Beneficial effect of beraprost sodium plus telmisartan in the prevention of arterial stiffness development in elderly patients with hypertension and cerebral infarction

Beraprost sodium (BPS, an analogue of prostacyclin) and telmisartan (TS, an angiotensin receptor blocker) have been reported to have a preventive effect on arterial stiffness in patients with cardiovascular diseases. The purpose of this study was to estimate the effects of a combined therapy using BPS and TS on arterial pulse wave velocity (PWV) values in elderly patients with hypertension and cerebral infarction. Over a 3-month period, 80 subjects with hypertension and histories of cerebral infarction received BPS only (120 microg/day p.o.), TS only (40 mg/day p.o.), both BPS and TS, or no medication at all (control). Arterial PWV and ankle brachial indices (ABI) were determined prior to and after 3 months of drug administration. During the follow-up, there were no significant changes in any of the parameters monitored with the exception of a significant decrease in systolic blood pressure in the BPS only, TS only, and BPS plus TS groups when compared to controls. The difference values for PWV in the control group, BPS only group, TS only group, and BPS plus TS group were +232.5, -114.6, -151.5, and -248.1 cm/s, respectively. The reduction values were significantly more pronounced in the BPS plus TS group than in the BPS only (P=0.037) and the TS only (P=0.022) groups. When BPS is combined with TS, an overall additive effect is seen in the improvement of PWV in Japanese patients with hypertension and cerebral infarction. This combination therapy is more beneficial than the corresponding monotherapies.     

动脉硬化检测技术在健康体检中的应用研究

目的:分析动脉硬化检测技术在健康体检中的应用价值,为临床防治疾病提供依据。方法:对我院2010年2月~2012年2月期间体检的2026例体检者样本资料进行分析,观察其脉搏波传播速度及踝臂指数情况,分析其余生化指标的相关性。结果:在本组研究中,所有受检人群随着年龄增加踝脉搏波速度(Brachial Ankle Pulse Wave Velocity)的值也逐渐升高,异常检出率也增高。女性baPWV值45~54岁之间快速增加,显著高于男性(P<0.01)。性别是baPWV升高的主要影响因素,年龄及收缩压也起到一定作用。结论:动脉硬化检测技术在筛查心血管病早期风险过程中呈现较好的相关性,为临床诊疗提供较好的应用价值。     

16周有氧运动对中老年baPWV及ABI的影响

目的：探讨16周有氧运动锻炼对中老年动脉硬化的干预作用及相关机制。方法：以27名中老年人为研究对象,平均年龄（62.70 ±3.26）岁,采用每次60 min、每周6次,共16周的广场舞/太极拳进行锻炼,分别测试锻炼前和锻炼8周末、16周末受试者收缩压（SBP）、舒张压（DBP）、左肱踝动脉脉搏波传导速度（L-baPWV）、右肱踝动脉脉搏波传导速度（R-baPWV）、左踝臂血压指数（L-ABI）和右踝臂血压指数（R-ABI）的变化,并检测血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、超氧化物歧化酶（SOD）、丙二醛（MDA）和谷胱甘肽过氧化物酶（GSH-Px）等相关指标的变化。结果：①与运动前相比,有氧运动锻炼8周末R-baPWV、R-ABI下降,16周末则L-baPWV、R-baPWV、R-ABI、L-ABI均呈显著性下降（P<0.01）;②与运动前比,8周末SBP和DBP显著下降（P<0.05）,16周末SBP、DBP和脉压差则显著降低（P<0.01,P<0.05）;③与运动前相比,在8周末、16周末受试者TC、LDL-c均显著降低（P<0.01）,HDL-c、TG在8周末和16周末的变化则无统计学意义;④与试验前相比,8周末血清SOD、GSH-Px、MDA无明显变化,16周末血清SOD、GSH-Px活性呈显著性升高、而血清MDA含量则呈显著性下降（P<0.01）。结论：通过16周有氧运动,可明显降低中老年人baPWV和ABI水平,调节血压、血脂及过氧化脂质水平,进而可能对动脉硬化程度起到一定的改善作用。     

脉搏波时标对臂踝脉搏波传播速度测量的影响

臂踝脉搏波传播速度(brachial-ankle pulse wave velocity,baPWV)测量是一种便捷、无创的方法,可用于人体动脉硬化度的评估,在临床和科学研究中广泛应用于血管早期病变的筛查和心血管系统风险的评估。本文设计开发了人体上臂和踝部脉搏波波形采集系统,并利用该系统对59名健康成年人进行实验,研究了目前三种最常用的脉搏波时标(pulse timing mark,PTM)定义方法对baPWV测量的影响。实验结果表明,选用不同的PTM方法所测得的baPWV结果具有显著的差异性(P0.001)。而且,PTM方法的不同还影响到了baPWV与年龄、血压的相互关系。     

