Short-term trajectories of exercise-induced plasma lipid changes in overweight females, with a focus on HDL cholesterol

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic

Background

Increased levels of plasma lipoproteins are among the modifiable risk factors of cardiovascular disease. Dietary changes and increased physical activity are the most powerful non-pharmacological interventions for the optimisation of plasma lipid levels.

Objectives

The aim of our study was to investigate the effect of an intensive short-term lifestyle intervention on plasma lipid trajectories in overweight non-diabetic females.

Materials and Methods

Two hundred and two healthy overweight (BMI > 27.5 kg/m2) females underwent an intensive short-term (10-week) intervention (at least four units of 1-hour exercise activity weekly at optimal energetic intake) aimed at lowering body weight. Plasma lipid (TC, LDL-C, HDL-C, TG) levels were examined at baseline and every two weeks over the course of the 10-week intervention.

Results

There was a significant decrease in BMI (Δ -4.7%, P<0.001) and body weight (Δ -4.9%, P<0.001) after the intervention. Positive changes (decreases) in TC (Δ -8%, P<0.001), TG (Δ -9%, P<0.001) and LDL-C (Δ -11%, P<0.001) were observed immediately after two weeks, but levels did not decrease further. In contrast, HDL-C did not increase as expected: after two weeks of intervention, we observed a significant decrease of about 6% (P<0.001) followed by a slow return to baseline values. But even after ten weeks of intervention, HDL-C values had not reached the values detected at baseline.

Conclusion

In overweight females, HDL-C decreased after short-term intensive lifestyle intervention. To confirm the protective effect of increased physical activity, plasma lipids need to be examined over a longer time period.

Portal hypertension is the main driver of liver stiffness in advanced liver cirrhosis

Liver stiffness (LS) is a novel non-invasive parameter widely used in clinical hepatology. LS correlates with liver fibrosis stage in non-cirrhotic patients. In cirrhotic patients it also shows good correlation with Hepatic Venous Pressure Gradient (HVPG). Our aim was to assess the contribution of liver fibrosis and portal hypertension to LS in patients with advanced liver cirrhosis. Eighty-one liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG and LS measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France). Liver collagen content was assessed in the explanted liver as collagen proportionate area (CPA) and hydroxyproline content (HP). The studied cohort included predominantly patients with Child-Pugh class B and C (63/81, 77.8%), minority of patients were Child-Pugh A (18/81, 22.2%). LS showed the best correlation with HVPG (r=0.719, p< 0.001), correlation of LS with CPA (r=0.441, p< 0.001) and HP/Amino Acids (r=0.414, p< 0.001) was weaker. Both variables expressing liver collagen content showed good correlation with each other (r=0.574, p<0.001). Multiple linear regression identified the strongest association between LS and HVPG (p < 0.0001) and weaker association of LS with CPA (p = 0.01883). Stepwise modelling showed minimal increase in r2 after addition of CPA to HVPG (0.5073 vs. 0.5513). The derived formula expressing LS value formation is: LS = 2.48 + (1.29 x HVPG) + (0.26 x CPA). We conclude that LS is determined predominantly by HVPG in patients with advanced liver cirrhosis whereas contribution of liver collagen content is relatively low.

Time trends in the relation between the achieved education and the cardiovascular risk factors prevalence and control in general population and in persons with coronary heart disease

Background

Achieved education is the most consistent and powerful socioeconomic status index and the differences in cardiovascular mortality (CV) according to achieved education in the Czech Republic are over a long period among most pronounced in Europe. Higher prevalence of CV risk factors in less educated is the major factor behind their higher CV morbidity and mortality.

Purpose

To analyse the changes in prevalence and control of CV risk factors according to achieved education in general population and in patients with stable CHD and their impact on CV mortality.

Methods

Based on data of 15 590 persons from 7 cross sectional epidemiological surveys carried through the Czech MONICA and post-MONICA project in 1985–2018 in identical 6 districts of the Czech Republic (general population) and on data of 2129 patients from 5 independent descriptive surveys of the Czech EUROASPIRE study in 1995–2018 (patients with stable CHD) time trends of major CV risk factors and their control in respondents with basic, secondary and university education were compared.

