Plasma Homocysteine Is Associated with Aortic Arterial Stiffness but not Wave Reflection in Chinese Hypertensive Subjects

Objective

Elevated plasma total homocysteine (tHcy) acts synergistically with hypertension to exert a multiplicative effect on cardiovascular diseases risk. The aim of this study was to determine the relationship between tHcy concentration and blood pressure, and to evaluate the role of plasma tHcy in arterial stiffness and wave reflection in hypertension.

Methods

In this cross-sectional study, a community-based sample of 1680 subjects (mean age 61.6 years) was classified into four groups according to tHcy level (<21.6 vs. ≥21.6 µmol/l) and blood pressure (hypertensive vs. normotensive). Levels of plasma tHcy and other biochemical parameters (e.g., lipids, glucose) were determined. Central arterial blood pressure, reflected pressure wave, and carotid-femoral pulse wave velocity (cf-PWV) were assessed by tonometry within 2 days of obtaining the blood specimen.

Results

Neither peripheral nor central blood pressure differed according to tHcy levels in normotensive and hypertensive subjects. Differences in cf-PWV according to tHcy were observed only in hypertensive subjects; differences in cf-PWV in normotensive subjects were not significant after adjusting for confounding factors. Central augmentation index did not differ according to tHcy level in either normotensive or hypertensive subjects. Results of univariate analysis revealed significant correlations between blood pressure parameters and tHcy concentration only among normotensive subjects; however, these correlations were not significant in a partial correlation analysis. Results of multiple regression analysis showed that plasma tHcy levels were independently correlated with cf-PWV in hypertensive subjects (β = 0.713, P = 0.004). The independent relationship between tHcy and central augmentation index was not significant by further multiple analyses in normotensive or hypertensive individuals.

Conclusions

Plasma tHcy level is strongly and independently correlated with arterial stiffness measured as cf-PWV only in hypertensive subjects. Thus, hypertension is a major link between tHcy and aortic arterial stiffness.     

Cytomegalovirus Seropositivity Is Associated with Increased Arterial Stiffness in Patients with Chronic Kidney Disease

Background

Patients with chronic kidney disease have an increased cardiovascular risk that is not fully explained by traditional risk factors but appears to be related to increased arterial stiffness. Cytomegalovirus (CMV) infection is associated with increased cardiovascular risk although the mechanisms for this are unknown. We examined whether CMV seropositivity was associated with increased arterial stiffness in patients with chronic kidney disease.

Methodology and Principal Findings

In 215 non-diabetic patients with chronic kidney disease, CMV seropositivity was determined using an anti-CMV IgG ELISA. Pulse wave velocity was measured and aortic distensibility assessed in the ascending, proximal descending and distal descending thoracic aorta. Patients seropositive for CMV had a higher pulse wave velocity and lower aortic distensibility at all 3 levels. These differences (except for ascending aortic distensibility) persisted in a subcohort matched for age, gender and renal function, and when the whole cohort was divided into quartiles of age. In multivariable analyses, CMV seropositivity was an independent determinant of pulse wave velocity and proximal and distal descending aortic distensibility.

Conclusions

In patients with chronic kidney disease, CMV seropositivity is associated with increased arterial stiffness and decreased distensibility of the proximal descending and distal aorta. These findings suggest that further research is required to examine CMV as a possible cause of arterial disease and increased cardiovascular risk in patients with CKD and may be relevant more widely for CMV seropositive patients with normal renal function.     

