Relationship between endothelial functions and acetylsalicylic acid resistance in newly diagnosed hypertensive patients.

BACKGROUND: We aimed to investigate the effects and dose dependency of aspirin on endothelial functions and prevalence of aspirin resistance in newly diagnosed hypertensive patients without previous drug therapy and development of cardiac complications. HYPOTHESIS: Acetylsalicyclic acid improves endothelial function. METHODS: Fifty-eight hypertensive patients and 61 healthy subjects in the control group were included in the study. Endothelial functions of the patient and control groups were evaluated with brachial artery examination. Patient and control groups were divided into 2 groups. A total of 100 mg and 300 mg of aspirin were given to the separate groups for 1 week. After 1 week, endothelial functions were reevaluated and aspirin resistance examined with a platelet function analyzer (PFA-100; Dade Behring, Marbourg, Germany). RESULTS: Baseline flow-mediated dilatation (FMD) change percent in hypertensive patients was 9.8%, and it was significantly lower than in the control group (12%) (P < 0.001). Frequency of acetylsalicylic acid (ASA) resistance was 20% and 26% in control and hypertensive patient groups, respectively (P = not significant). ASA resistance was 28% and 24% in 100 mg and 300 mg in hypertensive patients, respectively (P = not significant). FMD change percent increased both in the control and hypertensive groups after ASA treatment from 12.4% to 13.3% and 9.8 % to 11.9 %, respectively. FMD percentage change was significantly increased in hypertensive patients irrespective of ASA resistance (P = 0.02, for ASA resistance [+]; P < 0.012, for ASA resistance [-]). CONCLUSIONS: Endothelial functions were impaired more in hypertensive patients compared to the control group. Endothelial functions were improved with all ASA doses in hypertensive patients irrespective of ASA resistance.

[Which cut-off value of high sensitivity C- reactive protein is more valuable for determining long- term prognosis in patients with acute coronary syndrome?]. / Akut koroner sendromlu hastalarda yüksek duyarli C-reaktif proteinin uzun dönem prognozu belirlemede hangi kestirim degeri daha degerlidir?

OBJECTIVE: The aim of this study to investigate prognostic efficacy of high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS) and to identify the most valuable cut-off value of hs-CRP for determining long term prognosis. METHODS: A total of 240 ACS patients presenting within 6 h after the onset of chest pain were included to the study. Admission levels of hs-CRP were analyzed. Patients were followed for 1 year. Primary end-point of the study was new coronary event (NCE), defined as the combination of cardiac death, nonfatal myocardial infarction and recurrent rest angina. Risk factors for NCE were determined by logistic regression analysis. ROC-curve analysis was used to identify cut-off values of the risk factors. The prognostic efficacy of the cut-off value of hs-CRP was compared to other values determined from other studies. Kaplan Meier and log rank tests were used in survival analyses. Factors determining event-free survival were investigated by Cox regression analysis. RESULTS: During the follow-up period, 65 NCEs occurred. In multivariate analysis, hs-CRP was strongly associated with the occurrence of NCE (OR=4.79, 95% CI=2.10-10.44, p<0.001). Cut-off value of hs-CRP for NCE was 1.1 mg/dl (AUC=0.68, 95% CI=0.62-0.74, p<0.001). Compared to other values of different studies, hs-CRP>1.1 mg/dl had the optimal positive and negative predictive values. In the Cox regression analysis, hs-CRP was emerged as the most important parameter for determining event-free survival (RR=3.44, 95% CI=1.91-6.21, p<0.001). CONCLUSION: Admission levels of hs-CRP were emerged as the most important parameter for prognosis and the cut-off value of hs-CRP for predicting NCE was found as 1.1 mg/dl in this cohort of the study population. Further studies are required to confirm the most risky cut off value of hs-CRP for predicting long term prognosis among ACS patients and in general population.

Impact of the metabolic syndrome on high-sensitivity C reactive protein levels in patients with acute coronary syndrome.

OBJECTIVE: Underlying predisposition for a heightened inflammatory response is postulated as one of the mechanisms for elevated high-sensitivity C reactive protein (hs-CRP) levels in patients with acute coronary syndrome (ACS). It is unclear whether metabolic syndrome (MetS) may cause a predisposition for heightened hs-CRP response in patients with ACS. The aim of this study is to investigate the interaction between hs-CRP levels and presence of MetS in patients with and without ACS. METHODS: Two hundred and seventy-three consecutive patients presenting with a first ACS event and 261 MetS patients without any ACS event were included to the study. The study participants were divided into three groups as MetS (+) ACS (-) [n=261], MetS (-) ACS (+) [n=110], and MetS (+) ACS (+) [n=163]. Median levels of hs-CRP were compared between and within the three groups. RESULTS: Hs-CRP levels were lowest in MetS (+) ACS (-) subjects and highest in MetS (+) ACS (+) patients. Factors associated with hs-CRP levels were troponin elevation, presence of ACS, body mass index (BMI), and presence of MetS (R(2)=0.26, p<0.01). Predictors of elevated hs-CRP levels (>0.3mg/dl) were the presence of ACS (OR=3.6, 95% CI=1.9-6.5, p<0.01), presence of MetS (OR=2.1, 95% CI=1.0-4.0, p=0.02), troponin elevation (OR=5.7, 95% CI=2.8-11.5, p<0.01) and BMI (OR=1.1, 95% CI=1.0-1.1, p<0.01). CONCLUSIONS: The presence of MetS had an impact on the increase in hs-CRP levels observed with an ACS event in the study population. These findings suggested that a heightened baseline inflammatory status of MetS may predispose ACS patients to an augmented hs-CRP response.

Comparison of the long-term prognostic value of cystatin C to other indicators of renal function, markers of inflammation and systolic dysfunction among patients with acute coronary syndrome.

OBJECTIVE: Emerging evidence indicates the prognostic importance of cystatin C (Cys-C) in patients with coronary artery disease. However, whether Cys-C concentrations are associated with adverse clinical events among patients with acute coronary syndromes (ACS) have not been studied extensively. We compared the long-term prognostic efficacy of Cys-C with other markers of renal dysfunction, inflammation and systolic dysfunction in patients with ACS. METHODS AND RESULTS: Serum levels of Cys-C, high sensitive C-reactive protein (hs-CRP), brain natriuretic peptide (BNP) and creatinine were measured in 160 patients with ACS (112 males, 48 females, mean age 60+/-10 years) on admission. Primary end point of the study was major adverse cardiac events (MACE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalization within 12 months of follow-up. During the follow-up period, 42 (26%) patients met the MACE criteria. The occurrence of MACE was significantly higher among patients with higher Cys-C levels. In multivariate analysis, Cys-C was the most important parameter associated with the occurrence of MACE (OR=9.62, 95% CI=2.3-40.5, p<0.001). ROC curve analysis showed that the predictive cut-off value of Cys-C for MACE was 1051ng/ml. In the Cox regression analysis adjusted for multiple risk factors, Cys-C was found as the most powerful predictor for MACE (RR=9.43, 95% CI=4.0-21.8, p<0.001). CONCLUSION: The results of the present study indicate that admission levels of Cys-C may be a good prognostic indicator of recurrent cardiovascular events in patients with ACS. Further studies are needed to confirm these results.