RESUMEN
OBJECTIVE: To investigate the effect of raloxifene on atherosclerosis progression in healthy postmenopausal women. DESIGN: In a prospective fashion, a total of 155 healthy postmenopausal women were randomly assigned to receive raloxifene 60 mg/day or a matching placebo for 18 months. Atherosclerosis progression was evaluated by B-mode ultrasonography measuring the intima-media thickness (IMT) of the carotid arteries. Plasma levels of triglycerides, low-density lipoprotein cholesterol, soluble forms of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1, E-selectin, interleukin-6, tumor necrosis factor alpha, adiponectin, and the degree of insulin resistance by the homeostatic model assessment method were also determined. RESULTS: The progression slope of carotid IMT was 0.0112 mm/18 months in the raloxifene group and 0.0857 mm/18 months in the placebo group (P<0.004). Raloxifene treatment compared with placebo produced a significant decrease in plasma triglycerides (P<0.02), low-density lipoprotein cholesterol (P<0.02), soluble forms of intercellular adhesion molecule-1 (P<0.005) and vascular cell adhesion molecule-1 (P<0.04), E-selectin (P<0.02), interleukin-6 (P<0.005), tumor necrosis factor alpha (P<0.005) levels, and homeostatic model assessment index (P<0.005) and a significant increase in plasma adiponectin levels (P<0.001). Logistic regression analysis indicated that women receiving raloxifene had a lower risk of IMT progression (odds ratio=0.41; 95% CI: 0.32-0.70). CONCLUSION: Raloxifene treatment, possibly through an increase in plasma adiponectin levels, may slow the progression of IMT in postmenopausal women.
Asunto(s)
Aterosclerosis/diagnóstico por imagen , Conservadores de la Densidad Ósea/uso terapéutico , Antagonistas de Estrógenos/uso terapéutico , Clorhidrato de Raloxifeno/uso terapéutico , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , Anciano , Aterosclerosis/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/tratamiento farmacológico , Posmenopausia , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Túnica Íntima/efectos de los fármacos , Túnica Media/efectos de los fármacos , Ultrasonografía , Salud de la MujerRESUMEN
The objective of this study was to investigate the relationship between insulin resistance (IR) and subclinical atherosclerosis in patients with rheumatoid arthritis (RA). Carotid artery intima media thickness (IMT), using ultrasound evaluation, and other clinical and laboratory variables were investigated in 45 RA outpatients and in 48 controls with soft tissue disorders. IR was assayed by homeostasis model assessment (HOMA2) and metabolic syndrome by National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria. Insulin resistance, as defined by HOMA2-IR>1, was seen in 40 (88.9%) RA patients and in three (6.2%) controls (p<0.001). No significant difference was detected in the prevalence of metabolic syndrome. The median IMT was greater in RA patients (0.76 mm; interquartile range [IQR] 0.65, 0.85) than in the controls (0.66 mm; IQR 0.60, 0.72) (p<0.001). Dividing the RA patients according to the cut-off IMT value (0.72 mm), a difference was detected in both systolic (p=0.04) and diastolic blood pressure (p=0.02), disease activity score (DAS28) (p=0.008), HOMA2-IR (p<0.001) and cumulative oral steroid dose (p=0.001). Moreover, the frequency of cases with increased IMT was higher in glucocorticoid users than in non-users (21/23 vs. 9/22, respectively) (p<0.001). Spearman's rho correlation showed a significant positive relationship between IMT and HOMA2-IR (p<0.001). Multivariate stepwise analysis selected HOMA2-IR plus diastolic BP plus glucocorticoid exposure as the best predictive model for subclinical atherosclerosis (R2c=0.577, F=21, p<0.001). In conclusion, this study showed a significantly higher prevalence of IR in RA patients and pointed out a significant association between IR and subclinical atherosclerosis. This relationship may be driven primarily by exposure to steroid therapy.