脉搏波传导速度检测在评价高血压病患者大动脉弹性中的应用 与影响因素分析

目的:探讨脉搏波传导速度(PWV)检测在评估高血压病患者大动脉弹性中的应用价值与影响因素分析 方法:采用分层整体抽样法随机抽取高血压病患者2178例,同时抽取非高血压2182人作为对照组.应用Complior SP VP-1000动脉硬化检测仪测定颈一股动脉脉搏波传导速度(C-FPWV)评估大动脉弹性.采用多元逐步线性回归分析性别、年龄、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三脂(TG)、空腹血糖(FPG)和尿酸(UA)等指标与高血压痛患者大动脉弹性下降的影响因素.结果:C-FPWV平均值高血压组(1594± 264cm/s)显著高于对照组(1216± 231cm/s),两组差异有显著性意义(X2=31.659,P=0.00).＞40岁各年龄段PWV值上升程度,高血压组明显高于对照组(X2＝ 18.954～36.924,P=0.00),两组PWV值上升程度与年龄呈正相关.多元逐步线性回归分析表明:BMI≥28kg/m2、SBP≥ 140mmHg、DBP≥90mmHg、TC＞5.28± 0.62 mmol/L、TG＞ 1.68± 0.64mmol/L等指标高血压组明显高于对照组(t=14.314～17.428,P＜0.05).在性别、UA和FPG等指标两组无明显差异(X2=6.368～13.618,P＞0.05).结论:高血压痛患者PWV值上升程度显著高于非高血压者,BMI、SBP、TG、TC是高血压病患者大动脉弹性下降的主要影响因素.PWV值可作为评价大动脉弹性的可靠指标.     

Modifiable Risk Factors for Increased Arterial Stiffness in Outpatient Nephrology

Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.     

Effects of Exercise Modalities on Arterial Stiffness and Wave Reflection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Objectives

Physical activity is associated with lower cardiovascular and all-cause mortality. However, the effects of different exercise modalities on arterial stiffness are currently unclear. Our objectives were to investigate the effects of exercise modalities (aerobic, resistance or combined) on pulse wave velocity (PWV) and augmentation index (AIx), and to determine whether the effects on these indices differed according to the participants'' or exercise characteristics.

Methods

We searched the Medline, Embase and Cochrane Library databases from inception until April 2014 for randomized controlled trials lasting ≥4 weeks investigating the effects of exercise modalities on PWV and AIx in adults aged ≥18 years.

Results

Forty-two studies (1627 participants) were included in this analysis. Aerobic exercise improved both PWV (WMD: −0.63 m/s, 95% CI: −0.90, −0.35) and AIx (WMD:−2.63%, 95% CI: −5.25 to −0.02) significantly. Aerobic exercise training showed significantly greater reduction in brachial-ankle (WMD: −1.01 m/s, 95% CI: −1.57, −0.44) than in carotid-femoral (WMD: -0.39 m/s, 95% CI: −0.52, −0.27) PWV. Higher aerobic exercise intensity was associated with larger reductions in AIx (β: −1.55%, CI −3.09, 0.0001). In addition, aerobic exercise had a significantly larger effect in reducing PWV (WMD:−1.0 m/s, 95% CI: −1.43, −0.57) in participants with stiffer arteries (PWV ≥8 m/s). Resistance exercise had no effect on PWV and AIx. There was no significant effect of combined exercise on PWV and AIx.

Conclusions

We conclude that aerobic exercise improved arterial stiffness significantly and that the effect was enhanced with higher aerobic exercise intensity and in participants with greater arterial stiffness at baseline.

Trial Registration PROSPERO

Database registration: CRD42014009744,.     

Pulse Wave Propagation in Elastic Tubes Having Longitudinal Changes in Area and Stiffness

The behavior of both step waves and sinusoidal waves in fluid-filled elastic vessels whose area and distensibility vary with distance is explored theoretically. It is shown that the behavior of these waves may be explained, to a large extent, by considering the effect of the continuous stream of infinitesimal reflections that is set up whenever any wave travels in a region of vessel where the local impedance, (that is, the ratio of elastic wavespeed to tube area) is not constant. It is found that in such vessels the behavior of sinusoidal waves over distances which are a fraction of a wavelength can be quite different from their average behavior over several wavelengths. Both behaviors are described analytically. The results are applied to the mammalian circulatory system, one of the most interesting results being that a longitudinal variation in the pressure and velocity amplitudes which has a wavelength roughly one-half that of standing waves is predicted. The treatment is essentially a linearized quasi-one-dimensional one, the major assumptions being that the fluid is inviscid, the mean flow is zero, and the vessel is perfectly elastic and constrained from motion in the longitudinal direction. As in the physiological situation, the ratio of fluid velocity to pulse propagation speed is assumed small. For comparison with the analytical results, the linearized equations are also solved numerically by computer.     

