RESUMEN
INTRODUCTION: The aim of the present study was to investigate the association between cardiovascular risk factors and endothelial dysfunction in patients with mixed connective tissue disease (MCTD) and to determine which biomarkers are associated with atherosclerotic complications, such as cardiovascular disease. METHODS: Fifty MCTD patients and 38 healthy age-matched and sex-matched controls were enrolled in this study. In order to describe endothelial dysfunction, we assessed flow-mediated dilation (FMD), nitrate-mediated dilation (NMD) and carotid artery intima-media thickness (IMT). We investigated FMD of the brachial artery after reactive hyperemia and NMD after sublingual nitroglycerin administration, while the IMT of the common carotid artery was determined by ultrasound. Anti-U1 ribonucleoprotein (anti-U1RNP) antibodies, anti-cardiolipin (anti-CL) antibodies, anti-endothelial cell antibody (AECA) and endothelial cell markers, such as soluble thrombomodulin (TM) and von Willebrand factor antigen (vWFAg), were assessed. RESULTS: The endothelium-dependent vasodilation (FMD) was significantly impaired in patients with MCTD, as compared with controls (%FMD: 4.7+/-4.2% vs. 8.7+/-5.0%; P<0.001), while the percentage NMD did not differ (%NMD: 14.3+/-6.6% vs. 17.1+/-6.7%; P=0.073). Mean carotid IMT values were higher in patients than in controls (IMT: MCTD, 0.64+/-0.13 mm vs. controls, 0.53+/-0.14 mm; P<0.001). FMD negatively correlated with disease duration, the levels of apolipoprotein A1, the paraoxonase-1 activity, and systolic blood pressure in MCTD patients. The percentage FMD was significantly lower in MCTD patients with cardiovascular diseases (CVD), than in those without CVD (%FMD: 3.5+/-2.9 vs. 5.8+/-4.8, P<0.0002), while percentage NMD did not differ between patients with and without CVDs. Serum levels of autoantibodies (anti-U1RNP, AECA and anti-CL) were significantly higher in MCTD patients and differed between MCTD patients with and without CVD. Endothelial cell markers such as soluble TM (12.2+/-8.1 ng/ml vs. 3.2+/-1.3 ng/ml; P<0.001) and vWFAg (224.1+/-115% vs. 89.4+/-27.1%, P<0.001) were the highest in MCTD patients with CVD. CONCLUSIONS: FMD is a reliable sensitive marker of endothelial cell dysfunction in MCTD. Beside the traditional risk factors, anti-U1RNP, AECA and anti-CL antibodies may be important not only in the pathogenesis of MCTD but in the induction of endothelial cell activation, and may play crucial roles in the development of early atherosclerosis in MCTD.
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Endotelio Vascular/fisiopatología , Enfermedad Mixta del Tejido Conjuntivo/fisiopatología , Trombomodulina/sangre , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , Vasodilatación/fisiología , Factor de von Willebrand/metabolismo , Adolescente , Adulto , Anciano , Anticuerpos/sangre , Aterosclerosis/epidemiología , Autoanticuerpos/sangre , Biomarcadores/sangre , Arteria Braquial/efectos de los fármacos , Arteria Braquial/fisiopatología , Cardiolipinas/inmunología , Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Endotelio Vascular/metabolismo , Femenino , Humanos , Persona de Mediana Edad , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/metabolismo , Nitroglicerina/farmacología , Ribonucleoproteínas/inmunología , Factores de Riesgo , Sensibilidad y Especificidad , Ultrasonografía , Vasodilatadores/farmacología , Adulto JovenRESUMEN
UNLABELLED: Currently, peripheral arterial disease is an underdiagnosed disorder. Several modifiable and non-modifiable risk factors have role in its development and progression. As system disorder it might be a part and an important predictor of fatal cardio- and cerebrovascular events. CASE REPORT: The authors describe the case of a 73-year-old male with multilocational vascular disorder, with simultaneously occurring carotid disease, critical limb ischaemia with aorto-bifemoral bypass, multiple infarction with mechanical complication, inoperable coronary disease and with implantable cardioverter defibrillator for ventricular arrhythmia. CONCLUSION: Peripheral arterial disease affects the whole vascular system and can progress into serious cardiac and cerebral manifestations causing the patient's death inspite of comprehensive treatment.
