Objective
Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Disease‐related ...characteristics and traditional CV disease risk factors may contribute to atherosclerotic damage. However, there are limited data on the risk of overt CV events in primary Sjögren's syndrome (pSS).
Methods
We retrospectively analysed a cohort of patients with 1343 pSS. Disease‐related clinical and laboratory data, traditional CV disease risk factors and overt CV events were recorded. Prevalence of traditional CV disease risk factors and of major CV events was compared between a subgroup of 788 female patients with pSS aged from 35 to 74 years and 4774 age‐matched healthy women.
Results
Hypertension and hypercholesterolaemia were more prevalent, whereas smoking, obesity and diabetes mellitus were less prevalent, in women with pSS than in control subjects. Cerebrovascular events (2.5% vs. 1.4%, P = 0.005) and myocardial infarction (MI) (1.0% vs. 0.4%, P = 0.002) were more common in patients with pSS. In the whole population, central nervous system involvement (odds ratio (OR) 5.6, 95% confidence interval (CI) 1.35–23.7, P = 0.02) and use of immunosuppressive therapy (OR 1.9, 95% CI 1.04–3.70, P = 0.04) were associated with a higher risk of CV events. Patients with leucopenia had a higher risk of angina (P = 0.01).
Conclusions
pSS is associated with an increased risk of cerebrovascular events and MI. Disease‐related clinical and immunological markers may have a role in promoting CV events.
Aim The aim of this systematic review was to compare laparoscopic and/or laparoscopic‐assisted right colectomy (LRC) with open right colectomy (ORC). Many randomized clinical trial have shown that ...laparoscopic colectomy benefits patients with improved short‐term outcomes and comparable overall survival in respect to the open approach. These results, however, could not be applied to right colectomy owing to its wide range of resection and more complicated vascular regional anatomy.
Method We performed a meta‐analysis of the literature in order to compare LRC vs ORC by examining 21 end‐points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing right colectomy for cancer was carried out. The meta‐analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement. The search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL until March 2011. We included randomized and non randomized studies that compared the LRC vs ORC for benign disease and malignant neoplasm irrespective of publication status. Only studies in English, French, German, Spanish and Italian languages were considered for inclusion. Emergency right colectomies were excluded. To perform the statistical analysis we used the odds ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. An intention‐to‐treat analysis was performed.
Results Seventeen studies, 15 nonrandomized clinical trials and two randomized clinical trials, involving a total of 1489 patients, were identified. The mean operative time was longer in the group of patients undergoing LRC weighted mean difference (WMD) = 37.94, 95% CI: 25.01 to 50.88; P < 0.00001. Intra‐operative blood loss (WMD = −96.61; 95% CI: −150.68 to −42.54; P = 0.0005), length of hospital stay (WMD = −2.29; 95% CI: −3.96 to −0.63; P = 0.007) and short‐term postoperative morbidity (OR = 0.64; 95% CI: 0.49 to 0.83; P = 0.0009) were significantly in favour of LRC.
Conclusion Laparoscopic‐assisted right colectomy results in less blood loss, a shorter length of hospital stay and lower postoperative short‐term morbidity compared with ORC.
Abstract Background and aim Morbid obesity is often accompanied by insulin resistance and increased ectopic fat surrounding the heart. We evaluated the relation of epicardial and pericardial fat with ...insulin resistance and left ventricular (LV) structure and function. Methods and results Epicardial and pericardial fat thicknesses were determined at 2-dimensional echocardiography in 80 morbid obese subjects age 42 ± 12 years, 31% men, body mass index (BMI) 44.4 ± 7 kg/m2 . LV hypertrophy (LV mass ≥51 g/m2.7 ), inappropriately high LV mass for a given cardiac workload (observed vs predicted LV mass >128%), and stress-adjusted LV mid-wall fractional shortening were determined. Pericardial and epicardial fat thicknesses had direct associations with BMI ( r = 0.40 and 0.45, both p < 0.01) and waist circumference ( r = 0.37 and 0.45, both p < 0.01). Pericardial (partial r = 0.35, p < 0.01), but not epicardial fat thickness (partial r = 0.05, p = n.s.), was correlated with homeostasis model assessment-insulin resistance after adjustment for BMI. Pericardial fat also had a strong negative correlation with mid-wall fractional shortening ( p = 0.01) and a positive one with inappropriately high LV mass ( p < 0.01), while no such relation was found for epicardial fat (both p = n.s.). Independently of age, male sex, BMI, and anti-hypertensive treatment, pericardial fat thickness had an independent positive association with inappropriately high LV mass ( β = 0.29, p = 0.02), and a negative one with stress-adjusted mid-wall fractional shortening ( β = −0.26, p = 0.04). Conclusions Pericardial fat thickness is associated with insulin resistance, inappropriately high LV mass, and LV systolic dysfunction in obese individuals. Findings from this study confirm the existence of a connection between insulin resistance, cardiac ectopic fat deposition and cardiac dysfunction in morbid obesity.
