CONTENTS
СОДЕРЖАНИЕ
Address to the readers
Russ J Cardiol 2014, 3 (107): 5-6
CLINICAL GUIDELINES
ESC GUIDELINES ON DIABETES, PRE-DIABETES, AND CARDIOVASCULAR DISEASES DEVELOPED IN COLLABORATION WITH THE EASD
The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).
Russ J Cardiol 2014, 3 (107): 7-61
EDITORIAL
METABOLIC SYNDROME: CHALLENGING AND UNRESOLVED ISSUES
Chumakova G. A.1,2, Veselovskaya N. G.1,3, Gritsenko O. V.1,2, Ott A. V.3
Abstract
The paper focuses on the contradictory issues related to metabolic syndrome (MS), its criteria, and real-world prognostic value. Different types of obesity, which result from a variety of combinations of general and visceral obesity, are described. The authors emphasise the need for two separate definitions of MS (a wider one and a more specific one), which are characterised by different pathogenetic mechanisms and require different therapeutic approaches. The more specific MS definition could benefit from the inclusion of such criteria as fatty liver and polycystic ovary syndrome. More detailed definitions for the multiple risk factor cluster syndrome, as an alternative to the current MS definition, are proposed for further discussion.
Russ J Cardiol 2014, 3 (107): 63-71
Key words: metabolic syndrome, risk factor cluster, visceral obesity.
1Altay State Medical University, Barnaul; 2Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo; 3Altay Region Cardiology Dispanser, Barnaul, Russia.
INTERACTION BETWEEN SYMPATHO-ADRENAL ACTIVITY AND IMMUNE MEDIATORS IN PATIENTS WITH METABOLIC SYNDROME
Uzbekova N. R., Khuzhamberdiev M. A., Tashtemirova I. M.
Abstract
Aim. To investigate the interactions between the functional status of sympathoadrenal system and immune meditators in patients with metabolic syndrome (MS).
Material and methods. In total, 55 patients (age 35–57 years, mean age 46,7±2,1 years) were examined, including 30 individuals with MS. In all participants, the following parameters were assessed: carbohydrate metabolism parameters (fasting glucose and insulin), lipid metabolism parameters (total cholesterol (TCH), triglycerides, high-density lipoprotein CH (HDL–CH), and low-density lipoprotein CH (LDL–CH)), 24-hour urine excretion of free and conjugated catecholamines (CA), monoamine oxidase (MAO) activity, and cytokine status (interleukin-6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α).
Results. MS patients demonstrated a significant increase in all CA fractions, particularly noradrenaline (NA). The total NA levels were elevated, compared both to the levels of other bioactive amines and to the respective levels among controls and hypertensive patients. There was a positive correlation between 24-hour NA excretion and glycemic index (r=0,67, p<0,01), as well as between NA levels and body mass index (BMI) values (r=0,65, p<0,01). Moreover, there was a positive correlation between 24-hour NA excretion and blood pressure (BP) levels (r=0,62, p<0,01). The elevated 24-hour CA excretion was accompanied by a significant reduction in MAO levels across all study groups. There was a negative correlation between MAO and 24-hour NA excretion in MS patients (r= –0,68, p<0,01). These patients also had elevated levels of IL-6 and TNF-α. There was a positive correlation between IL-6 levels and the following parameters: elevated BP (r=0,67, p<0,01), BMI (r=0,59, p<0,01), TNF-α levels (r=0,53, p<0,01), and increased 24-hour NA excretion (r=0,65, p<0,01).
Conclusion: Increased sympatho-adrenal activity disturbs humoral immune response, which is an important pathogenetic marker of MS progression. This emphasises the need for pathogenetically sound strategy of pharmacological treatment for these patients.
Russ J Cardiol 2014, 3 (107): 72-75
Key words: sympatho-adrenal system, proinflammatory cytokines, metabolic syndrome.
Andizhan State Medical University, Andizhan, Uzbek Republic.
EPICARDIAL ADIPOSE TISSUE THICKNESS — AN ALTERNATIVE TO WAIST CIRCUMFERENCE AS A STAND-ALONE OR SECONDARY MAIN CRITERION IN METABOLIC SYNDROME DIAGNOSTICS?
Druzhilov M. A.1, Beteleva Yu.E.1, Kuznetsova T. Yu.2
Abstract
Aim. To assess the potential of echocardiographically assessed epicardial adipose tissue (EAT) thickness as a predictor of high cardiovascular risk (CVR) and subclinical target organ damage (STOD) in patients with abdominal obesity (AO).
