Тематичний Архів | Category Archives: Metabolic disorders

A.A. Al Salim, M.A. Stanislavchuk, N.V. Zaichko Relationship of LEPR Q223R gene polymorphism to cardiometabolic risk factors in postmyocardial infarction men with type 2 diabetes mellitus

The aim – to determine the relationship of leptin receptors LEPR Q223R gene polymorphism to cardiometabolic risk factors in postinfarction men with type 2 diabetes mellitus (DM).

Material and methods. The study involved 147 men with stable coronary heart disease after myocardial infarction, mean age 53.70±6.97 years. In 64 (43.5 %) patients coronary heart disease was combined with type 2 DM. LEPR Q223R gene polymorphism was determined by PCR mode real-time. We evaluated the prevalence of traditional markers of dyslipidemia, inflammatory syndrome, insulin resistance, depending on LEPR Q223R genotype.

Results. In patients with coronary heart disease and type 2 DM the prevalence of LEPR Q223R gene polymorphism was higher than in CHD patients without DM (OR 1.58; 95 % CI 0.99–2.53). LEPR Q223R gene polymorphism was associated with visceral obesity and proatherogenic pattern, especially in patients with CHD combined with type 2 DM. In the RR genotype carriers we registered more often hypertension (OR 2.81; 95 % CI 1.03–7.18), markers of visceral obesity (OR 5.37; 95 % CI 2.56–11.3), insulin resistance, dyslipidemia (hypertriglyceridemia, low HDL cholesterol) and high levels of hsCRP than in the QQ and QR genotype carriers.

Conclusions. In patients with CHD and type 2 DM LEPR Q223R gene polymorphism was associated with visceral obesity, insulin resistance and metabolic proatherogenic pattern.

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O.V. Korkushko, V.P. Chizhova, І.A. Antonyuk-Scheglova, V.B. Shatilo, J.B. Zhuravlyova The influence of disturbances of the carbohydrate metabolism and obesity upon functional state of endothelium of different caliber vessels in subjects over 50 years old

The aim – to estimate functional status of the endothelium depending on changes of carbohydrate metabolism and body mass index in subjects over 50 years old.

Materials and methods. The study involved 63 subjects, age 50–74 years, including 35 healthy subjects and 28 patients with prediabetes changes of carbohydrate metabolism. Standard glucose-tolerance test was performed, blood concentrations of glucose and insulin were measured. We also calculated insulin resistance index (HOMA-IR), the area under glucose curve, the indicators of the platelet aggregation, the functional status of endothelium, performed vital biomicroscopy of the vessels of bulbar conjunctiva.

Results. Prediabetes changes of the carbohydrate metabolism were associated with slight deterioration of endothelial function at the level of large vessels and the development of endothelial dysfunction at microcirculatory section of vasculature, along with increased platelet aggregation in obese patients (P<0,05). Conducting vital сapillaroscopy of bulbar conjunctiva we revealed slowing of the flow rate and sludge phenomena in venules, arterioles and capillaries. Conclusions. Elderly subjects with prediabetes reveal evolving endothelial dysfunction at microcirculatory level, which probably precedes endothelial dysfunction at the level of large vessels. Thrombogenicity is increased in subjects with prediabetes. Pathological changes of microcirculation were found as well, being more pronounced in patients with obesity.

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O.М. Kovalyova, T.V. Ashcheulova, S.V. Ivanchenko, O.V. Honchar. Relation of chemerin serum levels to metabolic disorders in patients with essential hypertension

The aim – to investigate relation of chemerin serum levels to metabolic disorders in hypertensive patients depending on body mass index (BMI).

Material and methods. 82 hypertensive patients (including 39 persons with accompanying obesity) have been observed; chemerin serum levels were evaluated in all patients in addition to standard biochemical methods and anthropometrical measurements.

