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Rallidis LS, Rizos CV, Papathanasiou KA, Liamis G, Skoumas I, Garoufi A, Kolovou G, Tziomalos K, Skalidis E, Kotsis V, Sfikas G, Doumas M, Anagnostis P, Lambadiari V, Giannakopoulou V, Kiouri E, Anastasiou G, Petkou E, Koutagiar I, Attilakos A, Kolovou V, Zacharis E, Antza C, Koumaras C, Boutari C, Liberopoulos E. Physical signs and atherosclerotic cardiovascular disease in familial hypercholesterolemia: the HELLAS-FH Registry. J Cardiovasc Med (Hagerstown) 2024; 25:370-378. [PMID: 38526957 DOI: 10.2459/jcm.0000000000001612] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
AIMS Three physical signs, namely tendon xanthomas, corneal arcus and xanthelasma, have been associated with heterozygous familial hypercholesterolemia (heFH). The prevalence and clinical significance of these signs are not well established among contemporary heFH individuals. This study explored the frequency as well as the association of these physical signs with prevalent atherosclerotic cardiovascular disease (ASCVD) in heFH individuals. METHODS Data from the Hellenic Familial Hypercholesterolemia Registry were applied for this analysis. The diagnosis of heFH was based on the Dutch Lipid Clinic Network Score. Multivariate logistic regression analysis was conducted to examine the association of heFH-related physical signs with prevalent ASCVD. RESULTS Adult patients ( n = 2156, mean age 50 ± 15 years, 47.7% women) were included in this analysis. Among them, 14.5% had at least one heFH-related physical sign present. The prevalence of corneal arcus before the age of 45 years was 6.6%, tendon xanthomas 5.3%, and xanthelasmas 5.8%. Among physical signs, only the presence of corneal arcus before the age of 45 years was independently associated with the presence of premature coronary artery disease (CAD). No association of any physical sign with total CAD, stroke or peripheral artery disease was found. Patients with physical signs were more likely to receive higher intensity statin therapy and dual lipid-lowering therapy, but only a minority reached optimal lipid targets. CONCLUSION The prevalence of physical signs is relatively low in contemporary heFH patients. The presence of corneal arcus before the age of 45 years is independently associated with premature CAD.
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Affiliation(s)
- Loukianos S Rallidis
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Konstantinos A Papathanasiou
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - George Liamis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Ioannis Skoumas
- 1 Cardiology Department of Athens Medical School, University of Athens, Hippokration Hospital, Athens
| | - Anastasia Garoufi
- Second Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, General Children's Hospital 'P. & A. Kyriakou', Athens
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens
| | - Konstantinos Tziomalos
- 1 Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
| | | | - Vasileios Kotsis
- 3 Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki
| | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki
| | - Michalis Doumas
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki
| | | | - Vaia Lambadiari
- 2 Propaedeutic Internal Medicine Department and Diabetes Research Unit, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | | | - Estela Kiouri
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - Georgia Anastasiou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Ermioni Petkou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Iosif Koutagiar
- 1 Cardiology Department of Athens Medical School, University of Athens, Hippokration Hospital, Athens
| | - Achilleas Attilakos
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, C' Pediatrics Clinic, Attikon University General Hospital, Athens
| | - Vana Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens
| | | | - Christina Antza
- 3 Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki
| | - Charalambos Koumaras
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki
| | - Chrysoula Boutari
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki
| | - Evangelos Liberopoulos
- 1 Propaedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
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Lambadiari V, Kountouri A, Psahoulia F, Koliou GA, Lazaris A, Michalopoulos E, Mallis P, Korakas E, Eleftheriadou I, Balampanis K, Sarris M, Tsirigotis P, Geroulakos G, Stavropoulos-Giokas C, Dimitriadis GD, Tentolouris N. Treatment with Umbilical Cord Blood Platelet Lysate Gel Improves Healing of Diabetic Foot Ulcer. J Clin Med 2024; 13:1310. [PMID: 38592188 PMCID: PMC10932121 DOI: 10.3390/jcm13051310] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study was conducted to examine the hypothesis that umbilical cord blood platelet lysate (UCB-PL) gel has a significant impact on the healing rate of DFU. Μethods: In this open-labeled, randomized controlled trial, 110 patients were randomized to treatment with UCB-PL gel (UCB-PL group, n = 52) every three days for one month or dressing with normal saline (control group, n = 58). All participants were followed up for 20 weeks post treatment. Ulcer surface area was assessed with the imitoMeasure application at two, four, and six weeks, and two, four and six months. This study's main outcome was the reduction in ulcer size over the six-month study period. RESULTS The mean ulcer area at baseline was 4.1 cm2 in the UCB-PL group and 1.7 cm2 in the control group. At six months post treatment, patients on the UCB-PL treatment displayed a significant reduction in ulcer size compared to baseline 0.12 (0-8.16) in contrast to a more modest change in the control group 1.05 (0-24.7). The ulcer area was decreased at the end of the study in 40 patients (97.6%) in the UCB-PL group and 27 (73%) in the control group (Fisher's p = 0.002). CONCLUSIONS The application of UCB-PL gel in DFU resulted in a significant reduction in ulcer size compared to regular saline dressing.
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Affiliation(s)
- Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Fοteini Psahoulia
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Georgia-Angeliki Koliou
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Andreas Lazaris
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.E.); (N.T.)
| | - Konstantinos Balampanis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Markos Sarris
- Health and Social Care Management, University of West Attica, 12241 Athens, Greece;
| | - Panagiotis Tsirigotis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Catherine Stavropoulos-Giokas
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.E.); (N.T.)
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Katogiannis K, Thymis J, Kousathana F, Pavlidis G, Korakas E, Kountouri A, Balampanis K, Prentza V, Kostelli G, Michalopoulou H, Tsilivarakis D, Lambadiari V, Ikonomidis I. Effects of Liraglutide, Empagliflozin and Their Combination on Left Atrial Strain and Arterial Function. Medicina (Kaunas) 2024; 60:395. [PMID: 38541121 PMCID: PMC10971983 DOI: 10.3390/medicina60030395] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024]
Abstract
Background and Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are cardioprotective drugs. We investigated their effects on left atrial function, a major determinant of cardiac diastolic dysfunction in type 2 diabetes mellitus. We also explored the association of changes in arterial stiffness with those of the LA strain after treatment. Materials and Methods: A total of 200 patients (59.5 ± 9.1 year old, 151 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n = 50 served as controls), liraglutide (n = 50), empagliflozin (n = 50) or their combination (liraglutide + empagliflozin) (n = 50). We measured at baseline and 6 months post-treatment: (a) left atrial and global left ventricular longitudinal strain by speckle tracking echocardiography; (b) pulse wave velocity (PWV) and central systolic blood pressure. Results: At baseline, there was a correlation of the LA reservoir strain with PWV (r = -0.209, p = 0.008), central SBP (r = -0.151, p = 0.030), EF (r = 0.214, p = 0.004) and GLS (r = -0.279, p = 0.009). The LA reservoir change 6 months post-treatment was correlated with the PWV change in all groups (r = -0.242, p = 0.028). The LA reservoir change 6 months post-treatment was correlated with the GLS change in all groups (r = -0.322, p = 0.004). Six months after intervention, patients treated with liraglutide, empagliflozin and their combination improved the left atrial reservoir strain (GLP1RA 30.7 ± 9.3 vs. 33.9 ± 9.7%, p = 0.011, SGLT2i 30 ± 8.3 vs. 32.3 ± 7.3%, p = 0.04, GLP1&SGLT2i 29.1 ± 8.7 vs. 31.3 ± 8.2, p = 0.007) compared to those treated with insulin (33 ± 8.3% vs. 32.8 ± 7.4, p = 0.829). Also, patients treated with liraglutide and the combination liraglutide and empagliflozin had improved left atrial conduction strain (p < 0.05). Empagliflozin or the combination liraglutide and empagliflozin showed a greater decrease of PWV and central and brachial systolic blood pressure than insulin or GLP-1RA. (p < 0.05). Conclusions: Impaired aortic elastic properties are associated with a decreased LA strain in type 2 diabetics. Treatment with liraglutide, empagliflozin and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with the improvement of arterial and myocardial functions.
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Affiliation(s)
- Konstantinos Katogiannis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
| | - John Thymis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
| | - Foteini Kousathana
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - George Pavlidis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Konstantinos Balampanis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Vasiliki Prentza
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Gavriella Kostelli
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
| | - Helen Michalopoulou
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
| | - Damianos Tsilivarakis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (F.K.); (G.P.); (E.K.); (A.K.); (K.B.); (V.P.); (V.L.)
| | - Ignatios Ikonomidis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece; (J.T.); (G.K.); (H.M.); (D.T.); (I.I.)
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Stefanou MI, Theodorou A, Malhotra K, Aguiar de Sousa D, Katan M, Palaiodimou L, Katsanos AH, Koutroulou I, Lambadiari V, Lemmens R, Giannopoulos S, Alexandrov AV, Siasos G, Tsivgoulis G. Risk of major adverse cardiovascular events and stroke associated with treatment with GLP-1 or the dual GIP/GLP-1 receptor agonist tirzepatide for type 2 diabetes: A systematic review and meta-analysis. Eur Stroke J 2024:23969873241234238. [PMID: 38400569 DOI: 10.1177/23969873241234238] [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] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Mounting evidence suggests that glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) attenuate cardiovascular-risk in type-2 diabetes (T2DM). Tirzepatide is the first-in-class, dual glucose-dependent-insulinotropic-polypeptide GIP/GLP-1 RA approved for T2DM. PATIENTS AND METHODS A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate: (i) the incidence of major adverse cardiovascular events (MACE); and (ii) incidence of stroke, fatal, and nonfatal stroke in T2DM-patients treated with GLP-1 or GIP/GLP-1 RAs (vs placebo). RESULTS Thirteen RCTs (9 and 4 on GLP-1 RAs and tirzepatide, respectively) comprising 65,878 T2DM patients were included. Compared to placebo, GLP-1RAs or GIP/GLP-1 RAs reduced MACE (OR: 0.87; 95% CI: 0.81-0.94; p < 0.01; I2 = 37%), all-cause mortality (OR: 0.88; 95% CI: 0.82-0.96; p < 0.01; I2 = 21%) and cardiovascular-mortality (OR: 0.88; 95% CI: 0.80-0.96; p < 0.01; I2 = 14%), without differences between GLP-1 versus GIP/GLP-1 RAs. Additionally, GLP-1 RAs reduced the odds of stroke (OR: 0.84; 95% CI: 0.76-0.93; p < 0.01; I2 = 0%) and nonfatal stroke (OR: 0.85; 95% CI: 0.76-0.94; p < 0.01; I2 = 0%), whereas no association between fatal stroke and GLP-1RAs was uncovered (OR: 0.80; 95% CI: 0.61-1.05; p = 0.105; I2 = 0%). In secondary analyses, GLP-1 RAs prevented ischemic stroke (OR: 0.74; 95% CI: 0.61-0.91; p < 0.01; I2 = 0%) and MACE-recurrence, but not hemorrhagic stroke (OR: 0.92; 95% CI: 0.51-1.66; p = 0.792; I2 = 0%). There was no association between GLP-1RAs or GIP/GLP-1 RAs and fatal or nonfatal myocardial infarction. DISCUSSION AND CONCLUSION GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and mortality in T2DM. While there is solid evidence that GLP-1 RAs significantly attenuate the risk of ischemic stroke in T2DM, dedicated RCTs are needed to evaluate the efficacy of novel GIP/GLP-1 RAs for primary and secondary stroke prevention.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mira Katan
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ioanna Koutroulou
- Second Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sotirios Giannopoulos
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gerasimos Siasos
- Third Department of Cardiology, Sotiria Thoracic Diseases General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Lambadiari V, Katsimbri P, Kountouri A, Korakas E, Papathanasi A, Maratou E, Pavlidis G, Pliouta L, Ikonomidis I, Malisova S, Vlachos D, Papadavid E. The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial. Int J Mol Sci 2024; 25:2475. [PMID: 38473723 DOI: 10.3390/ijms25052475] [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] [Received: 01/14/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
The effect of different diet patterns on psoriasis (PSO) and psoriatic arthritis (PSA) is unknown. Τhe aim of our study was to evaluate the effectiveness of a Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSO and PSA. Twenty-six patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8 weeks. At the end of this study, MD and KD resulted in significant reduction in weight (p = 0.002, p < 0.001, respectively), in BMI (p = 0.006, p < 0.001, respectively), in waist circumference (WC) (p = 0.001, p < 0.001, respectively), in total fat mass (p = 0.007, p < 0.001, respectively), and in visceral fat (p = 0.01, p < 0.001, respectively), in comparison with baseline. After KD, patients displayed a significant reduction in the Psoriasis Area and Severity Index (PASI) (p = 0.04), Disease Activity Index of Psoriatic Arthritis (DAPSA) (p = 0.004), interleukin (IL)-6 (p = 0.047), IL-17 (p = 0.042), and IL-23 (p = 0.037), whereas no significant differences were observed in these markers after MD (p > 0.05), compared to baseline. The 22-week MD-KD diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to KD.
