Research Items (24)
- Jan 2019
Context The review summarizes key studies assessing epidemiology, mechanisms, and consequences of cognitive dysfunction (CD) in type 1 diabetes (DM1). Evidence Synthesis In a number of studies, the severity of CD in DM1 was affected by the age of onset and diabetes duration, the presence of proliferative retinopathy and autonomic neuropathy. Diabetes-related CD has been observed not only in adults but also in children and adolescents. Most neuroimaging studies in DM1 did not show any differences in whole brain volumes, however, they did reveal selective deficits in grey matter volume or density within the frontal, posterior and temporal cortex, subcortical grey matter. Studies of middle-aged adults with long-standing DM1 using diffusion tensor imaging have demonstrated partial lesions of white matter and decreased fractional anisotropy in posterior brain regions. The mechanisms underlying diabetes-related CD are very complex and include factors related to diabetes per se and to diabetes-related cardiovascular disease and microvascular dysfunction: chronic hyperglycemia, hypoglycemia, macro- and microvascular disease, increased expression of inflammatory cytokines. The above mechanisms may contribute to the development and progression of both vascular dementia and Alzheimer disease. Conclusions Higher rates of CD and its faster progression in DM1 can be explained by both the direct effects of altered glucose metabolism on the brain and diabetes-related cardiovascular disease. Since the presence and progression of CD significantly worsens the quality of life of diabetic patients, further multidisciplinary studies based on the recent progress in both neuroimaging and type 1 diabetes management are warranted to tackle this problem.
- Dec 2018
Background. The aim of the study was to investigate the lipid levels in patients with various physical activity and polymorphous variants of ADRB2 (Gln27Glu and Arg16Gly) and ADRB3 (Trp64Arg) genes. Material and methods. One hundred and fifty subjects were enrolled in the study; mean age was 44.7 ± 8.9 y.o. Physical activity was assessed using Omron Walking style III step counter HJ-203-EK pedometer. Lipids were assessed via enzymatic method using Cormay reagent kit (Poland). Genotyping of polymorphous sites of ADRB2 (Gln27Glu, rs1042714 and Arg16Gly, rs1042713) and ADRB3 (Trp64Agr, rs4994) genes was performed using SNP-express-SHOT reagent kits manufactured by Litex Research and Production Company, via real-time polymerase chain reaction. Results. Individuals walking more than 5000 steps daily with Gly16Gly polymorphism had significantly higher blood lipids. Total cholesterol (TC), triglycerides, LDL and HDL-cholesterol levels were 5.10 (3.86-5.74), 1.13 (0.66-1.51), 3.28 (2.14-3.70), 1.43 (1.32-1.63) mmol/L in Arg16 group and 5.55 (5.23-6.96), 1.56 (0.45-2.02), 3.87 (3.09-4.46) and 1.30 (1.13-1.68) mmol/L in Gly16Gly group. The differences in lipid parameters were established for polymorphous variants of ADRB3 gene in patients walking more than 5000 steps daily. In Trp54 carriers, TC, triglycerides, LDL and HDL-cholesterol levels were 5.23 (4.00-5.69), 1.25 (0.80-1.56), 3.25 (2.22-3.80) and 1.41 (1.26-1.53) mmol/L, respectively. In 54Arg carriers group, lipids were significantly higher: TC 5.74 (5.59-6.88), triglycerides 1.51 (1.03-1.90), LDL-cholesterol 3.78 (3.38-5.06) and HDL-cholesterol 1.68 (1.13-1.81) mmol/L. Conclusion. This analysis suggests that carriers of Arg16 of ADRB2 gene and/or Trp54 of ADRB3 gene tend to have lower lipid parameters when they have high physical activity (walking more than 5000 steps a day) in comparison to carriers of 16Gly and/or 54Agr. There is no association between lipids level and ADRB2 (Gln27Glu and Arg16Gly) and ADRB3 (Trp64Agr) polymorphisms when individuals have low physical activity (walking less than 5000 steps a day).