Results. It was found that chemerin serum levels were significantly higher in all groups of hypertensive patients vs control group, regardless of accompanying obesity. It has been shown that relatively low average levels of serum chemerin and BMI were associated with less pronounced dyslipidemia; increasing chemerin concentration or BMI was associated with significant decrease in high density lipoproteins levels with a tendency to increase of atherogenic index. The relation between higher serum chemerin levels in hypertensive patients to accompanying obesity and diabetes mellitus and decreased kidney function has been revealed.

Conclusion. These data suppose chemerin involvement in pathogenesis of metabolic disorders in hypertensive patients with accompanying obesity.

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V.М. Kovalenko, T.V. Talaieva, A.S. Kozlyuk, V.V. Bratus. Mechanisms of development of cardiovascular pathology in osteoarthrosis

The aim – to study the pathogenetic specificity of the vascular injury in patients with OA, the role of the traditional cardiovascular risk factors and, especially, factors linked to the systemic inflammation.

Material and methods. There were investigated 3 groups of patients – 1st group (main) – 83 patients with osteoartritis (OA), 2nd group (reference group) – 20 patients with metabolic syndrome without OA, 3rd group (control group) – 25 healthy persons. All groups were comparable by age and sex. In all patients vascular Doppler study was performed; besides, we determined endothelial dependent relaxation of the brachial artery with evaluation of intraluminar diameter and blood flow velocity, ankle-brachial index, lipid and lipoprotein blood spectrum, glucose and glycated hemoglobin blood content. The extent of the systemic inflammation was elaluated by C-reactive protein and malone dialdehyde blood content.

Results. The obtained data witness that OA even in early stages is accompanied with significant vascular damage on background of systemic inflammation and proatherogenic metabolic changes, such as insulin resistance, diabetic dyslipidemia, hyperglycemia, modification of LDL and VLDL. Nevertheless, vascular damages corresponded more to arteriosclerotic type, were generalized and appeared as morpho-functional remodelling of both systemic vessels and micro-circulatory vessels. The signs of the vascular damage were related to the indexes of systemic inflammation, but not to the traditional factors of atherogenesis.

Conclusions. Pronounced increase of cardiovascular risk in patients on the early stages of OA is related to the development of generalized arteriosclerosis, but not to the coronary atheroslerosis. Morpho-functional vascular disturbances in patients with OA are the consequences of mainly systemic inflammation. This should be taken into account in diagnosis, treatment and prevention of acute coronary syndrome.

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O.Yu. Kulyk, O.I. Mitchenko, V.Yu. Romanov, L.V. Yakushko. Leptin resistance and cardiovascular risk in patients with essential hypertension and metabolic syndrome.

The aim – to study the relationship between leptin resistance and cardiovascular risk in patients with essential hypertension (EH) and metabolic syndrome (MS).

Material and methods. 160 patients (pts) with EH and MS have been surveyed, in 84 of them soluble leptin receptors were determined. Four groups have been formed: 1st – pts with MS without carbohydrate disorders, 2nd – pts with MS and insulin resistance (IR) without DM and IGT, 3rd – pts with MS and impaired glucose tolerance (IGT, 4th – pts with MS and diabetes mellitus (DM). In each group the analysis for men and women was carried out separately. The following methods were used: body mass index (BMI), waist circumference (WC), blood pressure monitoring, echocardiography, fasting levels of sOB-R, leptin, glucose, insulin.

Results. Among women, correlations between free leptin index and BMI (r=0.61, Р<0.05) and WC (r=0.60, P=0.05) were found. Relationships between free leptin index and total cholesterol (r=0.49, Р<0.05), triglycerides (r=0.37, Р<0.05), glucose (r=0.48, Р<0.05), systolic blood pressure (r=0.46, Р<0.05) and diastolic blood pressure (r=0.39, Р<0.05) were established, respectively. A similar trend was observed in male groups. In order to assess cardiovascular risk, all patients underwent additional stratification of cardiovascular risk using scales SСOREBMI, PROCAM, Framingham, DRS. Conclusions. Leptin resistance is associated with increased detection of cardiovascular risk factors in patients with EH and MS. Relation of free leptin index to factors of cardiovascular risk such as WC, BMI, cholesterol, triglycerides, glucose and blood pressure levels in male and female groups was found. In patients with EH, diabetes and MS high risk of complications by IRIS-II scale was associated with more sings of leptin resistance. Free leptin index was 5.45±1.09 in women and 4.5±1.6 in men, respectively, and may be used to optimize early detection of complications in patients with diabetes.