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Affiliation(s)
- Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Pelagia Katsimbri
- Rheumatology and Clinical Immunology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Argyro Papathanasi
- Second Department of Dermatology and Venereology, University of Athens Medical School, 12462 Athens, Greece
| | - Eirini Maratou
- Department of Clinical Biochemistry, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - George Pavlidis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Loukia Pliouta
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ignatios Ikonomidis
- Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | | | | | - Evangelia Papadavid
- Second Department of Dermatology and Venereology, University of Athens Medical School, 12462 Athens, Greece
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6
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Barkas F, Rizos CV, Liamis G, Skoumas I, Garoufi A, Rallidis L, Kolovou G, Tziomalos K, Skalidis E, Sfikas G, Kotsis V, Doumas M, Anagnostis P, Lambadiari V, Anastasiou G, Koutagiar I, Attilakos A, Kiouri E, Kolovou V, Polychronopoulos G, Koutsogianni AD, Zacharis E, Koumaras C, Antza C, Boutari C, Liberopoulos E. Obesity and atherosclerotic cardiovascular disease in adults with heterozygous familial hypercholesterolemia: An analysis from HELLAS-FH registry. J Clin Lipidol 2024:S1933-2874(24)00005-9. [PMID: 38331687 DOI: 10.1016/j.jacl.2024.01.005] [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] [Received: 05/03/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) and obesity are well-established risk factors of atherosclerotic cardiovascular disease (ASCVD). Despite high prevalence, their joint association with ASCVD remains largely unknown. OBJECTIVE To investigate the association of obesity with prevalent ASCVD in individuals with heterozygous FH (HeFH) enrolled in the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH). METHODS FH diagnosis was based on Dutch Lipid Clinic Network (DLCN) criteria. Adults with at least possible FH diagnosis (DLCN score ≥3) and available body mass index (BMI) values were included. Homozygous FH individuals were excluded. RESULTS 1655 HeFH adults (mean age 51.0 ± 14.4 years, 48.6% female) were included; 378 (22.8%) and 430 (26.0%) were diagnosed with probable and definite FH, respectively. Furthermore, 371 participants (22.4%) had obesity and 761 (46.0%) were overweight. Prevalence of ASCVD risk factors increased progressively with BMI. Prevalence of coronary artery disease (CAD) was 23.4% (3.2% for stroke and 2.7% for peripheral artery disease, PAD), and increased progressively across BMI groups. After adjusting for traditional ASCVD risk factors and lipid-lowering medication, individuals with obesity had higher odds of established CAD (OR: 1.54, 95% CI: 1.04-2.27, p = 0.036) as well as premature CAD (OR: 1.74, 95% CI: 1.17-2.60, p = 0.009) compared with those with normal BMI. No association was found with stroke or PAD. CONCLUSIONS Over half of adults with HeFH have overweight or obesity. Obesity was independently associated with increased prevalence of CAD in this population.
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Affiliation(s)
- Fotios Barkas
- Department of Hygiene & Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dr Barkas); Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (Drs Rizos, Liamis, Anastasiou, Zacharis)
| | - Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (Drs Rizos, Liamis, Anastasiou, Zacharis)
| | - George Liamis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (Drs Rizos, Liamis, Anastasiou, Zacharis)
| | - Ioannis Skoumas
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece (Drs Skoumas and Koutagiar)
| | - Anastasia Garoufi
- 2nd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece (Dr Garoufi)
| | - Loukianos Rallidis
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece (Drs Rallidis and Kiouri)
| | - Genovefa Kolovou
- Cardiometabolic Centre, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens, Greece (Dr Kolovou)
| | - Konstantinos Tziomalos
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Drs Tziomalos and Polychronopoulos)
| | - Emmanouil Skalidis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece (Drs Skalidis and Zacharis)
| | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Greece (Drs Sfikas and Koumaras)
| | - Vasilios Kotsis
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece (Drs Kotsis and Antza)
| | - Michalis Doumas
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece (Drs Doumas and Boutari)
| | - Panagiotis Anagnostis
- Department of Endocrinology, Police Medical Centre, Thessaloniki, Greece (Dr Anagnostis)
| | - Vaia Lambadiari
- 2nd Propaedeutic Internal Medicine Department and Diabetes Research Unit, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece (Dr Lambadiari)
| | - Georgia Anastasiou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (Drs Rizos, Liamis, Anastasiou, Zacharis)
| | - Iosif Koutagiar
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece (Drs Skoumas and Koutagiar)
| | - Achilleas Attilakos
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, C' Pediatrics Clinic, Attikon University General Hospital, Athens, Greece (Dr Attilakos)
| | - Estela Kiouri
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece (Drs Rallidis and Kiouri)
| | - Vana Kolovou
- Cardiometabolic Centre, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens, Greece (Dr Kolovou)
| | - Georgios Polychronopoulos
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Drs Tziomalos and Polychronopoulos)
| | - Amalia-Despoina Koutsogianni
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (Drs Rizos, Liamis, Anastasiou, Zacharis)
| | - Evangelos Zacharis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece (Drs Skalidis and Zacharis)
| | - Charalambos Koumaras
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Greece (Drs Sfikas and Koumaras)
| | - Christina Antza
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece (Drs Kotsis and Antza)
| | - Chrysoula Boutari
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece (Drs Doumas and Boutari)
| | - Evangelos Liberopoulos
- 1st Propedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, Athens, Greece (Dr Liberopoulos).
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Antza C, Rizos CV, Kotsis V, Liamis G, Skoumas I, Rallidis L, Garoufi A, Kolovou G, Tziomalos K, Skalidis E, Sfikas G, Doumas M, Lambadiari V, Anagnostis P, Stamatelopoulos K, Anastasiou G, Koutagiar I, Kiouri E, Kolovou V, Polychronopoulos G, Zacharis E, Koumaras C, Boutari C, Milionis H, Liberopoulos E. Familial Hypercholesterolemia in the Elderly: An Analysis of Clinical Profile and Atherosclerotic Cardiovascular Disease Burden from the Hellas-FH Registry. Biomedicines 2024; 12:231. [PMID: 38275402 PMCID: PMC10813545 DOI: 10.3390/biomedicines12010231] [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] [Received: 11/29/2023] [Revised: 12/23/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) carries a high risk of atherosclerotic cardiovascular disease (ASCVD). As the population ages, the age-related influence on clinical characteristics and outcomes becomes increasingly pertinent. This cross-sectional analysis from the HELLAS-FH registry aims to explore potential differences in clinical characteristics, treatment, ASCVD, and goal achievement between those younger and older than 65 years with FH. RESULTS A total of 2273 adults with heterozygous FH (51.4% males) were studied. Elderly FH patients (n = 349) had a higher prevalence of ASCVD risk factors, such as hypertension (52.1% vs. 20.9%, p < 0.05) and type 2 diabetes (16.9% vs. 6.0%, p < 0.05), compared to younger patients (n = 1924). They also had a higher prevalence of established ASCVD (38.4% vs. 23.1%, p < 0.001), particularly CAD (33.0% vs. 20.2%, p < 0.001), even after adjusting for major ASCVD risk factors. Elderly patients were more frequently and intensively receiving lipid-lowering treatment than younger ones. Although post-treatment LDL-C levels were lower in elderly than younger patients (125 vs. 146 mg/dL, p < 0.05), both groups had similar attainment of the LDL-C target (3.7% vs. 3.0%). CONCLUSIONS Elderly FH patients have a higher prevalence of ASCVD, particularly CAD. Despite more aggressive treatment, the achievement of LDL-C targets remains very poor. These results emphasize the importance of early FH diagnosis and treatment in reducing ASCVD.
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Affiliation(s)
- Christina Antza
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - George Liamis
- Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis Skoumas
- Cardiology Clinic, Hippokration General Hospital, 54643 Athens, Greece
| | - Loukianos Rallidis
- Department of Cardiology, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Garoufi
- Second Department of Pediatrics, General Children's Hospital "P. & A. Kyriakou", Medical School, National and Kapodistrian University of Athens, 15452 Athens, Greece
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA Apheresis Unit, Metropolitan Hospital, 15562 Athens, Greece
| | - Konstantinos Tziomalos
- 1st Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Emmanouil Skalidis
- Cardiology Clinic, University General Hospital of Heraklion, 70013 Heraklion, Greece
| | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, 56429 Thessaloniki, Greece
| | - Michalis Doumas
- Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Vaia Lambadiari
- 2nd Propaedeutic Internal Medicine Department, Diabetes Research Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Georgia Anastasiou
- Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Iosif Koutagiar
- Cardiology Clinic, Hippokration General Hospital, 54643 Athens, Greece
| | - Estela Kiouri
- Department of Cardiology, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Kolovou
- Cardiometabolic Center, Lipid Clinic, LA Apheresis Unit, Metropolitan Hospital, 15562 Athens, Greece
| | - Georgios Polychronopoulos
- 1st Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Evangelos Zacharis
- Cardiology Clinic, University General Hospital of Heraklion, 70013 Heraklion, Greece
| | - Charalambos Koumaras
- Department of Internal Medicine, 424 General Military Training Hospital, 56429 Thessaloniki, Greece
| | - Chrysoula Boutari
- Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Evangelos Liberopoulos
- 1st Propaedeutic Department of Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Pavlidis G, Tsilivarakis D, Katogiannis K, Vlastos D, Katsanos S, Katsanaki E, Thymis J, Parissis J, Lambadiari V, Ikonomidis I. Association of aortic stiffness early post myocardial infarction with left ventricular remodelling. Eur J Clin Invest 2024; 54:e14090. [PMID: 37675585 DOI: 10.1111/eci.14090] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Adverse left ventricular (LV) remodelling after myocardial infarction is associated with heart failure. We investigated whether aortic stiffness during acute ST-segment elevation myocardial infarction is associated with LV remodelling at long-term follow-up. METHODS In 109 patients within 48 h of myocardial infarction post-primary percutaneous coronary intervention and after 2 years, we measured: (a) carotid to femoral pulse wave velocity (PWV), (b) LV global longitudinal strain (GLS) and left atrial strain using speckle-tracking echocardiography, (c) PWV/GLS ratio as a surrogate marker of ventricular-arterial interaction, and (d) LV end-diastolic and end-systolic volumes. A > 15% decrease from the baseline in LV end-systolic volume at 2-year follow-up was considered as a criterion of reverse LV remodelling. RESULTS Compared with baseline, all patients had reduced PWV, LV end-diastolic and end-systolic volumes while PWV/GLS, GLS and reservoir left atrial strain were improved (p < .05) after 2 years. Baseline values of PWV, GLS, PWV/GLS ratio and reservoir left atrial strain were associated with percentage change of LV end-systolic volume at 2 years (p < .05). Multivariable analysis revealed that lower baseline values of PWV and a less impaired GLS and PWV/GLS were independently associated with reverse LV remodelling at 2 years with a C-statistic of .748, .711 and .787, respectively. CONCLUSION Aortic stiffness early post-infarction determines LV remodelling after 2 years of the ischemic event despite post successful revascularization. CLINICAL TRIAL REGISTRATION-URL http://www. CLINICALTRIALS gov. Unique identifier: NCT03984123, 30/04/2020.