Material and methods. In 132 normotensive AO patients (mean age 45,0±5,3 years), the following parameters were assessed: lipid and carbohydrate profile, glomerular filtration rate, microalbuminuria, and CVR levels by the SCORE scale. Triplex ultrasound of brachiocephalic arteries, echocardiography, bifunctional 24-hour blood pressure monitoring and arterial stiffness assessment were also performed.
Results. Mean levels of EAT thickness were significantly different across age groups (4,2±1,0 mm in those aged 31–45 years vs. 5,1±1,1 mm in those aged 46–55 years; p<0,001). Metabolic syndrome (MS) was diagnosed in 74 (56,1%) patients, based on the presence of AO and 2 additional criteria. In this group, the prevalence of STOD was relatively low. The combination of AO and EAT thickness ≥75% percentile for each age group (4,8 mm for 31–45-year-olds and 5,8 mm for 46–55-year-olds) was regarded as an alternative predictor of high CVR and STOD, observed in 38 (28,8%) patients. These individuals demonstrated a significantly higher prevalence of STOD (microalbuminuria, carotid atherosclerosis, carotid wall hypertrophy, left ventricular hypertrophy, and increased arterial stiffness). The alternative prognostic model was significantly more effective than the conventional one in terms of the identification of individuals with subclinical carotid atherosclerosis.
Conclusion. The alternative model for predicting high CVR and STOD in AO patients, which included the combination of such criteria of visceral obesity as AO and EAT thickness ≥75% percentile for each age group (4,8 mm for those aged 31–45 years and 5,8 mm for those aged 46–55 years), did not perform any worse than the conventional MS model. Of note, the alternative markers of visceral obesity were significantly more prevalent in patients who had both sets of criteria. AO patients with EAT thickness ≥75% percentile require further screening for carotid atherosclerosis.
Russ J Cardiol 2014, 3 (107): 76-81
Key words: epicardial adipose tissue, metabolic syndrome, cardiovascular risk.
1Karelia Republic Federal Security Service Medical Centre, Petrozavodsk; 2Petrozavodsk State University, Petrozavodsk, Russia.
ALTERNATIVE METHOD OF VISCERAL OBESITY ASSESSMENT IN THE DIAGNOSTICS OF METABOLIC SYNDROME
Veselovskaya N. G.1,3, Chumakova G. A.1,2, Ott A. V.2, Gritsenko O. V.1,3, Shenkova N. N.2
Abstract
At present, the existing main and additional criteria of metabolic syndrome (MS) lack a clear justification, which warrants further research.
Aim. To assess the potential of waist circumference (WC) and epicardial adipose tissue (EAT) thickness as alternative main criteria of MS.
Material and methods. In order to compare the specific features of MS diagnosed by different criteria of visceral obesity (WC and EAT thickness), 186 male patients with general obesity were divided into two groups: MS by the EAT thickness-based criteria and MS diagnosed by the WC-based criteria. In all participants, main and additional metabolic risk factors were assessed. Systolic EAT thickness (mm) was measured at the B-mode echocardiography, in the parasternal long-axis view, behind the free right ventricular wall.
Results. In patients with MS by the EAT thickness-based criteria (EAT thickness ≥7 mm), the levels of insulin (11,2 μIU/ml; 95% confidence interval (CI) 5,2–19,9 μIU/ml), HOMA-IR index (2,6; 95% CI 1,1–4,6), resistin (12,8 ng/ml; 95% CI 8,1–16,7 ng/ml), and interleukin-6 (12,4 pg/ml; 95% CI 7,6–15,0 pg/ml) were higher than those levels in patients with MS by the WC-based criteria (WC ≥94 cm): 6,9 (3,5–14,2) μIU/ml (p=0,040); 1,8 (0,9–3,4) (p=0,041); 10,8 (6,6–16,1) ng/ml (p=0,044); and 9,8 (4,8–13,6) pg/ml (p=0,044), respectively.
Conclusion. Our results have demonstrated that the EAT thickness ≥7 mm is a more accurate non-invasive marker of insulin resistance and visceral obesity-related neurohumoral and proinflammatory disturbances, compared to the traditional WC criterion (≥94 cm in men). In our opinion, the EAT thickness ≥7 mm could be used as a clarifying criterion of visceral obesity in MS.
Russ J Cardiol 2014, 3 (107): 82-86
Key words: epicardial adipose tissue thickness, waist circumference, metabolic syndrome.
1Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo; 2Altay State Medical University, Barnaul; 3Altay Region Cardiology Dispanser, Barnaul, Russia.