High‐Sensitivity C‐Reactive Protein in Japanese Patients with Type 2 Diabetes

Objective: To assess the relationship between high‐sensitivity (HS) C‐reactive protein (CRP) and metabolic syndrome (MetS) or atherosclerosis and to assess effects of strict metabolic control on the degree of inflammation and MetS in patients with type 2 diabetes. Research Methods and Procedures: Four hundred thirteen patients with diabetes were enrolled in the cross‐sectional study. Of these 413 patients, 161 patients were further admitted for 2.4 ± 0.4 weeks (mean ± SD) to investigate the change in HS‐CRP or other parameters under strict metabolic control. Results: Log‐transformed HS‐CRP value (log HS‐CRP) was strongly correlated with BMI (r = 0.448, p < 0.01). Log HS‐CRP was also correlated with the presence of MetS or each component of MetS. Furthermore, a positive significant trend in HS‐CRP levels was shown with an increasing number of MetS components (p < 0.05). Log HS‐CRP showed a significant positive correlation with carotid artery intima‐media thickness (IMT) (r = 0.152, p < 0.01). In multiple step‐wise regression analysis, BMI, hemoglobin A_1c, right IMT, duration of diabetes, and triglyceride were selected as explanatory variables for log HS‐CRP (R² = 0.412). Under strict metabolic control, HS‐CRP was significantly (p < 0.01) lower, together with lower levels of other markers for MetS. The change in HS‐CRP was significantly correlated with the change in BMI (r = 0.161, p = 0.04). Discussion: In subjects with type 2 diabetes, HS‐CRP levels are related to MetS and subclinical atherosclerosis. Strict weight management and metabolic control were associated with a reduction in HS‐CRP levels, and changes in HS‐CRP were related to changes in weight, supporting the hypothesis that lifestyle modification reduces inflammation and the risk of CHD.     

Acute effect of beraprost sodium on lower limb circulation in patients with non-insulin-dependent diabetes mellitus-evaluation by color doppler ultrasonography and laser cutaneous blood flowmetry

The acute effects of beraprost sodium (sodium (±)-(1R^*, 2R, 3aS^*, 8bS^*)-2, 3, 3a 8b-tetrahydro-2-hydroxy-l-((E)-(3S^*)-3-hydroxy-4-methylI-octen-6-yny1] -1H-cyclopenta [b] bensofuran-5-butyrate), a stable analogue of prostaglandin I₂ which works as a vasodilator and anti-platelet agent, were investigated in patients with non-insulin dependent diabetes mellitus. Its effects on the dorsal pedis artery were examined using a new real-time two-dimensional Doppler ultrasonographic technique and by laser blood flowmetry. Before and 60 min after oral administration of beraprost sodium (Dolner^® 40 μg) and elastase (Elaszym^® 1800 U), the cross-sectional area (CSA) of the dorsal pedis artery and its blood flow index (BFI), calculated from the maximum flow velocity and area, were determined. Dermal microcirculatory blood volume (MBV) was also measured by laser blood flowmetry. In the beraprost sodium group, the CSA, BFI and MBV were significantly increased, while in the elastase group, no significant changes were observed. These result suggest that beraprost sodium has a beneficial effect on diabetic macro- and microangiopathy.     

The effect of oral glucose tolerance testing on changes in arterial stiffness and blood pressure in elderly women with hypertension and relationships between the stage of diabetes and physical fitness levels

