Christos Papamichael

Laiko Hospital, Athínai, Attica, Greece

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Publications (150)557.03 Total impact

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    ABSTRACT: Context: Although adrenal incidentalomas (AI) are associated with high prevalence of cardiovascular risk (CVR) factors, it is not clear if patients with non-functioning AI (NFAI) have increased CVR. Objective: To investigate CVR in patients with NFAI. Design: Case-control study. Setting: The study was performed in a tertiary general hospital. Patients: Sixty normotensive, euglycemic patients with AI and 32 healthy controls (C) with normal adrenal imaging. Main Outcome Measures: All participants underwent adrenal imaging, biochemical and hormonal evaluation and the following investigations: (i) Measurement of Carotid intima-media thickness (IMT) and Flow-mediated dilatation (FMD) (ii) 2-h 75g oral glucose tolerance test and calculation of insulin resistance indices (HOMA,QUICKI,MATSUDA) (iii) Intravenous ACTH stimulation test (iv) Low-dose dexamethasone suppression test (LDDST) (v) NaCl (0.9%) post-dexamethasone saline infusion test. Results: Based on cut-offs obtained from controls autonomous cortisol secretion was documented in 26 patients (group CSAI) whereas 34 exhibited adequate cortisol and aldosterone suppression (group NFAI). IMT measurements were higher and FMD lower in CSAI-group compared to both NFAI and C, and in NFAI-group compared to C. HOMA index was higher and QUICKI and Matsuda indices were lower in CSAI- and NFAI-groups compared to C as well as in CSAI- compared to NFAI-group. The area under the curve for cortisol after ACTH stimulation (AUC-C) was higher in CSAI-group compared to NFAI-group and C, and in NFAI-group compared to C. In CSAI-group, IMT correlated with cortisol, UFC and cortisol after LDDST, whereas in NFAI-group IMT correlated with AUC-C and UFC. Conclusions: Patients with CSAI without hypertension, diabetes and/or dyslipidemia exhibit adverse metabolic and CVR factors. In addition, apparently NFAIs are associated with increased insulin resistance and endothelial dysfunction that correlate with subtle but not autonomous cortisol excess.
    The Journal of clinical endocrinology and metabolism 04/2014; · 6.50 Impact Factor
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    ABSTRACT: The metabolic dysfunction accompanying the polycystic ovary syndrome (PCOS) may increase the risk of hypertension and cardiovascular disease (CVD). Although menopause per se may be an additional risk factor of CVD, the association between PCOS in postmenopausal women and cardiovascular risk has not been adequately investigated. We aimed to evaluate the effect of PCOS on markers of subclinical atherosclerosis in nondiabetic postmenopausal women. This cross-sectional study included 286 postmenopausal women with intact ovaries. PCOS phenotype was defined if three of the following were present: insulin resistance, current hyperandrogenism or history of clinical androgen excess, history of infertility, central obesity and history of irregular menses. Traditional CVD risk factors, as well as indices of arterial structure (intima-media thickness, atheromatous plaques presence) and function [flow-mediated dilation, pulse wave velocity (PWV), augmentation index] were compared between women with a PCOS phenotype and the rest of the sample, who served as controls. Women with the PCOS phenotype (N = 43) had higher SBP and triglycerides and lower high-density lipoprotein (HDL)-cholesterol than controls. Mean values of PWV differed significantly between PCOS cases and controls (9.46 ± 1.74 vs. 8.60 ± 1.51 m/s, P = 0.001, univariate). Multivariate regression analysis showed that the PCOS phenotype, age and SBP were the only independent predictors of PWV. Arterial stiffness is increased in asymptomatic, nondiabetic women with a putative PCOS phenotype, independently of age, BMI or blood pressure. This might present one mechanism through which PCOS increases the risk of CVD and hypertension later in life.