Asunto(s)
Artritis Reumatoide/complicaciones , Aterosclerosis/etiología , Estenosis Coronaria/etiología , Resistencia a la Insulina , Adulto , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/epidemiología , Artritis Reumatoide/fisiopatología , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/epidemiología , Aterosclerosis/fisiopatología , Presión Sanguínea , Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/epidemiología , Estenosis Coronaria/fisiopatología , Femenino , Glucocorticoides/efectos adversos , Humanos , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Túnica Media/diagnóstico por imagen , UltrasonografíaRESUMEN
Ozonized autohemotransfusion has been used as a complementary therapy in patients with peripheral arterial disease (PAD). To determine whether ozone therapy could acutely modify artery vasodilatory capacity, a flow-mediated dilation test was performed at the brachial artery level before and after an ozonized autohemotransfusion in 16 patients with PAD, mean (± SD) age 55±1.8 years, and 14 healthy volunteers matched for age, sex and body mass index. Before ozonized autohemotransfusion, the mean baseline diameter of the brachial artery was higher in PAD patients than in healthy subjects (4.6±0.54 mm versus 3.6±0.54 mm, P<0.001) while mean flow-mediated brachial artery dilation and percentage of increase in flow were significantly lower in PAD patients than in controls (6.3±6.1% versus 11.8±2.4%, P<0.02; 433±61% versus 580±46%, P<0.02, respectively). No significant changes were observed after ozonized autohemotransfusion, indicating that ozonized autohemotransfusion does not modify endothelium-dependent ischemia-induced vascular reactivity.
RESUMEN
BACKGROUND: Atherosclerosis is a major cause of death in elderly individuals. Endothelial dysfunction is recognized as a key early event in atherogenesis. In the present study, we evaluated the possible beneficial effect of amino acid administration on endothelial regulation in elderly subjects. METHODS: A total of 25 healthy elderly subjects were administered essential amino acids (EAA) for 4 months. Before and after EAA administration, each subject underwent brachial reactivity investigation with and without an intra-arterial infusion of 4 micromol/min of N(G)-monomethyl-l-arginine (L-NMMA), an inhibitor of nitric oxide (NO) synthase. RESULTS: At baseline, age correlated with free plasma insulin growth factor-1 IGF-1 (r = -0.48; P < .01), plasma Trolox equivalent antioxidant capacity (TEAC) (r = -0.40; P < .04), and thiobarbituric acid-reactive substances (TBARS) (r = 0.42, P < .04), and homeostasis model assessment (HOMA) index (r = 0.45, P < .03), as well as with changes in diameter (r = -0.49, P < .01) and flow (r = -0.43, P < .03). Administration of EAA was associated with a significant increase in plasma TEAC (P < .001) and decline in plasma TBARS (P < .001) and with improvement in changes in diameter (7.15 +/-1.10 v 8.98 +/-1.80, P < .001) and flow (5.6 +/-1.2 v 6.4 +/- 1.2, P < .03). These latter two associations were independent of changes in HOMA index (P < .04 for both correlations). The beneficial effects of EAA administration on brachial reactivity were partly attenuated by L-NMMA. CONCLUSIONS: Administration of EAA may improve brachial reactivity in elderly persons and may also protect against the development of atherosclerosis via the rise in plasma-free IGF-1 levels.
