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Brosolo G, Da Porto A, Bulfone L, Vacca A, Bertin N, Vivarelli C, Catena C, Sechi LA. Daytime plasma cortisol and cortisol response to dexamethasone suppression are associated with a prothrombotic state in hypertension. Front Endocrinol (Lausanne) 2024; 15:1397062. [PMID: 38836224 PMCID: PMC11148267 DOI: 10.3389/fendo.2024.1397062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Background and aims A prothrombotic state was demonstrated in patients with Cushing's syndrome and is involved in the development and progression of cardiovascular and renal damage in hypertensive patients. This study was designed to examine the relationships between cortisol secretion and the hemostatic and fibrinolytic systems in hypertension. Methods In 149 middle-aged, nondiabetic, essential hypertensive patients free of cardiovascular and renal complications, we measured hemostatic markers that express the spontaneous activation of the coagulation and fibrinolytic systems and assessed daily cortisol levels (8 AM, 3 PM, 12 AM; area under the curve, AUC-cortisol) together with the cortisol response to dexamethasone overnight suppression (DST-cortisol). Results Plasma levels of D-dimer (D-dim), prothrombin fragment 1 + 2 (F1 + 2), and von Willebrand factor (vWF) were progressively and significantly higher across tertiles of AUC-cortisol and DST-cortisol, whereas no differences were observed in fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor-1, antithrombin III, protein C, and protein S. D-dim, F1 + 2, and vWF were significantly and directly correlated with age and both AUC-cortisol and DST-cortisol. Multivariate regression analysis showed that both AUC-cortisol and DST-cortisol were related to plasma D-dim, F1 + 2, and vWF independently of age, body mass index, blood pressure, and renal function. Conclusion Greater daily cortisol profile and cortisol response to overnight suppression are independently associated with a prothrombotic state in hypertensive patients and might contribute to the development of organ damage and higher risk of cardiovascular complications.
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Affiliation(s)
- Gabriele Brosolo
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Da Porto
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Luca Bulfone
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Antonio Vacca
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Nicole Bertin
- Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Cinzia Vivarelli
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A Sechi
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy
- Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
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Colangelo LA, Carroll AJ, Perak AM, Gidding SS, Lima JAC, Lloyd-Jones DM. Association of 20-Year Longitudinal Depressive Symptoms With Left Ventricular Geometry Outcomes in the Coronary Artery Risk Development in Young Adults Study: A Role for Androgens? Psychosom Med 2024; 86:60-71. [PMID: 38193784 PMCID: PMC10922617 DOI: 10.1097/psy.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Depression is a risk factor for coronary heart disease and left ventricular hypertrophy (LVH) is a potent predictor of coronary heart disease events. Whether depression is associated with LVH has received limited investigation. This study assessed cross-sectional and 20-year longitudinal associations of depressive symptoms with LVH outcomes after accounting for important known confounders. METHODS From 5115 participants enrolled in 1985-1986 in the Coronary Artery Risk Development in Young Adults Study, 2533 had serial measures of depressive symptoms and subsequent echocardiography to measure normal LV geometry, concentric remodeling, and LVH. The primary exposure variable was trajectories of the Center for Epidemiologic Studies Depression (CES-D) scale score from 1990-1991 to 2010-2011. Multivariable polytomous logistic regression was used to assess associations of trajectories with a composite LV geometry outcome created using echocardiogram data measured in 2010-2011 and 2015-2016. Sex-specific conflicting results led to exploratory models that examined potential importance of testosterone and sex hormone-binding globulin. RESULTS Overall CES-D and Somatic subscale trajectories had significant associations with LVH for female participants only. Odds ratios for the subthreshold (mean CES-D ≈ 14) and stable (mean CES-D ≈ 19) groups were 1.49 (95% confidence interval = 1.05-2.13) and 1.88 (95% confidence interval = 1.16-3.04), respectively. For female participants, sex hormone-binding globulin was inversely associated with LVH, and for male participants, bioavailable testosterone was positively associated with concentric geometry. CONCLUSIONS Findings from cross-sectional and longitudinal regression models for female participants, but not male ones, and particularly for Somatic subscale trajectories suggested a plausible link among depression, androgens, and LVH. The role of androgens to the depression-LVH relation requires additional investigation in future studies.