    Journal of hypertension 10/2013; 31(10):1998-2004. · 4.02 Impact Factor
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    ABSTRACT: Interactions between TNF-like Cytokine 1A (TL1A) and its receptors, death receptor-3 (DR3) and decoy receptor-3 (DcR3) may be important in atherogenesis. We hypothesized that dysregulation of this system predicts formation of new atheromatic plaques in rheumatoid arthritis (RA). Forty-five patients were prospectively followed up for 40.5±3.6months. Serum concentrations of TL1A and DcR3 were measured at baseline and carotid and femoral arteries examined by ultrasound at baseline and at the end of follow-up. Individual serum levels of TL1A correlated with the progression of carotid atheromatic plaque height (Spearman rho=0.550, p=0.003). Patients with low TL1A and undetectable DcR3 serum levels at baseline showed significantly fewer newly formed carotid plaques during the next 3.5years than the remaining patients (P=0.016). Univariate analysis showed that a "low TL1A/DcR3" immunophenotype predicted a preserved atherosclerosis profile in carotid (P=0.026), or carotid and/or femoral arteries (P=0.022). Dysregulated TL1A-induced signaling may be associated with risk for accelerated atherosclerosis in RA.
    Clinical Immunology 03/2013; 147(2):144-150. · 3.77 Impact Factor
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    ABSTRACT: J Clin Hypertens (Greenwich). 2012; 14:630-636. © 2012 Wiley Periodicals, Inc. The possible effects of sesame oil on hemodynamics are unknown. The aim of the study was to investigate the acute and long-term effects of sesame oil on hemodynamic responses in hypertensive men. The authors enrolled 30 hypertensive men in a two-phase study. In the first phase, patients consumed 35 g of either sesame oil or control oil. Central and peripheral blood pressure, pulse wave velocity, augmentation index (AI), C-reactive protein, tumor necrosis factor α, malonydealdehyde, and total antioxidant capacity (TAC) were assessed at fast and 2 hours postprandially. In the second phase, patients consumed 35 g of either sesame oil or control oil daily for 2 months. The above-mentioned parameters were assessed before and following 15, 30, and 60 days of oil consumption. Sesame oil decreased central and peripheral diastolic pressures 1 hour postprandially (P=.006). Fifteen days of sesame oil intake decreased peripheral systolic blood pressure (P=.016) and heart rate-corrected AI75 (P=.017) and increased TAC (P=.007). This is the first study to demonstrate a favorable acute and long-term effect of sesame oil on hemodynamics in hypertensive men. Further research is warranted to establish the potential protective role of sesame oil.
    Journal of Clinical Hypertension 09/2012; 14(9):630-6. · 2.36 Impact Factor
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    ABSTRACT: We tested the hypotheses that monthly fluctuations in markers of arterial stiffness and blood pressure hemodynamics differ between women with and without premenstrual syndrome. We also assessed hypertension prevalence and arterial stiffening in postmenopausal women with or without history of premenstrual symptoms. Twenty one pre-menopausal women with premenstrual syndrome and 15 women without were prospectively examined in three distinct phases of their menstrual cycle (menses, late follicular and luteal phase). Pulse-wave velocity and analysis were used to assess arterial stiffness and wave reflection indices, respectively. Endothelial function was evaluated by flow-mediated vasodilation. In a cross-sectional substudy, 156 postmenopausal women were assessed for possible associations between retrospectively reported PMS symptoms and hypertension. In women with premenstrual syndrome, arterial stiffness significantly increased during the luteal and menses phase (late follicular: 6.48 ± 1.07, luteal: 7.1 ± 1.26, menstruation: 7.12 ± 1.19 m/s, p = 0.003), while blood pressure peaked at the menses phase. Significant interactions between PMS and changes in arterial stiffness and blood pressure but not endothelial function, were observed. Changes in PWV were significantly associated with concomitant changes in blood pressure, C-reactive protein and the severity of PMS symptoms. The prevalence of hypertension (20.9% vs. 40.9%, p = 0.041) and pulse-wave velocity values (8.64 ± 1.52 vs. 9.37 ± 1.1, p = 0.046) were higher in postmenopausal women with 7 or more reported PMS symptoms. Arterial stiffness differences remained significant after adjustment for confounding factors. These results imply that PMS may affect arterial stiffness and BP monthly variability. Whether PMS is associated with new onset hypertension later in life needs further evaluation.