Results

The persons from general population as well as patients with CHD with higher education had consistently lower BMI and lower prevalence of obesity, the differences increased in due time (p&lt;0,001), the prevalence of obesity increased in all educational strata (p&lt;0,001). The total and non-HDL cholesterol were higher in lower educational population strata (p&lt;0,01), but not in CHD patients, there was a very pronounced continuous decrease in all educational strata (p&lt;0,001 for trend). Population systolic and diastolic blood pressures and prevalence of hypertension were higher in men and women with basic education (p&lt;0,01) and decreased during the analysed period (p&lt;0,001). In CHD patients the blood pressure was higher only in women. The prevalence of smoking was higher in men with basic education and decreased in all educational strata (p&lt;0,0001), in women the prevalence of smoking increased in women with basic and decreased in women with secondary and university education (p&lt;0,0001), in CHD patients the prevalence of smoking was lower and did not differ according to education. Prevalence of diabetes and of sedentary life style increased and was more prevalent in general as well as in CHD population in persons with lower education.

Conclusion

CV risk gradient in general population and in CHD patients decreased with level of education achieved, was present during the whole analysed period and became more pronounced in the 2016–18 survey. The education based differences were more pronounced in factors influenced by lifestyle (BMI, smoking) and less in factors influenced also by medical therapies (blood pressure, cholesterol levels). The impact on CV mortality is to be expected more pronounced in general CV prevention and less in already treated population. Observation of healthy life style remains a basic problem in CV prevention, particularly in persons with elementary education.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic

Statin Intolerance in Clinical Practice

PURPOSE OF REVIEW

In our pilot study, we aimed to determine how many patients with the statin intolerance history referred to the specialized center for the diagnostics and treatment of lipoprotein metabolism disorders really suffer from a complete statin intolerance. The purpose of the study was to prove that complete statin intolerance is overestimated and overdiagnosed, and with the detailed knowledge of the issue and patient approach, it is possible to find an appropriate statin treatment for the most of patients.

RECENT FINDINGS

With the increasing number of statin users worldwide, the issue of statin intolerance has been a frequently discussed topic in recent years. There are many factors that play a role in the manifestation of statin intolerance (predisposing factors as age, sex, and some diseases), genetic factors leading to a different metabolism, drug-drug interactions, psychological reasons, and the negative influence of the mass media. However, it is estimated that true complete statin intolerance, defined by an intolerance of at least three statins at their usual lowest daily doses, occurs in approximately 3-6% of all statin users. In our pilot study, we conducted a retrospective analysis of 300 patients who were referred to the Center of Preventive Cardiology with a history of statin intolerance. During the follow-up treatment, 222 patients (74%) were able to use some statin (rosu-, atorva-, simva-, fluvastatin), and in 21% of the cases (63 patient), the target values according their CV risk level were even achieved. Only 78 patients (26%) were confirmed as being complete statin intolerant following a thorough therapeutic effort. The most tolerated statin was rosuvastatin.

Genetic Markers at ANRIL, FTO and 2q36.3 Locus in Czech Patients Undergoing Coronary Artery Bypass Graft Surgery

Coronary artery bypass graft (CABG) surgery is one of the most commonly performed operations worldwide. We compared genotype frequencies of three major cardiovascular disease (CVD)-associated genetic markers (ANRIL, FTO and 2q36.3 locus) between 753 patients who underwent CABG at the Institute for Clinical and Experimental Medicine (Prague, Czech Republic) and 2,559 controls from the Czech post-MONICA study. Subjects with at least one major A allele in the rs10757274 polymorphism (ANRIL) were more prevalent in patients after CABG than in the controls (81.7 % vs 72.7 %; OR [95 % CI] 1.67 [1.35-2.05]; P < 0.0001). In contrast, variants within the FTO gene (OR 0.87; 95 % CI, 0.70-1. 09 in a TT vs. GG comparison, P = 0.24) and 2q36.3 locus (OR 1.16; 95% CI, 0.98-1.37 in a +A vs. CC comparison, P = 0.08) were not significantly associated with CVD in our study. Variants were not associated with anthropometric, biochemical, or clinical characteristics within the patient group. Our study suggests that patients with CABG are more commonly carriers of some but not all CVD-associated alleles.