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Affiliation(s)
- Laura A Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 10-132, Chicago, IL 60611
| | - Amanda M Perak
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
- Division of Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Samuel S Gidding
- Geisinger Genomic Medicine Institute, Geisinger, Danville, PA; 1631 Hale hollow Road, Bridgewater Corners, VT
| | - Joao AC Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
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Brosolo G, Da Porto A, Bulfone L, Vacca A, Bertin N, Catena C, Sechi LA. Cortisol secretion and abnormalities of glucose metabolism in nondiabetic patients with hypertension. J Hypertens 2024; 42:227-235. [PMID: 37796203 DOI: 10.1097/hjh.0000000000003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Glycometabolic changes are associated with hypercortisolism in Cushing's syndrome. Because impaired glucose tolerance (IGT) and insulin resistance are frequently detected in patients with essential hypertension, we hypothesized that in these patients, early glycometabolic abnormalities might be related to differences in regulation of cortisol secretion. METHODS In a cross-sectional study, we included 155 nondiabetic, essential hypertensive patients who were free of organ complications. The homeostasis model assessment (HOMA) index and the area under the curve of plasma glucose (AUC-glucose) and insulin (AUC-insulin) concentration following an oral glucose tolerance test were measured, together with daily plasma cortisol (8 a.m., 3 p.m. and 12 a.m.; AUC-cortisol) and 8 a.m. cortisol after 1 mg overnight dexamethasone suppression test (DST). RESULTS IGT was present in 27% of patients who were older and had higher BMI, plasma triglycerides and uric acid, AUC-cortisol and DST-cortisol, and lower HDL-cholesterol. Frequency of IGT increased progressively across tertiles of DST-cortisol, together with levels of glycated hemoglobin, fasting insulin and C-peptide, HOMA-index, AUC-glucose, and AUC-insulin. AUC-cortisol and DST-cortisol were directly correlated with insulin, C-peptide, HOMA-index, AUC-glucose, and AUC-insulin. Multivariate regression analysis showed that DST-cortisol was directly and independently correlated with HOMA index, AUC-glucose, and AUC-insulin. In a logistic regression model, both AUC-cortisol and DST-cortisol independently predicted IGT. CONCLUSION Daily cortisol and cortisol response to DST are independent determinants of IGT and insulin resistance in nondiabetic patients with hypertension, suggesting that even subtle differences in regulation of cortisol secretion might increase the risk of these patients to develop diabetes.
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Affiliation(s)
| | | | - Luca Bulfone
- Internal Medicine and European Hypertension Excellence Center
| | - Antonio Vacca
- Internal Medicine and European Hypertension Excellence Center
| | - Nicole Bertin
- Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
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Da Porto A, Donnini D, Vanin F, Romanin A, Antonello M, Toritto P, Varisco E, Brosolo G, Catena C, Sechi LA, Soardo G. Effects of Monacolin K in Nondiabetic Patients with NAFLD: A Pilot Study. Nutrients 2023; 15:nu15081887. [PMID: 37111106 PMCID: PMC10144054 DOI: 10.3390/nu15081887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver condition with significant risk of progression to steatohepatitis and cirrhosis. Therapeutic strategies in NAFLD include lifestyle changes mainly related to dietary interventions and use of drugs or nutritional components that could improve plasma lipid profiles and insulin sensitivity and decrease the local inflammatory response. In this study, we tested the effects of monacolin K, an inhibitor of HMCoA reductase. In a prospective, uncontrolled, open study, we treated 24 patients with NAFLD and mild hypercholesterolemia with 10 mg/day of monacolin K. At baseline and after 26 weeks, we measured in plasma liver tests, lipids, malondialdehyde, and oxidized glutathione, and assessed biochemical steatosis scores, liver elastography, and body composition with bioimpedance analysis. Monacolin K significantly reduced plasma alanine aminotransferase, cholesterol, triglycerides and the homeostatic model assessment (HOMA) index that indicated improved insulin sensitivity. No significant changes were found in body fat mass and visceral fat, nor in liver elastography, while the fatty liver index (FLI) was significantly decreased. Plasma levels of both malondialdehyde and oxidized glutathione were markedly reduced by monacolin K treatment, suggesting a reduction in oxidative stress and lipid peroxidation. In summary, this pilot study suggests possible benefits of monacolin K use in NAFLD patients that could be linked to a reduction in oxidative stress. This hypothesis should be further investigated in future studies.
