Annals of RSCB Vol. XVI, Issue 1
|
|
- Chester Rodgers
- 5 years ago
- Views:
Transcription
1 THE STUDY OF PROTHROBOTIC STATE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR DISEASES Oana Bădulescu 1, Codruţa Bădescu 2, Manuela Ciocoiu 1, Magda Bădescu 1 1 DEPARTMENT OF PATHOPHYSIOLOGY; 2 DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF MEDICINE AND PHARMACY "GRIGORE T. POPA" IASI, ROMANIA Summary Epidemiologic studies consider vascular complications as the first cause of death in diabetic patients. Persistent hyperglycemia is responsible for the affection of large vessels, causing severe diseases, such as myocardial infarction, cerebrovascular accident or diabetic gangrene. The objective of this study was to determine the thrombotic risk in patients with type 2 diabetes mellitus (DM) with or without cardiovascular disease (CVD) compared with non-diabetic patients with cardiovascular disease. The study comprises 18 patients admitted to the Geriatric Ward of the C. I. Parhon Hospital from June 1, 9 to December 1, 9. The patients were distributed in following groups: diabetic patients without ischemic cardiopathy-related disorders (DM), diabetic patients with clinical or off-clinical (EKG, Echocord) ischemic cardiopathy-related disorders (DM+IC), non-diabetic patients with ischemic cardiopathy-related disorders (IC); the patients were investigated by determining three factors of coagulation profile: von Willebrand Factor (vwf), factor X (Stuart-Power), DD-imers. The highest levels of the three studied parameters were found in the diabetic groups (DZ+CI) (p<,1) and (DZ-CI) (p<,5). The elevated levels of vwf in diabetic patients, reflect the effects of hyperglycemia on endothelium and the existence of plateletvwf interaction, which would explain the accelerated atherosclerosis in this patients. But diabetics vascular pathology it is also based on a lack of balance between the thrombosisthrombolysis processes, to the benefit of thrombosis, followed by the occurrence of ischemic events Key words. coagulation, fibrinolysis, hyperglycaemia, insulin resistance. Introduction Diabetes mellitus is a medical condition associated with evolving atherosclerosis (ATS) and with a high prevalence of micro- and macro-vascular diseases, which together are the main cause of morbidity and mortality in diabetic patients. Type 2 diabetes mellitus is characterized by fluctuating hyperglycemia, and as a consequence the development to varying degrees of protein glycation. Some of the established effects of hyperglycemia on oxidative stress, endothelial cell dysfunction, extracellular matrix formation and apoptosis are considered to play an important role in diabetes-related vascular 81 damage. (Bădescu et al., ). The insulin resistance is accompanied by the development of a chronic inflammatory, atherothrombotic phenotype which appears to underpin the strong association with both type 2 diabetes and cardiovascular diseases. Haemostatic mechanisms are altered both in response to insulin resistance itself, with further changes secondary to abnormal glucose metabolism as impaired glucose tolerance and frank type 2 diabetes develop. The abnormalities in haemostasis, in insulin resistance and diabetes seem co-ordinated to generate a prothrombotic phenotype. Evidence indicates that the use of antiplatelet regimens in both primary and
2 secondary prevention, leads to a fall in morbidity and mortality. Equally, in the acute setting, low molecular weight heparins and fibrinolytic agents have beneficial effects on outcomes. One of the earliest vascular changes associated with insulin resistance is the development of endothelial dysfunction, with suppression of phosphoinositide 3- kinase-mediated nitric oxide (NO) generation. This has a number of adverse effects on the vasculature, including the loss of control of platelet activation, normally afforded by NO. At the same time, insulin resistance is accompanied by increased levels of a number of proteins involved in the fluid phase of coagulation. Material and methods The study comprises 18 patients who were followed for 6 month, from June 1, 9 to December 1, 9. The patients were distributed in the following groups: - group 1 Diabetic women with clinical or off-clinical disorders (EKG, Echocord) related to ischemic cardiopathy (DM+IC) - group 2 Diabetic women without ischemic cardiopathy-related disorders (DM- IC) - group 3 Diabetic men with