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Koutsampasopoulos K, Vogiatzis I, Ziakas A, Papadopoulos CΕ, Loutradis C, Imprialos KP, Stavropoulos K, Vasilikos V, Athyros VG, Karagiannis A, Doumas M, Papademetriou V. Right ventricular performance in patients with heart failure with mildly reduced ejection fraction: the forgotten ventricle. Int J Cardiovasc Imaging 2022; 38:2363-2372. [PMID: 36434346 DOI: 10.1007/s10554-022-02652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
Right ventricular (RV) function is a major determinant of prognosis and adverse outcomes in patients with heart failure (HF). It is largely unknown if HF with mildly reduced ejection fraction (HFmrEF) patients have some special characteristics in RV function (RVF) that may distinguish them from HF with reduced or preserved ejection fraction (HFrEF or HFpEF) patients. Standard echocardiography was performed to estimate RVF [tricuspid annular systolic velocity (TDSV), plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and RV myocardial performance index (MPI-TEI index)] in a cross-sectional study. In 306 participants, the RV systolic function evaluated with TAPSE and TDSV was impaired in 39.1 and 24.2%, respectively. TAPSE, TAPSE/PASP and TDSV were lower in HFmrEF compared with HFpEF and higher compared with HFrEF (p < 0.001 for among-groups comparison). RV diastolic dysfunction varied between 12.6 and 43.8% depending on the echocardiographic parameter. Diastolic RVF determined by tricuspid inflow E/A wave ratio (Et/At) was impaired in less patients with HFmrEF compared with those with HFpEF or HFrEF (25.9% vs 48.4% vs 56.3%; p = 0.030, respectively). RV diastolic dysfunction by et'/at' (tissue Doppler tricuspid valve annulus e' and a' waves) was impaired in less patients with HFmrEF compared with HFrEF (11.8% vs 33.3%; p = 0.019). A multivariate regression analysis revealed a significant association between RV and LV systolic dysfunction. The present study shows a high prevalence of RV dysfunction in HFmrEF patients. Study findings provides some new insights on RV and LV systolic dysfunction coupling whereas RV diastolic dysfunction was not dependent on LV systolic dysfunction.
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Affiliation(s)
- Konstantinos Koutsampasopoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | | | - Antonios Ziakas
- 1st Cardiology Department, Aristotle University, Thessaloniki, Greece
| | | | - Charalampos Loutradis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | | | - Vasilios G Athyros
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
- VAMC, George Washington University, Washington, DC, USA.
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Stavropoulos K, Imprialos KP, Patoulias D, Katsimardou A, Doumas M. Impact of Primary Aldosteronism in Resistant Hypertension. Curr Hypertens Rep 2022; 24:285-294. [PMID: 35445928 DOI: 10.1007/s11906-022-01190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we aim to summarize the latest data on the association between primary aldosteronism and resistant hypertension, as well as to emphasize the necessity for screening for primary aldosteronism all patients with resistant hypertension. RECENT FINDINGS Epidemiological data suggests that up to one out of five patients with resistant hypertension suffer from primary aldosteronism. Patients with primary aldosteronism have increased incidence of renal disease, diabetes mellitus, atrial fibrillation, and obstructive sleep apnea, as well as they are characterized by an extended target organ damage and increased cardiovascular morbidity and mortality. Specific treatments for primary hyperaldosteronism (adrenalectomy and mineralocorticoid receptor antagonists) have significant impact on blood pressure, can reverse target organ damage, and mitigate cardiovascular risk. All patients with resistant hypertension should be evaluated for primary aldosteronism. Patients diagnosed with the disease may further undergo lateralization with adrenal vein sampling in order to receive the optimal therapeutic option which results in significant improvements in quality of life and cardiovascular profile.
