Тематичний Архів | Category Archives: Metabolic disorders

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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G.S. Isayeva, A.V. Martynenko, V.I. Volkov. Cardiovascular risk and it relation to hormonal state in perimenopausal women.

The present paper is dedicated to the problem of cardiovascular risk assessment in perimenopausal women. The special importance is given to understanding of woman hormonal balance impact, measured by the level of folliculi stimulating hormone. In a cross-sectional study 219 patients without coronary heart disease were included. In order to assess cardiovascular risk, SCORE scale was used. Cardiovascular risk was low or moderate in the majority of examined women. It was found that folliculi stimulating hormon had a most prominent impact upon cardiovascular risk in women 60–65 years old.

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O.I. Mitchenko, A.G. Kornatska, V.U. Romanov, O.V. Sopko.Cardiovascular risk features in women with polycystic ovary syndrome and metabolic syndrome.

The aim of our study was to examine cardiovascular risk factors in young women with polycystic ovary syndrome (PCOS) and metabolic syndrome (MS). In the first stage of the study we performed retrospective analysis of case reports of 109 reproductive age women with PCOS who were divided into three groups according to body mass index. In the second stage of the study a prospective examination of 90 young women with PCOS (mean age 29.1±1.4 years) who were divided into groups according to body mass index and the presence of MS was conducted. The study also included two groups of comparison – 15 women with metabolic syndrome without PCOS and 30 apparently healthy women. A wide range of cardiovascular risk factors was found in PCOS patients, including dyslipidemia (82.2 %), mainly due to the increase of total cholesterol and LDL cholesterol (70 %), abdominal obesity (78.8 %), insulin resistance (75.5 %), hypertension (31.1 %), impaired glucose tolerance (27.7 %) and diabetes (3.3 %). We found that appearance of abdominal type of obesity was more important for the formation of cardiovascular risk in PCOS women than body weight growth and was associated with a spectrum of metabolic disorders such as hypertriglyceridemia (66.6 %), low levels of HDL cholesterol (50.0 %), diabetes (12.5 %) and increased percentage of arterial hypertension (70.8 %) and glucose intolerance (45.8 %). In order to determine cardiovascular risk in PCOS women younger than 40 years SCORE scale should be used, but the possibility of single risk factor detection should be considered, including total cholesterol > 8 mmol/l or LDL cholesterol > 6 mmol/l, diabetes and atherosclerotic plaques of carotid arteries. These factors attributed 7.7 % of young women to high or very high cardiovascular risk.

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V.О. Serhiyenko.Cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus: N-tеrminal brain natriuretic peptide and structural-functional myocardial disorders.

The aim of the study was to examine N-tеrminal brain natriuretic peptide (NT-prоBNP), corrected QT interval and QT interval dispersion, parameters of structure and function of myocardium in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy (CAN). The study involved 77 patients with type 2 diabetes mellitus, including 15 patients without verified cardiovascular disease, 18 patients with subclinical stage CAN, 19 – functional, 25 – functional-organic stage CAN. Control group included 17 healthy subjects. It was established, that the increase of the NT-proBNP concentration in patients with type 2 diabetes mellitus may indicate a presence of subclinical CAN, which is often not established using traditional diagnostic methods. Increased concentration of NT-proBNP is correlated with presence and/or progression of CAN; statistically significantly and independently correlated with prolongation and dispersion of QT interval. Increased NT-proBNP concentration is significantly and independently associated with increased left ventricular mass in patients with type 2 diabetes mellitus. These results suggest the relation between structural, functional and electro-mechanical disturbances in patients with type 2 diabetes mellitus and CAN.

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O.I. Mitchenko, A.G. Kornatska, V.Yu. Romanov, O.V. Sopko.Endothelial function and intima – media thickness in women with metabolic syndrome and polycystic ovary syndrome.

The aim of our study was to evaluate early markers of atherosclerosis – endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery and carotid intima – media thickness (CIMT) in women with polycystic ovary syndrome (PCOS). We examined 90 reproductive age PCOS women (mean age 29.1±1.4 years), who were divided into clinical groups depending on the body mass index and presence of metabolic syndrome (MS). The study included also two groups of comparison – 15 women with metabolic syndrome without PCOS and 30 apparently healthy women. We found endothelial dysfunction in 71.1 % of PCOS women. Decrease of FMD was observed 2 times more often in PCOS and MS group than in MS group and 10 times more often than in healthy women of comparable age. Insulin resistance and hyperandrogenemia were found to be independent predictors of endothelial dysfunction. We found increased CIMT values compared to age and sex normogram in 59.0 % of patients in PCOS and MS group and 26.4 % – in PCOS without MS group, in general 34.4 % of women with PCOS had CIMT values ≥ 75th percentile, which indicates their increased cardiovascular risk. In 3 (13.6 %) patients with PCOS and MS we found atherosclerotic plaques of carotid arteries, which refers them to a very high cardiovascular risk group. Correlation analysis found close relationship between CIMT of PCOS women and total cholesterol, systolic blood pressure, LDL cholesterol, waist circumference and HOMA index. The abdominal type of obesity associated with range of metabolic disorders leading to endothelial dysfunction and CIMT increase was most important in causing endothelial dysfunction and CIMT increase.

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O.I. Mitchenko, V.Yu. Romanov, К.О. Yanovska, M.M. Gelmedova, L.V. Yakushko, T.V. Beliayeva, I.V. Chulayevska Leptin adiponectin index as a new additional surrogate marker of atherosclerotic lesions.

The aim of work was to explore the features of adypokins of adipose tissue and surrogate markers of atherosclerosis in patients with ischemic heart disease (IHD), hypertension and metabolic syndrome. We examined
87 men with hypertension with or without IHD. We determined body mass index, glucose, insulin, HOMA index, leptin, adiponectin, the ratio leptin/adiponectin (L/A), blood lipids, intima – media thickness (IMT) in the common carotid artery, endothelium-dependent vasodilation. Significant increase of proatherogenic adypokin – leptin and values of L/A index was revealed in patients with hypertension, metabolic syndrome and concomitant
IHD. Increase of IMT was most important in men with IHD and diabetes mellitus. L/A index may serve as an additional surrogate marker of atherosclerotic lesions. It correlates with the number of affected atherosclerotic
coronary arteries and body mass index.

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O.I. Mitchenko, V.Yu. Romanov, K.O. Yanovska The endocrine activity of adipose tissue and surrogate markers of atherosclerosis in patients with metabolic syndrome

The aim of our study was to determine the link between the endocrine activity of adipose tissue, intima – media thickness (IMT), endothelium-dependent vasodilatation depending on body mass index and insulin resistance. We examined 174 patients with metabolic syndrome (women – 88, men – 86), which were divided into the clinical groups according to body mass index and HOMA. We determined body mass index, glucose, insulin,
HOMA, leptin, adiponectin, the ratio leptin/adiponectin, blood lipids, IMT in the common carotid artery, endothelium-dependent vasodilatation. In women we observed significant relation between progression of insulin resistance, increase of IMT and deterioration of endothelial function; in male patients the tendency to increase of IMT and reduction of endothelium-dependent vasodilatation was shown. It has been proved that irrespective of gender increase of body mass thickness was associated with increase of intima – media complex of the common carotid artery and decrease of endothelium-dependent vasodilatation index. Progression of insulin resistance was associated with atherogenesis in the common carotid artery.

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