Ivan Tasic

Background: Metabolic syndrome (MetSy) is characterized by the presence of obesity, hypertension, altered glucose metabolism, and/or increased non-HDL cholesterol. This study aimed at elucidating the association between obesity with subclinical target organ damage and biochemical parameters included in MetSy pathogenesis. Methods: This study included 130 apparently healthy subjects. Plasma levels of oxidized-LDL-cholesterol (ox-LDL-Chol), nitric oxide (NO) metabolites, inducible NO synthase (iNOS), and plasminogen activator inhibitor-1 (PAI-1) were measured. Non-invasive assessment of liver disease included fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Carotid artery plaques were assessed by color Doppler imaging. Results: A total of 65 patients with MetSy were included in the MetSy group, while 65 without MetSy entered the control group. Ox-LDL-Chol levels were higher in the MetSy group compared to the control group, regardless of obesity. Levels of NO metabolites were similar in obese and non-obese patients with MetSy, but lower than in the control group. Obese patients with MetSy had higher iNOS values compared to non-obese ones, with similar PAI-1 levels. NAFLD was present in all obese patients with MetSy compared to 70% of non-obese subjects. Hypertension, higher values of waist-to-hip ratio, PAI-1, and remnant cholesterol were associated with NAFLD. Finding of asymptomatic carotid plaques was associated with patients’ age, hypertension, and higher waist-to-hip ratio. Conclusion: MetSy and obesity significantly alter the levels of NO metabolites, iNOS, ox-LDL-Chol, and PAI-1. High prevalence of NAFLD in obese patients with MetSy requires active screening and treatment of potential risk factors.

The aim of the paper was to examine the impact of disease duration and administered therapy on the development of metabolic syndrome (MetS) in patients with systemic lupus erythematosus (SLE). This study involved 55 patients (50 females and 5 males) with the diagnosis and 49 healthy controls of similar age. MetS was defined according to modified NCEP-ATP III diagnostic criteria, and obesity was defined by body mass index BMI > 30. In the group of SLE patients with MetS, there were 23 individuals (41.82%). In the control group, there were 10 (20.4%) patients with MetS. There were significantly more SLE patients with MetS in comparison to the controls (p = 0.04). Duration of the disease in the group with MetS was longer in comparison to those without MetS, but it was not statistically significant (15.35 ± 10.26 vs 10.44 ± 7.88, p = 0.073). The study confirmed that there is a moderate association (CC = 0.355) between disease duration and number of MetS parameters, however, this dependency was not statistically significant (p = 0.439). In the group without MetS, there were statistically more patients treated with antimalarial drugs monotherapy (p = 0.023). It has been found that the patients with MetS were treated with corticosteroid therapy longer than those without MetS, but it was not statistically significant (153.57 ± 103.34 vs 114.75 ± 83.32, p = 0.129). Patients with longer SLE duration have more often MetS. It has been shown that, statistically, more patients without MetS were treated with antimalarial drugs monotherapy, and that long-term CS use, in our study, was not associated with higher incidence of MetS.

Very high blood pressure (BP) is a common and significant problem in the emergency department (ED), affecting 4.6% of admitted patients [1]. Hypertensive urgency (HTN-U) is a diagnosis of exclusion...

Background and objectives: A long-term therapeutic strategy in hypertensive patients equally depends on measured arterial blood pressure values and total determined cardiovascular risk. The aim of the adequate hypertensive patient treatment is both the reduction in arterial blood pressure and the reduction of all preexisting modifiable risk factors, prevention of target organs damage, and adverse cardiovascular events. The aim of this study was to determine independent predictors of cardiovascular events in patients with hypertension and high cardiovascular (CV) risk, and whether the modifiable risk factors could affect long-term prognosis in the studied population. Materials and Methods: This prospective study included 142 hypertensive patients (65% females), mean age 63.1±8 years, with high CV risk. Each participant was followed for 6.2 years. Results: During the follow-up period, the incidence of non-fatal and fatal CV events was 19.7%, CV mortality 7%, and total mortality 9.9%. Our multivariate analysis showed that plaques in both carotid arteries (p = 0.042), diabetes mellitus (p = 0.042) and cholesterol at the beginning of the study (p = 0.016) were significantly associated with an increased risk of CV events. Patients’ age (p = 0.009), intima-media thickness (p = 0.001) and diabetes mellitus (p = 0.042) were significantly associated with an increased risk of CV mortality, and age (p = 0.007) and cholesterol (p = 0.002) were independent variables significantly associated with increased total mortality rates. Conclusions: The results of the present study showed that the main predictors of adverse CV events in high-risk hypertensive patients were years of age, cholesterol levels, diabetes, intima-media thickness, and carotid arteries plaques.