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Affiliation(s)
- George Pavlidis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Damianos Tsilivarakis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Katogiannis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlastos
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Katsanos
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Katsanaki
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Thymis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Goliopoulou A, Theofilis P, Oikonomou E, Anastasiou A, Pantelidis P, Gounaridi MI, Zakynthinos GE, Katsarou O, Kassi E, Lambadiari V, Tousoulis D, Vavuranakis M, Siasos G. Non-Alcoholic Fatty Liver Disease and Echocardiographic Parameters of Left Ventricular Diastolic Function: A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:14292. [PMID: 37762592 PMCID: PMC10532416 DOI: 10.3390/ijms241814292] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
The cardiovascular implications of non-alcoholic fatty liver disease (NAFLD) have been associated with heart failure with preserved ejection fraction (HFpEF). The purpose of this review was to conduct a bibliographic search regarding the correlation between NAFLD and the echocardiographic parameters of left ventricular diastolic function. A systematic literature search was conducted in PubMed and Embase for original research data reporting on the association of NAFLD with diastolic function markers [E/e', left atrial volume index (LAVi), left ventricular mass index (LVMi)]. Meta-analysis was performed using the meta and dmetar packages in R studio v.1.4.1106, with p < 0.05 values being considered significant. Results are expressed as the standardized mean difference (SMD) for continuous variables and as the odds ratio (OR) for categorical variables, with respective 95% confidence intervals (CI). Heterogeneity between studies was expressed with index Ι2. From the preliminary search, 2619 articles were found from which 31 studies were included in the final statistical analysis. The meta-analysis of 8 studies which reported on the prevalence of diastolic dysfunction showed that it was increased in patients with NAFLD (OR: 2.07, 95% CI 1.24-3.44 with p = 0.01, I2: 80% with p < 0.01). The meta-analysis of 21 studies showed significantly higher E/e' in NAFLD patients (SMD 1.02, 95% CI 0.43-1.61 with p < 0.001, I2: 97% with p < 0.001). Individuals with NAFLD had increased LAVi (SMD: 0.87, 95% CI 0.38-1.37 with p < 0.001, I2: 96% with p < 0.001) and LVMi (SMD: 0.89, 95% CI 0.31-1.48 with p = 0.003, I2: 100% with p < 0.001). To conclude, in the meta-analysis of 31 observational studies, NAFLD patients were found to have affected left ventricular diastolic function, supporting the hypothesis of NAFLD being associated with HFpEF.
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Affiliation(s)
- Athina Goliopoulou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Panagiotis Theofilis
- 1st Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Maria Ioanna Gounaridi
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Georgios E. Zakynthinos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Ourania Katsarou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (P.P.)
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11
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Bletsa E, Oikonomou E, Dimitriadis K, Stampouloglou PK, Fragoulis C, Lontou SP, Korakas E, Beneki E, Kalogeras K, Lambadiari V, Tsioufis K, Vavouranakis M, Siasos G. Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors. Life (Basel) 2023; 13:1742. [PMID: 37629599 PMCID: PMC10456116 DOI: 10.3390/life13081742] [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] [Received: 06/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.
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Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Panagiota K. Stampouloglou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Christos Fragoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Stavroula P. Lontou
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Emmanouil Korakas
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Eirini Beneki
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Vaia Lambadiari
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
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12
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Kountouri A, Korakas E, Maratou E, Ikonomidis I, Balampanis K, Liatis S, Tentolouris N, Toulas P, Kousathana F, Giatzakis C, Dimitriadis GD, Lambadiari V. Familial Partial Lipodystrophy: Clinical Features, Genetics and Treatment in a Greek Referral Center. Int J Mol Sci 2023; 24:12045. [PMID: 37569420 PMCID: PMC10419242 DOI: 10.3390/ijms241512045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Familial partial lipodystrophy (FPLD) is a rare syndrome in which a patient's phenotype is not merely dependent on the specific genetic mutation, but it is also defined by a combination of other demographic, environmental and genetic factors. In this prospective observational study in a Greek referral center, we enrolled 39 patients who fulfilled the clinical criteria of FPLD. A genetic analysis was conducted, which included sequence and deletion/duplication analyses of the LMNA and PPRARG genes, along with anthropometric and metabolic parameters. The treatment responses of patients who were eligible for treatment with metreleptin were evaluated at 3 and 12 months. In most of the patients, no significant changes were detected at the exon level, and any mutations that led to changes at the protein level were not associated with the lipodystrophic phenotype. On the contrary, various changes were detected at the intron level, especially in introns 7 and 10, whose clinical significance is considered unknown. In addition, treatment with metreleptin in specific FPLD patients significantly improved glycemic and lipidemic control, an effect which was sustained at the 12-month follow-up. More large-scale studies are necessary to clarify the genetic and allelic heterogeneity of the disease, along with other parameters which could predict treatment response.
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Affiliation(s)
- Aikaterini Kountouri
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.K.); (F.K.)
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.K.); (F.K.)
| | - Eirini Maratou
- Laboratory of Clinical Biochemistry, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece;
| | - Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, Second Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.K.); (F.K.)
| | - Stavros Liatis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece (N.T.)
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece (N.T.)
| | | | - Foteini Kousathana
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.K.); (F.K.)
| | - Christophoros Giatzakis
- DNAbiolab, Cretan Center for Research and Development of Applications on Genetics and Molecular Biology, 71306 Heraklion, Greece
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.K.); (F.K.)
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13
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Papathanasiou KA, Vrachatis DA, Kazantzis D, Kossyvakis C, Giotaki SG, Deftereos G, Raisakis K, Kaoukis A, Avramides D, Lambadiari V, Siasos G, Deftereos S. Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis. Egypt Heart J 2023; 75:29. [PMID: 37079174 PMCID: PMC10119349 DOI: 10.1186/s43044-023-00356-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA). METHODS The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices. RESULTS A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = - 0.66; 95% CI (- 1.01, - 0.32) and SMD = - 0.56; 95% CI (- 0.73, - 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35-0.67, and SMD = 0.35; 95% CI 0.20-0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79-2.02). Moderate statistical heterogeneity and small case-control studies are the main limitations of our meta-analysis. CONCLUSIONS Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence.
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Affiliation(s)
- Konstantinos A Papathanasiou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece.
| | - Dimitrios A Vrachatis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
| | - Dimitrios Kazantzis
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Sotiria G Giotaki
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Konstantinos Raisakis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Andreas Kaoukis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Dimitrios Avramides
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
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14
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Papagianni G, Panayiotou C, Vardas M, Balaskas N, Antonopoulos C, Tachmatzidis D, Didangelos T, Lambadiari V, Kadoglou NPE. The anti-inflammatory effects of aerobic exercise training in patients with type 2 diabetes: A systematic review and meta-analysis. Cytokine 2023; 164:156157. [PMID: 36842369 DOI: 10.1016/j.cyto.2023.156157] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/07/2023] [Accepted: 02/03/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a low-grade, chronic inflammatory disease, associated with increased cardiovascular risk. The purpose of this systematic review/ meta-analysis was to evaluate the effects of aerobic exercise training (AET) on inflammatory markers in T2DM patients. METHODS The literature search was conducted utilizing PubMed, Web of Science, Embase, and the Cochrane Library from their inception up to April 2022. We screened only for randomized controlled trials (RCTs) investigating the effects of AET on C-reactive protein (CRP) and adipokines: adiponectin, resistin, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-a), along with changes in anthropometric indices and glycemic control in adult T2DM patients. Pooled post-exercise weighted mean differences (WMDs) with 95% Confidence Intervals (CIs) were calculated for all outcomes of interest between exercise-treated patients and controls. RESULTS Twenty-six RCTs involving 1239 T2DM patients were retrieved from the databases for meta-analysis. The cumulative results showed that post-AET inflammatory markers were lower in exercise-treated patients compared to controls regarding CRP (mg/L): WMD: -0.91; 95%CIs: -1.43, -0.40; p < 0.001 resistin (mg/ml): (WMD: -2.08; 95%CIs: -3.32, -0.84; p < 0.001); TNF-a (pg/ml): (WMD: -2.70; 95%CIs: -4.26, -1.14; p < 0.001), and IL-6 (pg/ml): (WMD: -1.05; 95%CIs: -1.68, -0.43; p < 0.001). Those effects were accompanied by significant amelioration of fasting glucose (mg/dl) (WMD: -13.02; 95%CIs: -25.39, -0.66; p = 0.04), HbA1c (%) (WMD: -0.51; 95%CIs: -0.73, -0.28, p < 0.001), and fat mass (%) (WMD: -3.14; 95%CI: -4.71, -1.58; p < 0.001). Our meta-analysis demonstrated less-consistent results for adiponectin (μg/ml), (WMD: 1.00; 95%CI: -0.12, 2.12; p = 0.08) and body-mass index (kg/m2) (WMD: -1.34; 95%CI: -2.76, 0.08; p = 0.06) tending to differ between AET and control group. CONCLUSIONS AET can significantly reduce the inflammatory burden in T2DM patients. by ameliorating the circulating levels of CRP, resistin, TNF-a and IL-6, even without accompanied significant weight-loss. The clinical impact of those anti-inflammatory effects of AET needs to be determined.
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Affiliation(s)
- Georgia Papagianni
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Constantinos Antonopoulos
- Department of Vascular Surgery, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | | | | | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
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15
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Vrachatis DA, Papathanasiou KA, Kossyvakis C, Giotaki SG, Deftereos G, Kousta MS, Iliodromitis KE, Bogossian H, Avramides D, Giannopoulos G, Lambadiari V, Siasos G, Papaioannou TG, Deftereos S. Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review. Biomedicines 2023; 11:biomedicines11041022. [PMID: 37189639 DOI: 10.3390/biomedicines11041022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI?
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16
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Ikonomidis I, Katogiannis K, Chania C, Iakovis N, Tsoumani M, Christodoulou A, Brinia E, Pavlidis G, Thymis J, Tsilivarakis D, Kountouri A, Korakas E, Lambadiari V, Triposkiadis F, Skaltsounis L, Tseti I, Iliodromitis EK, Andreadou I. Association of hydroxytyrosol enriched olive oil with vascular function in chronic coronary disease. Eur J Clin Invest 2023:e13983. [PMID: 36912212 DOI: 10.1111/eci.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Hydroxytyrosol reduces low-density lipoprotein oxidation, contributing to prevention of atherosclerosis progression. METHODS In a prospective, crossover, double-blind, placebo-controlled trial, 30 chronic coronary artery syndrome (CCAS) patients were randomized to 4 capsules/day, containing 412.5 mg olive oil with 2.5 mg hydroxytyrosol (OOHT) each one or placebo for 1 month and then were crossed over to the alternate treatment (placebo or OOHT). We measured (a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), (b) flow-mediated dilation (FMD), (c) Coronary Flow Reserve (CFR) and markers of LV diastolic function by Doppler echocardiography, (d) pulse wave velocity (PWV), and (e) oxidative stress, inflammatory biomarkers and blood lipids at baseline and after treatment. RESULTS Treatment with OOHT improved PBR, FMD, CFR and PWV compared to baseline (1.8 ± .3 vs. 1.7 ± .4 μm, p = .040, 3.7 ± 2.1 vs. 6.5% ± 2.3%, p < .001, 2.3 ± .4 vs. 2.5 ± .4, p = .030 and 11.1 ± 1.8 vs. 11.8 ± 2.3 m/s, p = .002) while there was no effect after placebo (p = NS). No effect of OOHT treatment was observed on blood pressure. There was a parallel improvement of E' of the mitral annulus and deceleration time of the E wave of mitral inflow after OOHT (p < .05) but not after placebo. Compared to baseline, treatment with OOHT reduced malondialdehyde, a marker of lipid peroxidation, oxidized LDL, triglycerides, PCSK9 and CRP blood levels (p < .05) in contrast to placebo. CONCLUSIONS Hydroxytyrosol-enriched olive oil may have beneficial effects on endothelial, arterial and LV diastolic function likely by reducing oxidative and inflammatory burden in CCAS, though further studies are needed to confirm this mechanism.