Asunto(s)
Aminoácidos Esenciales/administración & dosificación , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Arteria Braquial/fisiología , Estrés Oxidativo/efectos de los fármacos , Administración Oral , Anciano , Antioxidantes/metabolismo , Velocidad del Flujo Sanguíneo/fisiología , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/efectos de los fármacos , Cromanos/sangre , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiología , Inhibidores Enzimáticos/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intraarteriales , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Óxido Nítrico Sintasa/antagonistas & inhibidores , Variaciones Dependientes del Observador , Radioinmunoensayo , Valores de Referencia , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo , Ultrasonografía , omega-N-Metilarginina/administración & dosificaciónRESUMEN
OBJECTIVE: To evaluate the effects of soy isoflavone administration on endothelial function in healthy postmenopausal women. DESIGN: Sixty naturally postmenopausal women were randomly assigned to receive isoflavone or placebo tablets for 6 months. Endothelium-dependent vasodilatation was measured by brachial reactivity technique along with levels of plasma soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, P-selectin and soluble thrombomodulin, von Willebrand factor, and tissue plasminogen activator. Differences between endothelium-dependent and endothelium-independent vasodilatation were assessed by evaluating brachial reactivity parameters after reactive hyperemia and after sublingual administration of nitroglycerin; furthermore, in the active group, the effect of isoflavones was also evaluated during the intra-arterial infusion of N-monomethyl-L-arginine. Serum levels of lipids [high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides and lipoprotein(a)] and hemostatic factors (prothrombin, fibrinogen, plasminogen activator inhibitor-1, and fibrin D-dimer) were also measured. To confirm the absorption of isoflavones, their blood concentrations were determined. RESULTS: Isoflavone treatment versus placebo was associated with a significant improvement in endothelium-dependent vasodilatation but had no impact on endothelial-independent arterial diameter and flow. Intra-arterial infusion of N-monomethyl-L-arginine inhibited the significant effect of isoflavones on endothelium-mediated vasodilatation. Furthermore, isoflavone group experienced statistically significant reductions in plasma concentrations of ICAM-1, VCAM-1, and E-selectin. Levels of soluble thrombomodulin, von Willebrand factor, tissue plasminogen activator, lipids, and hemostatic factors did not change significantly throughout the study in both groups. CONCLUSIONS: Our findings suggest a positive influence of soy isoflavones on endothelial function in healthy postmenopausal women as evidenced by an improvement in endothelium-dependent vasodilatation and a reduction in plasma adhesion molecule levels.
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Endotelio Vascular/efectos de los fármacos , Genisteína/farmacología , Isoflavonas/farmacología , Fitoestrógenos/farmacología , Posmenopausia , Arteria Braquial/anatomía & histología , Arteria Braquial/efectos de los fármacos , Arteria Braquial/fisiología , Dieta , Selectina E/sangre , Endotelio Vascular/fisiología , Femenino , Genisteína/administración & dosificación , Genisteína/sangre , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Isoflavonas/administración & dosificación , Isoflavonas/sangre , Persona de Mediana Edad , Selectina-P/sangre , Fitoestrógenos/sangre , Estudios Prospectivos , Glycine max , Molécula 1 de Adhesión Celular Vascular/sangre , Vasodilatación/efectos de los fármacosRESUMEN
In 44 patients affected by systemic lupus erythematosus (SLE) without any clinical signs of heart disease (group I) the myocardial performance index (MPI) was calculated to investigate left ventricular function. The index, as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), was measured by tissue Doppler echocardiography (TDE). Results achieved show a prolonged MPI with respect to the values recorded in healthy controls (group II). Its prolongation is due to a significant increase of IRT, whereas ICT and ET were within the normal limits. In patients with SLE without an evident cardiac engagement, this outcome seems to depend on a prevalent diastolic left ventricular dysfunction, perhaps due to a subclinical myocarditis. TDE is more precise than the conventional Doppler method in evaluating MPI and single time intervals, because their measurements are accomplished in concomitance of left ventricular wall motion rather than the flow movement.
Asunto(s)
Ecocardiografía Doppler de Pulso , Lupus Eritematoso Sistémico/complicaciones , Contracción Miocárdica/fisiología , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Pruebas de Función Cardíaca , Hemodinámica/fisiología , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Probabilidad , Estudios Prospectivos , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnósticoRESUMEN
To define the degree of heart derangement in recent myocardial infarction (MI) occurring in different wall locations of myocardium, we echocardiographically evaluated left ventricular volumes, ejection fraction, wall-motion score index, isovolumetric contraction and relaxation time, ejection time, and index of myocardial performance in 74 patients with MI. Participants were chosen among the patients with MI of comparable extent and interesting unlike zones of myocardial walls. Mean values of evaluated left ventricular end-diastolic and end-systolic volumes and ejection fraction were nearly alike in all patients, whereas wall-motion score index and index of myocardial performance were cleary prolonged in those with anterior MI in comparison with the values recorded in patients with lateral or inferior MI. The mean values of isovolumetric contraction and relaxation time suggest that a prevalent systolic dysfunction is present in the early phase of MI. In addition, the different index of myocardial performance prolongation in MI otherwise located suggests evidence that MI located in the anterior wall has more serious effect than lateral or inferior MI.