The mean pulse rate was significantly higher during rest and exercise in COPD patients compared with the controls. However, the chronotropic response determined by exercise was similar in COPD and control groups: 55.19 beats/minute and 57.21 beats/minute, respectively (p=0.686). The mean pulse rate during exercise correlated with hypoxemia (r=-0.354, p=0.47) and with resting pulse rate (r=0.871, p<0.001 for supine position). CONCLUSIONS: COPD associates elevated pulse rates during both rest and exercise. Hypoxemia and resting pulse rate are determinatives of chronotropic response during submaximal exercise in COPD patients.

The incidence of essential hypertension in elderly patients with metabolic syndrome.

UNLABELLED: IASI, DURING OCTOBER 2010-JULY 201The arterial hypertension of the elderly represents an important public health issue, with an ever increasing tendency, due to the population ageing process. AIM: The aim of this research is to contribute new data related to the incidence of essential hypertension in elderly patients with metabolic syndrome. MATERIAL AND METHODS: The current study was conducted on a number of 1,832 patients hospitalized in the Cardiovascular Rehabilitation Clinic of Rehabilitation Hospital Iasi, in the period October 2010-July 2012. Of these patients we selected the ones who were 65 years of age or more and who fulfilled at least three of the five criteria that define the metabolic syndrome, using the criteria recommended by AHA/NHLBI. RESULTS: The data obtained revealed an increased incidence of the cardiometabolic syndrome in patients over 65 years of age, in a percentage of 73%. The gender repartition revealed a higher frequency in the case of female patients (66%). Of the metabolic syndrome criteria, the highest incidence was registered for the essential hypertension. Most of the hypertensive patients were diagnosed with essential hypertension grade 3 (55%), while the rest had grade 2 (29%) and grade 1 respectively (16%). CONCLUSION: EHT has a significant occurrence in elderly patients. It seems that hypertension of the elderly has a higher occurrence in the case of female patients, due to the lack of hormonal protection. The association with the other risk factors related to the metabolic syndrome makes the elderly more prone to the occurrence and development of cardiovascular diseases. KEYWORDS: ESSENTIAL HYPERTENSION, ELDERLY PEOPLE,

Annexins, calcium-dependent phospholipid binding proteins in irreducible heart failure.

AIM: To analyze the expression and distribution of annexins V and VI in intact human hearts and in dilated cardiomyopathy (DCM) in patients with irreducible heart failure. MATERIAL AND METHODS: The study included nine patients with DCM and irreducible heart failure. By immunoblotting and indirect immunofluorescence, the amount and location of annexins was determined using samples of left ventricular (LV) myocardium collected during orthotopic heart allotransplantation. Samples of LV myocardium from 9 individuals who died of craniocerebral trauma served as controls. RESULTS: Quantitative analysis showed an increased level of both annexins in the myocardium of DCM patients compared with normal myocardium: 122 +/- 5% (p < 0.05) and 119 +/- 5% (p < 0.05) for annexins V and VI, respectively. In the intact heart annexin V was located at the sarcolemma and intercalated discs, while in the myocardium with heart failure mainly in the interstitium. In normal hearts, annexin VI was located at the sarcolema, including T-tubules, Z-lines and intercalated discs. In heart failure, annexin V1 was also located in the interstitium. CONCLUSIONS: Redistribution of annexins V and VI in the cardiomyocytes in the interstitial space may have important functional consequences and indicates the role of myocardial protein expression disturbances in the etiology and/or pathogenesis of heart failure in pa-

Impact of metabolic syndrome on the development of cardiovascular disease.

UNLABELLED: In recent years, the metabolic syndrome represents a major health problem worldwide, with a great impact in population, and also at individual level, by an increased prevalence of cardiovascular risk. MATERIAL AND METHODS: We conducted a descriptive study on a lot of 131 patients hospitalized in Cardiovascular Clinic of Rehabilitation Hospital in Iasi, in the period April 2012 - April 2013. RESULTS: In the analyzed group, the largest number of metabolic syndrome cases was recorded in the 50-59 years age group. There were no significant differences between the rural / urban areas (t = 0.113, p = 0.910). Frequency of ischemia was significantly higher in subjects with essential hypertension of IInd and IIIrd degree (Pearson Chi-square test = 3.955, df = 1, p <0.05). Significant differences were observed on females related to obesity and ischemia, meaning that women with higher obesity are predisposed to ischemic events. Regarding the degree of exercise testing and the origin area, no significant differences were registered (Pearson Chi-square test = 13.526, p = 0.004, df= 3). CONCLUSIONS: Our study offers new information on metabolic syndrome, analyzing epidemiological and clinical criteria.

Ebstein's anomaly.

Ebstein's anomaly is a rare congenital heart disease, accounting for less than 1% of all congenital heart diseases, characterized by a wide clinical, electrocardiographic, echocardiographic, anatomic and prognostic polymorphism. The disease can be fatal since birth or may remain asymptomatic until adulthood, sometimes being associated with septal defects, transposition of great vessels, preexcitation syndromes, or left ventricular noncompaction. The genetic changes underlying this syndrome are not fully known, but in the cases associating left ventricular nonompaction a mutation in MYH7 gene encoding the beta-myosin heavy chain was recently detected. The authors present 2 cases of Ebstein's anomaly with different onset and course and discuss the current clinical, electrocardiographic and echocardiographic criteria used for prognostic stratification of Ebstein disease in relation to international literature.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some co morbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

Significance of arterial stiffness and relationship with other noninvasive methods for the assessment of subclinical atherosclerosis inpatients with metabolic syndrome.

UNLABELLED: Measurement of arterial stiffness is an accurate method of assessment of endothelial dysfunction, together with other noninvasive methods, in the diagnosis of atherosclerotic burden in patients with MetS. MATERIAL AND METHODS: The study included 63 patients: MetS group (18 men, 20 women, mean age 58.86 +/- 8.86 years) and the control group (14 men, 11 women, mean age 59.68 +/- 10.0 years). They underwent the following examinations: assessment of arterial stiffness--pulse wave velocity (PWVao), augmentation index of brachial artery (Aixbr) and aorta (Aixao), central systolic blood pressure (SBPao); carotid ultrasound for detection of plaques and measurement of intima-media thickness (IMT); echocardiography--left ventricular hypertrophy (LVH); ankle-brachial index (ABI); biochemical parameters: C-reactive protein (CRP), fibrinogen (Fb), cholesterol (Col), HDLcol, LDLcol and triglycerides. RESULTS: MetS patients had higher PWVao (10.06 +/- 2.12 m/s vs 8.29 +/- 1.33 m/s, p = 0.0001) and SBPao (135.06 +/- 19.80 mmHg vs. 121.76 +/- 18.62 mmHg, p = 0.009). Carotid IMT was higher in MetS group (0.92 +/- 0.11 vs. 0.83 +/- 0.10 mm, p = 0.003). Almost all MetS patients were hypertensive (94.7% vs. 52%, p = 0.01); LVH was present in 57.9% of MetS patients and 20% of the controls (p = 0.05). The MetS group presented higher Col (208.76 +/- 38.41 vs. 176.20 +/- 30.08 mg/dl, p = 0.0003) and CRP levels (0.872 +/- 0.852 mg/dl vs. 0.476 +/- 0.392 mg/dl, p = 0.01). CONCLUSIONS: In MetS patients the most reliable marker of arterial stiffness was PWVao, followed by SBPao. Higher values of carotid IMT are also parameters of high atherosclerotic risk. CRP and Col can be considered biomarkers of high risk in MetS.