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O.I. Mitchenko, V.Yu. Romanov, G.Ya. Ilyushina. Dyslipidemia and surrogate markers of atherosclerosis in patients with essential hypertension, physiological and post-surgery menopause

The aim – to compare characteristics of lipid metabolism and early markers of atherosclerosis (thickness of intima – media complex and atherosclerotic plaques in the carotid arteries) in patients with essential hypertension (ЕH), physiological and post-surgery menopause, and possible impact of hormone replacement therapy (HRT).

Material and methods. 112 women with ЕH II stage (46.14±1.60 years) were examined: I group – 37 patients with ЕH II, post-surgery menopause without HRT; II group – 37 patients with ЕH II, post-surgery menopause, receiving combined HRT; III group – 38 patients with ЕH II and physiological menopause without HRT.

Results. Patients with ЕH and post-surgery menopause without HRT are characterized by the highest percentage of dyslipidemia (86.5 %), mainly due to higher levels of total cholesterol, LDL cholesterol, significant increase (P<0.01) of the complex intima – media of the carotid arteries compared to other groups, in 83.7 % carotid atherosclerotic plaques were detected. Patients with hypertension, post-surgery menopause, receiving HRT, despite less percentage of dyslipidemia, demonstrate effective implementation of primary cardiovascular prevention due to antiatherogenic actions of HRT. They have better condition of vessels, even compared to the comparable age patients with early physiological menopause. Conclusions. Usage of HRT in the reproductive age women with ЕH and post-surgery menopause is associated with better lipid metabolism, may reveal antiatherogenic effects upon vascular wall and be recommended as an option for primary cardiovascular prevention. Detection of the carotid atherosclerotic plaque may indicate necessity of using phytoestrogens, or other non-hormonal alternative therapies.

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O.I. Mitchenko, V.Yu. Romanov, O.Yu. Kulyk.

The aim – to study the levels of leptin and soluble leptin receptor (sOB-R) depending on carbohydrate and lipid disorders in patients with essential hypertension (EH) and metabolic syndrome (MS).

Material and methods. One hundred and sixty patients with EH and MS have been included, soluble leptin receptor levels were determined in 84 of them. Four groups have been formed: 1st – patients with MS without carbohydrate disorders, 2nd – patients with MS and insulin resistance without carbohydrate disorders, 3rd – patients with MS and impaired glucose tolerance, 4th – patients with MS and diabetes mellitus (DM). The separate analysis for men and women was carried out in all groups. The following methods were used: body mass index, waist circumference, monitoring of blood pressure, echocardiography, fast levels of sOB-R, leptin, glucose, insulin, with definition of an index of HOMA.

Results. Сhanges of the leptin and sOB-R levels depended on carbohydrate and lipid disorders. The pts of the 4th group had higher leptin levels compared to the 1st group both in women (61.96±9.51 vs 27.99±5.65 ng/ml) and in men (52,52±12.24 vs 12.42±2.73 ng/ml). The higher FLI ratios (the ratio of leptin to the leptin receptor sOB-R) were found in women (4.77±0.83) and men (3,93±1.27) with EH, MS and DM compared to the groups of patients without carbohydrate metabolism disorders (1.67±0.33 and 0.73±0.19, respectively). The close correlation was found between FLI and HOMA index (r=0.63, p=0.05 and r=0.51, p=0.05) in the female and male groups, accordingly.

