Prevention of atrial fibrillation and inflammatory response after on-pump coronary artery bypass using different statin dosages: a randomized, controlled trial

BACKGROUND

This randomized controlled trial aimed to evaluate the effects of seven-day preoperative treatment with two different dosages of atorvastatin on the incidence of postoperative atrial fibrillation (POAF) and release of inflammatory markers such as high-sensitive C-reactive protein (hsCRP) and interleukin-6 in patients undergoing elective first-time on-pump coronary artery bypass grafting (CABG).

METHODS

The cohort study comprised 212 consecutive patients, already taking statins, who underwent elective first-time CABG with cardiopulmonary bypass without history of atrial fibrillation (AF). Patients were randomly divided into two groups: those who received atorvastatin 40 mg (TOR40 group, 111 patients) and those who received 80 mg (TOR80 group, 101 patients) once a day for 7 days before the planned operation. The primary endpoint was the incidence of AF. The secondary endpoints were the postoperative variations of inflammatory markers, hospital length of stay, and the incidence of major adverse cardiac and clinical events.

RESULTS

A total of 26 patients (23.6 %) pretreated with atorvastatin 40 mg and 16 (15.8 %) patients pretreated with atorvastatin 80 mg had postoperative AF but the difference did not reach the statistical significance (p = 0.157). Median values of interleukin-6 and hsCRP at 12 and 24 h did not have differences between the two groups. No statistically significant differences in the other secondary endpoints were detected.

CONCLUSIONS

According to our result, 7-day preoperative treatment with a high dose of atorvastatin is associated with a trend to a decrease in the incidence of POAF compared with treatment at a lower dose, although it does not impact on the level of inflammatory markers.

CLINICAL TRIAL REGISTRATION

European Clinical Trials Database (EudraCT: 2006-005757-30).

Osteopontin: a new facilitating factor in alopecia areata pathogenesis?

Osteopontin (OPN) is a multifunctional glycophosphoprotein secreted by many cell types, including osteoblasts, lymphocites, macrophages, epithelial cells, and vascular smooth muscle cells. It has been implicated in many physiological and pathological processes, such as cell-mediated immunity, inflammation, cell survival, and tumor invasion and metastasis. Osteopontin has multiple emerging roles in cutaneous biology and pathology and OPN involvement has been emphasized in Th1-mediated diseases such as psoriasis. Alopecia areata (AA) is a form of non-scarring hair loss affecting anagen stage hair follicles with a multifactorial autoimmune pathogenesis characterized by a prevalent Th1 cytokine profile. Given the role of osteopontin in Th1-mediated inflammation, we have postulated that OPN may be involved in AA pathogenesis. The aim of our study was to investigate plasma OPN level in alopecia areata before and after DPCP treatment. Our results showed that OPN plasma levels in patients with alopecia areata were higher than in healthy controls, but patients achieving complete recovery after DPCP treatment did not show a statistically significant reduction of OPN plasma levels.

Early life permethrin exposure leads to hypervitaminosis D, nitric oxide and catecholamines impairment

The aim of this study is to gain more knowledge on the impact of early life pesticide exposure on premature aging. The effect of a low dose of the insecticide permethrin administered to rats during early life (1/50 LD50, from 6th to 21st day of life) was analyzed by measuring some metabolites in plasma and urine of 500-day-old animals. Significant differences in early life treated rats compared to the control group were found in the plasma levels of Ca(++), Na(+), 25-hydroxy-vitamin D, adrenaline, noradrenaline, nitric oxide, cholesterol and urea while in urine only Na(+) content was different. These results add information on the impact of permethrin during the neonatal period, supporting the evidence that early life environmental exposure to xenobiotics has long-term effects, inducing modifications in adulthood that can be revealed by the analysis of some macroelements, metabolites and catecholamines in plasma, when rats are 500 days old.

Low intensity exercise training in patients with chronic heart failure

OBJECTIVES

The present study was designed to evaluate whether a specific program of low intensity exercise training may be sufficient to improve the exercise tolerance of patients with chronic heart failure.

