The problem of recurrent urinary tract infections (UTI) in patients with type 2 diabetes mellitus (DM 2) is relevant, especially when there is a combination of predisposing factors, such as female ...gender, history of UTI episodes, and therapy with sodium glucose cotransporter type 2 (SGLT-2) inhibitors, and the choice of effective and safe means could cause some difficulties, including ina terms of the burden of antibiotic resistance.
To evaluate the effectiveness and safety of the phytoproduct Canephron
N for the prevention of exacerbations of recurrent cystitis and the effect on metabolic parameters in patients with type 2 diabetes taking SGLT-2 inhibitors.
Prospective, randomized, open, parallel group study in 60 women. The main group took the drug Canephron
N for 3 months. The main parameters for evaluating were the frequency of recurrence of cystitis, level of albuminuria and LDL-cholesterol peroxidation product - malondialdehyde.
Within 3 months of taking Canephron
N, exacerbations of chronic cystitis were diagnosed 2 times less often, a decrease in albuminuria was found in the form of an increase in the proportion of patients with an optimal level of albuminuria by 20%, a 50% reduction in the frequency of the initial increase in albuminuria, and the absence of moderate albuminuria in all patients at the end of course of therapy. A decrease in the level of MDA by 1.4 times was noted (
0.019).
Thus, the herbal drug Canephron
N can be used for accompanying therapy and prophylactic treatment in patients with recurrent cystitis on the background of DM 2, taking SGLT-2 inhibitors. The course of therapy should last at least 3 months.
One of the most common congenital metabolic disorders is familial hypercholesterolemia. Familial hyper-cholesterolemia is a condition caused by a type of genetic defect leading to a decreased rate of ...removal of low-density lipoproteins from the bloodstream and a pronounced increase in the blood level of total cholesterol. This disease leads to the early development of cardiovascular diseases of atherosclerotic etiology. Familial hypercholesterolemia is a monogenic disease that is predominantly autosomal dominant. Rare pathogenic variants in the
LDLR
gene are present in 75–85 % of cases with an identified molecular genetic cause of the disease, and variants in other genes (
APOB, PCSK9, LDLRAP1
,
ABCG5, ABCG8
, and others) occur at a frequency of < 5 % in this group of patients. A negative result of genetic screening for pathogenic variants in genes of the low-density lipoprotein receptor and its ligands does not rule out a diagnosis of familial hypercholesterolemia. In 20–40 % of cases, molecular genetic testing fails to detect changes in the above genes. The aim of this work was to search for new genes associated with the familial hypercholesterolemia phenotype by modern high-tech methods of sequencing and machine learning. On the basis of a group of patients with familial hypercholesterolemia (enrolled according to the Dutch Lipid Clinic Network Criteria and including cases confirmed by molecular genetic analysis), decision trees were constructed, which made it possible to identify cases in the study population that require additional molecular genetic analysis. Five probands were identified as having the severest familial hypercholesterolemia without pathogenic variants in the studied genes and were analyzed by whole-genome sequencing on the HiSeq 1500 platform (Illumina). The whole-genome sequencing revealed rare variants in three out of five analyzed patients: a heterozygous variant (rs760657350) located in a splicing acceptor site in the
PLD1
gene (c.2430-1G>A), a previously undescribed single-nucleotide deletion in the
SIDT1
gene c.2426del (p.Leu809CysfsTer2), new missense variant c.10313C>G (p.Pro3438Arg) in the
LRP1B
gene, and single-nucleotide deletion variant rs753876598 c.165del (p.Ser56AlafsTer11) in the
CETP
gene. All these variants were found for the first time in patients with a clinical diagnosis of familial hypercholesterolemia. Variants were identified that may influence the formation of the familial hypercholesterolemia phenotype.
Chronic heart failure is a global cardiac problem. The last decade can rightly be called a breakthrough in the treatment of this nosology, due to the emergence of a new group of drugs – SGLT2 ...inhibitors (gliflozins), which, both in patients with initial heart failure with different ejection fraction, and in the presence of risk factors for its development, have a persistent positive impact on the number of hospitalizations for heart failure. A number of pleiotropic effects of SGLT2 inhibitors are also attractive to the clinician, which include moderate weight loss, a decrease in body fat in visceral fat depots, a decrease in the level of hepatic transaminases in the blood, stimulation of erythropoiesis, which organically complements the strategy of complex cardiorenometabolic protection and emphasizes the unique role of this class drugs in modern cardiology. In the near future, we will have to learn the results of the ongoing multiple studies of gliflozin, which is highly likely to open new historical horizons in the treatment of patients with cardiovascular diseases, including various categories of patients with acute and chronic heart failure.