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Affiliation(s)
| | | | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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Imprialos KP, Koutsampasopoulos K, Katsimardou A, Bouloukou S, Theodoulidis I, Themistoklis M, Doumas M. Female Sexual Dysfunction: A Problem Hidden in the Shadows. Curr Pharm Des 2021; 27:3762-3774. [PMID: 34554899 DOI: 10.2174/1381612827666210719104950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Female sexual dysfunction (FSD) has been largely underdiagnosed and undertreated due to the lack of concrete definitions, validated assessment methods and efficient treatments. However, during the last few decades, there has been great progress in the clinical management and research of FSD. OBJECTIVE The purpose of this review is to describe the pathophysiology of FSD, report the prevalence of the disease in the setting of cardiovascular (CV) risk factors and disease, and review current and under investigation treatment options. METHODS A comprehensive review was performed to identify studies examining the association of FSD with CV risk factors and/or disease, as well studies reporting relevant management options. RESULTS The prevalence of FSD is increased in the general population (approximately 40%) and is significantly higher in patients with hypertension, diabetes mellitus, and dyslipidemia. In patients with overt CV disease, FSD is even more prevalent (up to 90%). The cause of FSD is multifactorial and includes a variety of vascular, hormonal, interpersonal and psychological factors, which are all intertwined. Several treatment options exist that are efficient in improving female sexual function, while a cluster of other options has been shown to offer benefits. CONCLUSION FSD is a major public health problem with great impact on the patients' quality of life. In the setting of increased CV burden, FSD is even more prevalent. Increased awareness is needed for the physician to establish a trustful environment with the patient, discuss such issues, and offer proper management options.
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Affiliation(s)
- Konstantinos P Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Aleksandra Katsimardou
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Sofia Bouloukou
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Iakovos Theodoulidis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mikos Themistoklis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Imprialos KP, Stavropoulos K, Doumas M, Athyros VG. The Impact of Ranolazine Treatment on Liver Tests in Patients With Coronary Artery Disease and Nonalcoholic Fatty Liver Disease. Angiology 2021; 73:5-6. [PMID: 33827290 DOI: 10.1177/00033197211005597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Konstantinos P Imprialos
- Second Prop. Department of Internal Medicine, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Prop. Department of Internal Medicine, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Michael Doumas
- Second Prop. Department of Internal Medicine, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Vasilios G Athyros
- Second Prop. Department of Internal Medicine, Aristotle University, School of Medicine, Thessaloniki, Greece
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Athyros VG, Stavropoulos K, Imprialos KP, Doumas M. Suboptimal management of dyslipidemia in everyday clinical practice: Alarming signals from real-world data. Int J Cardiol 2020; 316:240-241. [PMID: 32634493 PMCID: PMC7334918 DOI: 10.1016/j.ijcard.2020.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Vasilios G Athyros
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.
| | | | | | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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Douma M, Imprialos KP, Patoulias D, Katsimardou A, Stavropoulos K. COVID-19: The Waterloo of governments, healthcare systems, and large health organizations. Eur J Intern Med 2020; 77:153-155. [PMID: 32513503 PMCID: PMC7264018 DOI: 10.1016/j.ejim.2020.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Michael Douma
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece.
| | - Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece
| | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece
| | - Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece
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Abstract
The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.
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Affiliation(s)
- Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece.,VAMC and George Washington University, Washington, USA
| | - Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece
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Stavropoulos K, Imprialos KP, Faselis C, Karagiannis A, Papademetriou V. Determinants of pulse wave velocity index and potential implementations. J Clin Hypertens (Greenwich) 2019; 21:1493-1495. [DOI: 10.1111/jch.13661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- VAMC Georgetown University Washington District of Columbia
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- VAMC Georgetown University Washington District of Columbia
| | - Charles Faselis
- VAMC George Washington University Washington District of Columbia
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
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Stavropoulos KV, Imprialos KP, Doumas M, Faselis CJ. Mineralocorticoid Receptor Antagonists in Cardiovascular Medicine: Looking for the Forest Among the Trees. Curr Pharm Des 2019; 24:5489-5490. [DOI: 10.2174/138161282446190426120024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Konstantinos V. Stavropoulos
- Second Propedeutic Department of Internal Medicine Hippokration Hospital of Thessaloniki Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine Hippokration Hospital of Thessaloniki Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Michael Doumas
- Veterans Affairs Medical Center George Washington University Washington, DC, United States
| | - Charles J. Faselis
- Veterans Affairs Medical Center George Washington University Washington, DC, United States
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Papademetriou V, Toumpourleka M, Imprialos KP, Alataki S, Manafis A, Stavropoulos K. The Role of Mineralocorticoid Receptor Antagonists in Heart Failure with Reduced Ejection Fraction. Curr Pharm Des 2019; 24:5517-5524. [DOI: 10.2174/1381612825666190219141326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
Background:
Heart failure (HF) is a worldwide modern epidemic, associated with significant morbidity
and mortality. Several causes have been identified for the syndrome, most of which share common pathophysiologic
pathways, including neurohormonal activation. Central to the latter lies activation of the reninangiotensin-
aldosterone system, and its effects on cardiovascular disease progression.