Aim: To assess the value of body mass index (BMI) and adipokine levels in predicting development of atrial fibrillation (AF) in the general population. Methods: Three hundred and ninety eight patients were examined for the presence of phenotype metabolically healthy obesity (MHO), according to the Wildman criteria; adipokine levels were assessed by enzyme immunoassay method; AF was assessed by electrocardiography (ECG) and/or by ECG diurnal monitoring. Results: Obesity (group 1) and overweight (group 2) was present in 23.7% and 42.0% of participants; while 21.1% were normal body weight (group 3) and 13.1% had a BMI < 19.9 kg/m² (group 4). Phenotype MHO was detected in 19.6% patients. At follow-up, 32.4% of participants developed AF. Adiponectin levels were significantly higher in MHO patients as compared to metabolically unhealthy patients with abdominal obesity (AO). High molecular weight adiponectin (HMVAN) levels were significantly decreased in patients of groups 1 and 4, as compared to groups 2 and 3. Correlation between AF and HMWAN was determined by regressive analysis in patients of 1st and 4th groups (β =-0.24, P = 0.003 and β =-0.26, P = 0.002, respectively). Conclusion: The probability of developing AF increases with AO and decreased BMI, which is accompanied by a change in HMVAN levels. In MHO patients, the probability of AF developing is identical with persons having normal BMI. ABSTRACT Article history:
The aim: To establish unfavorable genetic polymorphisms on the development of comorbidity of DM2 and EH in Ukrainian population and to evaluate the effectiveness of α-lipoic acid appointment (α-LC) in complex therapy in patients with 3-4 crossed unfavorable genetic polymorphisms. The primary examination of 167 patients with DM2 in combination with EH showed that A/C and C/C genotypes of AGTR1, Pro/Pro genotype of PPARγ2, Arg/Arg and Gly/Arg genotypes of IRS-1, T/T and C/T genotypes of TCF7L2 are characterized by more severe hemodynamic and metabolic disorders, cardiovascular remodeling, thus, these genotypes can be regarded as unfavorable genotypes that are associated with the development of comorbidity. It was proved that in 96 patients with 34 crossed unfavorable genetic polymorphisms the severity of these disorders was greater than in 71 patients with 1-2 crossed unfavorable genotypes. Among 96 patients with 34 crossed unfavorable genetic polymorphisms two groups were distinguished: 47 patients received standard therapy and 49 patients additionally received α-LC (600 mg/day) for 3 months. It was established that the appointment of α-LC contributed to a more pronounced effect on endothelial dysfunction (ED) that confirmed a greater degree of endothelium-dependent vasodilation and higher levels of oxidative indicators stress (diene conjugates and malondialdehyde) in the inhibition of antioxidant system parameters (superoxide dismutase and catalase) (P<0.001). Furthermore the additional appointment of α-LC impacted more to the functioning of adipose tissue, which showed a more pronounced decrease in leptin (P<0.001) and increase in adiponectin (P<0.01), compared to basic therapy. Conclusions: A/C and C/C genotypes of AGTR1, Pro/Pro genotype of PPARγ2, Arg/Arg and Gly/Arg genotypes of IRS-1, T/T and C/T genotypes of TCF7L2 are associated with the development of comorbidity of DM2 and EH. The additional α-LC appointment to standard therapy impacted more to the severity of ED and adypokines balance than basic therapy.