The article presents step by step international CARE guidelines (CAse REport), which regulate the structure of the description of a clinical case and include a checklist of 13 points. This form of ...presentation of the material does not create any difficulties in understanding, does not require a long period of time to prepare a publication for the author, demonstrating a unique personalized experience and informing the medical community about interesting clinical manifestations, diagnostic or therapeutic approaches within a particular nosology, as well as describing rare or newly reported side effects of drugs or features of their prescription. Below as an example presented a clinical observation of a young man with diabetes mellitus of complex origin, which was diagnosed after the initial diagnosis of type 2 diabetes mellitus, which was later supplemented with recurrent pancreatitis, pancreatic cyst development and alcohol abuse with underlying severe hypertriglyceridemia (up to 67 mmol/l). Given the limited choice of glucose-lowering therapy, inability to prescribe metformin, glucagon-like peptide-1 agonists, infeasibility to use dipeptidyl peptidase 4 inhibitors and gliflozins (history of episodes of balanoposthitis), after a detailed discussion with the patient, a decision was made to prescribe a combination insulin drug – biphasic Lispro (RinLis Mix 25, Geropharm, Russia), which, together with fundamental lifestyle changes, strong alcohol avoidance, and regular medical follow-ups, allowed him to achieve glycemic targets and reduce plasma triglyceride levels, which once again supported the versatility of insulin as hypoglycemic agent, easiness to use and comprehensive glycemic control, if pre-mixed ultra-fast-acting insulin analogue and its protaminized analogue are prescribed. The prescription of insulin premix in this case is also justified in terms of clinical guidelines, as the man led a regular lifestyle, had low physical activity, an HbA1c level greater than 1.5% of the target value, as well as fasting and postprandial hyperglycemia.
Aim of the study was to evaluate the efficacy and safety of the combined use of statins with ezetimibe in patients of various nosological groups of high and very high cardiovascular risk.
Material ...and methods
. A prospective interventional non-randomized study included 40 people, mean age 60.7±9.5 years, high and very high cardiovascular risk, who did not receive statin therapy or took statins without reaching the target low density lipoprotein (LDL) cholesterol values. Patients were recommended to receive high-intensity statin therapy in combination with ezetimibe for 3 months. Biochemical parameters were determined by standard enzymatic methods and the beginning of combined lipid-correcting therapy and after 3 months.
Results
. In patients with high cardiovascular risk, the level of total cholesterol decreased by 39.7 % 3 months after treatment (6.8 ± 2.5 and 4.7 ± 2.5 mmol/L; p = 0.0001), the level of LDL cholesterol by 52.2 % (4.6 ± 2.4 and 2.8 ± 2.2 mmol/L; p = 0.0001), the TG level by 26 % (2.7 ± 1.1 and 2.0 ± 1.0 mmol/L; p = 0.008). In the group of patients with very high cardiovascular risk, we also noted a decrease in the total cholesterol level by 39.1 % (6.4 ± 1.4 and 4.4 ± 1.2 mmol/L; p = 0.0001), the level of LDL cholesterol by 45.5 % (4.4 ± 1.4 and 2.5 ± 0.9 mmol/L; p = 0.0001). We did not find statistically significant changes in the remaining lipid parameters. LDL cholesterol targets were achieved in 64 % of patients with high and 52 % of very high cardiovascular risk. There were no significant changes in activity of alanine and aspartate amino transferases, content creatine phosphokinase, glucose and glycated hemoglobin, glomerular filtration rate.
Conclusions
. Initial combination therapy with statin and ezetimibe is well tolerated and can reduce LDL cholesterol levels by 2 times within 3 months in various categories of patients with high and very high cardiovascular risk.
Aim
of the study was to investigate the main components of the lipid spectrum of blood serum in patients with coronary artery disease, depending on the level of estradiol (E2), testosterone (T) and ...age.
Material and methods
. We examined 161 men aged 35–65 years (median lower quartile; upper quartile 53.1 40.1; 59.4 years) with a history of myocardial infarction more than 30 days before inclusion in the study. Patients were divided into groups by age (35–55 and 56–65 years), as well as according to the content of sex hormones: T ≥ 12 nmol/l and T < 12 nmol/l, E2 ≥ 0.194 nmol/l and E2 < 0.194 nmol/l with double determination.
Results.
Of the studied components of the lipid profile, the greatest number of significant changes in men with coronary artery disease in different groups, depending on age and levels of sex steroids, had triglyceride (TG) level. In men aged 35–55 and 56–65 years with hypogonadism, TG concentration was higher compared to peers with normal androgen levels. In the older age group, relatively younger male patients, both when comparing a cohort of men with low T and with its normal values, TG content was also higher. In groups of patients with T level > 12 nmol/l and ≤ 12 nmol, when controlling for height and body weight, there is a statistically significant direct association of age in men of 56–65 years with TG concentration (r = 0.483, p = 0.023 and r = 0.549, p = 0.008, respectively). It was found that in patients with coronary artery disease in the age groups of 35–55 years and 56–65 years with E2 content ≥ 0.194 nmol/l, the TG level was higher than in men with normal estrogen concentration (p = 0.008 and p = 0.033, respectively). In a partial correlation analysis with control of height and body weight in men aged 35–55 years with coronary artery disease, a statistically significant relationship was found between the level of E2 ≥ 0.194 nmol/l and TG content (r = 0.566, p = 0.009), a similar relationship independent of anthropometric parameters was verified and in the older age group (r = 0.316, p = 0.011). In a multivariate analysis, the level of TG was determined by E2 concentration, the other variables under consideration did not statistically significantly affect it.