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Affiliation(s)
- Ignatios Ikonomidis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Katogiannis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Chania
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Iakovis
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece
| | - Maria Tsoumani
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriana Christodoulou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Brinia
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - George Pavlidis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John Thymis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Damianos Tsilivarakis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Leandros Skaltsounis
- Division of Pharmacognosy and Natural Products Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efstathios K Iliodromitis
- Laboratory of Echocardiography and Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
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17
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Dimitriadis GD, Lambadiari V. GLP-1 Receptor Agonists and SGLT-2 Inhibitors as Adjuncts to Insulin in Type 1 Diabetes: Benefits and Concerns. J Clin Endocrinol Metab 2023; 108:e52-e53. [PMID: 36507904 DOI: 10.1210/clinem/dgac704] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Affiliation(s)
- George D Dimitriadis
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, 12462-Haidari, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, 12462-Haidari, Athens, Greece
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18
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Makavos G, Ikonomidis I, Lambadiari V, Koliou GA, Pavlidis G, Thymis J, Rafouli-Stergiou P, Kostelli G, Katogiannis K, Stamoulis K, Kountouri A, Korakas E, Theodoropoulos K, Frogoudaki A, Katsimbri P, Papadavid E. Additive prognostic value of longitudinal myocardial deformation to SCORE2 in psoriasis. Eur Heart J Open 2023; 3:oead016. [PMID: 36942108 PMCID: PMC10023827 DOI: 10.1093/ehjopen/oead016] [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] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Abstract
Aims Psoriasis has been associated with increased cardiovascular (CV) risk. We investigated whether markers of CV function and their change after treatment have a prognostic value for adverse outcomes. Methods and results In a prospective study, at baseline and after 6 months of treatment with biological agents, we assessed in 298 psoriasis patients (i) left ventricular global longitudinal strain (GLS) and (ii) carotid-femoral pulse wave velocity (PWV), to evaluate their prognostic value for major adverse cardiovascular events (MACEs), including coronary artery disease, stroke, hospitalization for heart failure, and all-cause death over a 4-year follow-up period. During follow-up, 26 (8.7%) MACEs were recorded. By univariate analysis, decreasing absolute GLS values [hazard ratio (HR): 0.73, P < 0.001], decreasing GLS change after treatment (HR: 0.53, P = 0.008), and increasing PWV values (HR: 1.16, P = 0.049) were associated with adverse outcomes. Baseline GLS and its change post-treatment remained independent predictors of adverse events after adjusting for several confounders (P < 0.05). The addition of baseline GLS and its absolute change post-treatment to SCORE2 increased Harrell's C from 0.882 to 0.941. By multivariable analysis, for each 1% increase in absolute baseline GLS values, the risk of MACE decreased by 33% and for each 1% absolute increase of GLS post-treatment compared with the baseline value, the risk of MACE decreased by 58%. Conclusion Global longitudinal strain has an independent and additive prognostic value to SCORE2 for adverse CV events in psoriasis, providing timely decision-making for intensive anti-inflammatory treatment and aggressive modification of risk factors to reduce CV risk.
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Affiliation(s)
| | | | - Vaia Lambadiari
- 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Georgia-Angeliki Koliou
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - George Pavlidis
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - John Thymis
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Pinelopi Rafouli-Stergiou
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Gavriella Kostelli
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Konstantinos Katogiannis
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Konstantinos Stamoulis
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Aikaterini Kountouri
- 4th Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Emmanouil Korakas
- 4th Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Kostas Theodoropoulos
- 2nd Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Alexandra Frogoudaki
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Pelagia Katsimbri
- 4th Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece
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19
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Papachristoforou E, Liatis S, Psoma O, Kountouri A, Lambadiari V, Tsimihodimos V. Effect of the first and second COVID-19 associated lockdown on the metabolic control of patients with type 2 diabetes in Greece. J Diabetes Complications 2023; 37:108363. [PMID: 36542895 PMCID: PMC9703856 DOI: 10.1016/j.jdiacomp.2022.108363] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the effect of the COVID-19 lockdown periods on the metabolic control of patients with type 2 diabetes (T2D) in three academic diabetes centers in Greece. There was a slight improvement in BMI, blood pressure and lipid values while the remaining parameters remained stable.
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Affiliation(s)
- Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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20
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Anastasiou IA, Tentolouris KN, Lambadiari V, Eleftheriadou I, Tektonidou M, Tentolouris N. Effects of Advanced Glycation End Products via Oxidative Stress on Beta Cells: Insights from in vitro and in vivo Studies and Update on Emerging Therapies. Mini Rev Med Chem 2023; 23:2041-2052. [PMID: 37165506 DOI: 10.2174/1389557523666230510123038] [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] [Received: 01/27/2023] [Revised: 03/09/2023] [Accepted: 04/06/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Protein, lipid, and nucleic acid glycation reactions begin and continue as a result of persistent hyperglycemia in patients with diabetes mellitus. Advanced glycated end products (AGEs) are a complex group of chemical moieties that are formed as a result of the glycation process and play an important role in the pathogenesis of diabetes mellitus. When AGEs interact with their cellular receptor (RAGE), numerous signaling pathways, including nuclear factor kappa-light-chainenhancer of activated B cells (NF-κB), c-Jun N-terminal kinase (JNK), and mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK), are activated, increasing oxidative stress. OBJECTIVE The aim of this review was to summarize in vitro and in vivo studies underlining the involvement of AGEs on beta cell dysfunction and death via oxidative stress. METHODS A literature search of publications published between 1912 and December 2022 was conducted using MEDLINE, EMBASE, and the Cochrane Library, with restrictions on articles written in English. RESULTS Recent insights have revealed that oxidative stress has a crucial role in the development of beta cell dysfunction and insulin resistance, the major hallmarks of type 2 diabetes mellitus. Studies also revealed that AGEs decrease insulin synthesis and secretion in the pancreatic beta cells and induce cell apoptosis. CONCLUSION Experimental data have shown that both AGEs and oxidative stress contribute to beta cell dysfunction and development as well as to the progression of diabetic complications. Many anti- AGE therapies are being developed; however, it remains to be seen whether these therapies can help maintain beta cell function and prevent diabetes complications.
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Affiliation(s)
- Ioanna A Anastasiou
- First Department of Propaedeutic Internal Medicine, Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos N Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine, Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Maria Tektonidou
- First Department of Propaedeutic Internal Medicine, Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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21
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Oikonomou E, Souvaliotis N, Lampsas S, Siasos G, Theofilis P, Korakas E, Lambadiari V, Ikonomidis I, Pesiridis T, Zakynthinos G, Katsarou O, Tousoulis D, Vavouranakis M. The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels of patients with COVID-19. Cardiol J 2022; 29:1037-1039. [PMID: 36117293 PMCID: PMC9788738 DOI: 10.5603/cj.a2022.0088] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/24/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Nektarios Souvaliotis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece,Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Panagiotis Theofilis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Emmanouil Korakas
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vaia Lambadiari
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Georgios Zakynthinos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Ourania Katsarou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
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22
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Karamanakos G, Barmpagianni A, Kapelios CJ, Kountouri A, Bonou M, Makrilakis K, Lambadiari V, Barbetseas J, Liatis S. The association of insulin resistance measured through the estimated glucose disposal rate with predictors of micro-and macrovascular complications in patients with type 1 diabetes. Prim Care Diabetes 2022; 16:837-843. [PMID: 36272914 DOI: 10.1016/j.pcd.2022.10.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Insulin resistance (IR) is associated with a higher rate of type 1 diabetes (T1D) complications. We aimed to examine the relationship between estimated glucose disposal rate (eGDR), a readily available marker of IR in clinical practice and early predictor biomarkers of macrovascular and microvascular complications in patients with T1D. DESIGN A cross-sectional study. METHODS A total of 165 consecutive patients with T1D free of cardiovascular, eye, and renal complications were included in the study from 2016 to 2020. Participants were characterized as insulin resistant if their eGDR value was ≤ 8 mg/kg/min. Pulse wave velocity (PWV) and global longitudinal strain (GLS) were used as surrogates for subclinical atherosclerosis and left ventricular systolic dysfunction (LVSD), respectively. Four previously standardized tests based on the calculation of heart rate variability (HRV) were used to evaluate subclinical cardiac autonomic neuropathy (CAN). Early nephropathy was assessed by assessing urinary albumin to creatinine ratio (ACR). RESULTS The population sample (n = 165) included a majority of female patients (63%) and had a median age of 32 years (24-43), median disease duration of 14 years ( ± 9.5-21.5), a median BMI value of 23.7 kg/m2 (21.4-26.6), an HbA1C of 7.2% (6.7-8.2) and median eGDR (lower values indicate higher insulin resistance) of 9.2 mg/kg/min (8.2-9.9), while 21.8% (n = 36) of the participants were characterized as insulin resistant. After adjustment for age, gender, and the duration of diabetes, the presence of IR was significantly associated with higher prevalence of subclinical atherosclerosis (OR:2.59, 95% CI: 1.06-6.30, p = 0.036), CAN (OR:3.07, 95% CI: 1.02-9.32, p = 0.047) and subclinical LVSD (OR: 4.9, 95% CI: 1.94-12.79, p = 0.001). No association was shown with ACR. CONCLUSIONS In patients with T1D, insulin resistance, as measured by eGDR, correlates well with early CVD predictors and CAN. These associations appear independent of the effects of gender, aging, and disease duration.
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Affiliation(s)
- Georgios Karamanakos
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Aikaterini Barmpagianni
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos J Kapelios
- Department of Health Policy, London School of Economics and Political Science, London, UK; Cardiology Department, Laiko General Hospital, Athens, Greece, London School of Economics and Political Science, London, UK
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Propaedeutic and Research Institute, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - Maria Bonou
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Propaedeutic and Research Institute, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - John Barbetseas
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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23
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Nikolaou PE, Mylonas N, Makridakis M, Makrecka-Kuka M, Iliou A, Zerikiotis S, Efentakis P, Kampoukos S, Kostomitsopoulos N, Vilskersts R, Ikonomidis I, Lambadiari V, Zuurbier C, Latosinska A, Vlachou A, Dimitriadis G, Iliodromitis EK, Andreadou I. Comparative study on the cardioprotective effect of selective sodium glucose co-transporter 2 inhibitors in a non-diabetic mouse model of myocardial ischemia/reperfusion injury. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.247] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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24
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Kontoangelos K, Raptis A, Lambadiari V, Economou M, Tsiori S, Katsi V, Papageorgiou C, Martinaki S, Dimitriadis G, Papageorgiou C. Burnout Related to Diabetes Mellitus: A Critical Analysis. Clin Pract Epidemiol Ment Health 2022; 18:e174501792209010. [PMID: 37274843 PMCID: PMC10156041 DOI: 10.2174/17450179-v18-e2209010] [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] [Received: 12/24/2021] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 06/07/2023]
Abstract
Background Diabetes burnout is a condition when a patient with diabetes feels tired from his/her disease and neglects it for a certain period or continuously. Objective Diabetes burnout is frequent, and there is extended literature about psychosocial stress and its negative effects on health. Methods A search for relevant studies was conducted using PubMed, Google Scholar and ResearchGate. A systematic review was conducted on the relevant articles after critical appraisal. Only publications in English were selected. The objective of this study was to evaluate the association between burnout syndrome and diabetes mellitus. Results This article mainly focused on studies that evaluated the presence of burnout and diabetes mellitus effects. Diabetes can influence psychological health equally with somatic strength. Relatives can also express depression, guilt, fright, worry, rage, and burnout. Psychosocial job stress and extended working hours are linked with a higher possibility of myocardial infarction, diabetes mellitus, and hypertension. Conclusion Diabetes burnout is a combination of emotions and practices, ranging from tiredness to indifference, linked with a distressing sense of hopelessness. Revealing this health condition is necessary so that preventive measures can be taken.
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Affiliation(s)
- Konstantinos Kontoangelos
- 1 Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
- University Mental Health Neurosciences and Precision Medicine Research Institute “Costas Stefanis”, Athens, Greece
| | - Athanasios Raptis
- 2 Department of Internal Medicine-Propaedeutic-Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Vaia Lambadiari
- 2 Department of Internal Medicine-Propaedeutic-Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Marina Economou
- 1 Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
- University Mental Health Neurosciences and Precision Medicine Research Institute “Costas Stefanis”, Athens, Greece
| | - Sofia Tsiori
- 1 Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Katsi
- 1 Department of Cardiology, “Hippokration” Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute “Costas Stefanis”, Athens, Greece
| | - Sofia Martinaki
- 1 Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - George Dimitriadis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Charalabos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute “Costas Stefanis”, Athens, Greece
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25
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Ikonomidis I, Prentza V, Kountouri A, Pavlidis G, Katogiannis K, Thymis J, Pliouta L, Korakas E, Kostelli G, Mixalopoulou E, Balampanis K, Palaiodimou L, Zompola C, Tsivgoulis G, Lambadiari V. Four-month treatment with long-acting glucagon-like peptide-1 receptor agonists (GLP-1) or sodium-glucose co-trasporter-2 inhibitors (SGLT-2i) improves vascular function in type 2 diabetes mellitus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1940] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Patients with type 2 diabetes mellitus (T2DM) and ischemic stroke present impaired markers of vascular and endothelial function. Glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose contrasporter-2 inhibitors (SGLT-2) are novel antidiabetic agents reducing the risk of cardiovascular complications.