    Atherosclerosis 07/2012; 224(1):170-6. · 3.71 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation. We assessed longitudinally the factors associated with new carotid plaques in nondiabetic RA patients and apparently healthy individuals. In our present prospective observational study, carotid plaques were identified by ultrasonography at baseline and follow-up end, separated by an average of 3.6 ± 0.2 years, in 64 patients (mean age 59.2 ± 12.0 and disease duration at baseline 7.8 ± 6.2 years, 83% women, clinical and laboratory evaluation every 3 to 6 months). In a substudy, 35 of the patients were matched 1:1 for traditional cardiovascular risk factors with 'healthy' controls and were studied in parallel. New atherosclerotic plaques formed in 30% of patients (first plaque in 9%) who were significantly older than the remaining patients. Tobacco use, blood pressure, body mass index, average cumulative low-density lipoprotein, high-sensitivity C-reactive protein, erythrocyte sedimentation rate level, RA stage, functional class, disease duration and treatment modalities during follow-up did not differ significantly between subgroups after application of the Bonferroni correction. RA was in clinical remission, on average, for approximately 70% of the follow-up time and was not different between subgroups. Multivariate analysis including all the above parameters revealed that age (P = 0.006), smoking (P = 0.009) and duration of low-dose corticosteroid use (P = 0.016) associated independently with new plaque formation. RA patients displayed similar numbers of newly formed carotid plaques to the tightly matched for traditional cardiovascular risk factors 'healthy' controls, although more patients than controls had carotid plaques at baseline. Formation of new atherosclerotic plaques in this small cohort of patients with well-controlled RA depended mainly on traditional cardiovascular risk factors and corticosteroid use, whereas an adverse effect of residual systemic inflammation was not readily detectable.
    Arthritis research & therapy 03/2012; 14(2):R44. · 4.27 Impact Factor
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    ABSTRACT: Background: The aim of the study was to investigate the effects of sesame oil on endothelial function and to detect the underlying mechanisms, both in the postprandial state and after long-term consumption.Design: We enrolled 30 hypertensive men in a two-phase study. In the first phase, 26 volunteers consumed 35 g of either sesame oil or control oil. Endothelial function, inflammatory activation and nitric oxide syntase (NOS) inhibition was assessed after a 12-hour fast and 2 hours after consumption of an oil-containing standardized meal. In the second phase, 30 volunteers consumed 35 g of sesame oil or control oil daily for 2 months and the above-mentioned parameters were assessed at baseline, 15, 30 and 60 days.Methods: Endothelial function was estimated by endothelium-dependent FMD (flow-mediated dilatation) of the brachial artery.Results: Flow-mediated dilatation (FMD) improved significantly both after acute (p = 0.001) and long-term sesame oil consumption (p = 0.015, p = 0.005 and p = 0.011 for 15, 30 and 60 days respectively). Intracellular adhesion molecule (ICAM) levels decreased significantly after only 60 days of daily sesame oil intake (p = 0.014). By contrast, no changes were observed in the control group in either phase of the study.Conclusions: This is the first study to show that sesame oil consumption exerts a beneficial effect on endothelial function and this effect is sustained with long-term daily use.
    European journal of preventive cardiology. 01/2012;
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    ABSTRACT: To compare the prevalence of subclinical atherosclerosis between postmenopausal women and men of similar age early after the onset of menopause. In the first part of this cross-sectional study 186 non-diabetic young postmenopausal women (n = 101, menopausal age ≤ 10 years) and men (n = 85) aged 40-60 years without overt CVD were consecutively recruited from the outpatients clinics of an academic hospital. Subclinical carotid atherosclerosis was assessed by high-resolution ultrasonography. The presence of carotid atherosclerosis was defined as either increased carotid intima-media thickness (IMT>0.9 mm) and/or the presence of plaques. In the second part, 1:1 matching for age and traditional risk factors (hyperlipidemia, smoking, hypertension and BMI) was performed between men and women of this cohort resulting in a matched sub-sample of 76 subjects. By multivariate analysis, gender was not an independent determinant of any measure of carotid atherosclerosis. In the matched sub-sample, carotid IMT and the number of segments with atherosclerosis did not significantly differ between women and men (0.734 ± 0.119 mm and 1.47 ± 1.6 versus 0.717 ± 0.138 mm and 1.47 ± 1.5, p = 0.575 and p = 0.999, respectively). Also, the prevalence of increased IMT (60.5% in both genders), carotid plaques and subclinical atherosclerosis (31.6% and 63.2% versus 28.9% and 65.8%, p = 0.803 and p = 0.811, respectively) was similar between men and women. The prevalence and severity of carotid atherosclerosis was similar between men and young postmenopausal women matched for traditional risk factors. Whether these women may be better risk stratified irrespective of gender should be further assessed in prospective studies.