Hormonal and bone parameters in pubertal girls

Here we analyzed associations between muscles mass, total bone mineral content (BMC), lumbar spine bone density (BMD L1-L4) and serum or urine hormones in healthy peripubertal girls. Total BMC and areal BMD L1-L4, muscle mass and fat were measured by dual-energy X-ray absorptiometry (DXA). Muscle force (N) was estimated by a dynamometer. Circulating estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), 25-hydroxy vitamin D, parathyroid hormone (PTH), insulin-like growth factor 1 (IGF-1), leptin, osteocalcin, bone isoenzyme of alkaline phosphatase (bALP) and total calcium and phosphorus were quantified as the nocturnal melatonin and serotonin urinary excretion. Partial correlations adjusted for height, Tanner score and physical activity confirmed positive relationships between BMC or BMD L1-L4 (Z-score) and lean mass or fat. Furthermore, positive relationship was observed between BMC or BMD L1-L4 (Z-score) and serum leptin. After adjustment for Tanner score and physical activity, positive associations were observed between lean mass and IGF-1, leptin levels or muscle force. We proved positive relationships between bone mass and serum leptin in peripubertal girls.

Strong gender-specific additive effects of the NYD-SP18 and FTO variants on BMI values

The role of the FTO gene in obesity development is well established in populations around the world. The NYD-SP18 variant has been suggested to have a similar effect on BMI, but the role of this gene in determining BMI has not yet been verified. The objective of our study was to confirm the association between NYD-SP18 rs6971019 SNP and BMI in the Slavic population and to analyze i) the gender-specific effects of NYD-SP18 on BMI and ii) the simultaneous effect of FTO rs17817449 and NYD-SP18 on BMI. We analyzed a sample of a large adult population based on the post-MONICA study (1,191 males and 1,368 females). Individuals were analyzed three times over 9 years. NYD-SP18 rs6971019 SNP is related to BMI in males (2000/1 GG 28.3+/-3.7 kg/m(2) vs. +A 27.5+/-3.7 kg/m(2) P<0.0005; in other examinations P<0.05 and <0.005), but not in females (all P values over 0.48 in all three examinations). Further analysis revealed the significant additive effect (but not the interaction) of FTO and NYD-SP18 SNPs on BMI in males (all P<0.01). These results suggest that association between NYD-SP18 rs6971019 SNP and BMI may be restricted to males. Furthermore, variants within NYD-SP18 and FTO genes revealed a significant additive effect on BMI values in males.

Comparison of the relative telomere length measured in leukocytes and eleven different human tissues

The relative length of telomeres measured in peripheral blood leukocytes is a commonly used system marker for biological aging and can also be used as a biomarker of cardiovascular aging. However, to what extent the telomere length in peripheral leukocytes reflects telomere length in different organ tissues is still unclear. Therefore, we have measured relative telomere length (rTL) in twelve different human tissues (peripheral blood leukocytes, liver, kidney, heart, spleen, brain, skin, triceps, tongue mucosa, intercostal skeletal muscle, subcutaneous fat, and abdominal fat) from twelve cadavers (age range of 29 week of gestation to 88 years old). The highest rTL variability was observed in peripheral leukocytes, and the lowest variability was found in brain. We found a significant linear correlation between leukocyte rTL and both intercostal muscle (R=0.68, P<0.02) and liver rTL (R=0.60, P<0.05) only. High rTL variability was observed between different organs from one individual. Furthermore, we have shown that even slight DNA degradation (modeled by sonication of genomic DNA) leads to false rTL shortening. We conclude that the rTL in peripheral leukocytes is not strongly correlated with the rTL in different organs.