Purpose
The aim of the study is to investigate the effect of treatment with GLP-1 or SGLT2 on arterial stiffness and endothelial glycocalyx in patients with T2DM and ischemic stroke.
Methods
We recruited in total 81 patients with T2DM and ischemic stroke who received dulaglutide (n=27), dapagliflozin (n=27) or insulin (n=27). We measured at baseline and at four months post-treatment the: a) Carotid-femoral pulse wave velocity (PWV-Complior; ALAM Medical), b) Augmentation index (Aix), c) Central systolic blood pressure (cSBP), and d) Perfused boundary region (PBR) of the sublingual arterial microvessels(marker of endothelial glycocalyx thickness), e) Left ventricular global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
At baseline, patients among the three groups had similar age, sex, HbA1c and markers of endothelial and cardiovascular function (p>0.05). Dapagliflozin and dulaglutide showed a greater reduction of PBR, PWV and central SBP than insulin, despite a similar HbA1c reduction (p<0.05). After four months treatment, patients on dapagliflozin and on dulaglutide displayed a greater reduction of PWV (−10% and −8% vs −1%), of cSBP (−9% and −8% vs +1%), of Aix (−65% and −13% vs −3%) and of GLS (+11% and +7% vs +5%) compared to patients on insulin (p<0.05 for all comparisons) (Table 1). PBR values were improved only in patients who received dulaglutide (−4% vs dapagliflozin: −2% vs insulin +1%).
Conclusions
Dulaglutide and dapagliflozin improve cardiovascular function, but only dulaglutide improves endothelial glycocalyx in patients with T2DM and ischemic stroke after four months treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - V Prentza
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Mixalopoulou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - L Palaiodimou
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - C Zompola
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - G Tsivgoulis
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Ikonomidis I, Pavlidis G, Tsoumani M, Kousathana F, Katogiannis K, Tsilivarakis D, Thymis J, Kountouri A, Korakas E, Pliouta L, Parissis J, Bamias A, Filippatos G, Andreadou I, Lambadiari V. Endothelial dysfunction due to decreased nitric oxide bioavailability in dysglycaemic subjects and first-degree relatives of type 2 diabetic patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Oxidative stress plays an important role in the pathogenesis of type 2 diabetes mellitus.
Purpose
We aimed to investigate oxidative stress and nitrites/nitrates concentrations at baseline and during postprandial hyperglycaemia in 40 first-degree relatives (FDR) of type 2 diabetic patients with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic).
Methods
Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm (Microscan, Glycocheck), a marker of endothelial glycocalyx integrity, coronary flow reserve (CFR) in the distal left anterior descending coronary artery, left ventricular global longitudinal strain (GLS), malondialdehyde (MDA), protein carbonyls (PC) and nitrites/nitrates plasma levels were assessed at 0 and 120 min of a 2-hour OGTT. Insulin sensitivity was evaluated using Matsuda and insulin sensitivity index (ISI).
Results
In all subjects, there were no significant changes in MDA and PC at 120 min after OGTT (p>0.05). Compared with normoglycaemic subjects, in FDR and dysglycaemic subjects, nitrites/nitrates levels were significantly decreased at 120 min (−24% versus −30% versus −3%, respectively) with a parallel increase in PBR (+7% versus +10% versus −3%) and a reduction in CFR (−11% versus −14% versus −6%) and GLS (−4% versus −4% versus +0.1%) (p<0.05 for all comparisons). The percent reduction of nitrites/nitrates levels was associated with abnormal values of Matsuda and ISI, reversely related with the percent increase of PBR (r=−0.60, p=0.001) and positively related with the percent decrease of CFR (r=0.39, p=0.038) and GLS (r=0.48, p=0.008).
Conclusion
Insulin resistance determines acute endothelial responses during OGTT leading to reduced nitric oxide production with resultant coronary and myocardial dysfunction in FDR and dysglycaemic subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - F Kousathana
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - D Tsilivarakis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Parissis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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27
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Ikonomidis I, Kountouri A, Pavlidis G, Katogiannis K, Thymis J, Pliouta L, Korakas E, Balampanis K, Bamias A, Lambadiari V. Four-months treatment with dapagliflozin improves endothelial glycocalyx and cardiovascular function in patients with type 1 diabetes mellitus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2687] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Patients with type 1 diabetes mellitus (T1DM) present signs of vascular and endothelial dysfunction earlier compared to healthy individuals. According to clinical studies, SGLT-2i favorably affect cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the data regarding the efficacy of SGLT-2i on cardiovascular markers in patients with T1DM are scarce.
Purpose
We investigated the effects of dapagliflozin on endothelial and cardiovascular function in patients with T1DM.
Methods
We recruited in total 30 patients with T1DM and pour glycemic control who were under medication with insulin and received dapagliflozin (n=15) or intensification of insulin treatment (n=15) (control group). We measured at baseline and at four months post-treatment the: a) Carotid-femoral pulse wave velocity (PWV-Complior; ALAM Medical) b) Central systolic blood pressure (cSBP) c) Perfused boundary region (PBR) of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness) and d) Left ventricular global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
At baseline, patients among the two groups had similar age, sex, HbA1c and markers of endothelial and cardiovascular function (p>0.05). After four months treatment, patients who received dapagliflozin displayed an improvement in PBR5–25 (−41%, p<0.05), in PWV (−10%, p<0.05), in cSBP (−6%, p<0.05) and in GLS (+5%, P<0.05) compared to baseline. However, no statistically significant changes in PBR5–25, in PWV, in cSBP and in GLS were observed after intensification of insulin treatment (PBR5–25: +3%, PWV: +2%, cSBP: −2%, GLS: −3% at 4 months, P>0.05), despite a similar HbA1c reduction (Table 1). Changes of PBR after four months treatment with dapagliflozin correlated with a concomitant reduction of PWV and cSBP (P<0.05).
Conclusions
Four-months treatment with dapagliflozin improves endothelial glycocalyx and cardiovascular function in patients with T1DM, independently of glycemic control.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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28
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Ikonomidis I, Pavlidis G, Katogiannis K, Kapniari I, Theodoropoulos K, Kountouri A, Kostelli G, Tsilivarakis D, Thymis J, Katsimbri P, Parissis J, Filippatos G, Lambadiari V, Papadavid E. Differences in coronary flow reserve and flow-mediated dilation between plaque psoriasis and psoriatic arthritis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2643] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Psoriatic disease is associated with increased cardiovascular risk through mechanisms of inflammation and oxidative stress.
Purpose
We aimed to investigate endothelial glycocalyx, coronary microcirculatory function and flow-mediated dilation in patients with plaque psoriasis and psoriatic arthritis.
Methods
In 311 patients (mean age: 52±12 years) with psoriatic disease (185 with plaque psoriasis and 126 with psoriatic arthritis) and 150 controls with similar age, sex and atherosclerotic risk factors, we assessed: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (3) Flow-mediated dilation (FMD) of the brachial artery, and (4) LV global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
Compared with controls, patients with psoriatic disease had higher PBR (2.14±0.29 versus 1.78±0.25μm, p<0.001) and lower CFR (2.86±0.93 versus 3.39±0.68, p<0.001), FMD (6.97±3.9 versus 9.1±2.1, p<0.001) and GLS (−17.4±3.8 versus −21.9±1.5%, p<0.001). There was not significant difference between the two study groups (plaque psoriasis and psoriatic arthritis) in PBR (2.14±0.28 versus 2.14±0.31μm, p=0.990) and GLS (−17.2±3.9 versus −17.6±3.8%, p=0.297). Patients with psoriatic arthritis had more impaired CFR (2.75±0.85 versus 2.96±0.99, p=0.045) and FMD (5.45±3.2 versus 7.76±4, p=0.003) compared to patients with plaque psoriasis.
Conclusions
Patients with psoriatic disease have impaired endothelial, vascular and myocardial function compared with controls. Coronary microcirculatory function and flow-mediated dilation are more affected in psoriatic arthritis compared with plaque psoriasis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Kapniari
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
| | - K Theodoropoulos
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - D Tsilivarakis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - P Katsimbri
- Attikon University Hospital, 4th Department of Internal Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - J Parissis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Papadavid
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
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29
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Ikonomidis I, Kountouri A, Mitrakou A, Thymis J, Katogiannis K, Korakas E, Varlamos C, Bamias A, Thomas K, Andreadou I, Tsoumani M, Kavatha D, Antoniadou A, Dimopoulos MA, Lambadiari V. SARS-CoV-2 is associated withabnormal biomarkers of oxidative stress,and endothelial function linked with cardiovascular dysfunction four months after the infection. Eur Heart J 2022. [PMCID: PMC9619520 DOI: 10.1093/eurheartj/ehac544.153] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction COVID-19 infection has been associated with increase arterial stiffness, endothelialdysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have beensuggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation afterCOVID-19 infection. Purpose The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial,coronary, and myocardial function markers four months after SARS-CoV-2 infection. Methods In a case-control prospective study, we included 70 patients 4 months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) malondialdehyde (MDA), an oxidative stress marker, thrombomodulin and von Willebrand factor as endothelial biomarkers. Results COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively) but lower values than controls (3.42±0.65, p=0.0135, 9.06±2.11%, p=0.002 respectively). Compared to controls, both COVID-19 and hypertensives had greater PBR5–25 (2.07±0.15μm and 2.07±0.26μm p=0.8 vs 1.89±0.17μm, p=0.001), higher PWV, (12.09±2.50 vs 11.92±2.94, p=0.7 vs 10.04±1.80m/sec, p=0.036) increased cSBP (128.43±17.39 vs 135.17±16.83 vs 117.89±18.85) and impaired LV and RV GLS (−19.50±2.56% vs −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020 and −16.99±3.17% vs −18.63±3.20%, p=0.002 vs −20.51±2.28%, p<0.001). MDA and thrombomodulin were higher in COVID-19 patients than both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50nmole/L, p=0.001 and 3716.63±188.36 vs 3114.46±179.18, p=0.017 vs 2590.02±156.51pg/ml, p<0.001). COVID-19 patients displayed similar vWF values with hypertensives but higher compared with healthy controls (4018.03±474.31 vs 3756.65±293.28 vs 2079.33±855.10 ng/ml, p=0.718 and p=0.016 respectively). Conclusions SARS-CoV-2 infection is associated with oxidative stress, endothelial and vascular dysfunction, which are linked to impaired longitudinal myocardial deformation 4 months after COVID-19 infection. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - D Kavatha
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - M A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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30
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Ikonomidis I, Kountouri A, Mitrakou A, Katogiannis K, Thymis J, Korakas E, Pavlidis G, Andreadou I, Chania C, Bamias A, Thomas K, Antoniadou A, Lambadiari V, Filippatos G. Impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation four months after COVID-19 infection are partially improved at twelve months. Eur Heart J 2022. [PMCID: PMC9619591 DOI: 10.1093/eurheartj/ehac544.2645] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk. Purpose We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection Methods We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker. Results At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p<0.001) which increased at twelve months (p<0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p>0.05 for all the comparisons) and higher than those in controls (p<0.001, p=0.057, p=0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p=0.002, p=0.069 respectively), though remained impaired compared to controls (p=0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p=0.001,) and showed no statistically significant difference compared to controls (p>0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p=0.01, p=0.006 respectively). There was a modest improvement in GWW and GWE at twelve months,(p=0.043, p=0.001, respectively); however, these markers remained impaired compared to controls (p>0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p<0.001); however, these values remain higher than in controls (p=0.002) (Table 1). Conclusions SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - C Chania
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
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31
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Ikonomidis I, Katogiannis K, Frogoudaki A, Vrettou AR, Pavlidis G, Thymis J, Kostelli G, Kountouri A, Korakas E, Michalopoulou A, Koliou GA, Stamoulis K, Lambadiari V, Tsivgoulis G. Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).