    Atherosclerosis 12/2011; 221(2):508-13. · 3.71 Impact Factor
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    ABSTRACT: Interleukin (IL)-6 is a pleiotropic proinflammatory cytokine involved in the pathogenesis of both atherosclerosis and rheumatoid arthritis. The role of the IL-6/IL-6 receptor pathway in the documented acceleration of atherosclerosis in rheumatoid arthritis has not been examined. In a non-randomized prospective pilot study we asked whether endothelial dysfunction, defined as impaired flow mediated dilatation (FMD), and aortic stiffness, assessed by pulse wave velocity (PWV) improve after 3 and 6 monthly therapeutic infusions of the anti-IL-6 receptor antibody tocilizumab for active rheumatoid arthritis. We found that FMD increased from 3.3 ± 0.8 to 4.4 ± 1.2 to 5.2 ± 1.9% (p = 0.003), whereas PWV decreased from 8.2 ± 1.2 to 7.7 ± 1.3 to 7.0 ± 1.0m/s (p < 0.001). Whether these beneficial arterial changes are direct effects of the IL-6/IL-6 receptor pathway inhibition, maintained over time and translate into better clinical outcome warrants further studies.
    Atherosclerosis 12/2011; 219(2):734-6. · 3.71 Impact Factor
  • Artery Research 12/2011; 5(4):158–159.
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    ABSTRACT: Although increasing evidence supports an association between endogenous sex hormones and cardiovascular disease, the results still remain controversial. This study aims to examine the association between endogenous sex hormones and indices of vascular function and structure. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), and Δ4-androstenedione were measured in 120 healthy postmenopausal women aged 41 to 60 years. Possible associations with surrogate markers of subclinical atherosclerosis, arterial stiffness, and endothelial function were investigated. Indices of arterial structure included carotid and femoral intima-media thickness and atheromatous plaques presence. Indices of arterial function included flow-mediated dilation of the brachial artery, carotid-femoral pulse wave velocity (PWV), and augmentation index. Total testosterone and free androgen index (FAI) were the most important predictors of common carotid artery intima-media thickness (β = 0.376 and β = 0.236, P < .001 and P = .014, respectively). Similarly, FAI was the only significant independent predictor of PWV (β = 0.254, P = .027) after adjusting for age, smoking, body mass index, homeostasis model assessment of insulin resistance, and blood lipids. Free estrogen index showed a positive association with PWV, independently of age, smoking, and body mass index, but not of homeostasis model assessment of insulin resistance and blood lipids. Age-adjusted levels of DHEAS exhibited a significant independent negative association with measures of augmentation index. Follicle-stimulating hormone, luteinizing hormone, estradiol, sex hormone-binding globulin, and Δ4-androstenedione were not associated with any of the vascular parameters independently of traditional cardiovascular risk factors. Higher serum testosterone and FAI are associated with subclinical atherosclerosis in healthy recently menopausal women. This association is independent of traditional cardiovascular risk factors or insulin resistance. On the contrary, serum DHEAS exhibits a negative association with arterial stiffness.
    Metabolism: clinical and experimental 08/2011; 61(2):193-201. · 3.10 Impact Factor
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    ABSTRACT: Androgen may be detrimental in the development of cardiovascular disease in women. We investigated possible associations between the (TAAAA)n polymorphism of sex hormone binding globulin (SHBG) gene promoter, which influences transcriptional efficiency of the SHBG gene - and thus the tissue androgen availability - and early markers of atherosclerosis in apparently healthy women. In this prospective clinical study, 153 consecutive women (mean age 43.9±9 years, 66 of whom postmenopausal, without known diabetes, cardiovascular disease), visiting our internal medicine outpatients were examined for unrecognised features of the metabolic syndrome. Endothelium dependent vasodilatation (FMD) and intima media thickness of the common carotid artery (IMT) were recorded. According to the number of SHBG gene promoter repeats patients were classified as short (≤7), medium (=8) and long repeat (≥9) allele groups. The (TAAAA)n repeat length was an independent predictor of FMD in multivariate analysis (p<0.03). FMD was positively correlated with SHBG levels (p=0.004). Women carriers of two long alleles had increased IMT (p=0.031) although this was not independent in the multivariate analysis. Longer (TAAAA)n repeats in the SHBG gene promoter are associated with impaired FMD, which is an early marker of atherosclerosis. As this polymorphism has been associated with a more androgenic phenotype in women, this association may reflect the life-long tissue exposure to higher free androgens and indirectly supports the view that androgenic exposure may have adverse cardiovascular effects in women.
