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ABSTRACT: OBJECTIVES: Parathyroid hormone (PTH) is a major systemic calcium-regulating hormone. Recent evidence has suggested that measurement of PTH might provide complementary information for the diagnosis and risk stratification of patients with heart failure (HF). The aim of our study was to compare intact and bioactive PTH assays in patients with severe heart failure. Design and Methods The following measurements were carried out in blood samples from 73 patients with severe heart failure: bioactive PTH (1-84) assay, intact PTH assay, non-PTH (1-84), 25-hydroxyvitamin D, B-type natriuretic peptide (BNP), N-terminal proBNP (Nt-proBNP), Galectin-3 and high sensitive troponin T (hsTnT). RESULTS: The correlation between intact and bioactive PTH assays was very high in HF patients. However, the bioactive PTH concentrations were lower than those measured with the intact assay. Intact and bioactive PTH as well as non PTH (1-84) were significantly and positively correlated to BNP, Nt-proBNP, galectin-3 but not to hsTnT. The strongest relationships with these cardiac biomarkers and with cardiovascular death were observed with the bioactive PTH assay. CONCLUSIONS: The PTH concentrations obtained with intact and bioactive assays are not comparable in patients with severe HF. The specificity of PTH assays might therefore impact on the potential diagnosis and prognosis values of PTH testing in patients with heart failure.
Clinical biochemistry 12/2012; · 2.02 Impact Factor
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ABSTRACT: Background: Parathyroid hormone (PTH) is related to left ventricular hypertrophy and its circulating levels are associated with worse prognosis in patients with heart failure (HF). The objectives of our study were to measure the circulating levels of bioactive PTH 1-84 through third generation assay in HF patients, to determine their association with the disease severity as well as their relation with recognized biomarkers of HF worsening and prognosis. Methods: PTH 1-84 concentrations were determined in 76 HF patients and in 49 healthy volunteers. Circulating levels of amino-terminal pro-atrial natriuretic peptide (Nt-proANP), B-type natriuretic peptide (BNP), Nt-proBNP, proBNP and big endothelin-1 (Big ET-1) were also measured. Results: HF patients had increased PTH 1-84 levels in comparison to controls. A significant increase of the PTH 1-84 circulating concentrations was observed according to the New York Heart Association functional classes. PTH 1-84 circulating concentrations were also significantly correlated with Nt-proANP, BNP, Nt-proBNP, proBNP and Big ET-1. Conclusions: PTH 1-84 circulating levels are significantly increased in HF patients in comparison to healthy individuals. Our study has also demonstrated that circulating concentrations of bioactive PTH are related to HF severity and well-established biomarkers of the worsening of the disease.
Journal of endocrinological investigation 02/2012; · 1.57 Impact Factor
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ABSTRACT: It was recently reported that the prolonged use of statins may predispose to incident cataract in the general population. Cataract is a frequent comorbidity of diabetes, and statins are widely prescribed in patients with type 2 diabetes (T2D) both for primary and secondary cardiovascular prevention. For this reason, this study aimed to assess whether or not the use of statins was associated with an increased prevalence of cataract in such a high-risk population and, conversely, whether or not there was greater usage of statins, or any other lipid-lowering drugs, in T2D patients with cataract.
This was a cross-sectional analysis of 780 T2D outpatients, with a mean age (± 1 SD) of 64 ± 12 years and diabetes duration of 13 ± 9 years. Diabetic retinopathy (DR) was found in 23%, and cataract was diagnosed in 16.8% (n=131). Age and diabetes duration of the patients with cataract were significantly higher than those of patients without cataract (n = 649): 75 ± 9 vs 62 ± 11 years, and 20 ± 11 vs 12 ± 8 years, respectively (both P < 0.0001). HbA(1c) was non-significantly higher in the cataract group: 7.75 ± 1.55% vs 7.57 ± 1.49% (NS).
Statins, fibrates and/or ezetimibe use did not differ between patients with and without cataract, nor was cataract prevalence higher in statin users (n=435) vs non-users (n = 345). Statin use in patients with cataract was not higher than in cataract-free subgroups with mean age (n=218) or with both mean age and diabetes duration (n = 161) similar to those of patients with cataract.