CLINICAL AND BIOCHEMICAL PREDICTORS OF DIABETES MELLITUS MANIFESTATION AFTER MYOCARDIAL INFARCTION
Barbarash O. L.1,2, Gruzdeva O. V.1, Akbasheva O. E.3, Palicheva E. I.1,2, Uchasova E. G.1, Karetnikova V. N.1,2, Fedorova T. S.3
Abstract
Aim. To identify the most informative parameters of carbohydrate and lipid metabolism which predict the manifestation of type 2 diabetes mellitus (DM-2) within one year after myocardial infarction (MI).
Material and methods. The study included 200 MI patients who underwent the assessment of glucose and insulin levels, insulin resistance (IR) index, and lipid profile at Days 1 and 12. The incidence of new DM-2 cases which manifested within a year after MI was assessed.
Results. After one year after MI, incident DM-2 was diagnosed in 14,5% of the patients. It was associated with concomitant cardiovascular risk factors, adverse clinical course of acute and longer-term MI periods, and lipid metabolism disturbances. A higher risk of incident DM-2 after MI was linked to IR and an elevation in free fatty acid (FFA) levels (9,5 times or higher) during the acute MI phase.
Conclusion. Important risk factors of incident DM-2 which manifested within a year after MI were IR (hyperglycemia and hyperinsulinemia) and elevated FFA concentration during the in-hospital MI period. FFA could be a promising marker for DM-2 risk stratification among MI patients.
Russ J Cardiol 2014, 3 (107): 87-94
Key words: diabetes mellitus, insulin resistance, myocardial infarction.
1Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo; 2Kemerovo State Medical Academy, Kemerovo; 3Siberian State Medical University, Tomsk, Russia.
GLYCEMIA CONTROL, INSULIN RESISTANCE, AND FUNCTIONAL ACTIVITY OF T-HELPER SUBPOPULATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Kologrivova I. V., Koshelskaya O. A., Suslova T. E., Karpov R. S.
Abstract
Aim. To study the functional activity of T-helper subpopulations (pro-inflammatory T-helpers-17 (Th17) and T-helpers-1 (Th1) and immune-suppressing FoxP3+T-regulators (Treg)) and its association with clinical parameters, glycemic control levels, and insulin resistance severity among patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 35 patients (17 men and 18 women) with Stage 1–2 AH and DM-2, aged 47–63 years. The control group included 24 healthy volunteers, comparable by age and gender. All participants underwent standard clinical examination and assessment of carbohydrate and lipid metabolism parameters. Flow cytometry method was used for the ssessment of Treg levels and activated Th1 and Th17 numbers in the peripheral blood mononuclear cell fraction. Functional status of blood cells was assessed by the secretion levels of interleukin (IL) 1β, IL-2, IL-6, IL-17, IL-10, tumor necrosis factor (TFN) α, and interferon (IFN) γ.
Results. In diabetic patients, there was an increase in activated Th1 numbers and IL-17, IL-6, and TNF-α secretion, combined with a decrease in IL-10 secretion, FoxP3+ Treg numbers, and Treg/Th17 ratio, compared to the control group. In patients with HbA1c >7%, more pronounced abdominal obesity was associated with reduced Treg numbers and Treg/Th17 and Treg/Th1 ratios, as well as with elevated IL-17 secretion, compared to patients with adequate glycemia control. According to the cluster analysis results, DM-2 patients could be divided into two subgroups by the severity of insulin resistance and HOMA index levels. Among patients with higher HOMA levels, more pronounced abdominal obesity, hyperglycemia, and hyperinsulinemia were associated with increased Th1 numbers and pro-inflammatory cytokine (IL-2, IL-1β, and IL-17) secretion, compared to their peers with less severe insulin resistance.
Conclusion. Our results suggest an important association between insulin resistance, inadequate glycemia control, and functional dysbalance of T-helper subpopulations in patients with DM-2.
Russ J Cardiol 2014, 3 (107): 95-101
Key words: Type 2 diabetes mellitus, T-helpers, insulin resistance, glycemia control.
Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.
METABOLIC PHENOTYPES AND CARDIOVASCULAR RISK IN PATIENTS WITH TYPE 1 DIABETES MELLITUS
Leonova N. V.1, Chumakova G. A.2,3, Vigel A. K.1, Pushkareva S. V.1
Abstract
Patients with Type 1 diabetes mellitus (DM-1) represent a heterogeneous group with different phenotypes, which might include some individuals with genetic predisposition towards insulin resistance (IR) and metabolic phenotype (MPH) development. At present, the IR effects on cardiovascular risk development in DM-1 patients remain an understudied area.