Association between FTO 1st intron tagging variant and telomere length in middle aged females. 3PMFs study

The FTO gene plays an important role in the determination of body weight and BMI and it has been suspected of being associated with all-cause mortality, cardiovascular disease, cancer and end stage renal disease, but the causal mechanism of these effects is still unknown. One of the possibilities is the potential association with telomere length. Telomeres are repetitive DNA-sequences located at the ends of eukaryotic chromosomes' length of which is reduced in all somatic cells during ageing. Out of the 908 females (3PMFs study), in 783 females both FTO 1st intron tagging polymorphism (G>T, rs17817449) and the relative telomere length were successfully analysed. The relative telomere length was calculated as the ratio of telomere repeats to single-copy gene copies. The frequencies of the FTO genotypes were similar to other populations (GG=18.3%, GT=49.1% and TT=32.6%). We have detected, that the relative telomere length was significantly shorter (P<0.02, P<0.01 after adjustment for age, BMI, waist and subcutaneous fat), in carriers of at least one FTO risky (G) allele (0.85±0.39) in comparison to the carriers of the protective TT genotype (0.93±0.48). We have demonstrated that the FTO variant could be associated with the relative telomere length. Whether this represents a causality of association between the FTO variant and the non-communicable diseases needs to be further analysed.

Association between symptoms of chronic venous disease in the lower extremities and cardiovascular risk factors in middle-aged women

AIM

The association between chronic venous disease (CVD) and atherosclerosis has been intensively investigated. Because data regarding cardiovascular disease in women are sparse, we evaluated the potential association between the symptoms of CVD and cardiovascular risk factors including markers of preclinical atherosclerosis in middle-aged women.

METHODS

A questionnaire for chronic lower limb venous insufficiency was completed by 902 women, aged 45-54 years, from the general population. At the same time, all women were examined for the presence of cardiovascular risk factors, including the ankle/brachial systolic blood pressure index (ABI) and carotid intima media thickness of the common carotid arteries measured by ultrasound. Differences in cardiovascular risk factors and markers of preclinical atherosclerosis between women with and without symptoms of CVD were evaluated.

RESULTS

Symptoms (cramps, aching, edema, disturbance of sleep) suggestive of CVD in the lower extremities were reported by 606 (67.2%) women and 114 (12.6%) reported that those symptoms were severe enough to limit their usual daily activities. A higher prevalence of ABI of less than 0.91 was observed in women with any (P=0.005) or severe (P=0.029) CVD symptoms. A significantly higher prevalence of the following were observed in women with any or severe CVD symptoms: coronary artery disease, history of diabetes mellitus, increased body mass index, waist circumference, serum triglycerides, serum C-reactive protein and lower serum HDL cholesterol.

CONCLUSION

CVD symptoms were strongly associated with a higher prevalence of pathological values of ABI and several other manageable cardiovascular risk factors. These findings support the data that chronic venous disease might also indicate increased risk for atherosclerosis.

Radical surgery for pancreatic malignancy in the elderly

BACKGROUND

Improving life expectancy is associated with increasing incidence of pancreatic cancer. We reviewed morbidity and mortality in patients aged 65 years and older undergoing curative intent surgery in two centers in the Czech Republic.

METHODS

Data were retrieved by retrospective analysis of the medical records over the period 2000-2007. In total, 60 patients were included. The mean age was 71 years (median 70 years; range 65-85 years). Most patients (43, 72%) underwent hemipancreatoduodenectomy, combined in 4 with portomesenterial vessel resection. Twelve patients (20%) had distal pancreatectomy and 5 patients (8%) total pancreatectomy.

RESULTS

Overall morbidity was 28%. Only 10 patients (18%) developed serious surgical complications in terms of pancreatic leak (5, 8%), biliary leak (2, 3%), and intra-abdominal inflammatory collection (4, 7%). Four patients (6.6%) died within 30 days. The 1-year survival was 62.8%.

CONCLUSION

We can conclude that age per se is not a contraindication to surgery. Patient's overall general condition, co-existing co-morbidities, and ability to get over with any potential complications are more important. and IAP.

No relation between angiotensin‐converting enzyme gene polymorphism and smoking dependence

BACKGROUND

Smoking as a major risk factor for development of cancer and cardiovascular disease is thought to be partially genetically determined. The aim of this study was to investigate whether there is an association between insertion/deletion (I/D) polymorphism in angiotensin-converting enzyme (ACE) and smoking status and the number of cigarettes smoked per week.

METHODS

Using polymerase chain reaction, I/D polymorphism was evaluated in the ACE gene in 1204 male and 1375 female representative Caucasians. Information about smoking status and number of cigarettes smoked per week was collected via a questionnaire.