Increased Tea Consumption Is Associated with Decreased Arterial Stiffness in a Chinese Population

Background

Tea has attracted considerable attention for its potential cardioprotective effects. The primary chemical components of tea are thought to have a beneficial effect by reducing arterial stiffness. The objective of this study was to assess the association between tea consumption and brachial–ankle pulse wave velocity (baPWV) in a relatively healthy Chinese population.

Methods

We enrolled 3,135 apparently healthy subjects from October 2006 to August 2009. Subjects taking medication for diabetes, hypertension, or hyperlipidemia, or with a history of cardiovascular disease, were excluded from the study. The subjects were categorized into three groups according to their tea-drinking habits: (1) none to low (n = 1615), defined as non-habitual tea drinkers, or drinking for <1 year, or drinking ≤150 mL per day for ≥1 year ; (2) moderate tea consumption, defined as drinking for ≥1 year and consumption between 151 and 450 mL per day; and (3) heavy tea consumption, defined as a drinking for ≥1 year and consumption >450 mL per day. Multiple logistic regression was used to determine whether different levels of consumption were independently associated with the highest quartile of baPWV values, defined as ≥1428.5 cm/s.

Results

Of the 3,135 subjects, 48.5% had drunk >150 mL of tea per day for at least 1 year. In multivariate regression analysis with adjustment for co-variables, including, age, sex, current smoking, alcohol use, habitual exercise, total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio >5, obesity, newly diagnosed hypertension and diabetes, subjects with high tea consumption had a decreased risk of highest quartile of baPWV by 22% (odds ratio = 0.78, 95% confidence interval = 0.62–0.98, p = 0.032), while subjects with moderate tea consumption did not (p = 0.742), as compared subjects with none to low tea consumption.

Conclusions

High, but not moderate, habitual tea consumption may decrease arterial stiffness.     

高血压患者脉搏波参数与脉搏波传导速度的相关性研究

目的:探讨高血压患者脉搏波参数与脉搏波传导速度的相关性,为从脉图上辨识高血压病及脉搏波参数的拓展应用提供参考。方法:选择2012年6月至2013年6月在北京安贞医院和北京人民医院门诊和住院确诊的原发性高血压患者32例作为实验组,并招募健康成人志愿者29例作为对照组。利用中医四诊合参辅助诊疗仪与皮尺分别采集两组受试者的左侧寸口脉图信息和主动脉至桡动脉的血管长度,计算脉搏波参数及脉搏波传导速度,采用方差分析和皮尔逊简单相关的统计方法分析高血压患者不同的脉搏波参数与其脉搏波传导速度的相关性。结果:与对照组比较,实验组的PWV显著升高,有显著性差异(P0.05)。实验组H2/H1明显高于对照组(P0.05),但H4/H1、T1/T、T2/T比值均显著低于对照组(P0.05),差异均有显著性意义(P0.05)。高血压患者的H2/H1、T1/T、T2/T、H4/H1均与其PWV相关,其中H2/H1与PWV呈显著正相关(P0.05),T1/T、T2/T与PWV呈显著负相关(P0.05),H4/H1与PWV呈一般正相关(P0.05)。结论:高血压患者的脉搏波参数与脉搏波传导速度具有显著相关性,且潮波出现的幅值与脉搏波传导速度有显著正相关;脉搏波上升支和潮波的时值与脉搏波传导速度具有显著负相关,重搏波相对高度与脉搏波传导速度具有一般相关关系,因而可通过脉搏波参数的变化了解高血压患者血管弹性的状态。     

糖尿病患者重型颅脑外伤术后脑梗死发生的预防性治疗研究

目的:观察分析糖尿病患者重型颅脑外伤术后脑梗死发生情况.方法:重型颅脑外伤共112例,糖尿病患者31例,非糖尿病患者81例,糖尿病患者按术后血糖控制水平分为血糖控制良好组(＜16.0)和血糖控制不良组(＞16.0),分别为13例、18例;所有病人均采用常规去骨瓣开颅术清除血肿减压,术后早期行脱水治疗,糖尿病组患者给予胰岛素治疗,术后1天、3天、7天复查CT.结果:糖尿病组患者15例(48.4%)出现脑梗死,血糖控制良好组和血糖控制不良组分别为3例(23.1%)、12例(66.7%),非糖尿病组患者9例(13.2%)出现脑梗死.结论:通过术后早期控制血糖水平于合适状态(＜16.0),可有效降低糖尿病患者重型颅脑外伤术后脑梗死发生,明显改善患者预后.     