In this cross-sectional analysis of a large diabetic population at very high risk of both DR and cataract, chronic therapy with statins was not cataractogenic, and the presence of cataract was not associated with more statin or other lipid-lowering drug use. This suggests that the benefits of statin therapy in T2D may far outweigh any potential ocular drawbacks as a side effect which, in any case, were not supported by our findings.
Diabetes & Metabolism 12/2010; 37(2):139-43. · 2.41 Impact Factor
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ABSTRACT: High ferritin levels are associated with insulin resistance and liver steatosis, both thought of as emerging cardiovascular risk factors. The association between ferritin and cardiovascular disease is poorly documented in cardiometabolic states with higher cardiovascular risk, such as diabetes and metabolic syndrome. We therefore characterized a cohort of males with Type 2 diabetes mellitus (T2DM) according to ferritin levels and prevalent macroangiopathy.
The presence of overall macroangiopathy, peripheral and/or coronary artery disease was documented in 424 consecutive T2DM males, who were divided according to ferritin quartiles (Q) as follows: QI-III, normal ferritin (NF; n=318), mean+/-1 sd ferritin 133+/-72 ng/ml; and QIV patients, high ferritin (HF; n=106), ferritin 480+/-228 ng/ml.
Age, age at diabetes diagnosis, smoking, ethanol intake, body mass index, waist circumference, blood pressure and presence of metabolic syndrome did not differ between groups. However, the prevalence of macroangiopathy was unexpectedly much lower in patients with high ferritin, as follows: 25% vs. 43% for overall macroangiopathy; 7% vs. 16% for peripheral artery disease; and 16% vs. 31% for coronary artery disease (P=0.0009, P=0.0140 and P=0.0035, respectively, vs. NF patients). Insulin resistance index and prevalence of liver steatosis were higher in HF compared with NF patients as follows: 2.17% vs. 1.89% and 78% vs. 64% (P=0.0345 and P=0.0059, respectively). Liver enzymes (aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase) were significantly higher in HF, by 33%, 42% and 72%, respectively (all P<0.0002), suggesting a higher prevalence of steatohepatitis. Glycated haemoglobin, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, urate, high-sensitivity C-reactive protein and albuminuria were not different between groups.
Our results demonstrate that T2DM males with high ferritin levels exhibit a markedly decreased prevalence of macroangiopathy, despite more severe insulin resistance and higher markers of steatohepatitis. High ferritin levels and/or steatosis may thus paradoxically confer a lowered cardiovascular risk in diabetic males.
Diabetic Medicine 04/2010; 27(4):417-22. · 2.90 Impact Factor
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ABSTRACT: The available data suggest that Urocortin (UCN), a cardioprotective and vasoactive peptide known from fish neuroendocrinology, is involved in cardiac regulation. The aim of this study was to determine UCN plasma concentrations in patients with heart failure (HF). Plasma concentrations of UCN, measured in 42 fully treated HF patients. UCN, were determined using a specific ELISA assay after acidic extraction with Sep-Pak C18 columns. Circulating levels of other neurohormones Nt-proBNP, Nt-proANP and Big ET-1 were also determined. Reference values were obtained from 20 healthy age- and sex-matched subjects. In comparison with controls, UCN plasma concentrations (geometric mean [95% CI]) were significantly increased in HF patients (88 pmol/L [75-105] vs 46 [39-54], p<0.001). As expected, the other neurohormones were also significantly increased in HF patients (Nt-proBNP: 3501 pg/ml [2356-5202] vs 35 [24-51], Nt-proANP: 5498 pg/ml [4336-6971] vs 324 [255-411] and Big ET-1: 15.8 pg/ml [13.6-18.4] vs 5.9 [5.2-6.8]; p<0.01 for all vs controls). No significant correlation was observed between UCN and the other HF biomarkers. Our results demonstrate that plasma concentrations of UCN are significantly increased in patients with HF and that UCN may participate in the neurohumoral response of HF.