RESULTS

Frequencies of the alleles and genotypes of ACE I/D polymorphism did not differ between smokers, past smokers and individuals who had never smoked. No association was found between ACE I/D polymorphism and the number of cigarettes smoked per week, either in males or in females.

CONCLUSION

I/D polymorphism in the ACE gene does not play any role in genetic determination of predisposition to smoking.

Low incidence of adenocarcinoma and high-grade intraepithelial neoplasia in patients with Barrett's esophagus: a prospective cohort study

BACKGROUND AND STUDY AIMS

Barrett's esophagus is a premalignant condition. The risk of developing high grade intraepithelial neoplasia (HGIN) or adenocarcinoma is currently a matter of debate. Due to several shortcomings, previous studies have probably overestimated the risk. The main aim of our study was to investigate the incidence of HGD and adenocarcinoma in a cohort of patients with Barrett's esophagus.

PATIENTS AND METHODS

In a prospective, cohort study, all patients had intestinal metaplasia and macroscopic evidence of short- or long-segment (< 3 cm or > or = 3 cm) Barrett's esophagus. All patients underwent a standard protocol including regular endoscopies with biopsies and were treated with a proton pump inhibitor or antireflux surgery.

RESULTS

A total of 135 patients underwent 623 endoscopies during 700 patient-years (mean follow-up 5.2 +/- 2.3 years). Simultaneous HGIN and adenocarcinoma were detected in two patients with long-segment Barrett's esophagus (1.5%; 2 and 6 years after the index endoscopy). Low grade intraepithelial neoplasia (LGIN) was detected in 25 patients (18.5%); in 11 of these patients (44%), LGIN was not confirmed in later biopsies. Our study shows an incidence of HGIN/adenocarcinoma of 1/350 patient-years. Endoscopic regression of Barrett's esophagus was seen in 20.7% of patients.

CONCLUSION

The incidence of HGIN/adenocarcinoma is low in patients with adequately treated Barrett's esophagus. The annual risk of developing HGIN/adenocarcinoma is 0.21% (1.6% in long-segment Barrett's esophagus).

Higher Maternal Age at Delivery, and Lower Birth Orders Are Associated with Increased Risk of Childhood Type 1 Diabetes Mellitus

In several populations, maternal age at delivery and birth order have been demonstrated to variously affect the risk of Type 1 diabetes mellitus in the offspring. The aim of the present study was to investigate this relation in the Czech population. Questionnaire data on 640 children with childhood-onset Type 1 DM and data on 50 random controls to each case, obtained from the national Birth Registry and matched for the calendar year of birth, were analysed using multivariate logistic regression. The risk of Type 1 DM increases with higher maternal age at birth of the child (OR = 1.07, CI 95 % 1.05 - 1.09 per one year increment), and decreases with higher birth order (OR = 0.70, CI 95 % 0.62 - 0.79 per increment in birth order). There was no significant difference in these effects across the five-years bands of age at diabetes onset. We detected no independent effect of maternal education, either. Our study provides further evidence that the risk of Type 1 diabetes in the offspring increases with higher maternal age at delivery and lower birth order.

[Use of the Cocroft and Gault formula for evaluation of 24-hour urinary excretion of electrolytes]

Measurement of 24-hour electrolyte elimination requires exact urine collection over the period or study and cooperation of the individual being examined. These conditions are often not fulfilled. In an effort to be able to assess 24-hour elimination of Na+ and K+ in situations where urine collection is not absolutely complete, we developed a formula allowing to calculate the urinary elimination of the monitored electrolyte on the basis of its urinary concentration, urinary creatinine concentration, and urinary creatinine excretion using Cocroft and Gault's formula. The proposed formula is as follows: [formula: see text] This formula applies to men, when using it in women, a factor of 0.0015 has to be used instead of 0.0018. The method was used to measure urinary Na+ and K+ elimination in 60 hospitalized individuals after renal transplantation. Significant linear correlations were found between the values obtained by careful urine collection and the calculated (predicted) values using the above formula: r = 0.939, p < 0.001 with Na+ and r = 0.924, p < 0.001 with K+. The results provide support to the assumption that calculation of urinary Na+ and K+ elimination using the above formula may be useful in cases where urine collection over a period of 24 hours is not absolutely complete. (Tab. 1, Fig. 4, Ref. 2.)