Background. A precise estimate of cardiovascular (CV) risk in asymptomatic individuals is a key factor in the primary prevention of CV disease. Case report. In this report describe an asymptomatic individual presenting for CV status assessment. After the CV risk assessment using the SCORE risk charts and Framingham score, additional tests were performed, which provided better insight and reclassification of risk in this individual. Carotid Doppler sonography revealed plaques in the carotid arteries. Non-invasive assessment of coronary flow reserve (stress echocardiography test) demonstrated that a considerable area of the left ventricle is suffering ischemia when stressed. This was an indication for coronarography, which showed severe three-vessel coronary disease, that was later successfully treated by surgical revascularization. A year after the surgery a control stress echocardiography was performed, showing a satisfactory coronary flow reserve. Conclusion. A precise estimate of CV risk in asymptomatic individuals opens the road leading to early diagnosis, adequate therapy, and prevention of CV disease.

Hypertension with high cardiovascular (CV) risk is characterized by significant increase of one of the risk factors, especially cholesterol above 8 mmol/l in, for instance, familial hypercholesterolemia, or blood pressure (BP) ≥180/110 mmHg (stage III hypertension), diabetes mellitus, hypertensive left ventricular hypertrophy (LVH), moderate chronic renal failure with eGFR of 30-59 mL/min/1.73 m2 and/or calculated 10-year SCORE of 5-10%. Case report: We presented in this paper a patient with hypertension and high risk in whom diastolic hypertension, left ventricular hypertrophy, metabolic syndrome and obesity were predominant in the beginning, while diabetes mellitus prevailed in the further disease course. We presented the diagnostic protocol, as well as the risk assessment according to the European and American guidelines, and a proper selection of non-medicamentous and medicamentous therapy. The patient was treated and observed for 20 years, and the therapy based on the official hypertension guidelines was able to prevent major cardiovascular events and to suspend the progression of target organ damage in hypertension. Conclusion: Proper risk assessment in hypertensive patients, presence of risk factors and target organ damage have a decisive role in the selection of adequate therapy in hypertension. Achievement of target BP values, control of risk factors and regression of target organ damage constitute the basis of good quality of life of hypertensive patients and prevention of major cardiovascular events.

Abstract: Background: The impact of overt diabetes and poor glycemic control on the risk of cardiovascular disease is well established. Among patients with type 2 diabetes, several studies demonstrated a significant increase in coronary artery disease related death and cardiovacular events associated with HbA1c levels of greater than 7 % compared with lower levels. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a novel class of anti-diabetic drugs that lower blood glucose levels through the suppression of renal glucose reabsorption thereby promoting renal glucose excretion. Objectives: To summarize data on the potential mechanisms of SGLT-2 inhibition that could exert cardiovasular benefits in patients with diabetes mellitus. Method: We conducted an in-depth liturature search of SGLT-2 inhibitors and potential cardiovascular benefits and mechanisms that mediate those effects. Results: In diabetes, expression of the SGLT-2 genes is up-regulated and renal threshold increased, resulting in increased glucose reabsorption from glomerular filtrate, reducing urinary glucose excretion and worsening hyperglycemia. SGLT-2 inhibition should offer potential cardiovascular protection in diabetic patients via attenuating hyperglycemia, blood pressure, body weight, hyperuricemia, and diabetic nephropathy. Conclusion: The initial data of SGLT-2 inhibitors suggest beneficial effects on cardiovascular risk among patients with diabetes mellitus. Several mechanisms are hypothesized to mediate the abovementioned benefits. Future randomized, controlled studies are need in order to unveil the contribution of each mechanism to these outcomes.

The goal of the present study was to determine the prevalence of hyperuricemia in patients with coronary artery disease (CAD), within three months after coronary events. Also, we aimed to determine whether the presence of hyperuricemia holds correlation with severe CAD, overall heart functioning and risk factors for CAD. The study included 505 consecutive CAD patients, 385 males and 120 females, aged 60.9 ± 9.6 years, with a mean body mass index (BMI) 28.0 ± 3.7 kg/m². All patients were admitted to specialized cardiovascular rehabilitation within three months post-acute myocardial infarction (AMI) without revascularization (32.6%), percutaneous coronary intervention (PCI) with myocardial infarction (32.1%) and with coronary bypass graft (35.3%). The mean value of serum acidum uricum (SUA) was 345.5 ± 100.3 µmol/L, where 115 (22.8%) patients had asymptomatic hyperuricemia. Patients with asymptomatic hyperuricemia had significantly higher average number of risk factors, lower HDL cholesterol and higher creatinine and triglycerides levels, lower ejection fraction (EF). Multivariate stepwise analysis revealed that five parameters were capable to predict SUA levels. We can conclude that in patients with CAD, SUA levels are independently associated with BMI, triglyceride and creatinine levels and negatively with EF. Thus, one can say that asymptomatic hyperuricemia is not significantly associated with the severity of CAD.