Increased Arterial Stiffness in Systemic Lupus Erythematosus (SLE) Patients at Low Risk for Cardiovascular Disease: A Cross-Sectional Controlled Study

Cardiovascular disease (CVD) is a major cause of death in systemic lupus erythematosus (SLE) patients. Although the risk for cardiovascular events in patients with SLE is significant, the absolute number of events per year in any given cohort remains small. Thus, CVD risks stratification in patients with SLE focuses on surrogate markers for atherosclerosis at an early stage, such as reduced elasticity of arteries. Our study was designed to determine whether arterial stiffness is increased in SLE patients at low risk for CVD and analyze the role for traditional and non-traditional CVD risk factors on arterial stiffness in SLE. Carotid-femoral pulse wave velocity (PWV) was prospectively assessed as a measure of arterial stiffness in 41 SLE patients and 35 controls (CTL). Adjustment on age or Framingham score was performed using a logistic regression model. Factors associated with PWV were identified separately in SLE patients and in controls using Pearson''s correlation coefficient for univariate analysis and multiple linear regression for multivariate analysis. SLE patients and controls displayed a low 10-year risk for CVD according to Framingham score (1.8±3.6% in SLE vs 1.6±2.8% in CTL, p = 0.46). Pulse wave velocity was, however, higher in SLE patients (7.1±1.6 m/s) as compared to controls (6.3±0.8 m/s; p = 0.01, after Framingham score adjustment) and correlated with internal carotid wall thickness (p = 0.0017). In multivariable analysis, only systolic blood pressure (p = 0.0005) and cumulative dose of glucocorticoids (p = 0.01) were associated with PWV in SLE patients. Interestingly, the link between systolic blood pressure (SBP) and arterial stiffness was also confirmed in SLE patients with normal systolic blood pressure. In conclusion, arterial stiffness is increased in SLE patients despite a low risk for CVD according to Framingham score and is associated with systolic blood pressure and glucocorticoid therapy.     

Evaluation of Cardiovascular Risk With Arterial Stiffness in Patients With Nonfunctioning Pituitary Adenoma

Objective: Nonfunctioning pituitary adenoma (NFPA) accounts for 30% of all pituitary adenomas, and its incidence has been increasing compared to previous years. Increased risk of cardiovascular effects shown in recent studies is noteworthy in patients with NFPA diagnosis, but the number of studies on the subject is limited. In this study, we aimed to assess possible cardiovascular effects and risk via arterial stiffness measurements in patients diagnosed with NFPA.Methods: We performed arterial stiffness measurements for 30 patients diagnosed with NFPA and 30 healthy volunteers and compared the results to explore the relationship between arterial stiffness parameters, hormone levels, and adenoma size.Results: Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), central SBP, central DBP, augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and pulse wave velocity (PWV) values of the patients with NFPA diagnosis were significantly higher than the control group. PWV was found to have a significant and negative correlation with growth hormone and insulin-like growth factor 1 (IGF-1). A significant and positive correlation was found between adenoma median short-axis length and PWV. IGF-1 was found to have a significant and negative correlation with adenoma median long- and short-axis length. In multivariate linear regression analysis, we found that IGF-1 was an independent predictor of PWV.Conclusion: Both arterial stiffness parameters such as AIx@75 and PWV and peripheral SBP, DBP, and MBP values were found to be high in NFPA patients with no cardiovascular risk factors. Our findings suggest increased cardiovascular effect and risk in patients with NFPA diagnosis, and therefore, we recommend that patients are monitored closely in this respect.Abbreviations: ACTH = adrenocorticotropic hormone; AIx@75 = augmentation index corrected for a heart rate of 75 beats per minute; BMI = body mass index; CVD = cardiovascular disease; DBP = diastolic blood pressure; FSH = follicle-stimulating hormone; GH = growth hormone; HT = hypertension; IGF-1 = insulin-like growth factor 1; LH = luteinizing hormone; MBP = mean blood pressure; MRI = magnetic resonance imaging; NFPA = nonfunctioning pituitary adenoma; PP = pulse pressure; PWA = pulse wave analysis; PWV = pulse wave velocity; SBP = systolic blood pressure; TSH = thyroid-stimulating hormone     