BACKGROUND

Recent studies have shown that exercise training can improve exercise tolerance in patients with stable chronic heart failure, mainly through peripheral adaptations. These changes have been observed with exercise regimens at intensities of 70% to 80% of peak oxygen uptake and > 8 weeks.

METHODS

We studied 27 patients (23 men, 4 women; mean [+/- SD] age 57 +/- 6 years) with mild chronic heart failure. We classified patients into two groups: trained group and untrained group. The trained group underwent a low intensity (40% of peak oxygen uptake) training program three times/week for 8 weeks. The untrained group performed no exercise.

RESULTS

An increase in peak oxygen uptake (17%, p < 0.0001), lactic acidosis threshold (20%, p < 0.0002) and peak work load (21%, p < 0.0002) were obtained in the trained group only. Cardiac output and stroke volume were unchanged. A high correlation was found between the increases in peak oxygen uptake and volume density of mitochondria of vastus lateralis muscle (r = 0.77, p < 0.0002).

CONCLUSIONS

Patients with stable chronic heart failure can achieve significant improvement in functional capacity from a low intensity exercise training regimen. The mechanism responsible for this favorable effect involves an increase in mitochondrial density, which reflects an improvement in oxidative capacity of trained skeletal muscles.

[Effects of aerobic training in patients with moderate chronic heart failure]

To evaluate the effects of a program of moderate intensity in patients (pts) with clinically stable chronic heart failure (CHF), we studied 20 pts (18M, 2F, mean age 61 years) with dilated cardiomyopathy, Weber Class B, ejection fraction (EF) < 40% and aerobic capacity of 16 +/- 2 ml/kg/min on cardiopulmonary exercise testing. We randomly assigned pts to 2 groups, a training group (T, 10 pts) and a control group (C, 10 pts), similar for anatomical and clinical characteristics, group T underwent a thrice weekly, 8 week-long ambulatory program of aerobic activity, beginning at 40% of maximal oxygen uptake. At the end, in Group T we observed a significant increase of exercise tolerance (+45%; p < 0.005), peak oxygen uptake (VO2 max) (+20%; p < 0.001), anaerobic ventilatory threshold (AT) (+37%; p < 0.005), lactate threshold (+36%; p < 0.005), peak heart rate (< 10%; p < 0.01) and of peak systolic pressure (+12%; p < 0.007); and a significant reduction in resting heart rate (-17%; p < 0.005), resting diastolic pressure (-11%; p < 0.005), plasma lactate (LA) at rest (-26%; p < 0.01), at peak (-21%; p < 0.005) and at recovery (-22%; p < 0.005), plasma norepinephrine (NE) both at rest (-38%; p < 0.005) and at peak (-13%; p < 0.005) and of plasma epinephrine (E) (-38%; p < 0.005; -32%, p < 0.001, respectively). We observed no change in EF at the end in both groups nor any untoward cardiac effects during training. We didn't note any correlation between AT and venous oxygen saturation (r = 0.15; p = 0.65) changes at the end. The increase in peak VO2 after training was not correlated to any AT increase (r = 0.12; p = 0.72). We observed, however, a significant correlation between lactate threshold and AT changes after training (r = 0.81; p = 0.005) and between LA and resting, submaximal and peak NE (r = 0.89; p = 0.005) and E (r = 0.78; p = 0.007) changes at the end of training.

CONCLUSIONS

a) in pts with clinically stable CHF a program of aerobic activity well tolerated in terms of frequency, intensity and duration may determine a significant increase in exercise tolerance, aerobic capacity, AT and LA threshold, and a significant decrease in plasma LA, NE and E at rest, submaximal and peak levels; b) in our opinion, such modifications are partly determined by a delay in lactate accumulation and partly by sympathetic tone lowering, and permit us to underline the concept that physical inactivity may provoke important peripheral changes that, in turn, may reduce exercise tolerance and aerobic capacity, by creating a vicious circle difficult to break by medical therapy alone.