Objectives:
The aim of this review is to summarize the pathophysiology of aldosterone and the effects of its
blockage in the failing heart, as well as to provide state-of-the-art evidence, and address future perspectives regarding
the use of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction.
Method:
Literature was reviewed for studies that assess the pathophysiology of aldosterone in HF with reduced
ejection fraction (HFrEF), and the effects of mineralocorticoid receptor antagonists (MRAs) in this condition.
Results:
Several major society guidelines have synthesized the available evidence on HFrEF management, and
drugs that block the renin-angiotensin-aldosterone system at different levels continue to form the key component
of standard of care for these patients. Mineralocorticoid receptor antagonists are an important part of HFrEF
pharmacologic treatment, and their use is supported by a high level of evidence studies. This class of drugs demonstrated
significant benefits for morbidity and mortality, across the spectrum oh HFrEF, including patients after
acute myocardial infarction.
Conclusion:
Current evidence supports the central role of aldosterone in HFrEF progression, and the significant
benefits on outcomes with the use of MRAs.
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Affiliation(s)
| | - Maria Toumpourleka
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Alataki
- Medical Clinic IV-Department of Cardiology, Manicipal Hospital Karlsruhe, Academic Teaching Hospital, University of Freiburg, Karlsruhe, Germany
| | - Alexandros Manafis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Imprialos KP, Bouloukou S, Kerpiniotis G, Katsimardou A, Patoulias D, Bakogiannis C, Faselis C. Mineralocorticoid Receptor Antagonists in Essential and Resistant Hypertension. Curr Pharm Des 2019; 24:5500-5507. [DOI: 10.2174/1381612825666190306163310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 12/28/2022]
Abstract
Background:
Mineralocorticoid receptor antagonists are a second-line class of antihypertensive drugs,
which have been accounted for as the optimal add-on therapy in the triple algorithm for the management of resistant
hypertension.
Objectives:
To assess the effects of mineralocorticoid receptor antagonists in the treatment of patients with essential
hypertension and resistant hypertension.
Method:
We conducted a meticulous review of the literature and comprehensive identification of the clinical
trials assessing the efficacy of mineralocorticoid receptor antagonists in individuals with primary and resistant
hypertension.
Results:
MRAs have been thoroughly tested in several clinical studies in relevance to blood pressure lowering
effects, over the last six decades. Accumulating data observed that MRAs resulted in a significant reduction in
blood pressure level in patients with resistant hypertension. In addition, spironolactone was found to beneficially
affect the management of resistant hypertension.
Conclusion:
Mineralocorticoid receptor antagonists exert a significant antihypertensive effect. Future welldesigned
randomized controlled studies are greatly needed to address crucial clinical aspects in the field.
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Affiliation(s)
- Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Bouloukou
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kerpiniotis
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Bakogiannis
- Third Department of Cardiology, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charles Faselis
- Veterans Affairs Medical Center, George Washington University, Washington, DC 20422, United States
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Stavropoulos K, Imprialos KP, Stavropoulos N, Bouloukou S, Kerpiniotis G, Dimitriadis K, Tsioufis C, Doumas M. Sodium-glucose Cotransporter 2 Inhibitors: Nephroprotective Impact on Diabetic Kidney Disease. Cardiovasc Hematol Disord Drug Targets 2019; 18:120-126. [PMID: 29412122 DOI: 10.2174/1871529x18666180206155349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/09/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic nephropathy is a crucial microvascular complication of diabetes mellitus that is associated with elevated cardiovascular risk. SGLT-2 inhibitors are a new class of hypoglycemic drugs that positively affect several risk factors of cardiorenal damage. OBJECTIVES The study aimed to review and critically discuss available data on the association of SGLT-2 inhibitors treatment with kidney function, progress of diabetic kidney disease, and renal related outcomes, as well to unveil potential mechanisms of action that mediate such effects. METHOD We conducted a comprehensive search of the literature on the renal related effects of SGLT-2 inhibitors, to compose a narrative mini-review. RESULTS The administration of SGLT-2 inhibitors was observed to exert beneficial effects on a wide cluster of risk factors of chronic kidney disease, such as hyperglycemia, blood pressure, serum uric acid, and body weight. Data from the first two large, randomized, clinical trials of SGLT-2 inhibitors conducted to address the renal related outcomes of SGLT-2 inhibitors suggest substantial benefits on estimated glomerular filtration rate decline and albuminuria. CONCLUSION The initial data suggest clinically meaningful benefits of the SGLT-2 inhibitors in diabetic patients in relevance with chronic kidney disease. Future, well-designed randomised clinical trials need to be further investigated such as nephroprotective outcomes, that if confirmed, could lead to new perspectives in the management of diabetic nephropathy.