Serum Bilirubin Is Inversely Associated with Increased Arterial Stiffness in Men with Pre-Hypertension but Not Normotension

Objective

Serum bilirubin level has shown to be inversely associated with coronary atherosclerosis, and may serve as a protective biomarker of coronary artery disease. Serum bilirubin has also been shown to be negatively associated with brachial-ankle pulse wave velocity (baPWV) in men without a history of hypertension, and in men with hypertension. It is unknown whether such associations can be observed in the pre-hypertensive or normotensive population. This study thus aimed to investigate the relationship between serum bilirubin level and increased arterial stiffness in subjects with pre-hypertension and normotension for both genders.

Methods

A cross-sectional sample of 3,399 apparently healthy subjects undergoing a medical check-up at National Cheng Kung University Hospital was enrolled between October 2006 and August 2009, after excluding subjects with serum total bilirubin level greater than 20.52 μmol/L. Increased arterial stiffness was defined as baPWV of 1,400 cm/s or higher as the dichotomous variable and bilirubin as the continuous variable.

Results

Based on multiple linear regression analysis, serum bilirubin level was inversely associated with baPWV in non-hypertensive men (β = -0.066, p < 0.001) but not in non-hypertensive women. In addition, the inverse relationship between bilirubin level and baPWV was found statistically significant only in pre-hypertensive men (β = -0.110, p < 0.001). Multiple logistic regression analysis showed that serum bilirubin was inversely associated with increased arterial stiffness in men with pre-hypertension (odds ratio = 0.955, 95% confidence interval = 0.916–0.996, p < 0.05) but not normotension after adjustment for other confounding factors. However, the relationship between total bilirubin level and increased arterial stiffness did not reach statistical significance for female subjects with pre-hypertension and normotension.

Conclusion

Serum bilirubin is inversely associated with increased arterial stiffness in men with pre-hypertension but not normotension. The association between bilirubin level and arterial stiffness was not found significant in women.     

Club Cell-16 and RelB as Novel Determinants of Arterial Stiffness in Exacerbating COPD Patients

Background

Exacerbations of chronic obstructive pulmonary disease (COPD) are acute events of worsened respiratory symptoms that may increase the risk of cardiovascular disease (CVD), a leading cause of mortality amongst COPD patients. The utility of lung-specific inflammatory mediators such as club cell protein-16 (CC-16) and surfactant protein D (SPD) and that of a novel marker of CV outcomes in COPD- RelB- in predicting adverse cardiovascular events during exacerbation is not known.

Methods

Thirty-eight subjects with COPD admitted to the hospital for severe exacerbation were included in this analysis. Clinical, physiological and arterial stiffness measurements were performed within 72 hours of admission; this was followed by measurements taken every 3 days until hospital discharge, then once a week until 30 days after discharge, and then again at 90 and 180 days. Plasma concentrations of inflammatory mediators were measured from peripheral venous blood taken at admission, and at days 15, 30, 90 and 180.

Results

CC-16 and RelB concentrations were increased at day 15 of exacerbations whereas SPD concentrations were decreased. The course of change in CC-16 and RelB levels over time was inversely associated with that of carotid-femoral pulse wave velocity, the gold-standard measure of arterial stiffness. Increases in CC-16 could predict a decreased number of subsequent exacerbations during follow-up.