    Atherosclerosis 07/2011; 219(1):205-10. · 3.71 Impact Factor
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    ABSTRACT: BACKGROUND: The menopausal status is closely related with cardiovascular disease (CVD). Nevertheless, it is still not included in risk stratification by total cardiovascular risk estimation systems. The present study aimed to evaluate the extent of subclinical vascular disorders in young healthy postmenopausal women. METHODS: This cross-sectional study consecutively recruited 120 healthy postmenopausal women without clinically overt CVD or diabetes, aged 41-60years and classified as not high-risk by the Heartscore (<5%). In addition to risk factors used for Heartscore calculations, years since menopause and associated risk factors (triglycerides (range 37-278mg/dl), waist circumference (62-114cm), fasting blood glucose (69-114mg/dl) and HOMA-IR (0.44-5)) were also assessed. Carotid-femoral pulse wave velocity, carotid and femoral intima-media thickness in the abnormal range as well as atheromatous plaques both in carotid and femoral arteries were used to define the presence of subclinical atherosclerosis. RESULTS: Subclinical atherosclerosis and the presence of at least one plaque were identified in 55% and 28% of women, respectively. Subjects with subclinical atherosclerosis had higher age, years since menopause, HOMA-IR and blood pressure. By multivariate analysis years since menopause and systolic blood pressure independently determined subclinical atherosclerosis while 79% of intermediate-risk women (Heartscore 2-4.9%) being in menopause for at least 4years would be reclassified to a higher risk for the presence of atherosclerosis. CONCLUSION: Subclinical atherosclerosis was highly prevalent in postmenopausal women with low to medium Heartscore. Thus our data suggest that menopausal status and associated risk factors should be additionally weighted in risk calculations, regarding primary prevention strategies in this population.
    International journal of cardiology 07/2011; · 7.08 Impact Factor
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    ABSTRACT: Hyperprolactinemia has been recently associated with hypertension and endothelial dysfunction in humans, confirming animal studies performed in the 1970s that showed high prolactin levels to exert positive chronotropic and vasoconstrictive effects. Whether prolactin affects endothelial function, in the absence of hyperprolactinemia, remains unknown. Considering that secretion of prolactin presents circadian rhythmicity, we tested the hypothesis that in patients with hypertension, who present diurnal variation in their endothelial function as well, prolactin levels correlate with endothelial function and/or blood pressure. Endothelial function, assessed by flow-mediated dilatation (FMD) and serum prolactin were examined successively at 12 PM, 9 PM, and 7 AM in 27 nonhyperprolactinemic men with newly diagnosed, untreated essential hypertension. Both FMD and prolactin presented 24-h variation (P < 0.01). FMD reached its lowest values at 7 AM (2.1 ± 1.8%, mean ± s.d.); concurrently prolactin levels peaked (7.18 ng/ml, median). Across the three time points, prolactin changes inversely interacted with FMD changes (P = 0.002). Systolic and diastolic blood pressure also varied significantly but no interaction with prolactin changes was evident. Diurnal fluctuations of prolactin levels are associated with decreased endothelial function that occurs early in the morning in men with hypertension, although this study did not assess causality. Additional studies are required to determine whether these responses differ from normotensive individuals.
