[The role of thyroid hypofunction in development of metabolic syndrome].

AIM: To study the role of hypothyroidism and concomitant obesity in the development of metabolic syndrome (MS). MATERIAL AND METHODS: We examined 60 women suffering from obesity and hypothyroidism (TTH 22.24 +/- 4.031). We studied lipid spectrum, carbohydrate metabolism, BP and insulin resistance, fat tissue distribution, exercise tolerance. RESULTS: According to IDF (2005) criteria the women had: metabolic syndrome (83.4%), newly diagnosed hypothyroidism (95%), decompensated hypothyroidism (90%), subclinical hypothyroidism (65%) after six-month replacement therapy with L-T4 MS symptoms declined. CONCLUSION: Abnormally high level of TSH may be a component of metabolic syndrome.

[Metabolic and hemodynamic effects of combined treatment with metformine and rosiglitasone (avandium) in patients with diabetes mellitus type 2 and high cardiovascular risk].

AIM: To study efficiacy of 24-week combined therapy with metformin and rosiglitasone in correction of metabolic parameters, blood pressure and total cardiovascular risk in patients with diabetes mellitus type 2. MATERIAL AND METHODS: Blood pressure, body mass, glycemia and blood lipids, hyperinsulinemia, fat mass were studied in 30 patients with diabetes mellitus type 2 and hypertension on metformine treatment in a dose 1500 mg/day. When they entered the trial, metformine treatment was combined with rosiglitasone in a dose 4 mg/day. The combined treatment continued for 24 weeks. RESULTS: The above combination significantly improved carbohydrate and lipid metabolism. The levels of fasting and postprandial glycemia, glycosylated hemoglobin, insulin resistance index significantly reduced. Both total and visceral fat tissue mass diminished. Improvement was seen in 24-h blood pressure monitoring data and intracardiac hemodynamics. Total cardiovascular risk decreased by three scales. Side effects were not registered. CONCLUSION: Combined use of metformine and rosiglitasone in patients with diabetes type 2 is pathogenetically sound, highly effective and safe.

[Current options of insulin resistence correction in patients with metabolic syndrome].

AIM: To study thiasolidindion drug pioglitazone for efficacy in metabolic syndrome (MS). MATERIAL AND METHODS: Twenty patients with MS were examined at baseline and after 12 week therapy with pioglitazone. The examination included estimation of fasting and postprandial glycemia, insulin resistance index, HOMA-IR index, HbAlc, lipid profile, microalbuminuria (MAU), blood pressure, endothelium-related vasodilation. RESULTS: Pioglitazone therapy for 12 weeks significantly reduced HbAlc, fasting and postprandial glycemia, insulinemia, HOMA-IR, improved blood lipid spectrum, reduced visceral obesity. CONCLUSION: Positive effects were also achieved on blood pressure, MAU and endothelium-related vasodilation.

[An AT-II blocker in patients with type II diabetes and arterial hypertension].

The subjects of the study were 30 patients with type II diabetes mellitus and mild or moderate arterial hypertension. Clinical-and-hemodinamic organoprotective effects of eprosartan, a new angiotensin II blocker, was evaluated in these patients within 16 weeks. The study found a good hypotensive effect of monotherapy with eprosartan in a mean therapeutic dose of 600 mg/day--the target blood pressure levels were achieved in 63.3% of the patients. Fasting insulin level and insulin resistance decreased, which improved hydrocarbonate and lipid exchange parameters. Eprosartan was significantly effective as an organoprotective agent: the patients displayed improvement of eye ground vessel condition, decrease of microalbuminuria, improvement of cardiodynamic parameters i.e. decrease of the thickness of left ventricular (LV) back wall and intravenricular septum, as well as reduction of myocardial mass index. 70% of the patients demonstrated improvement of LV diastolic function.

[Metabolic and hemodynamic effects of pioglitazone in obese patients with type 2 diabetes].

The purpose of the study was to evaluate the effectiveness and safety of pioglitazon, a hypoglycemizing preparation belonging to the group of thiazolidinediones, in treatment of diabetes mellitus (DM) type 2. Twenty DM type 2 patients were included in the study. The use of pioglitazon during 12 weeks resulted in a significant decrease in glycated hemoglobin, fasting glycemia, and postprandial reduction in insulinemia and insulinoresistance index HOMA-IR, as well as an improvement of lipid blood spectrum and the lessening of visceral obesity. Besides, a positive effect on arterial pressure was noted. The study revealed no significant adverse effects; good tolerance to treatment was noted in 90% of the patients.

[The role of fat tissue in development of metabolic disorders in patients with diabetes mellitus type 2 and obesity].