clinical or off-clinical ischemic cardiopathyrelated disorders (DM+IC) - group 4 Diabetic men without ischemic cardiopathy-related disorders (DM- IC) - group 5 Non-diabetic women with ischemic cardiopathy-related disorders (IC) - group 6 Non-diabetic men with ischemic cardiopathy-related disorders (IC) The major objective of our study was: the determination of the thrombotic risk in patients with type 2 diabetes mellitus with or without cardiovascular disease compared with non-diabetic patients with cardiovascular disease. Results and disscussions In the studied group, we followed the values of three parameters (von Willebrand factor, fibrinogen, DD-imers), in correlation with the duration of the diabetes mellitus. Fibrinogen In women, fibrinogen had the most homogeneous individual values in the group of diabetic women without ischemic cardiopathy (DM-IC) (4,14CV%). in diabetic women with cardiovascular diseases associated (DZ+IC), the fibrinogen values is directly, but week, correlated with the duration of the disease (r=,29); in diabetic women without cardiovascular diseases (DZ-IC), the fibrinogen values are indirect and weak correlated with the duration of the disease (r = -,25). In men, comparing the fibrinogen values, it was observed the same aspects as in women s groups. Fibrinogen had the most homogeneous individual values in the group of diabetic men with ischemic cardiopathy (DM+IC) (8,95CV%). - in group of diabetic men with ischemic cardiopathy (DM+IC), there was no correlations between fibrinogen values and the duration of the disease (r=,8) ; - in diabetic patients without cardiovascular diseases (DZ-IC) the elevated values of fibrinogen are associated in percentage of 43% with the duration of the disease. Regarding the mean values of fibrinogen, these did not show a significant differences between genders or between the studied groupes. 82
3 7 r= diabetic women with IC DM+IC DM-IC nondm+ic Male Female 7 r= diabetic women without IC Fig.1: Correlations between fibrinogen values () and the duration of the DM, in women r= diabetic men with IC r= diabetic men without IC Fig.2: Correlations between fibrinogen values () and the duration of the DM, in men Fig.3: The mean values of fibrinogen () in the studied groups von Willebrand Factor In women, vwf had the most homogeneous individual values in group of diabetic women with ischemic cardiopathy ( DM+IC) (13,3CV%). it was observed a direct correlation (r=,86) with the duration of the disease in diabetic women with ischemic cardiopathy associated (DM+IC) ; an indirect correlation (r =-,22) was observed in the group of diabetic women without ischemic cardiopathy (DM-IC); the highest values of vwf were found in recently diagnosed DM. In men, comparing the values of von Willebrand factor, it was observed the same aspects as in women groups: von Willebrand factor had the most homogeneous individual values in the group of diabetic men with ischemic cardiopathy (DM+IC) (28,47CV%). a direct, but weak correlation (r=,21), was observed in the group of diabetic men with ischemic cardiopathy (DM+IC); a moderate direct correlation between elevated values of vwf and the duration of the disease (r =,59) was observed in the group of diabetic men without ischemic cardiopathy (DM-IC). Regarding the mean values of vwf, these did not show a significant differences between genders or between the studied groupes. 83
4 r= diabetic women with IC r= diabetic women without IC Fig.4: Correlations between Von Willebrand factor values (%) and the duration of the DM, in women r= diabetic men with IC r= diabetic men withoutic Fig.5 :Correlations between Von Willebrand factor values (%) and the duration of the DM, in men DM+IC DM-IC nondm +IC Male Female Fig. 6: The mean values of von Willebrand factor (%) in the studied groups DD-imers In women, DD-imers had the most homogeneous individual values in the group of diabetic women without ischemic cardiopathy ( DM-IC) (15,91CV%). it was observed an indirect correlation (r=-,65) with the duration of the disease in diabetic women with ischemic cardiopathy (DM+IC) ; in the group of diabetic women without ischemic cardiopathy (DM-IC) it was observed a direct correlation (r =,24) with the duration of the disease; the DD-imers' values increase with the history of DM. In men, it was observed that DD-imers had the most homogeneous individual values in group of diabetic men with ischemic cardiopathy (DM+IC)(8,39CV%). a direct, but weak, correlation with the duration of the disease (r=,23) it was observed in group of diabetic men with ischemic cardiopathy (DM+IC); an indirect correlation (r = -,38) it was observed in diabetic men without cardiovascular disease (DZ-CI); the elevated values of DD-imers are associated with the recently diagnosed DM. Regarding the mean values of DD-imers', these presented the following differences: there were not significant differences between genders ; in women, diabetic patients with cardiovascular diseases (DZ+CI) have significantly higher mean values than diabetic patients without cardiovascular diseases (DZ+CI) (p<,5) ; in men, no significant differences were recorded in mean values of DD-imers, in the studied groups. 84
5 8 r= diabetic women with IC 8 r= duration of the disease (years) Fig.7: Correlations between DD-imers values () and the duration of the DM, in women. 8 8 r= duration of the disease (years) r= duration of the disease (years) Fig.8: Correlations between DD-imers values () and the duration of the DM, in men DM+IC DM-IC nondm+ic Female Male Fig. 9: The mean values of DD-imers () in the studied groups The elevated levels of vwf are an indication of endothelial cell damage and are correlated with other cardiovascular risk factors (Blann., 1991). Many studies have reported an association between elevated FVIII and/or vwf levels, the presence of atherosclerotic disease (Egeberg, 1962) and the risk of future cardiovascular events in patients with angina and previous myocardial infarction (Jansson et al., 1991). The mechanisms linking the elevated levels of vwf FVIII to insulin resistance and type 2 diabetes may be related to the presence of underlying endothelial dysfunction and or inflammation, both of which are involved in the development of insulin resistance. It was shown that the fibrinogen plays a part in increasing the sensitivity of platelets to aggregating agents. The fibrinogen is linked to the platelet receptors and may play an agonist part in the in vitro platelet aggregation. It was also shown that after the stimulation with agonists, the fibrinogen adhesion to platelets in diabetic subjects increases. The level of the plasmatic fibrinogen is high in the diabetics and this level is in direct relation to glycemia regulation. Therefore, it is natural to say that in diabetes the interaction fibrinogen thrombocytes takes place, which contributes to the increase of the sensitivity of thrombocytes by stimulating it with the agonists and may play a part in the acceleration of the process of atherosclerosis in diabetics. Plasma levels of fibrinogen influence thrombogenesis, affecting the rheology of blood flow, blood viscosity and platelet aggregation, and elevated levels have been shown to be a strong and independent cardiovascular risk factor in prospective epidemiological studies.
6 Hyperglycemia per se has been implicated in the development of prothrombotic changes in clamp studies (Stegenga et al., 6) where under conditions of euinsulinaemic hyperglycemia, twofold increases in thrombin antithrombin complexes and circulating soluble tissue factor were documented. Hyperinsulinemia in the presence of euglycaemia led to increases in PAI-1, and the authors made the observation that glucose modulated thrombotic processes whilst insulin regulated fibrinolysis. In vitro, glycated albumin has been reported to increase tissue factor expression in both monocytes and umbilical vein endothelial cells to indicate a mechanism by which glycation might initiate coagulation processes. Association studies in nondiabetic subjects have indicated correlations between serum advanced glycation end products (AGE) and both PAI-1 and fibrinogen levels to support the concept that AGE accumulation may stimulate prothrombotic changes in man. In addition, higher levels of glycation were associated with endothelial cell apoptosis which might contribute to vascular damage. Multiple coagulation pathways are abnormal in individuals with type 2 DM. There is impaired fibrinolysis, in part due to elevated PAI-1 levels. Increased PAI-1 levels are associated with thrombotic disorders, including myocardial infarction and are an important predictor of the development of type 2 DM (Stegenga et al., 6). Several components contribute to this elevation of PAI-1: one is insulin resistance and resulting hyperinsulinemia, possibly independent of hyperglycemia, as