    American Journal of Hypertension 02/2011; 24(5):569-73. · 3.67 Impact Factor
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    ABSTRACT: Recent studies have reported that prehypertension is associated with increased values of common carotid artery intima-media thickness (CCA-IMT). The aim of this study was to assess the impact of daytime ambulatory blood pressure (BP) levels on the association of prehypertension with CCA intima-media thickening in prehypertensive subjects. A total of 807 subjects with office systolic BP<140 and diastolic BP<90mmHg, underwent 24h ambulatory BP (ABP) monitoring and carotid artery ultrasonographic measurements. The study population was divided into 3 groups according to office and daytime ABP levels: (1) normotensives: subjects with office BP<120/80mmHg and daytime ambulatory BP values within the normal range, (2) actual prehypertensives: individuals with office SBP (120-139mmHg) and/or DBP (80-89mmHg) and daytime ambulatory BP values within the normal range and (3) prehypertensives with masked hypertension (MH): patients with office SBP (120-139mmHg) and/or DBP (80-89mmHg) and elevated daytime ambulatory BP values. Prehypertensive patients with MH had higher (p<0.01) CCA-IMT values (0.712mm; 95%CI: 0.698-0.725) than actual prehypertensives (0.649mm; 95%CI: 0.641-0.656) and normotensives (0.655mm; 95%CI: 0.641-0.670) even after adjustment for baseline characteristics. Normotensives and actual prehypertensives did not differ significantly regarding CCA-IMT values (p>0.05). After adjusting for potential confounders, (including demographic characteristics, vascular risk factors, and office BP) prehypertension with MH was independently (p<0.01) associated with a 0.06mm increment in CCA-IMT (95%CI: 0.03-0.09). Patients with office BP levels in the prehypertensive range, who also have elevated daytime ABP levels, had higher CCA-IMT values than patients with prehypertension with normal daytime ABP values and normotensive individuals.
    Atherosclerosis 01/2011; 214(1):215-9. · 3.71 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis in the carotid arteries, but little is known about the magnitude of this process in peripheral arteries. Assessing preclinical atherosclerosis in both arterial beds in RA might provide additional prognostic value during risk stratification for primary prevention. Therefore in the present structural study we examined femoral versus carotid subclinical atherosclerosis in RA and controls. Intima-media thickness (IMT) and atheromatous plaque presence and vulnerability in femoral versus carotid arteries were examined in 80 RA patients without overt cardiovascular disease or diabetes and 80 controls matched 1:1 for age, gender and traditional cardiovascular disease risk factors. Femoral IMT and plaque prevalence were increased in RA than controls (p=0.001 and 0.008, respectively). These increases remained significant after adjustment for potentially confounding factors that differed between groups, such as C-reactive protein and HDL-cholesterol serum levels, and statin use. Femoral plaque vulnerability did not differ between RA and controls. The presence of RA was found to be an independent predictor of increased femoral IMT (p=0.004), after adjustment for traditional cardiovascular risk factors, C-reactive protein and treatment with angiotensin converting enzyme inhibitors and statins. Femoral plaques were less frequent than carotid plaques in RA patients (22.5% vs 45.0% respectively, p=0.003) and in contrast to carotid plaques were independent of age and glucose levels. Subclinical peripheral atherosclerosis in RA is more advanced than in controls. Prospective studies are required to confirm that RA is an independent risk factor for peripheral arterial disease.
    Atherosclerosis 09/2010; 212(1):305-9. · 3.71 Impact Factor
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    ABSTRACT: Estrogens and androgens may play an important role in vascular health in both sexes. The aim of this study was to examine the relation of endogenous sex hormone levels with early markers of atherosclerosis in a cohort of apparently healthy males. 124 males (age 46.25 ± 9.56) attending a preventive medicine program were examined for unrecognised features of the metabolic syndrome. Flow-mediated dilatation (FMD) and intima-media thickness (IMT) of the common carotid artery were evaluated. Obesity parameters were recorded; estradiol, testosterone, SHBG, free testosterone, insulin, as well as glucose and lipid levels were measured. FMD was positively correlated with estradiol (r = 0.201, P = 0.041) and negatively with total cholesterol (r = -0.205, P = 0.022), low density lipoproteins (r = -0.232, P = 0.009), and triglyceride levels (r = -0.179, P = 0.046). In multivariate analysis, the association of FMD with estrogen was independent of BMI and lipid levels. No significant association between FMD and testosterone levels was found. Subjects with an increased mean IMT (> 0.73 mm, i.e., > 3rd tertile) had lower levels of free (P = 0.021) and bioavailable (P = 0.016) testosterone. In multivariate logistic regression analysis, this association was no longer significant when age or cholesterol levels were considered. Endogenous estrogen levels are associated with FMD, independently of age and lipid levels, showing a protective effect in middle-age male subjects. Circulating androgens are associated, although not independently, with structural changes such as the IMT of carotid artery; this effect is possibly influenced by lipid levels and age.