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Enfermedades Vasculares Periféricas/diagnóstico , Enfermedades Vasculares Periféricas/terapia , Anciano , Angiografía de Substracción Digital , Aorta/cirugía , Estenosis Carotídea/complicaciones , Angiografía Coronaria , Enfermedad Coronaria/complicaciones , Desfibriladores Implantables , Electrocardiografía , Resultado Fatal , Arteria Femoral/cirugía , Humanos , Isquemia/complicaciones , Isquemia/cirugía , Pierna/irrigación sanguínea , Masculino , Enfermedades Vasculares Periféricas/complicaciones , Choque Cardiogénico/complicaciones , Taquicardia Ventricular/complicaciones , Taquicardia Ventricular/terapia , Procedimientos Quirúrgicos VascularesRESUMEN
OBJECTIVE: Endothelial dysfunction and vasculopathy of the small and large vessels are crucial pathogenic factors in systemic sclerosis (SSc). Accelerated atherosclerosis and impaired flow-mediated vasodilation have been described in SSc. We evaluated arterial stiffness in patients with SSc compared to healthy controls. METHODS: Augmentation index (AI) and pulse wave velocity (PWV) of the brachial artery were measured in 40 patients with SSc and 35 age and sex matched healthy controls using an arteriograph system. RESULTS: AI was significantly higher in SSc patients (9.02) compared to controls (-41.15) (p < 0.0001). PWV was similarly higher in patients with SSc (9.67 m/s) than in controls (8.00 m/s) (p = 0.0017). PWV was significantly higher in patients with localized SSc (10.04 +/- 2.01 m/s) compared to those with diffuse SSc (8.39 +/- 1.87 m/s) (p = 0.034). There was a significant, positive linear correlation between AI and PWV (r = 0.32, p = 0.045). We also observed significant correlations between AI and age (r = 0.31, p = 0.048), PWV and age (r = 0.36, p = 0.021), and PWV and disease duration (r = 0.40, p = 0.011) in SSc patients. CONCLUSION: Increased AI and PWV of the aorta in comparison to age and sex matched healthy controls indicate increased large-vessel stiffness in patients with SSc. PWV and AI are reproducible indicators of the presence and degree of arterial stiffening. Because arterial stiffness may correlate with disease duration and age in patients with SSc, it may be a useful diagnostic test in the assessment of arterial function. Increased vascular stiffness may be therapeutically targeted by statins and other vasoprotective agents during the management of SSc.
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Arteria Braquial/fisiopatología , Esclerodermia Sistémica/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiopatología , Determinación de la Presión Sanguínea , Estudios de Casos y Controles , Elasticidad , Endotelio Vascular/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Pulsátil/fisiologíaRESUMEN
In this study the authors analyzed the action of Flavon Max product on the cardiovascular system of patients with severe coronary disease. Two randomized, double-blind, placebo controlled trials were carried out using impedance-cardiography, arteriography, vascular Doppler and biochemical laboratory methods. The results demonstrate that Augmentation Index measured with arteriography and C reactive protein (CRP) levels were significantly ameliorated after 2 x 2 months Flavon Max therapy. In conclusion, this product is beneficial as adjuvant in the treatment of atherosclerotic coronary disease.