Patients and methods
In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE).
Results
Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p<0.001) were impaired in patients with stroke (p<0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively).
LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p<0.05).
Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p>0.05).
PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec).
Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p<0.05).
Conclusions
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Frogoudaki
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A R Vrettou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Michalopoulou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G A Koliou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Stamoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Tsivgoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Department of Neurology , Athens , Greece
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Ikonomidis I, Pavlidis G, Katogiannis K, Kapniari I, Theodoropoulos K, Kountouri A, Kostelli G, Tsilivarakis D, Thymis J, Katsimbri P, Parissis J, Filippatos G, Lambadiari V, Papadavid E. Biologics improve endothelial, vascular and left ventricular myocardial function in patients with psoriatic arthritis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2644] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Psoriatic arthritis is characterized by systemic inflammation leading to an increased risk of cardiovascular diseases.
Purpose
We aimed to investigate the effects of biologics on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in patients with psoriatic arthritis.
Methods
One hundred twenty patients (mean age: 51±11 years) with psoriatic arthritis were randomized to receive biologics [n=60; anti-tumor necrosis factor-α (etanercept, adalimumab, infliximab), anti-interleukin (IL)-12/23 (ustekinumab) or anti-IL-17 (secukinumab)] or nonbiologics (n=60; methotrexate or cyclosporine). At baseline and 4 months post-treatment, we measured: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Pulse wave velocity (PWV - Complior; ALAM Medical), (3) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (4) Flow-mediated dilation (FMD) of the brachial artery and (5) LV global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
Compared with baseline, all patients had reduced PWV (11±2.1 versus 10.3±1.5m/s, p=0.001) and increased FMD (5.45±3.2 versus 9.77±4.7, p=0.004) at 4 months. PBR remained unchanged in both study groups (p>0.05). Compared with nonbiologics, biologics resulted in a greater reduction of PWV (−10% versus −4%) and in a greater increase of CFR (+11% versus −1%), FMD (+102% versus +56%) and GLS (+10% versus −2%) (p>0.05 for all comparisons) 4 months post-treatment. In patients treated with biologics, the percent increase of GLS post-treatment was related with the percent reduction of PWV (r=−0.28, p=0.034) and with the percent increase of FMD (r=0.42, p=0.006).
Conclusion
In psoriasis arthritis, biologics confers a greater improvement of endothelial, vascular and LV myocardial function compared with nonbiologics after 4-month treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Kapniari
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
| | - K Theodoropoulos
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - D Tsilivarakis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - P Katsimbri
- Attikon University Hospital, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Parissis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Papadavid
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens , Athens , Greece
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Lambadiari V, Korakas E, Oikonomou E, Bletsa E, Kountouri A, Goliopoulou A, Ikonomidis I, Siasos G. COVID-19, Endothelium and the Cardiometabolic Patient: A Possible Role for Capillary Leak Syndrome. Biomedicines 2022; 10:biomedicines10102379. [PMID: 36289641 PMCID: PMC9598505 DOI: 10.3390/biomedicines10102379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/05/2022] Open
Abstract
Capillary leak syndrome is an under-diagnosed condition leading to serious hypoalbuminemia with diffuse edema, pulmonary edema, severe hypotension, and possibly death. Sepsis leading to hemophagocytic lymphohistiocytosis (HLH) is a major risk factor; however, capillary hyper-permeability is the core underlying pathophysiological mechanism. Endothelial dysfunction plays a major role in cardiometabolic disease through insulin resistance, lipotoxicity, and, eventually, oxidative stress and chronic inflammation. We review the literature concerning the aforementioned mechanisms as well-established risk factors for adverse COVID-19 outcomes. We especially focus on data regarding the underlying endothelial effects of SARS-CoV-2 infection, including direct damage and increased vascular leakage through a hyper-inflammatory cascade and diminished nitric oxide bioavailability. Interestingly, an increased incidence of hypoalbuminemia has been observed in patients with severe COVID-19, especially those with underlying cardiometabolic disease. Importantly, low albumin levels present a strong, positive association with poor disease outcomes. Therefore, in this review article, we highlight the important role of cardiovascular risk factors on endothelium integrity and the possible link of endothelial damage in the hypoalbuminemia-associated adverse prognosis of COVID-19 patients.
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Affiliation(s)
- Vaia Lambadiari
- 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Emmanouil Korakas
- 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Correspondence:
| | - Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Athina Goliopoulou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
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Kadoglou NPE, Kapetanios D, Korakas E, Valsami G, Tentolouris N, Papanas N, Lambadiari V, Karkos C. Association of serum levels of osteopontin and osteoprotegerin with adverse outcomes after endovascular revascularisation in peripheral artery disease. Cardiovasc Diabetol 2022; 21:171. [PMID: 36050687 PMCID: PMC9438128 DOI: 10.1186/s12933-022-01605-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Osteoprotegerin (OPG) and osteopontin (OPN) are vascular calcification inhibitors with a known role in the atherosclerotic and inflammatory process. We investigated their relationship with adverse outcomes (restenosis/adverse cardiovascular events) after endovascular revascularisation of patients with peripheral arterial disease (PAD). Methods 203 consecutive patients were enrolled in the PAD group (PADG) and 78 age and sex-matched subjects with less than two cardiovascular risk factors served as control group (COG). PADG underwent standard medical assessment at baseline and 12 months after the procedure. During follow up major adverse cardiovascular events (MACEs) including arterial restenosis with need for reintervention were documented and the PADG was divided accordingly into two subgroups. Results During 12-month follow-up, 82 MACE were recorded (MACE subgroup). The rest of 124 PAD patients remained free of MACE (non-MACE subgroup). At baseline, OPG (9.89 ± 2.85 ng/ml vs 3.47 ± 1.95 ng/ml, p < 0.001) and OPN (79.99 ± 38.29 ng/ml vs 35.21 ± 14.84 ng/ml, p < 0.001) levels were significantly higher in PADG compared to COG, as well as in MACE subgroup compared to non-MACE subgroup (13.29 ± 3.23 ng/ml vs 10.86 ± 3 ng/ml and 96.45 ± 40.12 ng/ml vs 78.1 ± 38.29 ng/ml, respectively). An independent association of PAD with OPG and OPN was found in the whole patient cohort. Although OPG and OPN were significantly related to MACE incidence in the univariate analysis, multiple logistic regression analysis failed to detect any independent predictor of MACE within the PADG. Conclusion Baseline high OPG and OPN levels were independently associated with PAD presence. Even higher levels of those biomarkers were detected among PAD patients with MACE, however, their prognostic role should be further clarified.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Medical School, University of Cyprus, 215/6 Old road Lefkosias-Lemesou, 2029, Aglatzia, Nicosia, Cyprus. .,Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Dimitrios Kapetanios
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Emmanouil Korakas
- 2nd Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - Georgia Valsami
- School of Health Sciences, Department of Pharmacy, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - Christos Karkos
- 5Th Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Papachristoforou E, Kountouri A, Maratou E, Kouretas D, Skaperda Z, Tsoumani M, Efentakis P, Ikonomidis I, Lambadiari V, Makrilakis K. Association of Hypoglycemia with Biomarkers of Oxidative Stress and Antioxidants: An Observational Study. Healthcare (Basel) 2022; 10:healthcare10081509. [PMID: 36011166 PMCID: PMC9408616 DOI: 10.3390/healthcare10081509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Hypoglycemia has been associated with complications from the vasculature. The contributing effects of oxidative stress (OS) on these actions have not been sufficiently studied, especially in daily, routine clinical practice. We examined the association of hypoglycemia encountered in daily clinical practice with biomarkers of OS and endogenous antioxidant activity in persons with diabetes [type 1 (T1D) or type 2 (T2D)], as well as individuals without diabetes, with a history of hypoglycemia. Several biomarkers of OS (MDA, ADMA, ox-LDL, 3-NT, protein carbonyls, 4-HNE, TBARS) and antioxidant capacity (TAC, superoxide scavenging capacity, hydroxyl radical scavenging capacity, reducing power, ABTS) were measured. Blood was drawn at the time of hypoglycemia detection and under euglycemic conditions on a different day. A total of 31 participants (mean age [±SD] 52.2 ± 21.1 years, 45.2% males) were included in the study. There were 14 (45.2%) persons with T2D, 12 (38.7%) with T1D, and 5 (16.1%) without diabetes. We found no differences in the examined biomarkers. Only TBARS, a biomarker of lipid peroxidation, showed lower values during hypoglycemia (p = 0.005). This finding needs confirmation in more extensive studies, given that MDA, another biomarker of lipid peroxidation, was not affected. Our study suggests that hypoglycemia encountered in daily clinical practice does not affect OS.
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Affiliation(s)
- Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eirini Maratou
- Laboratory of Clinical Biochemistry, Attikon University Hospital, 12462 Athens, Greece
| | - Dimitris Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Zoi Skaperda
- Department of Biochemistry and Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Maria Tsoumani
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Panagiotis Efentakis
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-213-2061061; Fax: +30-213-2061794
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Ikonomidis I, Thymis J, Simitsis P, Koliou GA, Katsanos S, Triantafyllou C, Kousathana F, Pavlidis G, Kountouri A, Polyzogopoulou E, Katogiannis K, Vlastos D, Kostelli G, Triantafyllidi H, Parissis J, Papadavid E, Lekakis J, Filippatos G, Lambadiari V. Impaired Endothelial Glycocalyx Predicts Adverse Outcome in Subjects Without Overt Cardiovascular Disease: a 6-Year Follow-up Study. J Cardiovasc Transl Res 2022; 15:890-902. [PMID: 34713396 DOI: 10.1007/s12265-021-10180-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/03/2021] [Accepted: 10/17/2021] [Indexed: 01/15/2023]
Abstract
We investigated whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. In 600 healthy subjects, we measured perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter ranging 5-25 µm using a dedicated camera (Sideview Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We prospectively monitored the occurrence of cardiovascular events (MACE-death, myocardial infarction, and stroke) during a 6-year follow-up. Fifty-seven MACE were documented. Increased values of PBR5-25 predicted higher risk for MACE in a model including sex, age, hyperlipidemia, diabetes, hypertension, smoking, family history of coronary disease, treatment with ACEi/ARBs, or lipid-lowering agents (hazard ratio (HR), 6.44, p = 0.011; net reclassification improvement (NRI), 28%; C-statistic: 0.761). PBR5-25 was an independent and additive predictor of outcome when added in a model including the European Heart SCORE, diabetes, family history of CAD, and medication (HR, 4.71; NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01).Glycocalyx integrity is an independent and additive predictor to risk factors for MACE at 6-year follow-up in individuals without cardiovascular disease. ClinicalTrials.govIdentifier:NCT04646252. PBR5-25 was an independent and additive predictor of adverse cardiovascular events in a model including the European Heart SCORE, diabetes, family history of coronary disease, and medication (HR: 4.71, NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01, NRI:37.9%).