Conclusions

Lung-specific (CC-16) and novel (RelB) biomarkers are associated with systemic cardiovascular changes over time. CC-16 can predict subsequent exacerbations in subjects with severe COPD and may be an important biomarker of pulmonary and systemic stress in COPD.     

Increased Arterial PET/CT 18F-Fluorodeoxyglucose Uptake in Obese and Overweight Patients

ObjectivesWe aimed to investigate the association between BMI and early atherosclerotic activity in cancer patients. We also compared the inflammatory and macroscopic calcification processes of atherosclerosis in the aortic segments and large arteries by ¹⁸F-FDG PET/CT of between normal and high BMI patients.MethodsWe conducted a retrospective review of cancer patients presented to our institution within the period between February and May 2018. Patients were classified according to their BMI into two groups: normal BMI group and high BMI group. Data of average SUVmax and SUVmean for four segments of the aorta, common iliac arteries, and femoral arteries were estimated and compared between both groups. Moreover, the macroscopic calcification on CT images for each vascular section was also reported.ResultsNinety-eight patients were classified into two groups: normal BMI group (n = 52; 53.1%), and high BMI group (n = 46; 46.9%). Average SUVmax was significantly higher in obese participants in all arterial segments (P < 0.05). However, the SUVmean was significantly higher in obese patients in only three arterial segments aortic arch, left femoral artery and descending thoracic aorta (P < 0.05).Moreover, the differences between the two study groups in terms of the frequency of macroscopic calcifications were not statistically significant for all vascular segments. BMI positively correlated with SUVmax and SUVmean of the vascular segments (r value from 0,219 to 0,575/p value between 0,023 and 0,0001).ConclusionsFluorine-18-FDG PET/CT imaging revealed that patients with high BMI have more accelerated atherosclerotic inflammatory process in their major vessels compared to their age-matched controls with normal BMI. Future studies should assess the associated between these findings and the cardiovascular events in the long term.     

Assessment of Model Based (Input) Impedance,Pulse Wave Velocity,and Wave Reflection in the Asklepios Cohort

Objectives

Arterial stiffness and wave reflection parameters assessed from both invasive and non-invasive pressure and flow readings are used as surrogates for ventricular and vascular load. They have been reported to predict adverse cardiovascular events, but clinical assessment is laborious and may limit widespread use. This study aims to investigate measures of arterial stiffness and central hemodynamics provided by arterial tonometry alone and in combination with aortic root flows derived by echocardiography against surrogates derived by a mathematical pressure and flow model in a healthy middle-aged cohort.

Methods

Measurements of carotid artery tonometry and echocardiography were performed on 2226 ASKLEPIOS study participants and parameters of systemic hemodynamics, arterial stiffness and wave reflection based on pressure and flow were measured. In a second step, the analysis was repeated but echocardiography derived flows were substituted by flows provided by a novel mathematical model. This was followed by a quantitative method comparison.

Results

All investigated parameters showed a significant association between the methods. Overall agreement was acceptable for all parameters (mean differences: -0.0102 (0.033 SD) mmHg*s/ml for characteristic impedance, 0.36 (4.21 SD) mmHg for forward pressure amplitude, 2.26 (3.51 SD) mmHg for backward pressure amplitude and 0.717 (1.25 SD) m/s for pulse wave velocity).

Conclusion

The results indicate that the use of model-based surrogates in a healthy middle aged cohort is feasible and deserves further attention.     

Arterial Wall Stiffness and the Risk of Atherosclerosis in Egyptian Patients with Overt and Subclinical Hypothyroidism