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Fármacos Cardiovasculares/farmacología , Puente de Arteria Coronaria , Flavonoides/farmacología , Fenoles/farmacología , Adulto , Anciano , Angiografía , Proteína C-Reactiva/metabolismo , Cardiografía de Impedancia , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polifenoles , Factores de Tiempo , Túnica Íntima/patología , Túnica Media/patología , Arteria Cubital/patología , Ultrasonografía DopplerRESUMEN
The aim was to measure the level of antibodies to oxidized LDL (oxLDL) and C-reactive protein (CRP) in the serum of patients with acute coronary syndrome (ACS). The results were correlated with data obtained from patients with stable coronary artery disease (stable CAD) and healthy controls. Thirty-three patients with ACS and 62 stable CAD patients were enrolled in the study. Fifty healthy individuals served as controls. The evaluation of anti-oxLDL autoantibodies was performed by ELISA, while CRP levels were measured by turbidimetry. The level of antibodies to oxLDL was significantly higher in both groups of patients with ACS and stable CAD compared to controls. The comparison between the acute and stable groups showed that anti-oxLDL levels were higher in the acute group, but because of high SD, the difference was not significant. By performing group analysis, anti-oxLDL levels were found to be significantly higher in ACS patients with unstable clinical state (circulatory insufficiency, malignant arrhythmias, recurring ischemic pain, need for urgent coronary intervention and death). CRP level in patients with ACS was significantly higher than in those with stable CAD. A positive correlation was found between anti-oxLDL antibodies and CRP levels both in patients with ACS and stable CAD. The association between the two biomarkers was stronger in the ACS group. In conclusion, our findings support the notion that the presence of antibodies to oxLDL, a plaque-specific antigen, plays a major role as a predictor of complicated manifestations of ACS.
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Autoanticuerpos/sangre , Proteína C-Reactiva/inmunología , Enfermedad de la Arteria Coronaria/inmunología , Lipoproteínas LDL/inmunología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Autoinmunidad , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
In the development of atherosclerotic plaques we can identify three autoantigens, the pathological value of which has been proven by experimental and clinical data. These antigens are the 60 kDa heat-shock-protein, beta2-glycoprotein I and oxidized LDL. They have role in the antigen-specific T-cell differentiation processes, moreover, against these antigens autoantibodies are produced, which have prothrombotic activity, leading to the acceleration of atherosclerosis. In autoimmune diseases besides these factors other mechanisms are present, which lead to the development of autoimmune vasculopathies. The current review gives an overview of these vasculopathies.
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Autoanticuerpos/sangre , Enfermedades Vasculares/inmunología , Síndrome Antifosfolípido/inmunología , Autoinmunidad , Chaperonina 60/inmunología , LDL-Colesterol/inmunología , Humanos , Peroxidación de Lípido , Linfocitos T/inmunología , beta 2 Glicoproteína I/inmunologíaRESUMEN
Systemic lupus erythematosus is associated with accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Objectives were to determine endothelial dysfunction with a non-invasive method in lupus patients and to analyse correlation with risk factors and atherosclerotic complications. Sixty-one SLE patients and 26 healthy age- and sex-matched control subjects were entered into the study. The diameters of brachial artery at rest, during reactive hyperaemia, and after glyceril trinitrate administration, as well as the intima-media thickness of the common carotid artery were measured using high-resolution B-mode ultrasonography. Demographic characteristics, lipid profile, paraoxonase activity, concentration of anti-phospholipid antibodies and anti-oxLDL were assessed together with atherosclerotic complications. The endothelium dependent vasodilation (FMD) was significantly impaired in SLE patients as compared to controls. The absolute difference of vessel diameter (Deltad) was 0.25+/-0.15 mm vs. 0.38+/-0.16 mm (p=0.001), and Deltad as in percent of the rest diameter was 7.31+/-5.2% vs. 9.86+/-3.87% (p=0.013) in lupus patients and controls, respectively. Nitrate mediated dilation (NMD) did not differ. FMD negatively correlated with age, systolic and diastolic blood pressure in SLE, but did not show significant correlation with the other examined parameters. However, FMD significantly differed between SLE patients with (5.54+/-4.36%) and without (8.81+/-5.28%) cardiovascular complications (p=0.01). The determination of flow-mediated vasodilation is a useful method to detect endothelial dysfunction in lupus patients, as reduced capacity of brachial artery may distinguish between SLE patients and healthy subjects, as well as lupus patients with and without atherosclerotic vascular complications.