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Affiliation(s)
- Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- EACVI, Laboratory of Preventive Cardiology, 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Rimini 1, Athens, 12462, Haidari, Greece.
| | - John Thymis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Simitsis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia-Angeliki Koliou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiridon Katsanos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charilaos Triantafyllou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Kousathana
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Pavlidis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Katogiannis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlastos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gavriella Kostelli
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Triantafyllidi
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lekakis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Filippatos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Rizos C, Liamis G, Garoufi A, Skoumas I, Rallidis L, Kolovou G, Tziomalos K, Skalidis E, Kotsis V, Lambadiari V, Anagnostis P, Dima I, Kiouri E, Kolovou V, Polychronopoulos G, Zacharis E, Antza C, Liberopoulos E. One year follow-up of patients with familial hypercholesterolemia: Preliminary data from the HELLAS-FH registry. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.648] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ikonomidis I, Katogiannis K, Kourea K, Gavriella K, Tsilivarakis D, Lambadiari V, Kouretas D, Biondi-Zoccai G. The effect of smoking on exhaled carbon monoxide and arterial elasticity during prolonged surgical mask use in the COVID-19 era. Eur J Prev Cardiol 2022; 29:e355-e358. [PMID: 35798027 PMCID: PMC9384314 DOI: 10.1093/eurjpc/zwac101] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Konstantinos Katogiannis
- 2nd Cardiology Department, ‘Attikon University Hospital’, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kallirhoe Kourea
- 2nd Cardiology Department, ‘Attikon University Hospital’, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostelli Gavriella
- 2nd Cardiology Department, ‘Attikon University Hospital’, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Damianos Tsilivarakis
- 2nd Cardiology Department, ‘Attikon University Hospital’, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
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Kadoglou NP, Khattab E, Velidakis N, Patsourakos N, Lambadiari V. A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review. Kardiol Pol 2022; 80:880-890. [PMID: 35734817 DOI: 10.33963/kp.a2022.0155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
Novel imaging techniques and biomarkers have emerged as surrogate markers of carotid plaque vulnerability. In parallel, statin administration in patients with established carotid atherosclerosis not requiring revascularization has reduced the number of consequent cerebrovascular events. This reduction is not only attributed to the lipid-lowering properties of statins but also to their pleiotropic actions. The present literature review aimed to summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers and propose an alternative approach to their implementation. Moreover, we assessed the perioperative use of statins in patients undergoing carotid revascularization and the impact of aggressive vs. conventional statin therapy. Recent studies using: (1) ultrasound indices of plaque echogenicity; (2) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans for plaque inflammation assessment; or (3)magnetic resonance imaging (MRI) scans quantifying intraplaque hemorrhage, and lipid-rich necrotic core (LRNC) have shown quite promising results in evaluation of carotid plaque vulnerability. Based on those imaging modalities, a growing number of studies have demonstrated a very modest carotid plaque regression due to/induced by statins, while their stabilizing impact is disproportionally higher. Other studies assaying several biomarkers (e.g. inflammation, etc.) have confirmed a statin-induced carotid plaque stabilization. All the aforementioned benefits followed a dose-dependent pattern of statins, on top of the low-density lipoprotein cholesterol (LDL-C) target in current guidelines. In the case of symptomatic patients with carotid atherosclerosis suitable for revascularization, robust evidence implicates a significant statin-related reduction of perioperative cardiovascular risk only in patients undergoing endarterectomy.
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Affiliation(s)
| | | | | | | | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
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Kadoglou NP, Khattab E, Velidakis N, Patsourakos N, Lambadiari V. A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review. Kardiol Pol 2022:VM/OJS/J/90477. [PMID: 35729867] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Novel imaging techniques and biomarkers have emerged as surrogate markers of carotid plaque vulnerability. In parallel, statins' administration in patients with established carotid atherosclerosis not requiring revascularization have reduced the consequent cerebrovascular events. This is not only attributed to the lipid-lowering properties of statins, but to their pleiotropic actions as well. The aim of the present literature review was to summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers proposing an alternative approach of their implementation. Moreover, we assessed the perioperative use of statins in patients undergoing carotid revascularization and the impact of aggressive vs. conventional statin therapy. Recent studies using: 1) ultrasound indices of plaque echogenicity, 2) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scan for plaque inflammation assessment or 3) magnetic resonance imaging (MRI) scan quantifying intraplaque hemorrhage, and lipid rich necrotic core (LRNC) have shown quite promising results for the objective evaluation of carotid plaque vulnerability. Based on those imaging modalities a growing number of studies have demonstrated a very modest carotid plaque regression of statins, while their stabilizing impact is disproportionally higher. Other studies assaying several biomarkers (e.g. inflammation, etc.) have confirmed a statin-induced carotid plaque stabilization. All the aforementioned benefits followed a dose-dependent pattern of statins, on the top of the low-density lipoprotein cholesterol (LDL-C) target in current guidelines. In case of symptomatic patients with carotid atherosclerosis suitable for revascularization, robust evidence implicates a significant statin-related reduction of perioperative cardiovascular risk only in patients undergoing endarterectomy.
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Affiliation(s)
| | | | | | | | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
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Ikonomidis I, Pavlidis G, Tsoumani M, Kousathana F, Katogiannis K, Tsilivarakis D, Thymis J, Kountouri A, Korakas E, Pliouta L, Raptis A, Parissis J, Andreadou I, Lambadiari V. Endothelial Dysfunction Is Associated with Decreased Nitric Oxide Bioavailability in Dysglycaemic Subjects and First-Degree Relatives of Type 2 Diabetic Patients. J Clin Med 2022; 11:jcm11123299. [PMID: 35743370 PMCID: PMC9224886 DOI: 10.3390/jcm11123299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2023] Open
Abstract
Oxidative stress plays an important role in the pathogenesis of diabetes. We investigated oxidative stress and nitrite/nitrate concentrations at baseline and during postprandial hyperglycaemia in 40 first-degree relatives (FDRs) of diabetic patients with normal oral glucose tolerance test (OGTT) results, 40 subjects with abnormal OGTT results (dysglycaemic) and 20 subjects with normal OGTT results (normoglycaemic). Malondialdehyde (MDA), protein carbonyls (PCs), nitrite/nitrate plasma levels, the perfused boundary region (PBR—Glycocheck) of the sublingual microvessels, a marker of glycocalyx integrity, coronary flow reserve (CFR) and left ventricular global longitudinal strain (GLS) were assessed at 0 and 120 min of the OGTT. Insulin sensitivity was evaluated using Matsuda and the insulin sensitivity index (ISI). In all subjects, there were no significant changes in MDA or PC after the OGTT (p > 0.05). Compared with normoglycaemic subjects, FDRs and dysglycaemic subjects had significantly decreased nitrite/nitrate levels (−3% vs. −24% vs. −30%, respectively), an increased PBR and reduced CFR and GLS at 120 min (p < 0.05). The percent reduction in nitrite/nitrate was associated with abnormal Matsuda and ISI results, reversely related with the percent increase in PBR (r = −0.60) and positively related with the percent decrease in CFR (r = 0.39) and GLS (r = 0.48) (p < 0.05). Insulin resistance is associated with reduced nitric oxide bioavailability and coronary and myocardial dysfunction in FDRs and dysglycaemic subjects.
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Affiliation(s)
- Ignatios Ikonomidis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
- Correspondence: ; Tel.: +30-2105832187; Fax: +30-2105832192
| | - George Pavlidis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
| | - Maria Tsoumani
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15741 Athens, Greece; (M.T.); (I.A.)
| | - Foteini Kousathana
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
| | - Konstantinos Katogiannis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
| | - Damianos Tsilivarakis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
| | - John Thymis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
| | - Emmanouil Korakas
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
| | - Loukia Pliouta
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
| | - Athanasios Raptis
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
| | - John Parissis
- 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (K.K.); (D.T.); (J.T.); (J.P.)
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15741 Athens, Greece; (M.T.); (I.A.)
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (F.K.); (A.K.); (E.K.); (L.P.); (A.R.); (V.L.)
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Fragkou PC, Palaiodimou L, Stefanou MI, Katsanos AH, Lambadiari V, Paraskevis D, Andreadou E, Dimopoulou D, Zompola C, Ferentinos P, Vassilakopoulos TI, Kotanidou A, Sfikakis PP, Tsiodras S, Tsivgoulis G. Effects of low molecular weight heparin and fondaparinux on mortality, hemorrhagic and thrombotic complications in COVID-19 patients. Ther Adv Neurol Disord 2022; 15:17562864221099472. [PMID: 35646159 PMCID: PMC9136435 DOI: 10.1177/17562864221099472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation dose in COVID-19. Objective: We aim to systematically assess the currently available data regarding the effects of different dosing regimens of low molecular weight heparin and/or fondaparinux (LMWH/F) on mortality risk as well as the risk of arterial/venous thrombotic events and hemorrhagic complications in confirmed COVID-19 cases. Design: We conducted a living systematic review and meta-analysis on the effects of different LMWH/F doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients. Data Sources and Methods: MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database, and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH/F among confirmed COVID-19 cases. Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between LMWH/F and mortality during the following comparisons: (1) no LMWH/F versus any LMWH/F; (2) prophylactic versus higher than prophylactic LMWH/F; (3) prophylactic versus therapeutic LMWH/F; (4) intermediate versus therapeutic LMWH/F; and (5) lower than therapeutic versus therapeutic LMWH/F. Mortality was higher in patients receiving prophylactic versus intermediate LMWH/F (OR = 2.01; 95% CI: 1.19–3.39). However, this effect was mostly driven by observational data. No associations were detected between the intensity of LMWH/F and the risk of thrombotic and hemorrhagic events, except the lower risk for hemorrhage in patients on prophylactic compared to higher LMWH/F doses. Conclusion: The risk for all-cause mortality was higher in patients receiving prophylactic LMWH/F compared to those on an intermediate dose of LMWH/F, based on observational data. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies. Registration: The study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (Registration number: CRD42021229771).
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Affiliation(s)
- Paraskevi C. Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Vaia Lambadiari
- Second Department of Internal Medicine Research Unit and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Andreadou
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, ‘Panagiotis and Aglaia Kyriakou’ Children’s Hospital, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Theodoros I. Vassilakopoulos
- Third Department of Critical Care Medicine, School of Medicine, National and Kapodistrian University of Athens, Evgenideio Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Rimini 1, Chaidari, Athens 12462, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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Nikolaou PE, Mylonas N, Makridakis M, Makrecka-Kuka M, Iliou A, Zerikiotis S, Efentakis P, Kampoukos S, Kostomitsopoulos N, Vilskersts R, Ikonomidis I, Lambadiari V, Zuurbier CJ, Latosinska A, Vlahou A, Dimitriadis G, Iliodromitis EK, Andreadou I. Cardioprotection by selective SGLT-2 inhibitors in a non-diabetic mouse model of myocardial ischemia/reperfusion injury: a class or a drug effect? Basic Res Cardiol 2022; 117:27. [PMID: 35581445 DOI: 10.1007/s00395-022-00934-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 01/21/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023]
Abstract
Major clinical trials with sodium glucose co-transporter-2 inhibitors (SGLT-2i) exhibit protective effects against heart failure events, whereas inconsistencies regarding the cardiovascular death outcomes are observed. Therefore, we aimed to compare the selective SGLT-2i empagliflozin (EMPA), dapagliflozin (DAPA) and ertugliflozin (ERTU) in terms of infarct size (IS) reduction and to reveal the cardioprotective mechanism in healthy non-diabetic mice. C57BL/6 mice randomly received vehicle, EMPA (10 mg/kg/day) and DAPA or ERTU orally at the stoichiometrically equivalent dose (SED) for 7 days. 24 h-glucose urinary excretion was determined to verify SGLT-2 inhibition. IS of the region at risk was measured after 30 min ischemia (I), and 120 min reperfusion (R). In a second series, the ischemic myocardium was collected (10th min of R) for shotgun proteomics and evaluation of the cardioprotective signaling. In a third series, we evaluated the oxidative phosphorylation capacity (OXPHOS) and the mitochondrial fatty acid oxidation capacity by measuring the respiratory rates. Finally, Stattic, the STAT-3 inhibitor and wortmannin were administered in both EMPA and DAPA groups to establish causal relationships in the mechanism of protection. EMPA, DAPA and ERTU at the SED led to similar SGLT-2 inhibition as inferred by the significant increase in glucose excretion. EMPA and DAPA but not ERTU reduced IS. EMPA preserved mitochondrial functionality in complex I&II linked oxidative phosphorylation. EMPA and DAPA treatment led to NF-kB, RISK, STAT-3 activation and the downstream apoptosis reduction coinciding with IS reduction. Stattic and wortmannin attenuated the cardioprotection afforded by EMPA and DAPA. Among several upstream mediators, fibroblast growth factor-2 (FGF-2) and caveolin-3 were increased by EMPA and DAPA treatment. ERTU reduced IS only when given at the double dose of the SED (20 mg/kg/day). Short-term EMPA and DAPA, but not ERTU administration at the SED reduce IS in healthy non-diabetic mice. Cardioprotection is not correlated to SGLT-2 inhibition, is STAT-3 and PI3K dependent and associated with increased FGF-2 and Cav-3 expression.