Background
Hyperlipidaemia is a major risk factor for cardiovascular disease, and atherosclerosis is the underlying cause of both myocardial infarction and stroke. We have previously shown that the ...Pro251 variant of perilipin‐2 reduces plasma triglycerides and may therefore be beneficial to reduce atherosclerosis development.
Objective
We sought to delineate putative beneficial effects of the Pro251 variant of perlipin‐2 on subclinical atherosclerosis and the mechanism by which it acts.
Methods
A pan‐European cohort of high‐risk individuals where carotid intima‐media thickness has been assessed was adopted. Human primary monocyte‐derived macrophages were prepared from whole blood from individuals recruited by perilipin‐2 genotype or from buffy coats from the Karolinska University hospital blood central.
Results
The Pro251 variant of perilipin‐2 is associated with decreased intima‐media thickness at baseline and over 30 months of follow‐up. Using human primary monocyte‐derived macrophages from carriers of the beneficial Pro251 variant, we show that this variant increases autophagy activity, cholesterol efflux and a controlled inflammatory response. Through extensive mechanistic studies, we demonstrate that increase in autophagy activity is accompanied with an increase in liver‐X‐receptor (LXR) activity and that LXR and autophagy reciprocally activate each other in a feed‐forward loop, regulated by CYP27A1 and 27OH‐cholesterol.
Conclusions
For the first time, we show that perilipin‐2 affects susceptibility to human atherosclerosis through activation of autophagy and stimulation of cholesterol efflux. We demonstrate that perilipin‐2 modulates levels of the LXR ligand 27OH‐cholesterol and initiates a feed‐forward loop where LXR and autophagy reciprocally activate each other; the mechanism by which perilipin‐2 exerts its beneficial effects on subclinical atherosclerosis.
OBJECTIVE:There is paucity of data about central blood pressure (BP) and vascular phenotypes in young individuals. The identification of the main determinants of central BP parameters and the BP ...amplification phenomenon may help in defining the clinical relevance of BP patterns in adolescence. We aimed at evaluating the anthropometric and hemodynamic factors associated with central pulse pressure (cPP), peripheral pulse pressure (pPP) and central-to-peripheral PP amplification (PPamp) in a population of healthy adolescents.
DESIGN AND METHOD:We studied 459 subjects (boys 57%, mean age 16.8 ± 1.5y, SBP/DBP 124/67 ± 11/7 mmHg) attending the Liceo Donatelli High School in Terni, Italy. pPP was measured by validated oscillometry. cPP was estimated from radial applanation tonometry (SphygmoCor GTF) calibrated to brachial MAP/DBP. PPamp was expressed as pPP/cPP. Indexed left ventricular mass (iLVM = LVM/BSA) and stroke index (SI = stroke volume/BSA) were derived from 2D-echocardiography (Teicholzʼs formula, Devereux correction). Carotid-femoral (cf-PWV) and carotid-radial (cr-PWV) pulse wave velocities were measured by applanation tonometry (SphygmoCor). PWV ratio was expressed as cf-PWV/cr-PWV. cPP, pPP and PPamp were introduced as dependent variables in three separate stepwise multivariate regression models. Age, male sex, BSA, heart rate (HR), MAP, stroke index (SI:stroke volume/BSA) and cf-PWV were included in each model as independent factors.
RESULTS:average cPP was 36 ± 7 mmHg, PPamp 1.57 ± 0.13. cPP was positively associated with male sex, BSA, MAP, SI, and negatively with HR. The above variables explained 47% of the cPP variance. pPP was positively associated with male sex, BSA and SI (44% of pPP variance explained). PPamp was positively associated with age, HR and cf-PWV (17% of PPamp variance explained). Results did not change when BMI and height replaced BSA, iLVM replaced SI, and cr-PWV or PWV ratio replaced cf-PWV.(Figure is included in full-text article.)
CONCLUSIONS:Anthopometric and hemodynamic factors differently impact on cPP, pPP and PPamp. HR and MAP are significantly related to cPP, but not to pPP. HR, cf-PWV and age are all positively related to PPamp. These results could help in better elucidate the clinical relevance of some BP patterns frequently observed in adolescence, such as isolated systolic hypertension and spurious hypertension.
OBJECTIVE:Heart rate (HR) is directly associated to central-to-peripheral pulse wave amplification. We aimed at evaluating the associations between heart rate and each BP component in a cohort of ...healthy adolescents.
DESIGN AND METHOD:470 healthy adolescents (17 ± 1.4 years, 56% boys, brachial BP 123/67 ± 11/7 mmHg, HR 72 ± 12 bpm) were enrolled in the present study. Brachial BP was measured on 3 occasions by validated devices. Central BP was estimated by radial and brachial applanation tonometries, and calibrated to brachial MAP/DBP (SphygmoCor).