This article demonstrates the results of the comparative analysis of parameters of the structural and functional heart, blood vessels and liver remodeling in patients with essential hypertension combined with diabetes mellitus type 2 and obesity. It was established that irrespective of BMI the patients with essential hypertension and diabetes mellitus type 2 in comparison with hypertensive patients had different values ?of thickness of the intima-media in the carotid arteries (which were significantly higher), different pulse wave velocity in the great vessels, the size of the cavities and myocardial mass of the left ventricle, the integral index of diastolic filling E/e (integral ratio of maximum velocities of early diastolic filling according to spectral and tissue Doppler studies), the index of rigidity of the liver parenchyma according to shift-wave elastography and significantly lower value of endothelium-dependent vasodilatation of the brachial artery (p<0.05). Even a slight increase in body mass index (not higher than 34.9 kg/m2) was associated with a deterioration of endothelial function and structural and functional properties of heart, blood vessels, liver, which is more pronounced in terms of comorbidity.
The mechanisms of development and progression of essential hypertension (EH) and concomitant type 2 diabetes (DM2) still remain not completely studied, so the comprehensive evaluation of the contribution of various indicators to the formation of this comorbidity have scientific interest. The aim of the study was comprehensive assessment of the variability of anthropometric, echocardiographic and biochemical parameters in patients with EH and concomitant DM2. We examined 243 patients aged 4560 years. The main group consisted of 153 patients with EH stage II, grade 2 and DM2 moderate, subcompensated; comparison group 70 patients with EH stage II, grade 2 without DM2. The control group consisted of 20 healthy individuals. Integrated data processing was carried out with the help of factor analysis using principal component. In the analysis there were 73 variables, based on the relationships among which there were four factors that together explain 52.61% of the total variability of the empirical data. In this case the first and the most powerful factor explained 33.07% of the total variability of indices. The highest load of Factor 1 were at indicators diene conjugates, malondialdehyde, tumor necrosis factor-α, interleukin-6, blood glucose, insulin, HbA1c, HOMA, leptin, intima-media thickness of the common carotid artery, while at the negative pole of this factor were superoxide dismutase, catalase, endothelium-dependent vasodilatation, adiponectin, HDL). Averaged factor estimates for Factor 1 were: 0.517±0.025 in the main group, −0.986±0.039 in the comparison group and −2.476±0.037 in the control group with highly significant differences between the factor scores in all groups (P<0.001). Conclusion: We discovered four main factors, the general action of which explained 52.61% of variability indices in comorbid pathology EH and DM2. Factor assessment of the most powerful Factor 1 with high significance made the studied groups of patients differ from each other.
- Jun 2014
Arterial hypertension combined with obesity is a very common form of comorbid disease in most countries all over the world. The combination of these diseases is characterized by mutual burdening of remodelling processes in important target organs, what greatly increases the risk of cardiovascular complications and death. The mechanisms of injury progression to vital organs in essential hypertension (EH) and obesity have some common features. The most important risk factors of target organs damage are hemodynamic and neurohumoral: inflammatory, effectors of the renin- angiotensin-aldosterone system, insulin resistance and others. Polyethiologic remodelling, lack of knowledge concerning violations in structural and functional status of important target organs and mechanisms of the interactions of their progression with this comorbidity require further study of these issues. The objective of the study was the comparative study of the state of integral indicators of structural and functional state of the heart, blood vessels and liver in patients with EH second stage with normal body weight and with concomitant obesity I and II degrees. This study found that the presence of obesity I and II in patients with EH stage II is associated with the concentric type of left ventricular hypertrophy, saved by its ejection fraction and impaired diastolic filling processes. For the patients with EH in the early stages of obesity the following characteristics are quite typical: considerable increase of intima media thickness in the carotid arteries, increasing the stiffness in the main arteries and liver parenchyma, impaired of the functional state of endothelial.