Conclusions. Carbohydrate and lipid disorders were strongly related to the ratio of leptin and sOB-R in patients with EH and MS. FLI ratio may be used as a marker of leptin resistance in order to improve estimation of the cardiometabolic risk.

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I.M. Gorbas, O.O. Kvasha, I.P. Smyrnova, S.B. Osipenko.Improvement of lipid and carbohydrate exchange in patients with metabolic disorders

The aim – to study the effect of long-term (6 months) use of the drug for lipid and carbohydrate metabolism improvement in patients with metabolic disorders.
Material and methods. Open-label, non-comparative study included 30 men and women within 6 months of receiving drug for lipid and carbohydrate metabolism improvement (blueberry paste) in patients with metabolic disorders. Participants were examined at the start of the study, after 3 and 6 months of taking the paste. Study of lipids, glucose, C-reactive protein, prothrombin index was performed, anthropometric measurements were conducted, blood pressure was measured.
Results. Reduction of prothrombin index was registered after 3 months of taking bluberry paste, further usage had no effect on this index. After 6 months, a significant decrease in total cholesterol, LDL cholesterol and C-reactive protein at 9, 13 and 29 %, respectively, was recorded. A significant reduction in mean glucose levels from 5.26±0.12 to 4.58±0.14 mmol/l (P<0.001) was revealed. The influence of blueberry paste on body weight and blood pressure was not registered. Conclusions. The usage of the drug has positive impact on lipid and carbohydrate metabolism, resulting in a significant decrease in the content of cholesterol, LDL cholesterol, glucose and C-reactive protein and can be used for correction of lipid and carbohydrate metabolism both separately and in combination with primary treatment.

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S.V. Shevchuk, Y.S. Seheda.Cardiovascular risk stratification in patients with antiphospholipid syndrome.

There is strong evidence that patients with antiphospholipid syndrome have an increase risk of early development of cardiovascular events with resulting mortality. However, the existence of specific mechanisms of atherogenesis in antiphospholipid syndrome may affect cadiovascular risk assessment. The main purpose of this study was to evaluate the risk of coronary events by the most common rating scales, to compare it with traditional and specific risk factors and to investigate correlation of individual risk of vascular lesions with its actual state. The study included 77 patients with antiphospholipid syndrome and 37 age- and sex-matched healthy subjects. Traditional risk factors such as dyslipidemia, obesity, arterial hypertension age, sex, diabetus mellitus, sedentary lifestyle were assessed in each participant. State of the cardiovascular system was evaluated on the basis of laboratory and instrumental examination. To identify patients with silent myocardial ischemia daily ECG monitoring was used. We investigated plasma levels of total cholesterol, triglycerides, high-density lipoprotein, TNF-α, CRP, paraoxanase activity, IL-1, anticardiolipin antibodies IgG and anti-b2-glycoprotein antibodies. In addition, we evaluated flow-mediated vasodilation of brachial artery, assessed thickness of intima-media complex of the common carotid artery and the presence of atherosclerotic plaques in the common carotid artery. Risk stratification of cardiovascular events was performed by using Framingham, SCORE and Reynolds scales. Individual risk of cardiovascular lesions in patients with antiphospholipid syndrome was 1.65–2.78 times higher than in the general population. Significant differences of the cardiovascular risk measured by different scales were established: 39 % high risk individuals have been registered by SCORE scale, compared to 14.3 % patients by Framingham and 20.8 % patients by Reynolds scale. The main factors increasing individual cardiovascular risk in patients with antiphospholipid syndrome were dyslipidemia, high blood pressure, male gender, diabetes mellitus and smoking. SCORE scale does not reflect the real state of the cardiovascular system in patients with antiphospholipid syndrome, estimated by instrumental methods. In conclusion, it is necessary to develop new algorithms of cardiovascular risk assessment in patients with antiphospholipid syndrome based on the specific risk factors.

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