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Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikiforos Stavropoulos
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, United Kingdom
| | - Sofia Bouloukou
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kerpiniotis
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- Veterans Affairs Medical Center, Georgetown University, Washington, DC, United States
| | - Michael Doumas
- Veterans Affairs Medical Center, George Washington University, Washington, DC, United States
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Stavropoulos K, Imprialos KP, Doumas M, Karagiannis A, Papademetriou V. Insomnia and hypertension: A misty landscape. J Clin Hypertens (Greenwich) 2019; 21:835-837. [DOI: 10.1111/jch.13519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Veterans Affairs Medical Center Georgetown University Washington District of Columbia
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Veterans Affairs Medical Center George Washington University Washington District of Columbia
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Vasilios Papademetriou
- Veterans Affairs Medical Center Georgetown University Washington District of Columbia
- Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
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Athyros VG, Boutari C, Stavropoulos K, Anagnostis P, Imprialos KP, Doumas M, Karagiannis A. Statins: An Under-Appreciated Asset for the Prevention and the Treatment of NAFLD or NASH and the Related Cardiovascular Risk. Curr Vasc Pharmacol 2019; 16:246-253. [PMID: 28676019 DOI: 10.2174/1570161115666170621082910] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/10/2017] [Accepted: 03/11/2017] [Indexed: 12/13/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease (30% of the general population) and up to 40% of cases advance to the more severe form of the disease: nonalcoholic steatohepatitis (NASH), which is causally related to cirrhosis and cardiovascular disease (CVD). There is no generally accepted effective treatment for NAFLD/NASH. The joint guidelines of the European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD) and the European Association for the Study of Obesity (EASO) suggest the "off label" use of pioglitazone in patients without type 2 diabetes mellitus (T2DM) and pioglitazone in subjects with T2DM or vitamin E or their combination for the treatment of NASH; however pioglitazone has considerable limitations: weight gain, bone fractures in women, and heart failure. The aim of this narrative review is to assess the existing evidence supporting statin use for the treatment of NASH and the reduction of the high CVD risk of these patients. Animal data suggest that there is some benefit from statin use in liver histology in models of NASH. In humans, 3 post hoc analyses of randomised controlled trials (n=1,600, n=1,123, n=8,864) suggest that the use of atorvastatin (even in 80 mg/day) has a beneficial effect on NAFLD/NASH, in terms of liver enzyme reduction and ultrasonographic amelioration. Moreover, and most importantly, statin treatment halved CVD morbidity and mortality in statin-treated NAFLD/NASH patients compared with statin-treated participants with normal liver structure and function and reduced by 2/3rds CVD events in comparison with NAFLD/NASH patients that were not on a statin (90% of this population is not on statins because of the unjustified fear for liver damage). Three biopsy studies (n=20, n=107 and n=356) showed that statin treatment had a protective effect on steatosis, steatohepatitis and fibrosis. Data suggest that statin treatment in humans substantially improve or cure NAFLD/NASH, but above all substantially reduce CVD morbidity and mortality. Administration of potent statins appears safe and effective in saving lives in NAFLD/NASH patients.