AIM: To specify changes in clinicolaboratory parameters in reduction of obesity in patients with diabetes mellitus type 2 (DM-2). MATERIAL AND METHODS: Antropometry, densitometry of fat tissue (FT) were made and parameters of fat and carbohydrate metabolism (lipidogram, glycated hemoglobin, immunoreactive insulin), FT secretory activity (leptin, adiponectin, TNF-alpha) were studied in 75 obese DM-2 patients. After the above primary examination all the patients were randomized into 2 groups: group 1 (n = 55) received xenical (120 mg 3 times a day) and kept moderate hypocaloric diet; group 2 (n = 20) received only the above diet therapy. Active treatment lasted 24 weeks. RESULTS: In addition to symptoms of metabolic syndrome (MS) the patients were found to have secretory disturbances of FT activity: elevation of leptin and TNF-alpha levels, subnormal adiponectin. These alterations directly correlated with body mass, FT mass gain, increase in waist circumference. Hyperleptinemia, hyperinsulinemia and hypoadiponectinemia were considered as markers of insulin resistance (IR) and related conditions. Xenical promoted a significant weight loss resulting in a positive trend in the parameters of adipokines, fat and carbohydrate metabolism, in reduction of IR. CONCLUSION: Xenical is beneficial for patients with DM-2 and obesity because it improves metabolic processes.

[Effect of metabolic factors on the vasorelaxation endothelial function in patients with type II diabetes and arterial hypertension].

The aim of the study was to evaluate the functional condition of the endothelium in patients with type II diabetes and arterial hypertension, depending on various metabolic factors. 85 patients aged 54.69 +/- 7.08 years were under dynamic observation. The patients had had diabetes and arterial hypertension (AH) for 5.99 +/- 4.37 and 8.65 +/- 5.52 years, respectively. The average HbAlc level was 7.91 +/- 1.73 mmol/ 1, total cholesterol level--6.35 +/- 1.81 mmol/l, body weight index--32.98 +/- 5.14 kg/m2. The average systolic and diastolic blood pressure levels were 162 +/- 7.6 and 97 +/- 3.4 mmHg, respectively. Carbohydrate and lipid exchange parameters, the extent of hyperinsulinemia and insulin resistance, and lipid peroxidation activity were evaluated. The functional condition of the endothelium was evaluated by D. Celermajer non-invasive measurement of flow-induced endothelium-dependent vasodilatation (EDVD) of the brachial artery (BA) using high-resolution ultrasound. 87% of the patients with type II diabetes and AH had endothelial dysfunction (ED), revealed by reactive hyperemia test; 30% of the patients had significant disorder of vasoreactivity (no BA artery diameter increase, but paradoxical vasoconstriction in response to reactive hyperemia). The presence and length of endothelial dysfunction (ED) in the patients with type II diabetes and AH depended on the length of diabetes, the length and extent of AH, and presence of long-term macro- and microvascular complications (coronary heart disease, diabetic retino- and nephropathy). The study did not found any dependence of the vasorelaxing endothelial function on glycosylated hemoglobin level, atherogenic blood lipid spectrum fractions, or lipid peroxidation activity. EDVD positively correlated with ApoA-1 protein level, reflecting the antiatherogenic potential of blood lipid spectrum.

[NO synthesis in the vascular endothelium of patients with type II diabetes].

The subjects of the study were 30 patients with type II diabetes and arterial hypertension. The purpose of the study was comparative clinical characterization of type II diabetes patients with and without microalbuminuria (MAU), and evaluation of effects of 16-week therapy aimed at stimulation of NO synthesis by vascular endothelium, on the pathogenesis of diabetic nephropathy. The results show that patients with MAU, unlike those without it, are characterized by longer course of diabetes, more pronounced lipid exchange disorder, more variable arterial pressure, higher pressure load index, elevated activity of lipid peroxidation (LP) processes, prominent disorder of NO-producing endothelial function. After 16 weeks of treatment, both groups demonstrated significant increase of NO basal secretion, prominent reduction of arterial hypertension, significant improvement of important carbohydrate and lipid exchange parameters, reduction of LP activity, and thus reduction of MAU. The listed changes were more significant in patients with MAU.

[Complex assessment of metabolic parameters in obese patients treated with xenical]. / Kompleksnaia otsenka metabolicheskikh pokazatelei u bol'nykh s ozhireniem na fone lecheniia ksenikalom.