Conclusions.
Hypogonadism in men in each age group studied is associated with elevated TG content. A significant role in the development of hypertriglyceridemia in men is played by hyperestrogenemia in both age groups, being an independent, independent of androgenic status, proatherogenic factor.
The aim
of the study was to investigate Klotho protein levels in men with type 2 diabetes blood and its associations with several cardiometabolic risk factors.
Material and methods.
The study ...included 37 men with diabetes and 141 men without diabetes. Fasting blood samples were collected to measure Klotho protein levels and some biochemical parameters.
Results and its discussion.
The Klotho protein level in men with diabetes was significantly lower than in men without diabetes (374 117; 500 and 515 315; 1009 pg/dl, p<0.0001). Among the examined men with diabetes with a glomerular filtration rate of less than 60 ml/min/1.73 cm
2
, the concentration of Klotho protein was 4 times lower than in the comparison group (104 93; 118 and 413 147; 535 pg/dl, p = 0.014) In men with diabetes, the Klotho protein was inversely correlated with the ratio of waist to hip circumference (-0.329; p = 0.047). But with multivariate analysis, only a tendency towards a negative association of the Klotho protein with abdominal obesity was determined (-0.385, p = 0.078).
Conclusion.
The content of Klotho protein in men with diabetes is significantly lower, especially in middle-aged men and in those with a reduced glomerular filtration rate. In men with diabetes, the Klotho protein has a negative correlation with the presence of abdominal obesity. In a multivariate analysis among men with diabetes, the Klotho protein tends to be inversely associated with the presence of abdominal obesity.
Despite the advances in lipidology over the past decade, the control of dyslipidemia at the population level in Russia, as in a number of European countries, remains unsatisfactory. The need for ...novel organizational approaches to solving the problem at the regional and federal levels is obvious. This publication provides an overview of the implemented projects and the successful practical experience of lipid centers in Russia, as well as the prospects for the development of novel models that will optimize the care provision for patients with lipid metabolism disorders at the population level.
Aim. Russian multicenter register of familial hypercholesterolemia (FH) was transformed into Register of patients with FH and very high cardiovascular risk with insufficient effect of hypolipidemic ...therapy (RENESSANS Registry) in 2017 The aim of RENESSANS was maximal inclusion of patients not only with FH, but also those with atherosclerotic cardiovascular diseases (CVD), who did not achieve targeted level of low density lipoprotein cholesterol (LDL-C) using hypolipidemic drug therapy.Material and methods. The RENESSANS Registry is an open, national, observing study that includes patients with definite and probable (according to Dutch lipid clinic network and Simon Broome Registry criteria) heterozygous and homozygous FH, as well as patients of very high cardiovascular risk. There were designed two register forms: for patients with FH and for very high cardiovascular risk patients. Doctors filled out forms in paper and electronic variants. They took into consideration the risk factors of atherosclerosis and anamnesis of CVD, adherence to diet and hypolipidemic therapy. Concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were measured in blood serum in all centers. LDL-C level was defined according to Friedewald formula: LDL-C=TC-HDL-C-TG/2,2 (mmol/l).Results. The Registry consisted of 1208 FH patients and 497 patients with very high risk (average age 54±13 and 61±8, respectively, 37% men). Baseline levels of lipids were 9,4±2,3 and 6,9±1,5 mmol/l for TC, 6,6±2,1 and 4,5±1,3 mmol/l for LDL-C, respectively. The frequency of hypolipidemic therapy in both groups is 70%, while targeted level of LDL-C was achieved extremely rarely.Conclusion. The results show insufficient adherence and low effectiveness of standard hypolipidemic therapy both in patients with FH and very high cardiovascular risk. PCSK9 inhibitors are recommended for resistant hypercholesterolemia treatment. The RENESSANS Registry allows to improve FH diagnostics, to assess treatment effectiveness and choose patients who need treatment with PCSK9 inhibitors.
To evaluate the effect of decompensated HF with preserved or slightly impaired EF on the risk of cardiovascular complications during a 5‑year follow-up.
33 patients with arterial hypertension and HF ...with preserved or slightly impaired EF (NT-proBNP ≥125 pg/ml, mean, 500.1±590.32 pg/ml and EF ≥40 %, mean, 57.0±10.29 %) were observed for 5 years. EchoCG, markers of immune inflammation and hormonal changes (endothelin, tumor necrosis factor (TNF), interleukin-6 (IL-6), aldosterone, renin) were evaluated at baseline. The endpoint was development of acute fatal and non-fatal cardiovascular events (CVEs). The one-way regression analysis was used to identify predictors of the risk for CVEs. The ROC analysis was used to determine "threshold levels" of significant predictors for this risk.
During the 5‑year follow-up period, CVEs developed in 13 (39.4 %) patients. The CVE predictors included baseline increases in creatinine and IL-6, NT-proBNP and a greater decrease in EF (р.
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