Objective: Hypothyroidism is associated with an increased risk of atherosclerosis. Pulse wave velocity (PWV) is an index of arterial wall stiffness widely used for noninvasive assessment of early atherosclerosis. We assessed PWV in Egyptian patients with hypothyroidism.Methods: The study included 100 Egyptian females aged 18 to 55 years. They were classified into three groups: group I, 40 women with overt hypothyroidism; group II, 40 women with subclinical hypothyroidism; and group III, 20 euthyroid women as a control group. The three groups were age matched. Doppler ultrasonography was used to calculate the heart-femoral PWV.Results: PWV was significantly higher in women with overt and subclinical hypothyroidism as compared with the control group (9.55 ± 1.81 m/s and 9.30 ± 1.28 m/s, respectively vs. 7.82 ± 2.14 m/s; P<.001 and <.01, respectively). There was a positive correlation between thyroid-stimulating hormone (TSH) and PWV in women with overt hypothyroidism and in those with subclinical hypothyroidism (P<.05 for both). Multivariate regression analysis showed that age and diastolic blood pressure were independent determinants of PWV in women with overt and subclinical hypothyroidism (P<.01 for all). TSH was also an independent determinant of PWV in both groups (P<.05 for both).Conclusion: PWV is significantly higher in Egyptian women with overt and subclinical hypothyroidism as compared with normal control subjects. This denotes early increase in arterial wall stiffness in patients with hypothyroidism, even in the subclinical phase. The positive correlation between PWV and TSH in both groups of patients suggests that the risk of atherosclerosis is proportionate to the severity of hypothyroidism.Abbreviations: ABI = ankle/brachial index; baPWV = brachial-ankle pulse wave velocity; BP = blood pressure; CIMT = carotid intima-media thickness; ECG = electrocardiogram; FT4 = free thyroxine; HDL = high-density lipoprotein; hfPWV = heart-femoral pulse wave velocity; LDL = low-density lipoprotein; PTT = pulse transit time; PWV = pulse wave velocity; SCH = subclinical hypothyroidism; TSH = thyroid-stimulating hormone     

Artificial Saliva in the Management of Patients Suffering from Xerostomia

Hyposalivation results in the sensation of a dry mouth “subjective xerostomia.” Besides the sensation of a dry mouth in serious conditions, distressing clinical symptoms are observed, e.g. difficulties in oral functioning, mucositis, progressive dental caries and nocturnal oral discomfort. A mucin-containing artificial saliva to relieve patients'complaints from xerostomia has been developed. Its chemical and physical properties are demonstrated. In a 3-year retrospective study the efficacy of this substitute and a CMC-containing saliva has been evaluated for a total of 137 patients. Patients were free in choosing a mucin- or CMC preparation. Ninety-six patients reported a considerable relief of their complaints with mucin-saliva, one patient wished to continue using the CMC product. To increase efficacy of the saliva substitute on intra-oral saliva reservoir has been developed for dentate and edentulous persons.     

中、重度牙周炎与冠心病患者白细胞介素17 及血脂水平的比较

目的:研究汉族人群中、重度牙周炎与冠心病的相关性并初步探讨白细胞介素17在二者相关性中的可能作用。方法:检测和分析40名健康者(健康组)、40例中、重度牙周炎患者(牙周炎组)、28例冠状动脉粥样硬化性心脏病患者(冠心病组)及47例患冠心病伴中、重度牙周炎的患者(冠心病+牙周炎组)血清白细胞介素17水平、血脂水平(血清低密度脂蛋白、高密度脂蛋白、胆固醇、总胆固醇和甘油三酯)和牙周临床指数(附着丧失、探诊深度和探诊出血)。结果:单因素方差分析结果显示,健康组、牙周炎组、冠心病组及牙周炎+冠心病组的血清白细胞介素17水平分别为(13.01±1.23)、(24.45±2.13)、(59.90±2.23)和(68.87±3.43)ng/L,各组血清白细胞介素17间的差异具有统计学意义(P<0.05),且经协方差分析校正年龄、受教育状况、血压和体重指数后显示,各组血清白细胞介素17水平间的差异仍具有统计学意义(P<0.05)。多元Logistic回归分析结果显示,中、重度牙周炎患者发生冠心病的可能性高于牙周健康者,其发生冠心病的相对风险率比值比为2.416(P=0.039;95%CI:1.126-6.659)。经协方差分析校正年龄、受教育状况、血压和体重指数后,各组血清总胆固醇水平间差异仍具有统计学意义(P=0.018)。结论:严重的牙周感染可能通过改变白细胞介素17水平,影响全身炎症反应和冠心病的发生及发展,可能是冠心病事件的危险因素之一。