[Purpose] The purpose of this study was to assess changes in blood glucose level, blood pressure, and arterial stiffness after a 75 g oral glucose tolerance test (OGTT) in elderly women aged over 65 years with hypertension and either normal glycemic control, impaired fasting glucose tolerance, or diabetes mellitus. We also wished to investigate the relationship between stages of diabetes and physical fitness.[Methods] A total of 24 elderly women with hypertension were assigned to a control group (CON; n=7), impaired fasting glucose group (IFG; n=9), and diabetes mellitus group (DM; n=8). In each group, blood glucose level, brachial ankle pulse wave velocity (PWV), and blood pressure were measured at baseline as well as 60 and 120 minutes after a 75 g OGTT. Physical fitness factors such as hand grip strength, balance test, 4 m gait speed test, chair stand test, short physical performance battery, and 6-minute walking test were subsequently assessed.[Results] In all three groups, blood glucose levels were significantly increased at 60 and 120 minutes after a 75 g OGTT. In the DM group, blood glucose levels were significantly higher before and after a 75 g OGTT than in the CON group. In the CON group, PWV was significantly increased at 60 minutes after a 75 g OGTT; however, there were no changes in other groups after glucose ingestion. In the CON group, systolic and diastolic blood pressures were significantly decreased at 60 and 120 minutes after a 75 g OGTT compared to baseline. However, there was no change in blood pressure after ingestion in the DM group. The IFG group had greater grip strength than the CON group; however, there were no differences in other variables between the groups.[Conclusion] After a 75 g OGTT, elderly women with hypertension and diabetes maintain higher blood glucose levels compared to those with hypertension alone. Unlike elderly women with hypertension alone, those with hypertension and diabetes did not show changes in arterial stiffness and blood pressure after a 75 g OGTT. Therefore, elderly women with hypertension and diabetes may not be able to control their blood vessels following a 75 g OGTT due to impaired vascular endothelial function. Moreover, there was no association between diabetes stage and physical fitness in elderly women with hypertension.     

Synthesis of structurally unstable type III procollagen in patients with cerebral artery aneurysm

The biosynthesis of collagen was studied in skin fibroblast cultures established from 11 patients with cerebral artery aneurysms. Six patients had familial subarachnoid hemorrhage (SAH), while five patients were considered as sporadic cases. The structural stability of the triplet-helical medium procollagen was studied by measuring the thermal denaturation temperature (T_m) of type I and type II procollagen molecules. Structural instability of type III procollagen was demonstrated in two patients with familial SAH. Te T_m of type III procollagen was 39.0°C and 39.5°C in two of the cell lines, while the control value was 40.3°C. The stability of type I procollagen did not differ from that of the controls, and the main features of the biosynthesis of collagen were similar in the aneurysm patient cell lines and in the controls. The results suggest that a structural defect of type III procollagen may serve as an etiological factor in the formation of cerebral artery aneurysms.     

脑梗塞患者血清抗心磷脂抗体含量变化的研究

目的探讨脑梗塞患者血清中抗心磷脂抗体(ACA)含量变化的意义。方法采用酶联免疫吸附试验(ELISA)对80例脑梗塞患者血清中ACA含量进行检测,并与40例作为对照组进行比较。结果脑梗塞组血清中ACA阳性率明显高于对照组(P<0.01);ACA分型中,脑梗塞组血清中IgG阳性率明显高于对照组(P<0.01)。结论检测血清中ACA含量,可作为研究ACA与脑梗塞关系的一项可靠指标,对脑梗塞的病理机制研究以及对疾病的预防、治疗和预后判断可能有一定帮助。     

The effects of age and gender on the relationship between HMGCR promoter-911 SNP (rs33761740) and serum lipids in patients with coronary heart disease

Background

Hydroxymethylglutaryl-Coenzyme A Reductase (HMGCR) catalyzes the rate-limiting step of cholesterol biosynthesis. This enzyme is the target of the widely available cholesterol lowering statins. In this population-based case–control study, the frequencies of -911 C>A polymorphism (rs3761740) of the HMGCR gene in patients with coronary heart disease (CHD) and healthy subjects were investigated and the correlations between the different genotypes and hypercholesterolemia with cardiovascular risk factors were analyzed.

Methods

The HMGCR genotypes were determined in 365 patients with CHD and 365 controls by PCR–RFLP assay. Anthropometric measurements were measured in all participants.

Results

There was no significant difference in the genotype frequencies of the HMGCR polymorphism between the male subjects of both patient and control groups, however, the HMGCR-CC genotype was found to be more frequent in female patients with CHD than female controls (p = 0.002). The HMGCR-CC genotype showed higher total-cholesterol (TC) and LDL-cholesterol (LDL-C) levels than the CA + AA genotypes in male CHD patients (p = 0.018). Due to this significant sex interaction, a multivariate analysis was conducted on the patient group. In the multivariate logistic regression analysis, the HMGCR-CC genotype was significantly associated with age < 55 (OR = 2.837, p = 0.001) and TC ≥ 5.18 mmol/L (OR = 1.970, p = 0.027) in male subjects. However, this association was not observed in female patients (p > 0.05). This analysis confirmed that the HMGCR-CC genotype was associated with elevated TC levels in male CHD patients with age < 55 years.

Conclusion

These results suggest that age and sex modify the contribution of the HMGCR-911 polymorphism to fasting serum TC, LDL-C levels and risk of CHD.