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Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Chrysa Boutari
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | | | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.,Georgetown University Hospital, Washington, DC, USA, and Washington DC VA Medical Center, Washington, DC, United States
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
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Imprialos KP, Stavropoulos K, Doumas M, Tziomalos K, Karagiannis A, Athyros VG. Sexual Dysfunction, Cardiovascular Risk and Effects of Pharmacotherapy. Curr Vasc Pharmacol 2019; 16:130-142. [PMID: 28595561 DOI: 10.2174/1570161115666170609101502] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sexual dysfunction affects millions of people with an increasing prevalence, worldwide. The pathophysiology of the disease shares several similarities with cardiovascular disease (CVD), including atherosclerosis, endothelial dysfunction, structural vascular damage and subclinical inflammation. Erectile dysfunction (ED) and female sexual dysfunction are common among patients with CVD and risk factors such as hypertension, diabetes, obesity and metabolic syndrome. Given the common pathogenesis of the diseases, ED is an independent prognostic factor of future ED events. Patients with overt ED or risk factors are usually treated with several drugs for the management of these conditions. Several of these drugs have been evaluated for their effect on sexual activity. RESULTS AND CONCLUSION Among the antihypertensive drugs, diuretics and beta-blockers seem to exert a detrimental impact on sexual function, with nebivolol being the only beta-blocker with favorable properties through an increase in nitric oxide bioavailability. In contrast, renin-angiotensin system inhibitors and calcium-channel blockers have a neutral effect on sexual activity. Hypoglycemic drugs have been less evaluated in the ED setting, with metformin, pioglitazone and liraglutide presenting favorable results. Statins on the other hand have not provided consistent results with observational studies suggesting a detrimental role in sexual activity and a few randomized studies indicating a neutral or even beneficial effect on erectile function.
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Affiliation(s)
- Konstantinos P Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Konstantinos Stavropoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Konstantinos Tziomalos
- First Propaedeutic Department of Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki. Greece
| | - Asterios Karagiannis
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Vasilios G Athyros
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
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Stavropoulos K, Imprialos KP, Grassos C. Letter by Stavropoulos et al Regarding Article, "Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control". Circulation 2018; 137:2664-2665. [PMID: 29891626 DOI: 10.1161/circulationaha.117.032605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece (K.S., K.P.I.)
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece (K.S., K.P.I.)
| | - Charris Grassos
- Department of Cardiology, Hypertension Excellence Centre-ESH, KAT General Hospital, Athens, Greece (C.G.)
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Stavropoulos K, Imprialos KP, Katsiki N, Petidis K, Kamparoudis A, Petras P, Georgopoulou V, Finitsis S, Papadopoulos C, Athyros VG, Doumas M, Karagiannis A. Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone? J Clin Hypertens (Greenwich) 2018; 20:942-948. [PMID: 29722113 DOI: 10.1111/jch.13291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 01/28/2023]
Abstract
Primary aldosteronism (PA) is a common form of secondary hypertension. Several guidelines recommend that patients with adrenal incidentaloma have a high probability of suffering from PA. We conducted a prospective study of 269 consecutive adults with adrenal incidentaloma to investigate the prevalence and clinical characteristics of PA. In total, 9 participants were detected with PA, suggesting a prevalence of 3.35% among the study population. PA participants had a higher blood pressure level by 14/20.8 mm Hg and a lower serum potassium level by 0.8 mmol/L (P < .05). Importantly, all patients with PA presented with concurrent indications (hypertension with or without hypokalemia) for screening of the disease, but they have not undergone relative screening by the referring physician, thus casting doubts about the appropriate implementation of current guidelines in real-life practice. Intense efforts are needed to familiarize physicians with recommendations for PA to minimize undiagnosed cases and the detrimental sequelae of this endocrine form of hypertension.