Aim. To assess the prevalence of cardiometabolic risk factors (RF) and micro- and macrovascular complications by phenotype in patients with DM-1.
Material and methods. The study included 3371 DM-1 patients from the Altay Region Diabetes Register. All participants were divided into two groups, by the waist circumference/hip circumference ratio: those with normal phenotype (NPH) and those with metabolic phenotype (MPH). Overall and separately in two age groups (under 50 and ≥50 years), the prevalence of the following characteristics was assessed: overweight, obesity, arterial hypertension, diabetic retinopathy, diabetic nephropathy, diabetic polyneuropathy, acute myocardial infarction, stroke (S), angina, and lipid metabolism disturbances.
Results. MPH was registered in 46,5% of DM-1 patients. Overall, MPH patients were 7 years older than their NPH peers. The percentage of men was higher among MPH participants. Among DM-1 patients with MPH, the prevalence of all clinical conditions was significantly higher (p<0,05), with S as the only exception. The effect of MPH on macroangiopathy development was greater than that for microangiopathy development. MPH participants were characterised by a higher prevalence of hypercholesterolemia and hypertriglyceridemia (p<0,01); however, this difference was less obvious in older patients. In the age group of 50 years and older, the strength of the association between MPH and cardiovascular diabetic complications was different from that in younger patients.
Conclusion. In DM-1 patients, MPH is an additional RF of cardiovascular disease development, which should be taken into account while choosing the appropriate therapeutic strategy
Russ J Cardiol 2014, 3 (107): 102-106
Key words: insulin resistance, metabolic and normal phenotype, macro- and microangiopathy.
1Regional Clinical Hospital, Barnaul; 2Altay State Medical University, Barnaul; 3Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.
CLINIC AND PHARMACOTHERAPY
MODERN POTENTIAL IN THE TREATMENT OF METABOLIC SYNDROME PATIENTS — FOCUS ON ENDOTHELIUM
Mychka V. B.1, Tolstov S. N.2, Salov I. A.2, Prokhorova Yu.V.1, Uzueva E. I.1, Vertkin A. L.1
Abstract
Numerous publications on the use of β-blockers in patients with arterial hypertension (AH) and metabolic syndrome (MS) have reported adverse effects of these medications on carbohydrate and lipid metabolism, as well as reduced cerebral perfusion. This review presents the benefits of a third-generation β-blocker — nebivolol (NebiletR) — in the treatment of MS patients. The authors refer to their own findings that demonstrate effectiveness and safety of nebivolol monotherapy in individuals with AH and MS. Nebivolol treatment resulted in a sustained reduction of systolic and diastolic blood pressure levels and also improved carbohydrate and lipid metabolism parameters, which beneficially differentiates nebivolol from all other known β-blockers. Nebivolol treatment did not demonstrate any negative effects on thyroid hormone levels and reduced aldosterone levels. Nebivolol-induced increase in the endothelial production of nitric oxide resulted in a significant improvement of cerebral perfusion. Moreover, nebivolol treatment was associated with a reduction in mean 24-hour QT interval duration, which was increased at baseline. These findings suggest a beneficial effect of nebivolol on myocardial electrophysiology. Nebivolol appears to be a promising medication in the treatment of patients with MS and AH.
Russ J Cardiol 2014, 3 (107): 107-113
Key words: metabolic syndrome, arterial hypertension, nitric oxide, β-blockers, nebivolol.
1A.I. Evdokimov Moscow State Medico-Stomatological University, Moscow; 2V.I. Razumovskyi Saratov State Medical University, Saratov, Russia.
LITERATURE REVIEW
DIABETES MELLITUS AND CARDIOVASCULAR COMPLICATIONS: FOCUS ON HEMOSTASIS
Petrik G. G.1,2, Pavlishchuk S. A.1, Kosmacheva E. D.1,2
Abstract
This literature preview presents modern evidence on the mechanisms of prothrombotic status development in diabetes mellitus, taking into consideration the association between metabolic disturbances, increased functional platelet activity, and hemocoagulation.
Russ J Cardiol 2014, 3 (107): 114-118
Key words: hemostasis, coagulation, metabolic disturbances, diabetes mellitus, platelets.
1Kuban State Medical University, Krasnodar; 2S.V. Ochapovskyi Regional Clinical Hospital No. 1, Krasnodar Region, Russia.
POST-RELEASE
The 2nd international conference of the Heart and Brain. Paris, France 27 February – 1 March 2014.
Russ J Cardiol 2014, 3 (107): 119-120