[Does acetylsalicylic acid and vitamin K antagonists are risk factors of macular degeneration related with age?]. / Czy kwas acetylosalicylowy i antagonisci witaminy K sa czynnikami ryzyka wystapienia zwyrodnienia plamki zóltej zwiazanego z wiekiem?

AIM: The aim of this study was to evaluate the effects of chronic use of acetylsalicylic acid (ASA) and vitamin K antagonists (VKA) on the incidence of age related macular degeneration (AMD). MATERIALS AND METHODS: The study included 292 individuals (187 women, 105 men, aged 45-94 (mean 73.2 ± 10.2 years). All individuals completed a survey and underwent a full eye examination. Patients were divided into four groups according to the presence or absence of degenerative changes at the bottom of an eye: group D - 80 patients with drusen (23 men and 57 women), 27,4% of studied population, group GA - 25 patients with geographic atrophy (10 men, 15 women), 8,56% of studied population, group CNV - 52 patients with neovascular form of AMD (28 men, 24 women), 17,81% of studied population, group Z - 135 healthy people (44 men, 91 women), 46,23% of studied population. Among study group 79 patients (27,1%) used aspirin, 32 people (11%) used vitamin K antagonists (acenocoumarol or warfarin), 181 people (61,9%) didn't use any drug. RESULTS: Patients from D and CNV group took ASA and VKA more often than patients from GA and Z group. The percentages were: in a group Z - 30,37%, in group D - 46,25%, in group GA - 32%, in group CNV - 48,08% (p=0,0407). There was no relationship between belonging to a group and use of ASA (p=0,3169). A statistically significant relationship between belonging to a group and use of VKA was discovered. The number of people using VKA in group D and CNV was statistically significantly higher than in the healthy control group and percentage were as follows: in group Z - 8,15%, in group D - 17,5%, in group GA 0%, in group CNV - 13,46% (p=0,0159). Patient groups differed statistically significantly due to age (p=0,0043), sex (p=0,0197), family history of macular diseases (p <0,0001), smoking (p=0,011), prevalence of hypercholesterolemia (p=0,0437), ischemic heart disease (p= 0,0173). The consumption of fish at least once a week and eating fruits and vegetables more often than once a day was associated with a reduced incidence of AMD p=0,0009, p=0,0003. Patients without AMD assessed their quality of life at a higher level than people with AMD (p<0,0001). ASA and VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. Also age ≥75, fish consumption > 1 week, male gender were independent risk factors for AMD in specified groups. CONCLUSIONS: Patients with drusen and exudative form of AMD took ASA and VKA more often than healthy people and patients with geographic atrophy. ASA or VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. In selected groups: age ≥75, male gender and reduced consumption of fish was found to be an independent risk factor for AMD. Number of people taking ASA and VKA is increasing and further studies are needed to assess their impact on the organ of vision.

The influence of risk factors for metabolic syndrome on vascular complications.

We assessed the influence of metabolic syndrome (MetS) characteristics on vascular complications. The study included 108 patients (72 women and 36 men, age 57.0 ± 8.5 years) with MetS that was diagnosed according to International Diabetes Federation criteria. The prevalence of micro- and macrovascular complications was assessed: vascular changes in the fundus of the eye-72%, ischemic heart disease-54.9%, estimated glomerular filtration rate (eGFR) <90 mL/min-38.9%, diabetic foot-5.55%, and cerebrovascular accident-3.7% of patients. A negative correlation between high-density lipoprotein cholesterol (HDL-C) concentration, creatinine levels, and level of vascular changes in the fundus of the eye was found. Moreover, the level of obesity and fasting glucose level had positive correlation with the intensity of vascular changes in the fundus of the eye. Characteristics of MetS (obesity and fasting glucose level) have high impact on advancing vascular complications in these patients. High level of HDL-C decreases the intensity of vascular changes in patients with MetS.

[Vascular complications in patients with metabolic syndrome]. / Powiklania naczyniowe u chorych na zespól metaboliczny.

UNLABELLED: All risk factors of metabolic syndrome (MS) are responsible for endothelial dysfunction what accelerate the development of atherosclerosis. It causes increased cardiovascular risk and development of cardiovascular complications in these subjects. The aim of the study was to assess the presence of vascular complications in subjects with MS. MATERIAL AND METHODS: The study comprised of 108 patients with metabolic syndrome (36 males and 72 females), aged 46-67 (57+/-8.5) years. MS was diagnosed according to the International Diabetes Federation criteria from 2005. Ischaemic heart disease was diagnosed according to the coronarography or patient care documentation. The assessment of nephrological complications was conducted with use of glomerular filtration rate (eGFR) calculated by using the simplified Modification of Diet in Renal Disease Study (MDRD) equation. The occurrence of brain strokes and diabetic foot was estimated basing on medical history and documentation. Vascular complications in the bottom of the eye were assessed with ophtalmoscopic examination and fluorescein angiography. RESULTS: The frequency of vascular complications in subjects with MS was: vascular complications in the bottom of the eye - 72.7% (symptoms of vascular angiopathy without retinopathy - 41.2%, retinopathy - 31.5%), ischaemic heart disease - 54.9%, eGFR < 90 m/min. - 38.9%, diabetic foot - 5.55%. brain stroke - 3.7%. Ischaemic heart disease was present in all subjects with MS qualified to the second and higher class of retinopathy. CONCLUSIONS: In patients with MS, ischaemic heart disease was the most common macroangiopathic complication, with increasing in the frequency together with retinopathy intensification. Changes in the bottom of the eye were the most common microangiopathic complications. Early identification and treatment of metabolic syndrome may have important value in prophylaxis and delay of vascular complications.

[Plasma nitric oxide and vascular endothelial growth factor levels in patients with metabolic syndrome and co-existing vascular complications]. / Stezenie tlenku azotu i naczyniowo-sródblonkowego czynnika wzrostu w osoczu chorych na zespól metaboliczny ze wspólistniejacymi powiklaniami naczyniowymi.

UNLABELLED: Subjects with metabolic syndrome (MS) are especially exposed to co-existing several cardiovascular risk factors. It's aggregated action leads to the endothelial damage. Tissue hipoxaemia increases VEGF synthesis. NO may also play the crucial role in VEGF synthesis The balance between factors increasing and decreasing VEGF synthesis has special importance in development of vascular complications. The aim of the study was to estimate plasma nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels in patients with metabolic syndrome and vascular complications. MATERIAL AND METHODS: The study was conducted in two groups of patients. I Group--54 patients with metabolic syndrome (diagnosed according to the IDF criteria from 2005) and macro- and microvascular complications, aged 46-67 (58 +/- 6.7) years. II Group--20 healthy subjects, aged 40-61 (51 +/- 5.1) years. Plasma levels of NO and VEGF were determined in all participants. RESULTS: Plasma level of nitric oxide in subjects with metabolic syndrome and vascular complications was 6.48 +/- 1.5 micromol/l and in healthy participants 10.08 +/- 1.09 micromol/l (p < 0.05). Plasma level of vascular endothelial growth factor in subjects with metabolic syndrome and vascular complications was 193.45 +/- 131.0 pg/ml and in healthy participants 71.09 +/- 14.49 pg/ml (p < 0.05). CONCLUSIONS: Endothelial dysfunction seems to be the substantial factor responsible for the vascular complications in subjects with metabolic syndrome, which manifests in increased plasma level of VEGF and decreased plasma level of NO.