Peptides 12/2009; 31(2):354-6. · 2.43 Impact Factor
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ABSTRACT: Laterality is associated with various health conditions. No study has addressed the influence of handedness on Type 2 diabetes mellitus (T2DM) phenotype, including glucose homeostasis, glucose-lowering therapies and metabolic control.
Five hundred and seventy-six consecutive adult T2DM outpatients underwent homeostasis model assessment (HOMA) of pancreatic B-cell function (B), insulin sensitivity (S), hyperbolic product (B x S) and age-standardized B x S deficit. Right-handed patients (87.5%; RH; n = 504) had similar age, gender, diabetes duration and education than non-right-handed patients (12.5%; non-RH; n = 72).
Non-RH were more insulin-sensitive: 66% (39%) vs. 52% (36%) [mean (1 sd); P = 0.0024] and had significantly higher B x S and lower age-adjusted B x S deficit: 35% (20%) vs. 26% (17%) and 1.08% (0.40%) vs. 1.32% (0.55%)/year (non-RH; P = 0.0005 and P < 0.0001, respectively).
Non-right-handed T2DM patients are more insulin-sensitive, have higher hyperbolic product and less age-standardized B x S deficit. These may modulate glucose-lowering therapy requirements and glycaemic control.
Diabetic Medicine 12/2009; 26(12):1289-92. · 2.90 Impact Factor
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ABSTRACT: Urotensin II (UII) is a potent vasoactive cyclic peptide thought to play a role in myocardial hypertrophy and remodelling. We therefore determined UII plasma levels in congestive heart failure (CHF) patients and its relationship with the severity of the disease and well-established markers of left ventricular function. UII was significantly higher in CHF patients (n = 57) than in controls (n = 48) [geometric mean (pg/ml), 95% PI: 1.32 (0.67-2.59) versus 0.84 (0.31-1.61), p < 0.0001], was related to the functional class of the disease and correlated negatively with left ventricular ejection fraction (r = -0.316, P = 0.016). Furthermore, UII correlated significantly with Big-ET1 (r = 0.32, p = 0.03), BNP (r = 0.42, p = 0.005) but poorly with Nt-proANP (r = 0.28, p = 0.07). Our results suggest that UII could play a role in worsening the course of congestive heart failure and is associated with established markers of cardiovascular dysfunction.
Peptides 07/2006; 27(6):1527-31. · 2.43 Impact Factor
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Journal of Clinical Endocrinology & Metabolism 03/1998; 83(3):1043-4. · 6.50 Impact Factor
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ABSTRACT: SOLVD was a double-masked, placebo-controlled trial whose initial sample size goal was to randomize 6100 participants into two concurrent trials: treatment and prevention. The objective was to determine if participants with severe left ventricular dysfunction (left ventricular ejection fraction < or = 35%, with congestive heart failure (2569) and participants without overt heart failure (4228) had improved survival with angiotensin-converting enzyme inhibitors. Participants were identified from cardiac catheterization, echocardiography and radionuclide laboratories, and inpatient units. The treatment trial recruitment goal was attained 13 months ahead of schedule while recruitment for the prevention trial was extended 11 months beyond the scheduled time. Recruitment of relatively asymptomatic participants with a low ejection fraction in a hospital-based trial necessitated novel strategies. Coronary care units and clinics for follow-up of acute cardiac conditions, not typically employed in studies of chronic diseases, were useful recruitment sources. Different approaches to encourage participation also needed to be employed. Expanding selected entry criteria was evaluated and the success of varying strategies was reviewed. The authors recommend tailoring of strategies to the target population, staffing flexibility, principal investigator involvement, and broad entry criteria in recruitment activities.
Controlled Clinical Trials 11/1992; 13(5):325-38.