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Affiliation(s)
| | | | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Petidis
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Panagiotis Petras
- Fifth Surgical Department, Aristotle University, Thessaloniki, Greece
| | | | - Stefanos Finitsis
- Department of Radiology and Interventional Radiology, Aristotle University, Thessaloniki, Greece
| | | | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.,Veterans Affairs Medical Center, George Washington University, Washington, DC, USA
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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Abstract
Statins are commonly use for the management of dyslipidemia, worldwide. Various studies have demonstrated that statins offer significant reduction in the risk of cardiovascular morbidity and mortality. However, this class of drugs has been implicated in potential liver toxicity, thus has been considered as a 'forbidden-drug' in patients with increased liver enzymes. Areas covered: Studies have shown that statins might offer clinical benefits in the setting of viral hepatitis, progression of cirrhosis, and hepatocellular carcinoma. More importantly, this class of drugs was shown to ameliorate liver histological (in both imaging and biopsy studies) and functional alterations in patients with non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. In addition, two large survival studies have demonstrated reduction in the risk for cardiovascular events with statin use in patients with elevated transaminase levels at baseline. Expert commentary: These benefits were of greater extent compared with patients with normal liver function tests at baseline. However, current international guidelines seem to neglect these findings and are not including statins in the management algorithm of patients with non-alcoholic fatty liver disease or steatohepatitis. Future randomized studies providing biopsy-proven benefits will establish the use of statins in the prevention of cardiovascular events and therapeutic algorithm of these patients.
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Affiliation(s)
- Konstantinos P Imprialos
- a Second Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Konstantinos Stavropoulos
- a Second Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Michael Doumas
- b Veterans Affairs Medical Center , George Washington University , Washington , DC , USA
| | - Anastasia Skalkou
- a Second Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioanna Zografou
- a Second Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios G Athyros
- a Second Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
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Doumas M, Stavropoulos K, Imprialos KP, Athyros VG, Karagiannis A. Renal sympathetic denervation: Ashes to ashes or rebirth from the ashes? J Clin Hypertens (Greenwich) 2018; 20:634-636. [PMID: 29575573 DOI: 10.1111/jch.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Michael Doumas
- 2nd Prop. Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.,VAMC and George Washington University, Washington, DC, USA
| | | | | | - Vasilios G Athyros
- 2nd Prop. Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Prop. Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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Athyros VG, Doumas M, Imprialos KP, Stavropoulos K, Georgianou E, Katsimardou A, Karagiannis A. Diabetes and lipid metabolism. Hormones (Athens) 2018; 17:61-67. [PMID: 29858856 DOI: 10.1007/s42000-018-0014-8] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/05/2017] [Indexed: 12/21/2022]
Abstract
The authors review the association between diabetes mellitus (DM) and aberrations of lipid metabolism related to DM, diabetic dyslipidemia (DD). DM is considered as a major health burden worldwide and one of the most important modifiable cardiovascular disease (CVD) risk factors. This applies to both the developed and the developing countries, especially the latter. While patients with type 1 DM, 10% of all DM cases, usually do not have dyslipidemia, DD is frequent among patients with type 2 DM (T2DM) (prevalence > 75%) and is mainly a mixed dyslipidemia [increase in triglycerides (TGs), low high-density lipoprotein cholesterol (HDL-C), and small-dense (atherogenic), low-density lipoprotein cholesterol (LDL-C) particles]. The components of DD, which is characterized by quantitative (mentioned above), qualitative, and kinetic abnormalities all contributing to CVD risk, are mostly related to insulin resistance. Statins, ezetimibe, and PCSK9 inhibitors can be used in monotherapy or consecutively in combinations if needed. Statins compose the main drug. For the residual CVD risk after statin treatment, the use of statin-fibrate combinations is indicated only in patients with mixed dyslipidemia. In conclusion, DD is a major health problem worldwide. It is a significant CVD risk factor and should be treated according to current guidelines. The means today exist to normalize all quantitative, qualitative, and kinetic aberrations of DD, thereby reducing CVD risk.
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Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece.
- 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University, 15 Marmara St., 551 32, Thessaloniki, Greece.