there is an insulin promoter site on the PAI-1 gene. (Stegenga et al., 6). Another factor promoting increases in PAI-1 are the elevations in triglycerides and very-low density lipoprotein cholesterol, which also promote PAI-1 synthesis. Furthermore, PAI-1 is also produced by platelets in excessive amounts by visceral adipocytes. Hypercoagulation may also be promoted by tumor necrosis factor α (TNF-α), adiponectin and interleukin-6. There is also increased activation of factor VII as well as increased levels of fibrinogen and vwf. Abnormalities of visceral fat and its metabolic function may provide a common precursor insulin resistance, lipid abnormalities and abnormalities in coagulation/fibrinolysis. Visceral fat produces proinflammatory cytokines such as interleukin-6 and TNF-α, which in turn elevate fibrinogen levels. These cytokines are responsible for some of the endothelial dysfunction that causes an increase in vwf. There is also some experimental evidence to support the notion that the coagulopathy is driven by hyperglycemia rather than hyperinsulinemia (Stegenga et al., 6). Nevertheless, most studies have found a relation of either hyperinsulinism or hypertriglyceridemia to specific abnormalities in coagulation. Conclusions The assessment of the blood flow, vascular reactivity and certain endothelial dysfunction markers has been shown to be associated with an unfavorable cardiovascular prognosis. In DM, hyperglycemia and the metabolic syndrome components directly or indirectly cause endothelial dysfunction. The development of endothelial dysfunction, in pacients with type 2 diabetes mellitus, promotes vasospasm, thrombosis and inflammation, processes that may all be involved in the early stages of atherosclerotic disease, a view supported by clinical studies. DM is by itself a major atherogenesis risk factor. The risk of developing cardiovascular events is higher in DM patients, because hyperglycemia determines subsequent metabolic disorders, by forming AGE and then by triggering quantitative and qualitative changes in serum lipoproteins, mechanisms which would explain the atherosclerosis acceleration in these patients. References Bădescu, M., Roşca M., Bohotin, C.: Fiziopatologie Generală. Vol. 2, chap. 1, ,. Edited by M. Badescu, Ed. Cantes, Iasi Blann A., Increased circulating levels of von Willebrand Factor antigen in smokers may be due to lipid peroxides. Med. Sci. Res. 1991; 19: Egeberg O.,Clotting factor levels in patients with coronary atherosclerosis. Scand. J. Clin. Lab. Invest. 1962; 14: Jansson J., Nilsson T., Johnson O. von Willebrand factor in plasma: a novel risk factor for recurrent myocardial infarction and death. Br. Heart J. 1991; 66: Stegenga M.E., van der Crabben S.N., Levi M., Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans. Diabetes. 6;55:
Annals of RSCB Vol. XVII, Issue 1/2012
CORRELATIONS BETWEEN ENDOTHELIAL DYSFUNCTION AND GLYCEMIA IN VENOUS THROMBOSIS PATHOGENESIS Codruţa Bădescu 1, Oana Bădulescu 2, Manuela Ciocoiu 2, Magda Bădescu 2, M. Costuleanu 2 1 DEPARTMENT OF INTERNAL
More informationPOLYCYTHEMIA VERA SYNDROME-AS A PROTROMBOTHIC STATE
Rev. Med. Chir. Soc. Med. Nat., Iaşi 2014 vol. 118. no. 2 BASIC SCIENCES ORIGINAL PAPERS POLYCYTHEMIA VERA SYNDROME-AS A PROTROMBOTHIC STATE Oana Viola Bădulescu 1, Manuela Ciocoiu 1, Iris Bararu 2 Mădălina
More informationMacrovascular Disease in Diabetes
Macrovascular Disease in Diabetes William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research Conflicts CPC Clinical Research (University-based
More informationPlatelet function in diabetes
Platelet function in diabetes Agneta Siegbahn, MD, PhD, FESC Professor Clinical Coagulation Science Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Disclosures: None
More informationPEOPLE WITH TYPE 2 diabetes are disproportionately
0163-769X/04/$20.00/0 Endocrine Reviews 25(1):153 175 Printed in U.S.A. Copyright 2004 by The Endocrine Society doi: 10.1210/er.2002-0034 Nontraditional Risk Factors for Cardiovascular Disease in Diabetes
More informationLa Trombosi Arteriosa
La Trombosi Arteriosa Prof. Giovanni Davì Medicina Interna Chieti Platelet activation and thrombosis Harrison 19 edizione Platelets are essential for primary hemostasis and repair of the endothelium They
More informationCh. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma
Chapt. 45 Ch. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma Inheritance of X-linked gene for Factor VIII hemophilia A Explain the
