Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients?

Background and Objectives: The relationship between osteoarthritis (OA) and osteoporosis (OP) has been analysed for over four decades. However, this relationship has remained controversial. Numerous observational and longitudinal studies have shown an inverse association between the two diseases and a protective effect of one against the other. On the other hand, some studies show that patients with OA have impaired bone strength and are more prone to fractures. The study's main objective was to determine the bone mineral density (BMD) of the spine and hip (femoral neck) of postmenopausal women of different ages, with radiologically determined OA of the hip and knee, as well as to determine the correlation between BMD values and age in the experimental group. Materials and Methods: The retrospective cohort study included 7018 patients with osteoarthritis of peripheral joints and the spine, examined by a rheumatologist in an outpatient rheumatology clinic at the Institute for Treatment and Rehabilitation, Niska Banja from July 2019 to March 2021. A nested anamnestic study was conducted within the cohort study of patients, and it included two groups: an experimental group composed of 60 postmenopausal women, and a control group composed of the same number of women. Out of 120 patients, 24 did not meet the criteria for the continuation of the study (due to technical errors­radiographic and/or densitometry artefacts). Fifty-six postmenopausal women (aged 45−77 years) with hip and knee radiological OA were examined as an experimental group. The participants were divided into two subgroups according to age (45−60 years and over 61 years). The control group included 40 healthy postmenopausal women of the same age range, without radiological OA, with normal BMD of the hip and spine. All patients with OA met the American College of Radiology (ACR) criteria. OA of the hip and knee was determined radiologically according to Kellgren and Lawrence (K&L) classification, and patients were included in the study if a K&L grade of at least ≥ 2 was present. Hip and spine BMD was measured by dual-energy X-ray absorptiometry (DXA). Results: Compared to the control group, we found statistically significantly lower BMD and T-scores of the spine in older postmenopausal women: BMD (g/cm2), p = 0.014; T-score, p = 0.007, as well as of the hip: BMD (g/cm2), p = 0.024; T-score p < 0.001. The values of BMD and T-score of the spine and hip are lower in more severe forms of OA (X-ray stage 3 and 4, according to K&L), p < 0.001. We found negative correlation between BMD and T-score and age only for the hip: BMD (g/cm2), ρ = 0.378, p = 0.005; T-score ρ = −0.349, p = 0.010. Conclusions: Older postmenopausal women with radiographic hip and knee OA had significantly lower BMD of the hip and spine as compared to the control group without OA, pointing to the need for the prevention and treatment of OA, as well as early diagnosis, monitoring, and treatment of low bone mineral density.

Diabetic Cardiomyopathy: Clinical and Metabolic Approach.

BACKGROUND: Having in mind that diabetes mellitus (DM) and obesity are some of the greatest health challenges of the modern era, diabetic cardiomyopathy (DCM) is becoming more and more recognized in clinical practice. Main Text: Initially, DM is asymptomatic, but it may progress to diastolic and then systolic left ventricular dysfunction, which results in congestive heart failure. A basic feature of this DM complication is the absence of hemodynamically significant stenosis of the coronary blood vessels. Clinical manifestations are the result of several metabolic disorders that are present during DM progression. The complexity of metabolic processes, along with numerous regulatory mechanisms, has been the subject of research that aims at discovering new diagnostic (e.g. myocardial strain with echocardiography and cardiac magnetic resonance) and treatment options. Adequate glycaemic control is not sufficient to prevent or reduce the progression of DCM. Contemporary hypoglycemic medications, such as sodium-glucose transport protein 2 inhibitors, significantly reduce the frequency of cardiovascular complications in patients with DM. Several studies have shown that, unlike the above-stated medications, thiazolidinediones and dipeptidyl peptidase-4 inhibitors are associated with deterioration of heart failure. CONCLUSION: Imaging procedures, especially myocardial strain with echocardiography and cardiac magnetic resonance, are useful to identify the early signs of DCM. Research and studies regarding new treatment options are still "in progress".

Electrocardiographic criteria which have the best prognostic significance in hypertensive patients with echocardiographic hypertrophy of left ventricle: 15-year prospective study.

BACKGROUND: Electrocardiography is the first-choice technique for detecting left ventricular hypertrophy in patients with arterial hypertension. It is necessary to know the probable outcome for every patient during the treatment, with the aim of improving cardiovascular event prevention. HYPOTHESIS: Certain electrocardiographic criteria for left ventricular hypertrophy may predict outcomes of patients with left ventricular hypertrophy during a 15-year follow-up. METHODS: Fifteen-year prospective study of 83 consecutive patients (53 male and 30 female; mean age 55.3 ± 8.1) with echocardiographic left ventricular hypertrophy (left ventricular mass index 170.3 ± 31.6 g/m2 ). Electrocardiographic left ventricular hypertrophy was determined by means of Gubner-Ungerleider voltage, Lewis voltage, voltage of R wave in aVL lead, Lyon-Sokolow voltage, Cornell voltage and Cornell product, voltage RV6 and RV5 ratio, Romhilt-Estes score, Framingham criterion and Perugia criterion. RESULTS: One or more composite events were registered in 32 (38.5%) patients during 15-year follow-up. Positive Lyon-Sokolow score (17.6% vs. 47.3%; P < 0.05), Lewis voltage (9.8% vs. 21.9%; P < 0.05), Cornell voltage (15.7% vs. 37.5%; P < 0.05), and Cornell product (9.8% vs. 34.4%; P < 0.01) were more frequent in a group of patients with composite events. Odd ratio for Cornell product was 4.819 (95% CI 1.486-15.627). CONCLUSION: Patients with echocardiographic left ventricular hypertrophy who had positive Lewis voltage, Lyon-Sokolow voltage, Cornell voltage, and Cornell product showed worse 15-year outcome. The strongest predictor of cardiovascular events was positive result of Cornell product.