| | - Michael Doumas
- Veteran Affairs Medical Center, George Washington University, Washington, DC, USA
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece
| | - Eleni Georgianou
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University, Thessaloniki, Greece
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Stavropoulos K, Imprialos KP, Athyros VG, Doumas M. Renal resistive index for renovascular hypertension: In the quest of the Holy Grail. J Clin Hypertens (Greenwich) 2018; 20:589-591. [DOI: 10.1111/jch.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vasilios G. Athyros
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Imprialos KP, Stavropoulos K, Stavropoulos N, Patoulias D, Petidis K, Grassos C, Dimitriadis K, Tsioufis C. Sodium-glucose Cotransporter 2 Inhibitors: Impact on Body Weight and Blood Pressure Compared with other Antidiabetic Drugs. Cardiovasc Hematol Disord Drug Targets 2018; 18:104-113. [PMID: 29412121 DOI: 10.2174/1871529x18666180206144342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/09/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sodium-glucose co-transporters 2 inhibitors have emerged as a novel antidiabetic class of drugs offering significant ameliorating effects on a variety of cardiovascular risk factors, secondary to their mechanism of action, including blood pressure and body weight. OBJECTIVE The purpose of this article is to discuss available data on the impact of SGLT-2 inhibitors on blood pressure and body weight compared with other available anti-diabetic drugs and to present potential mechanisms mediating these effects. METHODS A comprehensive review of the literature was performed to identify studies examining the effects of SGLT-2 inhibitors on blood pressure and body weight. RESULTS SGLT-2 inhibition has been related with a mild decrease in blood pressure of approximately 3-5mmHg in systolic and 1-2mmHg in diastolic blood pressure. These data have been confirmed with 24h ambulatory measurements, as well. Furthermore, given the loss of calories in the urine, a mild decrease in body weight is anticipated, as well. Studies with this class of drugs noted a reduction in body weight of 2 to 3 kg, similar to the loss noted with the use of glucagon-like peptide 1 analogues, the only class of drugs that has offered significant reductions in body weight so far. Consclusion: The beneficial effects of the SGLT-2 inhibition on an abundance of cardiovascular risk factors, including blood pressure and body weight, have created great expectations for potential benefits from the cardiovascular events standpoint, a theory that was confirmed in the two available cardiovascular studies of this promising class of drugs.
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Affiliation(s)
| | | | - Nikiforos Stavropoulos
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, United Kingdom
| | - Dimitrios Patoulias
- Second Propaedeutic Department of Medicine, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Petidis
- Second Propaedeutic Department of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Kyriakos Dimitriadis
- First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
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Stavropoulos K, Imprialos KP, Doumas M, Athyros VG. Carotid intima-media thickness as a target-organ damage and treatment-target: Need for a major revision? J Clin Hypertens (Greenwich) 2018; 20:255-257. [DOI: 10.1111/jch.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Vasilios G. Athyros
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Doumas M, Imprialos KP, Stavropoulos K, Athyros VG. Peripheral arterial stiffness as a surrogate of central hemodynamics: A new era for cardiovascular risk estimation? J Clin Hypertens (Greenwich) 2018; 20:469-471. [PMID: 29370478 DOI: 10.1111/jch.13204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michael Doumas
- Veterans Affairs Medical Center, George Washington University, Washington, DC, USA
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Imprialos KP, Stavropoulos K, Doumas M. Antihypertensive drug treatment: the real-life challenge. J Clin Hypertens (Greenwich) 2018; 20:115-117. [DOI: 10.1111/jch.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Michael Doumas
- VAMC and George Washington University; Washington DC USA
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Imprialos KP, Stavropoulos K, Doumas M. Sodium-glucose Co-transporters 2 Inhibitors: The Miraculous Route from Hypoglycemic to Cardiovascular Drugs. Cardiovasc Hematol Disord Drug Targets 2018; 18:83-85. [PMID: 30009694 DOI: 10.2174/1871529x1802180628114731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Veterans Affairs Medical Center, George Washington University, Washington, DC, United States
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Stavropoulos K, Imprialos KP, Doumas M. Sacubitril/valsartan instead of renin-angiotensin system inhibition alone: A step forward in resistant hypertension. J Clin Hypertens (Greenwich) 2017; 20:65-68. [DOI: 10.1111/jch.13146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Michael Doumas
- Veterans Affairs Medical Center; George Washington University; Washington DC USA
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Stavropoulos K, Imprialos KP, Doumas M. Abnormal blood pressure dipping in diabetic kidney disease: A black-race nightmare? J Clin Hypertens (Greenwich) 2017; 19:1336-1338. [DOI: 10.1111/jch.13078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
- VAMC and George Washington University; Washington DC USA
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Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Imprialos KP, Stavropoulos K, Doumas M, Karagiannis A, Athyros VG. The effect of SGLT2 inhibitors on cardiovascular events and renal function. Expert Rev Clin Pharmacol 2017; 10:1251-1261. [DOI: 10.1080/17512433.2017.1370371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Medicine, VAMC George Washington University, Washington, DC, USA
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Stavropoulos K, Imprialos KP, Doumas M. Bypass of confirmatory tests for case detection of primary aldosteronism in leaner patients? J Clin Hypertens (Greenwich) 2017; 19:798-800. [DOI: 10.1111/jch.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Michael Doumas
- VAMC and George Washington University; Washington DC USA
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Doumas M, Stavropoulos KV, Boutari C, Imprialos KP, Karagiannis A. Blood pressure and cardiovascular outcomes: a closer look. Lancet 2017; 389:1295-1296. [PMID: 28379148 DOI: 10.1016/s0140-6736(17)30833-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/13/2016] [Indexed: 10/19/2022]
Affiliation(s)
| | - Konstantinos V Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Macedonia 54642, Greece.
| | - Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Macedonia 54642, Greece
| | - Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Macedonia 54642, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Macedonia 54642, Greece
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Imprialos KP, Boutari C, Stavropoulos K, Doumas M, Karagiannis AI. Stroke paradox with SGLT-2 inhibitors: a play of chance or a viscosity-mediated reality? J Neurol Neurosurg Psychiatry 2017; 88:249-253. [PMID: 27895093 DOI: 10.1136/jnnp-2016-314704] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/09/2016] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. Current therapeutic strategies have not provided constant beneficial cardiovascular-related results. Sodium-glucose co-transporters 2 (SGLT-2) inhibitors have emerged as a novel antidiabetic class of drugs that exert favourable results in a variety of other cardiovascular risk factors too, such as increased blood pressure and body weight. The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) study was the first trial that evaluated cardiovascular outcomes in patients with diabetes with the use of empagliflozin, a member of this new class of drugs. Empagliflozin was associated with remarkable reduction of cardiovascular morbidity and mortality and all-cause death. On the contrary, stroke incidence was slightly increased, although the result did not reach statistical significance. It could be assumed that a drug providing such beneficial effects on cardiovascular outcomes, would have also the same impact in stroke risk. This finding could theoretically be attributed to 'play of chance'. However, an increase of haematocrit was observed in EMPA-REG and other SGLT-2 inhibitors studies. Accumulating evidence suggests a direct association between increased haematocrit and stroke risk. Could this 'stroke paradox' be a result of the increased haematocrit levels noted with SGLT-2 inhibitors? The aim of this review is to critically assess both possibilities, given that increased stroke rates (if indeed true) should not be neglected and unattended.
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Affiliation(s)
- Konstantinos P Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Asterios I Karagiannis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Imprialos KP, Boutari C, Stavropoulos K, Doumas M, Athyros VG, Karagiannis AI. Current challenges in antihypertensive treatment in the elderly. Pol Arch Intern Med 2016; 126:540-51. [DOI: 10.20452/pamw.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Imprialos KP, Boutari C, Stavropoulos K, Sampani E, Karagiannis AI. Renin-Angiotensin System Inhibitors: Do They Have the Same Impact at All Ages? J Clin Hypertens (Greenwich) 2016; 18:828. [DOI: 10.1111/jch.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Erasmia Sampani
- Department of Nephrology; Hippokration Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Asterios I. Karagiannis
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Boutari C, Stavropoulos K, Imprialos KP, Petidis K, Doumas M. Antihypertensive Drug-Related Side Effects: Is It the Unique Indicator for Nonadherence? Am J Hypertens 2016; 29:662. [PMID: 26988421 DOI: 10.1093/ajh/hpw024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chrysoula Boutari
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P Imprialos
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Petidis
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Stavropoulos K, Imprialos KP, Boutari C, Athyros VG, Karagiannis AI. Canagliflozin and Hypertension: Is It the Optimal Choice for All Hypertensive Patients? J Clin Hypertens (Greenwich) 2016; 18:1073. [DOI: 10.1111/jch.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Asterios I. Karagiannis
- Second Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Sarafidis PA, Lazaridis AA, Imprialos KP, Georgianos PI, Avranas KA, Protogerou AD, Doumas MN, Athyros VG, Karagiannis AI. A comparison study of brachial blood pressure recorded with Spacelabs 90217A and Mobil-O-Graph NG devices under static and ambulatory conditions. J Hum Hypertens 2016; 30:742-749. [DOI: 10.1038/jhh.2016.11] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 10/14/2015] [Indexed: 11/09/2022]
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