RESULTS:Brachial and central BP were 123/67 ± 11/7 mmHg and 105/69 ± 9/8 mmHg. SBPamp was 1.17 ± 0.04, PPamp was 1.57 ± 0.13, while DBP amplification was 0.97 ± 0.01 (DBP ’attenuation’). HR had a direct correlation with brachial and central DBP (r = 0.38 and r = 0.46, both p < 0.01) and central SBP (r = 0.09, p = 0.04), but not with peripheral SBP (p = 0.59), and a negative one with brachial and central PP (r = −0.24 and r = −0.37, both p < 0.01). HR had a positive association with PPamp (r = 0.38, p < 0.01), and a negative one with SBPamp (r = −0.14, p < 0.01) and DBPamp (r = −0.55, p < 0.01). The slope of BP change for each 10-bpm HR increase was steeper for central DBP (2.8 ± 0.3 mmHg), than for peripheral DBP (2.2 ± 0.3 mmHg, p for difference between regression coefficients < 0.01), and for central and brachial DBP than for central SBP (0.7 ± 0.3 mmHg, both p < 0.01).
CONCLUSIONS:HR is associated with more pronounced changes in DBP than in SBP, and in central than peripheral DBP. Increasing HR may attenuate DBP from centre to periphery. The assumption that DBP is constant along the arterial tree may not be valid during dynamic conditions.
Background: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. Endothelial dysfunction represents the earliest stage of atherosclerosis. Objective: To evaluate ...the influence of chronic inflammatory state on endothelial function in patients with RA by measuring endothelial reactivity in young patients with RA with low disease activity and without traditional cardiovascular risk factors. Methods: Brachial flow mediated vasodilatation (FMV), assessed by non-invasive ultrasound, was evaluated in 32 young to middle aged patients with RA (age ⩽59 years), with DAS28 ⩽3.2 and without overt cardiovascular disease, and in 28 age and sex matched controls. Results: Mean (SD) FMV was significantly lower in patients than in controls (3.2 (1.3)% v 5.7 (2.0)%; p<0.001), inversely related to low density lipoprotein cholesterol (r = −0.45, p<0.05) and C reactive protein (CRP), expressed as the value at the moment of ultrasound evaluation (r = −0.44, p<0.05), as the average of CRP levels evaluated at different times during the disease (r = −0.47, p<0.05), or as the average of ⩾4 determinations multiplied by the disease duration (r = −0.40, p<0.05). In a multivariate regression model, a lower brachial flow mediated vasodilatation was independently predicted by low density lipoprotein cholesterol (β = −0.40, p<0.05), average CRP levels multiplied by the disease duration (β = −0.44, p<0.05), and brachial artery diameter (β = −0.28, p<0.05). Conclusions: Young to middle aged patients with RA with low disease activity, free from cardiovascular risk factors and overt cardiovascular disease, have an altered endothelial reactivity that seems to be primarily related to the disease associated chronic inflammatory condition.
Abstract Purpose Our study evaluated brain natriuretic peptide (BNP) changes over time after adjuvant radiotherapy (RT) in women with left-sided breast cancer investigating its correlation with heart ...dosimetric parameters. Methods Forty-three patients underwent clinical cardiac examination, electrocardiogram (ECG), echocardiography and BNP measurement before RT (T0) and 1 (T1), 6 (T6) and 12 months (T12) after. After T12 cardiac assessment was performed annually in each patient. Mean values and standard deviation (SD) of BNP, left ventricular ejection fraction (LVEF), V20, V25, V30, V45 and mean dose were calculated. Normalized BNP (BNPn) was calculated as follows: BNPnT1 = BNPT1/BNPT0, BNPnT6 = BNPT6/BNPT0, BNPnT12 = BNPT12/BNPT0. Absolute BNP and BNPn values were used for data analysis. Results Median follow-up from the end of RT to the last check-up was 87 months (range 37–120 months). Minimum follow-up was 74 months except for two patients, who died at respectively 37 and 47 months after RT. In all patients LVEF did not change significantly ( p = 0.22) after RT. BNP increased significantly ( p < 0.001), particularly 1 and 6 months after RT. It slightly decreased after 12 months. BNP did not correlate with V20, V25, V30, V45, mean dose and MHD. All BNPn correlated significantly ( p < 0.05) with V20, V25, V30, V45, mean dose and MHD. Four patients had a cardiac event; in the only subject who developed myocardial infarction, V20, V25, V30 and V45 were the highest and BNP increased from T1 and persisted high even at T12. Conclusion Our results confirm that BNP could be a useful minimally invasive marker of early RT related cardiac impairment.
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