More informationThe Study of Endothelial Function in CKD and ESRD
The Study of Endothelial Function in CKD and ESRD Endothelial Diversity in the Human Body Aird WC. Circ Res 2007 Endothelial Diversity in the Human Body The endothelium should be viewed for what it is:
More informationDyslipidemia Endothelial dysfunction Free radicals Immunologic
ATHEROSCLEROSIS Hossein Mehrani Professor of Clinical Biochemistry Definition Atherosclerosis: Is a chronic inflammatory process characterized by plaque formation within the vessel wall of arteries and
More informationJOSHUA K. KAYIMA INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY
INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY JOSHUA K. KAYIMA ASSOCIATE PROFESSOR DEPT. OF CLINICAL MEDICINE AND THERAPEUTICS UNIVERSITY OF NAIROBI Introduction According to
More informationPATIENTS AND METHODS:
BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by erosive synovitis that involves peripheral joints and implicates an important influence in the quality
More informationROLE OF INFLAMMATION IN HYPERTENSION. Dr Barasa FA Physician Cardiologist Eldoret
ROLE OF INFLAMMATION IN HYPERTENSION Dr Barasa FA Physician Cardiologist Eldoret Outline Inflammation in CVDs the evidence Basic Science in Cardiovascular inflammation: The Main players Inflammation as
More informationAdipose Tissue as an Endocrine Organ. Abdel Moniem Ibrahim, MD Professor of Physiology Cairo University
Adipose Tissue as an Endocrine Organ Abdel Moniem Ibrahim, MD Professor of Physiology Cairo University Functions of Adipose Tissue Adipose tissue expresses and secretes a variety of bioactive peptides,
More informationHemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.
Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators
More informationClassification of Endothelial Dysfunction. Stefano Taddei Department of Internal Medicine University of Pisa, Italy
Classification of Endothelial Dysfunction Stefano Taddei Department of Internal Medicine University of Pisa, Italy Pathogenesis of atherosclerosis from endothelial dysfunction to clinical disease endothelial
More informationTerm-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY
MCC-006 POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PGDCC) 00269 Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY Time : 2 hours Maximum Marks : 60 Note : There will be multiple
More informationFibrinogen Plasma Level, Platelet Count and Mean Platelet Volume of Sudanese Diabetic Patients with Retinopathy
Clinical Medicine Journal Vol. 1, No. 5, 2015, pp. 157-161 http://www.aiscience.org/journal/cmj ISSN: 2381-7631 (Print); ISSN: 2381-764X (Online) Fibrinogen Plasma Level, Platelet Count and Mean Platelet
More informationMetabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine
Metabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine Setting the scene GB, 43 yo AA man followed for hypothyroidism returns on LT4 125 mcg/d and has a TSH=1.1
More informationDiabetes and Concomitant Cardiovascular Disease: Guideline Recommendations and Future Directions
Diabetes and Concomitant Cardiovascular Disease: Guideline Recommendations and Future Directions Diabetes is one of the largest global health emergencies of 21 st century, with the number of people with
More informationΦΛΕΓΜΟΝΗ ΚΑΙ ΔΙΑΒΗΤΗΣ
ΦΛΕΓΜΟΝΗ ΚΑΙ ΔΙΑΒΗΤΗΣ ΘΩΜΑΣ ΠΑΠΑΔΟΠΟΥΛΟΣ, MD, PHD ΕΠΕΜΒΑΤΙΚΟΣ ΚΑΡΔΙΟΛΟΓΟΣ ΙΑΤΡΙΚΟ ΔΙΑΒΑΛΚΑΝΙΚΟ ΚΕΝΤΡΟ Inflammation as a cause of disease has entered the popular imagination. Diet ( macronutrients )
More informationIschemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010
Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories
More informationA Study to Show Postprandial Hypertriglyceridemia as a Risk Factor for Macrovascular Complications in Type 2 Diabetis Mellitus
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2018/21 A Study to Show Postprandial Hypertriglyceridemia as a Risk Factor for Macrovascular Complications in Bingi Srinivas
More informationMechanisms of Vascular Dysfunction in Diabetes Mellitus Lynette Pittman, RN, Nurse Clinician, Heart Health Services, Calgary Health Region
Mechanisms of Vascular Dysfunction in Diabetes Mellitus Lynette Pittman, RN, Nurse Clinician, Heart Health Services, Calgary Health Region By 2020 cardiovascular disease (CVD) will dominate all other causes
More informationATEF ELBAHRY,FACA,FICA,MISCP,FVBWG.