AIM: To study effects of xenical combined with moderately hypocaloric diet on fat tissue mass, carbohydrate and lipid metabolism in patients with metabolic syndrome. MATERIAL AND METHODS: The study included 60 patients with body mass index (BMI) over 30 kg/m2, mild and moderate arterial hypertension, dyslipidemia, impaired glucose tolerance (IGT) and diabetes mellitus (DM) type 2. The patients were divided into two groups. 30 patients of group 1 received xenical in a dose 120 mg 3 times a day for 24 weeks. 30 patients of the control group received only the above diet for 24 weeks. The examination included 24-h monitoring of arterial pressure, anthropometric measurements, tests for glycemia, C-peptide, cholesterol, triglycerides (TG), LDLP, HDLP. RESULTS: Group 1 patients reduced their weight by 10.8 +/- 7.5 kg and fat tissue mass by 9.4 +/- 9.2 kg. This was in correlation with improvement of fatty, carbohydrate metabolism, arterial pressure. After 24 weeks of therapy xenical lowered cholesterol by 15%, LDLP cholesterol by 20%, TG by 28%, systolic and diastolic pressure by 5 and 4%. CONCLUSION: Combination of xenical with hypocaloric diet can be used in therapy of patients with metabolic syndrome.

[The role of hypersympathycotony in development of arterial hypertension in patients with metabolic syndrome: potential of pathogenetically sound therapy]. / Rol' gipersimpatikotonii v rezvitii arterial'noi gipertonii u patsientov s metabolicheskim sindromom: vozmozhnosti patogeneticheski obosnovannoi terapii.

AIM: To assess hypotensive efficacy and metabolic neutrality of moxonidine (physiotenz)--a selective agonist of imidasoline receptors--in patients with mild and moderate arterial hypertension (AH) associated with diabetes mellitus (DM) type 2. MATERIAL AND METHODS: Follow-up and treatment were conducted in 30 hypertensive diabetics (mean age 52.43 +/- 4.65 years). Mean duration of DM and AH was 4.77 +/- 2.69 and 6.93 +/- 2.98 years, respectively. The study was made of lipid exchange, glycemia, levels of glycosylated hemoglobin (GH), fasting and postprandial immunoreactive insulin. Hypotensive efficacy was examined by 24-h monitoring of arterial pressure after 16 weeks of therapy. RESULTS: Mean 24-h systolic arterial pressure fell by 8.02%, diastolic arterial pressure--by 6.47%. The drug had a good effect on a 24-h profile of arterial pressure: a significant decrease of day and night pressure load index, lowering of initially high 24-h variability of systolic and diastolic arterial pressure, normalization of two-phase profile of arterial pressure. Carbohydrate metabolism improved also: GH, glycemia, immunoreactive insulin decreased. There was a significant trend to a change in qualitative composition of blood lipid--a decrease in lipoproteins atherogenic fractions and a rise in HDLP. CONCLUSION: Physiotens is a highly effective hypotensive drug for use in mild and moderate AH in DM of type 2.

[Possible participation of angiotensin-converting enzyme and leukocyte elastase in the pathogenesis of insulin-independent diabetes mellitus]. / O vozmozhnom uchastii angiotenzin-prevrashchaiushchego fermenta i leikotsitarnoi élastazy v patogeneze insulin-nezavisimogo sakharnogo diabeta.

It is commonly accepted that the tolerance to insulin and hyperglycemia of the patients with non-insulin dependent diabetes mellitus (NIDDM) is due to some defect of insulin receptors or disturbances in the signaling pathway of the cell. This disease is often accompanied by hypertension. In this paper the high activity of plasma kallikrein-kinin system (KKS) (kallikrein activity was 6-8 times higher than normal), of angiotensin-converting enzyme (ACE) (4 times greater than normal), and of leukocyte elastase (2.7 times higher than normal) were demonstrated in plasma of patients with NIDDM. Increasing of KKS activity was coincident with rising of ACE activity, which may be the cause of the fast bradykinin inactivation and arising of hypertension. The treatment with ACE inhibitor during 3 months (4 mg of Perindopril per day) decreased ACE activity in patients' plasma which was accompanied with decreasing of the arterial pressure and some restoration of the carbohydrate metabolism indicators. The hyperinsulinemic euglycaemic clamping of 7 patients with NIDDM and essential hypertension showed that ACE-inhibitor (Perindopril, 4 mg) prevented bradykinin from destruction and increased the glucose consumption by tissues. The high activity of polymorphonuclear leukocytes and secretion of the elastase in NIDDM patients' plasma and/or instability of plasmatic and granular membranes of leukocyte in conditions of hyperglycaemic plasma are probably the cause of endothelial irritation and high ACE secretion. Secondly, the leukocyte may be the cause of injuring and decreasing of susceptibility of the cell receptors for insulin and bradykinin.