Impact of metabolic syndrome on clinical severity and long-term prognosis in patients with myocardial infarction with ST-segment elevation.

AIMS: The aim of this study is to evaluate the impact of metabolic syndrome (MetS) on clinical severity and long-term prognosis in patients with myocardial infarction with ST-segment elevation (STEMI). METHODS: We examined 507 patients with STEMI, who were admitted for primary percutaneous coronary intervention classified according to the presence of MetS using American Heart Association and the National Heart, Lung, and Blood Institute definition. After applying these criteria, the patients were categorized into groups as patients with MetS and without MetS. We compared baseline characteristics, clinical findings, and outcomes between these groups. During the 48-month follow-up, we collected data about major adverse cardiac events (MACE) and mortality. RESULTS: The MetS group comprised 217 patients with MetS (mean age = 60.71 ± 11.52 years; 59 females), while the control group comprised 290 subjects (mean age = 57.50 ± 10.95 years; 54 females). The patients with and without MetS had similar parameters of clinical severity of STEMI but differed in severe coronary artery disease. During the follow-up period, a significantly higher percentage of myocardial infarction (6.91% vs 2.06%) and new revascularization (16.59% vs 8.97%) was recorded in the MetS group. On multivariate analysis, MetS was independently associated with MACE (HR = 1.834, 95% CI = 1.162-2.896, p = 0.009) but not with mortality (HR = 1.603, 95% CI = 0.864-2.973, p = 0.134). Among cardiovascular events that compose MACE, MetS was associated with new revascularization (HR = 2.204, 95% CI = 1.273-3.815, p=0.005). CONCLUSION: The presence of MetS in patients with STEMI is an independent risk factor for MACE, and this syndrome is strongly associated with new revascularization.

A Critical Approach of Guideline Therapeutic Recommendations for NAFLD.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive form of the disease are associated with cardiovascular risk factors including obesity, dyslipidaemia, hyperglycaemia and hypertension. When NAFLD is associated with cardiovascular disease, mortality of NAFLD patients is increased due to cardiovascular disease. Prevalence of NAFLD and NASH is high, but it seems that epidemic of the disease is under-recognized and under-appreciated. Linking pathophysiological mechanisms are complex and still not well understood. The main related pathophysiological mechanisms are lipid factors, insulin resistance, inflammation, proinflammatory cytokines, oxidative stress, pro-coagulant status, hyperglycaemia and adipokines. First-line management focuses on lifestyle modifications in both diseases. Several therapeutic interventions, insulin sensitizer agents, lipid lowering drugs, antioxidants, such as vitamin E, have been proposed. Statins appear to be safe, but their use in the treatment of NAFLD and NASH is under-appreciated. Many different agents are being investigated as future drugs for the treatment of this clinical entity. The aim of the review is to examine the extent of the epidemic and the mediating mechanisms, to critically evaluate current guideline recommendations, and to consider current and future medications for this disease.

QTc dispersion and Cornell duration product can predict 10-year outcomes in hypertensive patients with left ventricular hypertrophy.

BACKGROUND: Persistent and adequate treatment of patients with arterial hypertension leads to more favorable disease outcome. HYPOTHESIS: Aside for the present left ventricular hypertrophy (LVH), there are other non-invasive parameters which can represent additional predictors of unfavorable prognosis in patients with essential arterial hypertension during the 10-year follow-up. METHODS: A hypertensive group with LVH (124 patients; age 57.0 ± 8.0; 84 males and 40 females) was included in the study and examined noninvasively. Patients used regular medication therapy during the follow-up period. RESULTS: During the 10-year follow-up period, unfavorable outcome was recorded for 40 (32.3%) patients. Patients with unfavorable outcome had higher baseline values of left ventricular mass index (178.9 ± 29.5 g/m2 vs 165.5 ± 29.5 g/m2 ; P < 0.05) and QTc dispersion (64.1 ± 24.7 ms vs 54.8 ± 19.4 ms; P < 0.05). Frequency of positive Cornell product was higher in the group of patients with unfavorable outcome (35% vs 22.2%; P < 0.01). Positive Lyon-Sokolow score did not show statistical significance (25% vs 11.9%; P = 0.06). Cornell product (ß = 0.234; P < 0.01) and QTc dispersion >65 ms (ß = 0.184; P < 0.05) had prognostic significance in LVH (multiple regression analysis: R = 0.314, R = 0.099, adjusted R = 0.084, standard error of the estimate = 0.449, P < 0.05). CONCLUSIONS: Patients with a positive Cornell product and larger QTc dispersion had more unfavorable 10-year outcomes compared with other patients with LVH.