Anna Skalska

Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle–brachial index (ABI).

INTRODUCTION An inverse relationship between natriuretic peptides (N-terminal fragment of the prohormone brain natriuretic peptide [NT-proBNP]) and body mass index (BMI) among healthy people and patients with chronic heart failure (CHF) was observed. OBJECTIVES The aim of the study was to assess the relationship between nutritional status and NT-proBNP concentrations in older persons. PATIENTS AND METHODS NT-proBNP concentrations, medical histories, and malnutrition risk using Mini Nutritional Assessment were evaluated. Body composition was measured with dual energy X-ray absorptiometry. The relationship of nutritional status with NT-proBNP concentrations (in tertiles) was assessed. RESULTS The mean (SD) age of 106 participants was 72.16 (9.38) years. Heart failure was diagnosed in 72.6% of patients. The risk of malnutrition was recognized in 28.3%, and the percentage of patients at risk increased in subsequent NT-proBNP tertiles: from 16.7% in the first tertile to 48.6% in the third tertile (P = 0.005). The risk of malnutrition was associated with an increase in NT-proBNP concentrations per tertile (odds ratio [OR], 2.30; 95% CI, 1.30-4.07; P = 0.004). Based on a multivariable logistic model, the NT-proBNP concentration in the third tertile was associated with an over 9-fold higher risk of malnutrition (OR, 9.80; 95% CI, 2.00-48.17; P = 0.005) as compared with the lowest concentration. Among patients with CHF, the relationship between NT-proBNP and nutritional status was even stronger. CONCLUSIONS High NT-proBNP levels contribute to increased risk of malnutrition in older patients with heart failure. In patients with elevated NT-proBNP levels, the risk of malnutrition should be assessed.

Recently, the relationship between vitamin D deficiency and various pathologies as well as functional decline has been reported. The aim of the study was to assess the relationship between 25-hydroxyvitamin D, 25(OH)D, levels and functional status in elderly patients. Mean age of 140 participants (women, 67.1%) was 79.64 ±6.99 years. The study had a cross‑sectional design. Physical performance was measured using the handgrip strength, Timed Up and Go, single-leg stance, and tandem stance tests, as well as a balance platform. Cognition was evaluated with the Abbreviated Mental Test Score (AMTS), while functional status with the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Plasma 25(OH)D levels were measured. Less able patients (worse results in all tests) had significantly lower 25(OH)D levels. Subjects with 25(OH)D levels within the 3rd tertile had a higher AMTS score and handgrip strength; they swayed less on the balance platform and performed better in the IADL. In multivariate logistic regression analysis, 25(OH)D levels of 23.26-47.75 nmol/l were associated with increased odds of cognitive impairment (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.04-9.68; P = 0.04), but also with less lateral sway (OR, 0.24; 95% CI, 0.09-0.64; P = 0.005). Plasma 25(OH)D levels above 47.75 nmol/l were associated with better performance in the tandem stance test (OR, 0.14; 95% CI, 0.04-0.52; P = 0.003) and further decreased lateral sway (OR, 0.27; 95% CI, 0.10-0.77; P = 0.01). In elderly people with comorbid conditions, 25(OH)D levels were not associated with handgrip strength, but were associated with balance and cognitive function. These associations as well as high prevalence of vitamin D deficiency necessitate further research evaluating the effect of vitamin D supplementation on the functional status in elderly people.

Endothelin-1 (ET-1) and oxidative stress are involved in the development of hypertension-induced cardiovascular complications. The aim of this study was to evaluate the relationship between plasma ET-1 level and plasma antioxidant capacity and carotid atherosclerosis. In 61 treated patients with hypertension (44 women, 35 diabetics, mean age 72.4±7.2 years) medical histories, ambulatory blood pressure, blood tests (glucose, creatinine, cholesterol, haemoglobin A1c (HbA1c), ET-1) and common carotid artery intima–media thickness (CCA-IMT) measurement were carried out. Plasma antioxidant capacity was assessed by the ferric-reducing ability of plasma (FRAP). Subjects with diabetes presented with higher concentrations of glucose (7.01±2.3 vs 5.14±0.6 mmol l⁻¹, PP−1, P−1, Pr=0.40, Pr=−0.36, P<0.01) was observed. In a stepwise regression analysis, after adjustment for all confounders, CCA-IMT was independently influenced by age, systolic blood pressure (SBP), HbA1c and ET-1. When FRAP was included in the regression model, CCA-IMT was significantly influenced by age, FRAP, HbA1c and SBP. ET-1 promotes the increase in CCA-IMT contributing to the development of end-organ damage. Plasma antioxidant capacity may modulate this deleterious effect, but whether better antioxidant defence may prevent against the development of atherosclerosis remains to be elucidated.

The aim of the study was to evaluate of the association between renal function and the intima-media thickness of common carotid artery (CCA-IMT) in treated hypertensive patients. Eighty-seven hypertensives (51.7% diabetic), aged >45 years, were examined. Renal function was evaluated by plasma concentration of creatinine, cystatin C (in 64 patients) and creatinine clearance, calculated according to the Cockcroft-Gault formula. HbA1c measurement and blood pressure monitoring were performed. CCA-IMT was measured at near and far wall of the CCA and of the bulb on both sides and averaged. In 63 hypertensives (72.4%) IMT was over 0.9 mm. These subjects were older (71.17+/-9.72 vs 57.75+/-7.76 years; p<0.0001), had higher pulse pressure (57.45+/-11.73 vs 49.35+/-8.35, p = 0.004), cystatin C concentration (1.25+/-0.34 vs 0.99+/-0.17 mg/l; p = 0.002), higher HbA1c (7.24+/-1.59 vs 6.25+/-1.28, p = 0.01), and lower creatinine clearance (71.28+/-28.32 vs 93.86+/-25.04; p<0.0001) in comparison to patients with IMT <0.9 mm. Groups did not differ with respect to creatinine concentration. The logistic regression analysis showed that CCA-IMT was independently influenced only by age, and the effect of age was stronger in older patients. After exclusion of age, 0.1 mg/l higher concentrations of cystatin C or 10 ml/min lower estimated creatinine clearance were significantly associated with 56% and 34%, respectively, higher probability of CCA-IMT of more than 0.9 mm. Cystatin C concentration seems to be a useful indicator of renal function impairment associated with carotid intima-media thickening. Similar information is obtained when estimated creatinine clearance is used.