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Affiliation(s)
- Panagiota Efstathia Nikolaou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece
| | - Nikolaos Mylonas
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece
| | - Manousos Makridakis
- Centre of Systems Biology, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
| | | | - Aikaterini Iliou
- Faculty of Pharmacy, Section of Pharmaceutical Chemistry, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Stelios Zerikiotis
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece
| | - Panagiotis Efentakis
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece
| | - Stavros Kampoukos
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece
| | - Nikolaos Kostomitsopoulos
- Centre of Clinical Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
| | | | - Ignatios Ikonomidis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Coert J Zuurbier
- Laboratory of Experimental Intensive Care and Anesthesiology, Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Antonia Vlahou
- Centre of Systems Biology, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
| | - George Dimitriadis
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15771, Athens, Greece.
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Anagnostis P, Rizos CV, Skoumas I, Rallidis L, Tziomalos K, Skalidis E, Kotsis V, Doumas M, Kolovou G, Sfikas G, Garoufi A, Lambadiari V, Dima I, Kiouri E, Agapakis D, Zacharis E, Antza C, Kolovou V, Koumaras C, Bantouvakis G, Liamis G, Liberopoulos EN. Association between lipoprotein(a) concentrations and atherosclerotic cardiovascular disease risk in patients with familial hypercholesterolemia: an analysis from the HELLAS-FH. Endocrine 2022; 76:324-330. [PMID: 35262845 DOI: 10.1007/s12020-022-03013-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
AIMS Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the general population. However, such a role in patients with familial hypercholesterolemia (FH) is less documented. The purpose of this study was to evaluate the association between Lp(a) concentrations and ASCVD prevalence in adult patients with FH. METHODS This was a cross-sectional study from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH). Patients were categorized into 3 tertiles according to Lp(a) levels. RESULTS A total of 541 adult patients (249 males) with possible/probable/definite FH heterozygous FH (HeFH) were included (mean age 48.5 ± 15.0 years at registration, 40.8 ± 15.9 years at diagnosis). Median (interquartile range) Lp(a) concentrations in the 1st, 2nd and 3rd Lp(a) tertile were 6.4 (3.0-9.7), 22.4 (16.0-29.1) and 77.0 (55.0-102.0) mg/dL, respectively. There was no difference in lipid profile across Lp(a) tertiles. The overall prevalence of ASCVD was 9.4% in the first, 16.1% in the second and 20.6% in the third tertile (p = 0.012 among tertiles). This was also the case for premature ASCVD, with prevalence rates of 8.5, 13.4 and 19.8%, respectively (p = 0.010 among tertiles). A trend for increasing prevalence of coronary artery disease (8.3, 12.2 and 16.1%, respectively; p = 0.076 among tertiles) was also observed. No difference in the prevalence of stroke and peripheral artery disease was found across tertiles. CONCLUSIONS Elevated Lp(a) concentrations are significantly associated with increased prevalence of ASCVD in patients with possible/probable/definite HeFH.
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Affiliation(s)
- Panagiotis Anagnostis
- Department of Endocrinology, Police Medical Centre of Thessaloniki, Thessaloniki, Greece
| | - Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Ioannis Skoumas
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece
| | - Loukianos Rallidis
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Konstantinos Tziomalos
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Emmanuel Skalidis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - Vasileios Kotsis
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens, Greece
| | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Anastasia Garoufi
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Β' Pediatrics Clinic, General Children's Hospital "Pan. & Aglaia Kyriakou", Athens, Greece
| | - Vaia Lambadiari
- 2nd Propedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ioanna Dima
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece
| | - Estela Kiouri
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitrios Agapakis
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
- Department of Internal Medicine, General Hospital of Goumenissa, Goumenissa, Greece
| | - Evangelos Zacharis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - Christina Antza
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Vana Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens, Greece
| | - Charalambos Koumaras
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Greece
| | - George Bantouvakis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - George Liamis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Evangelos N Liberopoulos
- Department of Endocrinology, Police Medical Centre of Thessaloniki, Thessaloniki, Greece.
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
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Mallis P, Michalopoulos E, Balampanis K, Sarri EF, Papadopoulou E, Theodoropoulou V, Georgiou E, Kountouri A, Lambadiari V, Stavropoulos-Giokas C. Investigating the production of Platelet Lysate obtained from low volume Cord Blood Units: Focus on Growth Factor content and Regenerative Potential. Transfus Apher Sci 2022; 61:103465. [DOI: 10.1016/j.transci.2022.103465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
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Lambadiari V, Ozdemir Saltik AZ, de Portu S, Buompensiere MI, Kountouri A, Korakas E, Sharland H, Cohen O. Cost-Effectiveness Analysis of an Advanced Hybrid Closed-Loop Insulin Delivery System in People with Type 1 Diabetes in Greece. Diabetes Technol Ther 2022; 24:316-323. [PMID: 34962140 DOI: 10.1089/dia.2021.0443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/13/2022]
Abstract
AbstractIntroduction: Usage of automated insulin delivery systems is increasing for the treatment of people with type 1 diabetes (T1D). This study compared long-term cost-effectiveness of the Advanced Hybrid Closed Loop MiniMed 780G (AHCL) system versus sensor augmented pump (SAP) system with predictive low glucose management (PLGM) or multiple daily injections (MDI) plus intermittently scanned continuous glucose monitoring (isCGM) in people with T1D in Greece. Methods: Analyses were performed using the IQVIA CORE Diabetes Model, with clinical input data sourced from various studies. In the AHCL versus SAP plus PLGM analysis, patients were assumed to have 7.5% baseline glycated hemoglobin (HbA1c), when comparing AHCL with MDI plus isCGM baseline HbA1c was assumed to be 7.8%. HbA1c was reduced to 7.0% following AHCL treatment initiation but remained at baseline levels in the comparator arms. Analyses were performed from a societal perspective over a lifetime time horizon. Future costs and clinical outcomes were discounted at 1.5% per annum. Results: AHCL was associated with increased quality-adjusted life expectancy of 0.284 quality-adjusted life years (QALYs) and EUR 10,173 lower mean total lifetime costs with SAP plus PLGM. Compared with MDI plus isCGM, AHCL was associated with increased quality-adjusted life expectancy of 2.708 QALYs, EUR 76,396 higher mean total lifetime costs, and an incremental cost-effectiveness ratio of EUR 29,869 per QALY. Extensive sensitivity analysis confirmed the robustness of results. Conclusions: Over patient lifetime, the MiniMed 780G system is likely to be cost saving compared with the SAP plus PLGM system and cost-effective compared with MDI plus isCGM in people with T1D in Greece.
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Affiliation(s)
- Vaia Lambadiari
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Simona de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | - Aikaterini Kountouri
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Helen Sharland
- Ossian Health Economics and Communications, Basel, Switzerland
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Ikonomidis I, Thymis J, Kourea K, Kostelli G, Neocleous A, Katogiannis K, Makavos G, Polyzogopoulou E, Plotas P, Lambadiari V, Parissis J. Fagerstrom score predicts smoking status six months after hospitalization for acute myocardial infarction: a prospective study. Hellenic J Cardiol 2022; 67:28-35. [DOI: 10.1016/j.hjc.2022.05.007] [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] [Received: 03/13/2022] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
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Chatziralli I, Dimitriou E, Lambadiari V, Kazantzis D, Kapsis P, Theodossiadis G, Theodossiadis P, Sergentanis TN. The Impact of Laboratory Findings and Optical Coherence Tomography Biomarkers on Response to Intravitreal Anti-VEGF Treatment in Patients with Diabetic Macular Edema. Semin Ophthalmol 2022; 37:668-675. [PMID: 35468026 DOI: 10.1080/08820538.2022.2069470] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with diabetic macular edema (DME). METHODS The study included 36 treatment naïve patients with DME, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity (BCVA) measurement, dilated fundoscopy, optical coherence tomography, color fundus photography and fluorescein angiography, while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as "favorable" or "non-response". Potential associations between laboratory/imaging biomarkers and treatment response were assessed. RESULTS Univariate analysis showed that favorable response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST)≤405 μm (p < .001), absence of subretinal fluid (p = .034), absence of exudates (p = .041), absence of disorganization of the inner retinal layers (p = .037), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p < .001 and p = .002, respectively), absence of epiretinal membrane (ERM) (p = .040) and absence of macular ischemia (p = .042), while increased lipoprotein(a) was associated with no treatment response (p = .025). At the multivariate analysis, CST was found to be independent predictor of treatment response, while EZ, ELM and ERM were found to predict treatment response perfectly and they could not be entered in the model. CONCLUSION Intact EZ and ELM, absence of ERM and CST≤405 μm at baseline can predict favorable treatment response in patients with treatment naïve DME, while no correlation with baseline laboratory parameters was found.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Kapsis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Theodossiadis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros N Sergentanis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Athanasaki A, Melanis K, Tsantzali I, Stefanou MI, Ntymenou S, Paraskevas SG, Kalamatianos T, Boutati E, Lambadiari V, Voumvourakis KI, Stranjalis G, Giannopoulos S, Tsivgoulis G, Paraskevas GP. Type 2 Diabetes Mellitus as a Risk Factor for Alzheimer’s Disease: Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10040778. [PMID: 35453527 PMCID: PMC9029855 DOI: 10.3390/biomedicines10040778] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 01/16/2023] Open
Abstract
Alzheimer’s disease is the most common type of dementia, reaching 60–80% of case totals, and is one of the major global causes of the elderly population’s decline in functionality concerning daily life activities. Epidemiological research has already indicated that, in addition to several others metabolic factors, diabetes mellitus type 2 is a risk factor of Alzheimer’s disease. Many molecular pathways have been described, and at the same time, there are clues that suggest the connection between type 2 diabetes mellitus and Alzheimer’s disease, through specific genes, autophagy, and even inflammatory pathways. A systematic review with meta-analysis was conducted, and its main goal was to reveal the multilevel connection between these diseases.
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Affiliation(s)
- Athanasia Athanasaki
- Department of Neurology, Evangelismos Hospital, 10676 Athens, Greece; (A.A.); (S.N.)
| | - Konstantinos Melanis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Ioanna Tsantzali
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Maria Ioanna Stefanou
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Sofia Ntymenou
- Department of Neurology, Evangelismos Hospital, 10676 Athens, Greece; (A.A.); (S.N.)
| | - Sotirios G. Paraskevas
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Theodosis Kalamatianos
- 1st Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (T.K.); (G.S.)
| | - Eleni Boutati
- 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (E.B.); (V.L.)
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (E.B.); (V.L.)
| | - Konstantinos I. Voumvourakis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - George Stranjalis
- 1st Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (T.K.); (G.S.)
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - George P. Paraskevas
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
- Correspondence: ; Tel.: +30-2105832466
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Mitsis A, Kadoglou NPE, Lambadiari V, Alexiou S, Theodoropoulos KC, Avraamides P, Kassimis G. Prognostic role of inflammatory cytokines and novel adipokines in acute myocardial infarction: An updated and comprehensive review. Cytokine 2022; 153:155848. [PMID: 35301174 DOI: 10.1016/j.cyto.2022.155848] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 01/12/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022]
Abstract
Acute myocardial infarction (AMI) is one of the major causes of morbidity and mortality worldwide. The inflammation response during and after AMI is common and seems to play a key role in the peri-AMI period, related with ischaemia-reperfusion injury, adverse cardiac remodelling, infarct size and poor prognosis. In this article, we provide an updated and comprehensive overview of the most important cytokines and adipokines involved in the complex pathophysiology mechanisms in AMI, summarizing their prognostic role post-AMI. Data so far support that elevated levels of the major proinflammatory cytokines TNFα, IL-6 and IL-1 and the adipokines adiponectin, visfatin and resistin, are linked to high mortality and morbidity. In contrary, there is evidence that anti-inflammatory cytokines and adipokines as IL-10, omentin-1 and ghrelin can suppress the AMI-induced inflammatory response and are correlated with better prognosis. Mixed data make unclear the role of the novel adipokines leptin and apelin. After all, imbalance of pro-inflammatory and anti-inflammatory cytokines may result in worst AMI prognosis. The incorporation of these inflammation biomarkers in established prognostic models could further improve their prognostic power improving overall the management of AMI patients.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Cyprus.
| | | | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - Sophia Alexiou
- Second Cardiology Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - George Kassimis
- Second Cardiology Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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