    Endocrine 04/2010; 37(2):329-35. · 1.42 Impact Factor
  • Blood Purification 02/2010; 29(4):327-8. · 2.06 Impact Factor
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    ABSTRACT: The extent of target organ damage has been associated with both central hemodynamics and arterial stiffening, and the time rate of blood pressure (BP) changes in essential hypertension. However, the relative significance of these parameters has not been examined. We recruited 232 consecutive uncomplicated newly diagnosed hypertensive patients and 241 normotensive individuals. Twenty-four-hour ambulatory BP monitoring was performed in all individuals. The time rate of SBP variation was computed as the first derivative of the SBP values against time. Aortic central SBP and central DBP, central pulse pressure, central augmentation index and central augmentation pressure were assessed noninvasively by pulse wave analysis. Common carotid artery intima-media thickness was measured by high-resolution ultrasonography. Median 24-h time rate of BP changes was 0.571 +/- 0.114 mmHg/min. Traditional risk factors, office SBP, several ambulatory BP monitoring parameters (24-h SBP, 24-h pulse pressure, 24-h heart rate and BP dipping), 24-h time rate of BP changes, time rate of BP changes at different time intervals, and central SBP, central pulse pressure, central augmentation index and central augmentation pressure significantly correlated with intima-media thickness. Age, sex, BMI, 24-h time rate of BP changes, time rate of BP changes measured at 0100-0600 h and 24-h heart rate remained significant associates of intima-media thickness after adjustment for confounding factors. By multivariate stepwise linear regression, 24-h time rate of BP changes and time rate of BP changes at 0100-0600 h had incremental value over traditional risk factors, other ambulatory BP monitoring parameters and central hemodynamics. These findings indicate that time rate of BP variation is superior to central hemodynamics as an associate of carotid intima-media thickness in hypertensive and normotensive individuals.
    Journal of hypertension 11/2009; 28(1):51-8. · 4.02 Impact Factor
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    ABSTRACT: Increased arterial stiffness (AS) might be one significant acute mediator of the well-attested association between female depression and cardiovascular disease. We tested this hypothesis in an inpatient sample of 20 drug-free women undergoing a new clinically severe major depressive episode of recent onset with an adequately matched mentally healthy control group. Patients' clinical (Hamilton Depression Rating Scale) and vascular (Pulse-Wave-Velocity, PWV) assessments were performed both before the initiation and after the completion of their six-week antidepressant treatment. Although initially patients exhibited significantly higher PWV values than controls, this was decreased and reached comparable levels to controls after treatment completion. Moreover, full-responders exhibited significantly greater vascular improvement than their partial-responders counterparts and the magnitude of their amelioration was strongly associated with the magnitude of their clinical improvement. Our sample-size was small and patients' follow-up short. Our findings provide support to the hypothesis that current severe major depressive episode in women leads acutely to aggravation of arterial stiffness, reversible however upon timely and effective antidepressant treatment.
    Journal of affective disorders 10/2009; 122(1-2):164-6. · 3.76 Impact Factor

Publication Stats

2k Citations
557.03 Total Impact Points


  • 2005–2013
    • Laiko Hospital
      Athínai, Attica, Greece
    • National Technical University of Athens
      • School of Mechanical Engineering
      Athínai, Attica, Greece
  • 1999–2013
    • Athens State University
      Athens, Alabama, United States
  • 1992–2013
      Athínai, Attica, Greece
  • 1999–2012
    • National and Kapodistrian University of Athens
      • • Division of Propedeutic Medicine I
      • • Faculty of Medicine
      • • Division of Clinical Therapeutics
      Athens, Attiki, Greece
  • 2009
    • Sykehuset i Vestfold HF Tønsberg
      Tønsberg, Vestfold county, Norway
  • 2005–2009
    • Harokopion University of Athens
      • Department of Nutrition and Dietetics
      Athens, Attiki, Greece
    • Eginition Hospital Athens
      Athínai, Attica, Greece
  • 2008
    • Aristotle University of Thessaloniki
      • Faculty of Medicine
      Thessaloníki, Kentriki Makedonia, Greece