Presence of comorbidity in patients - that is essential hypertension and type 2 diabetes is associated with early progression of target organs affection and cardiovascular complications. Hyperinsulinemia and insulin resistance are some of the factors that determine the frequency of cardiovascular complications in type 2 diabetes. According to some authors, endothelial dysfunction is a link between insulin resistance and cardiovascular diseases. To investigate severity of endothelial dysfunction in patients with essential hypertension and type 2 diabetes and its correction by using a complex treatment α-lipoic acid we have examined 84 patients with essential hypertension stage II and type 2 diabetes in a moderate condition before and after 6 months treatment. The patients were divided into two groups: the first one consisted of the patients who received only basic therapy, and another one consisted of those patients who in addition to basic therapy received also α-lipoic acid in tablets at a dose of 600 mg/day. After the investigation it was discovered that changes in the vascular wall in patients with essential hypertension and type 2 diabetes are characterized by increase of intima-media thickness and pulse wave velocity in the carotid arteries and abdominal aorta, decrease of endothelium-dependent vasodilation degree and increase of the levels of proinflammatory cytokines. Under the influence of the mentioned complex therapy in these patients it was found some improvement of metabolic homeostasis and correction of endothelial dysfunction. The effect on the structural and functional state of great vessels and proinflammatory cytokines, gained due to additional prescription of α-lipoic acid to the patients with essential hypertension and type 2 diabetes, was more considerable that the one which was shown in the group of patients who received only standard therapy.
- Mar 2014
Comorbidity of essential hypertension and type 2 diabetes is a serious problem connected with early affection of target organs and further cardiovascular complications. Pathogenetic mechanisms, determining the progress of essential hypertension, insulin resistance and type 2 diabetes, mostly have mutual symptoms and lead to the progression of disease. Many investigators consider cardiovascular pathology to be disease which has free radical nature. Activation of free radical oxidative process and endothelial dysfunction are recognized one of the most important pathogenetic mechanisms of cardiovascular diseases. To investigate structural and functional changes of heart and vessels, state of the pro- and antioxidant status, levels of proinflammatory cytokines in patients with essential hypertension and type 2 diabetes we have examined 102 patients with essential hypertension stage II and type 2 diabetes in a moderate condition. After the investigation it was discovered that changes of cardiohemodynamics in patients with essential hypertension and type 2 diabetes are characterized by the following aspects: systolic function of left ventricle is conserved, concentric hypertrophy of left ventricle predominates and also there is diastolic dysfunction similar to disordered relaxation. Changes of blood vessel walls in the examined patients are shown by growing intima-media thickness and pulse wave velocity in carotid artery and aorta and also by dropping endothelium dependent vasodilation. The mentioned structural and functional changes in heart and magistral vessels go together with growing levels of cytokines, activation of pro-oxidant system with suppression of antioxidant system, what is shown by correlation connections of different intention and direction.
- Jan 2014
run a pathophysiological cascade leading to endothelial dysfunction, cardiac remodeling and vascular immunoinflammatory activation and apoptotic processes. The research, which aimed to assess the contribution of type 2 diabetes to the development of cardiac and vascular remodeling in patients with essential hypertension, was carried out. The study involved 180 examined patients: 107 patients with essential hypertension in combination with type 2 diabetes and 73 patients with essential hypertension without type 2 diabetes. Our findings showed that patients with essential hypertension and type 2 diabetes were characterized by preserved systolic function of the left ventricle and, compared to patients without type 2 diabetes, more pronounced predominance of concentric (67.3%) and eccentric (17.8%) hypertrophy of the left ventricle, which are the worst cases of remodeling. In patients with essential hypertension in combination with type 2 diabetes, the degree of left ventricle diastolic dysfunction was more pronounced than in nondiabetic patients. Diastolic dysfunction type violations of the left ventricle relaxation were present in 100% of patients with essential hypertension without type 2 diabetes, while in 13.1% of patients with type 2 diabetes heavier pseudonormal type of the left ventricle diastolic dysfunction was diagnosed. The distinctive feature in the group of patients with a combination of essential hypertension and type 2 diabetes compared with a group of patients with essential hypertension without type 2 diabetes were significantly higher values of intima-media thickness, pulse wave velocity in carotid arteries and abdominal aorta, as well as a significantly lower value of endothelium-dependent vasodilation.