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Affiliation(s)
- Andrea Da Porto
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Debora Donnini
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Fabio Vanin
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Arianna Romanin
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Martina Antonello
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Paolo Toritto
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Eleonora Varisco
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Gabriele Brosolo
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Cristiana Catena
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Leonardo A Sechi
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giorgio Soardo
- Clinica Medica, Department of Medicine, University of Udine, 33100 Udine, Italy
- Liver Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
- Italian Liver Foundation, Area Science Park, Basovizza, 34149 Trieste, Italy
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Brosolo G, Da Porto A, Bulfone L, Vacca A, Bertin N, Vivarelli C, Sechi LA, Catena C. Association of arterial stiffness with a prothrombotic state in uncomplicated nondiabetic hypertensive patients. Front Cardiovasc Med 2023; 10:1119516. [PMID: 36895833 PMCID: PMC9988910 DOI: 10.3389/fcvm.2023.1119516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Background and aims Past studies reported a significant contribution of a prothrombotic state to the development and progression of target organ damage in hypertensive patients. Stiffening of arterial vessels is associated with aging and hypertension, and additional factors could contribute to this process. This study was designed to examine the relationships between arterial stiffening and the hemostatic and fibrinolytic system. Methods In 128 middle-aged, nondiabetic, essential hypertensive patients without major cardiovascular and renal complications, we measured coagulation markers that express the spontaneous activation of the hemostatic and fibrinolytic system and assessed stiffness of the arterial tree by measurement of the carotid/femoral pulse wave velocity (cfPWV) and pulse wave analysis with calculation of the brachial augmentation index (AIx). Results Levels of fibrinogen (FBG), D-dimer (D-d), and plasminogen activator-inhibitor 1 (PAI-1) were significantly higher in patients with PWV and AIx above the median of the distribution. FBG, D-d, and PAI-1 were significantly and directly related with both cfPWV and AIx, and multivariate regression analysis indicated that the relationships of D-d and PAI-1 with both cfPWV and AIx and of FBG with AIx, were independent of age, body mass index, severity and duration of hypertension, use of antihypertensive drugs, blood glucose, and plasma lipids. Conclusion In middle-aged, uncomplicated, nondiabetic patients with essential hypertension, spontaneous activation of plasma hemostatic cascade and impaired fibrinolysis is significantly and independently associated with stiffening of the arterial tree.
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Affiliation(s)
- Gabriele Brosolo
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Da Porto
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Luca Bulfone
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Antonio Vacca
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Nicole Bertin
- Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Cinzia Vivarelli
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A Sechi
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy.,Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy.,Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy.,Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy.,Thrombosis and Hemostasis Unit, Department of Medicine, University of Udine, Udine, Italy
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Catena C, Brosolo G, Da Porto A, Donnini D, Bulfone L, Vacca A, Soardo G, Sechi LA. Association of non-alcoholic fatty liver disease with left ventricular changes in treatment-naive patients with uncomplicated hypertension. Front Cardiovasc Med 2022; 9:1030968. [PMID: 36312275 PMCID: PMC9606246 DOI: 10.3389/fcvm.2022.1030968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Cardiac structural and functional changes have been demonstrated in patients with non-alcoholic fatty liver disease (NAFLD). Because of the frequent association of NAFLD with hypertension, we aimed to examine the relationship of liver steatosis with left ventricular (LV) changes in patients with hypertension. Materials and methods In a cross-sectional study, we included 360 untreated, essential hypertensive patients who were free of major cardiovascular and renal complications. Liver steatosis was assessed by three different biochemical scores (NAFLD Liver Fat Score, LFS; Fatty Liver Index, FLI; Hepatic Steatosis Index, HSI). Echocardiography was performed with standard B-mode and tissue-Doppler imaging. Results LV hypertrophy was present in 19.4% and LV diastolic dysfunction in 49.2% of patients who had significantly higher body mass index (BMI), blood pressure (BP), and homeostatic model assessment (HOMA) index and higher frequency of the metabolic syndrome and liver steatosis that was defined by presence of 2 or more positive scores. LV mass index increased progressively across patients who had none, 1, or 2 or more liver steatosis scores, with associated progressive worsening of LV diastolic function. LV mass index was significantly and positively correlated with age, BMI, BP, HOMA-index, LFS, and HSI. Logistic regression analysis showed that age, BP, and liver steatosis scores independently predicted LV hypertrophy and diastolic dysfunction. Liver steatosis independently predicted LV dysfunction but not LV hypertrophy even after inclusion in analysis of the HOMA-index. Conclusion NAFLD is associated with LV hypertrophy and diastolic dysfunction in untreated patients with hypertension. In hypertension, NAFLD could contribute to LV diastolic dysfunction with mechanisms unrelated to insulin resistance.
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Affiliation(s)
- Cristiana Catena
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Gabriele Brosolo
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Da Porto
- Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Debora Donnini
- Liver Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Luca Bulfone
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Antonio Vacca
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy
| | - Giorgio Soardo
- Liver Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A. Sechi
- Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy,Diabetes and Metabolism Unit, Department of Medicine, University of Udine, Udine, Italy,Liver Unit, Department of Medicine, University of Udine, Udine, Italy,*Correspondence: Leonardo A. Sechi,
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