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ABSTRACT: BackgroundIt was recently reported that the prolonged use of statins may predispose to incident cataract in the general population. Cataract is a frequent comorbidity of diabetes, and statins are widely prescribed in patients with type 2 diabetes (T2D) both for primary and secondary cardiovascular prevention. For this reason, this study aimed to assess whether or not the use of statins was associated with an increased prevalence of cataract in such a high-risk population and, conversely, whether or not there was greater usage of statins, or any other lipid-lowering drugs, in T2D patients with cataract.Patients and methodsThis was a cross-sectional analysis of 780 T2D outpatients, with a mean age (± 1 SD) of 64 ± 12 years and diabetes duration of 13 ± 9 years. Diabetic retinopathy (DR) was found in 23%, and cataract was diagnosed in 16.8% (n = 131). Age and diabetes duration of the patients with cataract were significantly higher than those of patients without cataract (n = 649): 75 ± 9 vs 62 ± 11 years, and 20 ± 11 vs 12 ± 8 years, respectively (both P < 0.0001). HbA1c was non-significantly higher in the cataract group: 7.75 ± 1.55% vs 7.57 ± 1.49% (NS).ResultsStatins, fibrates and/or ezetimibe use did not differ between patients with and without cataract, nor was cataract prevalence higher in statin users (n = 435) vs non-users (n = 345). Statin use in patients with cataract was not higher than in cataract-free subgroups with mean age (n = 218) or with both mean age and diabetes duration (n = 161) similar to those of patients with cataract.ConclusionIn this cross-sectional analysis of a large diabetic population at very high risk of both DR and cataract, chronic therapy with statins was not cataractogenic, and the presence of cataract was not associated with more statin or other lipid-lowering drug use. This suggests that the benefits of statin therapy in T2D may far outweigh any potential ocular drawbacks as a side effect which, in any case, were not supported by our findings.RésuméButIl a été récemment rapporté que l’usage prolongé de statines pourrait prédisposer à la survenue de cataractes dans la population générale. La cataracte est une co-morbidité fréquente du diabète, et la prescription de statines largement recommandée aux patients diabétiques de type 2 (DT2), tant en prévention cardiovasculaire primaire que secondaire. Nous avons analysé si l’utilisation de statines était associée à une prévalence accrue de cataracte dans cette population à haut risque, et inversement, si les patients DT2 souffrant de cataracte étaient plus souvent traités par statines ou par d’autres agents hypolipémiants.MéthodesAnalyse transversale de 780 patients ambulatoires avec DT2; l’âge moyen (± 1 DS) était de 64 ± 12 ans, et la durée du diabète de 13 ± 9 ans. Une rétinopathie diabétique (RD) était présente chez 23 % des patients. Une cataracte était diagnostiquée dans 16,8 % de la cohorte (n = 131). L’âge et la durée du diabète des patients avec cataracte étaient significativement supérieurs à ceux des patients sans cataracte (n = 649), respectivement 75 ± 9 versus 62 ± 11 ans, et 20 ± 11 versus 12 ± 8 ans (P à chaque fois inférieur à 0,0001). L’HbA1c était non-significativement plus élevée dans le groupe avec cataracte: 7,75 ± 1,55 % versus 7,57 ± 1,49 %.RésultatsL’utilisation de statines, de fibrates et/ou d’ézétimibe n’était pas différente entre les patients avec ou sans cataracte. La prévalence de cataracte n’était pas plus élevée chez les utilisateurs de statines (n = 435) versus les non-utilisateurs (n = 345). La prescription de statines chez les patients avec cataracte n’était pas supérieure à celle de sous-groupes de patients sans cataracte d’âge moyen similaire (n = 218), ou à la fois d’âge et de durée de diabète similaires (n = 161) à ceux des patients avec cataracte.ConclusionsDans cette étude transversale d’une population de patients avec DT2 à haut risque à la fois de RD et de cataracte, l’usage chronique de statines ne paraît pas cataractogène, et la présence de cataracte n’est pas associée à une utilisation accrue de statines ou d’autres hypolipémiants. Ces observations suggèrent que les bénéfices d’un traitement par statines chez des patients DT2 dépassent largement le risque théorique d’effet délétère sur le cristallin, qui n’est d’ailleurs pas étayé dans cette étude.
Diabetes & Metabolism.