Hyperglycemia and Coronary Events: where is the link? ATEF ELBAHRY,FACA,FICA,MISCP,FVBWG. Cardiovascular (CV) disease is the primary complication of diabetes ~65% of deaths are due to CV disease Coronary
More informationPlasma fibrinogen level, BMI and lipid profile in type 2 diabetes mellitus with hypertension
World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original
More informationDiabetes Mellitus and Dementia. Andrea Shelton & Adena Zadourian
Diabetes Mellitus and Dementia Andrea Shelton & Adena Zadourian Abstract Diabetes mellitus increases the risk for developing dementia...but there is inconsistency with the subtypes of dementia Diabetes
More informationFACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS
New Horizons In Atherothrombosis Treatment 2012 순환기춘계학술대회 FACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS Division of Cardiology, Jeonbuk National University Medical School Jei Keon Chae,
More informationPathophysiology of Lipid Disorders
Pathophysiology of Lipid Disorders Henry Ginsberg, M.D. Division of Preventive Medicine and Nutrition CHD in the United States CHD is the single largest killer of men and women 12 million have history
More informationPart IV Antithrombotics, Anticoagulants and Fibrinolytics
Part IV Antithrombotics, Anticoagulants and Fibrinolytics "The meaning of good and bad, of better and worse, is simply helping or hurting" Emerson Chapter 16: Blood Coagulation and Fibrinolytic System
More informationHEME 10 Bleeding Disorders
HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional
More informationEndothelial dysfunction and subclinical atherosclerosis in HIV/HCV- coinfected patients in the Lower Silesia Region, Poland
Endothelial dysfunction and subclinical atherosclerosis in HIV/HCV- coinfected patients in the Lower Silesia Region, Poland Katarzyna Barska 1,2, Wiesława Kwiatkowska 1,2, Brygida Knysz 1,3, Justyna Drelichowska
More informationFOCUS ON CARDIOVASCULAR DISEASE
The Consequences of Vitamin D Deficiency: FOCUS ON CARDIOVASCULAR DISEASE Vitamin D deficiency is a global health problem. With all the medical advances of the century, vitamin D deficiency is still epidemic.
More informationBacillopeptidase F Proprietary Blend (BFPB) A Natural Enzyme Extracted by a Patented Fermentation Production Process to Support Healthy Circulation
Bacillopeptidase F Proprietary Blend (BFPB) A Natural Enzyme Extracted by a Patented Fermentation Production Process to Support Healthy Circulation What is Plasmanex1? Plasmanex1 is a dietary supplement
More informationCardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
More informationRole of apolipoprotein B-containing lipoproteins in the development of atherosclerosis Jan Borén MD, PhD
Role of apolipoprotein B-containing lipoproteins in the development of atherosclerosis Jan Borén MD, PhD Our laboratory focuses on the role of apolipoprotein (apo) B- containing lipoproteins in normal
More informationArteriosclerosis & Atherosclerosis
Arteriosclerosis & Atherosclerosis Arteriosclerosis = hardening of arteries = arterial wall thickening + loss of elasticity 3 types: -Arteriolosclerosis -Monckeberg medial sclerosis -Atherosclerosis Arteriosclerosis,
More informationCardiovascular Complications of Diabetes
VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary
More informationNovel Markers of Arterial Dysfunction
혈관연구회창립심포지움, 3 월 3 일, 2005 Novel Markers of Arterial Dysfunction Kwang Kon Koh, MD, FACC, FAHA Cardiology Gachon Medical School Incheon, Korea Atherosclerosis: A progressive process PHASE I: Initiation
More informationCardiovascular Complications Of Chronic Kidney Disease. Dr Atir Khan Consultant Physician Diabetes & Endocrinology West Wales Hospital, Carmarthen
Cardiovascular Complications Of Chronic Kidney Disease Dr Atir Khan Consultant Physician Diabetes & Endocrinology West Wales Hospital, Carmarthen Markers of kidney dysfunction Raised Albumin / Creatinine
More informationVENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?
VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital
More informationComplications of Diabetes mellitus. Dr Bill Young 16 March 2015
Complications of Diabetes mellitus Dr Bill Young 16 March 2015 Complications of diabetes Multi-organ involvement 2 The extent of diabetes complications At diagnosis as many as 50% of patients may have
More informationfactor for recurrent myocardial infarction and death
Br Heart J 1991;66:351-5 Internal Medicine, SkellefteA Hospital, Sweden J-H Jansson Clinical Chemistry, UmeA University Hospital, Sweden T K Nilsson Internal Medicine, UmeA University Hospital, Sweden
More informationComparison of Mean Platelet Volume in Acute Myocardial Infarction vs. Normal Coronary Angiography
Global Journal of Health Science; Vol. 8, No. 11; 2016 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education Comparison of Mean Platelet Volume in Acute Myocardial Infarction
More informationDecreased Inflammatory Markers in Diabetic Patients with Angiographically Proved Coronary Artery Disease after 18 Months of Statins Therapy
Decreased Inflammatory Markers in Diabetic Patients with Angiographically Proved Coronary Artery Disease after 18 Months of Statins Therapy DANIEL LIGHEZAN, ROXANA BUZAS, CORINA SERBAN, IOANA SUCEAVA University
More informationApproach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate
Approach to bleeding disorders &treatment by RAJESH.N General medicine post graduate 2 Approach to a patient of bleeding diathesis 1. Clinical evaluation: History, Clinical features 2. Laboratory approach:
More informationDepression, omega 3 fatty acid therapy 13
Subject Index Adhesion molecules fish oil effects 12, 13 omega 3 fatty acid desaturase transfection effects on expression in endothelial cells 31 Alzheimer s disease (AD), omega 6 fatty acid/omega 3 fatty
More informationThe Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk
Update 2013 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine Denver Health
More informationMetabolic Syndrome. DOPE amines COGS 163
Metabolic Syndrome DOPE amines COGS 163 Overview - M etabolic Syndrome - General definition and criteria - Importance of diagnosis - Glucose Homeostasis - Type 2 Diabetes Mellitus - Insulin Resistance
More informationDiabetes-induced cardiovascular disease. A literature study on the emergence of cardiovascular disease in diabetes mellitus type II patients.
Diabetes-induced cardiovascular disease A literature study on the emergence of cardiovascular disease in diabetes mellitus type II patients. AUGUST 2011 Pjotr Postma 1 Title: Name: Diabetes-induced cardiovascular
More information2 : 11. Sidharth Das, Cuttack. Introduction: reference to Indians:
2 : 11 Role of Glucotoxicity in the Pathogenesis of Complications in Diabetes Mellitus Introduction: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
More informationDiabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology
Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the
More informationCardiovascular Disease
Cardiovascular Disease Chapter 15 Introduction Cardiovascular disease (CVD) is the leading cause of death in the U.S. One American dies from CVD every 33 seconds Nearly half of all Americans will die from
More informationOUR MISSION: DELIVERING THE PROOF OF THE
OUR MISSION: DELIVERING THE PROOF OF THE HEALTH EFFECTS REVIEW OF THE LATEST RESEARCH INTO DIETARY RISKS TO CARDIO HEALTH AND THEIR IMPLICATIONS FOR FOOD DEVELOPMENT ERIC CHAPPUIS DIRECTOR, CONSULTING
More informationDiabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center
Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??
More informationBLEEDING DISORDERS Simple complement:
BLEEDING DISORDERS Simple complement: 1. Select the statement that describe the thrombocytopenia definition: A. Marked decrease of the Von Willebrandt factor B. Absence of antihemophilic factor A C. Disorder
More informationDiabetic Dyslipidemia
Diabetic Dyslipidemia Dr R V S N Sarma, M.D., (Internal Medicine), M.Sc., (Canada), Consultant Physician Cardiovascular disease (CVD) is a significant cause of illness, disability, and death among individuals
More informationCardiovascular disease, studies at the cellular and molecular level. Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009
Cardiovascular disease, studies at the cellular and molecular level Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009 Content Introduction The number 1 killer in America Some statistics
More informationCRP and fibrinogen imply clinical outcome of patients with type-2 diabetes. and coronary artery disease
CRP and fibrinogen imply clinical outcome of patients with type-2 diabetes and coronary artery disease Marijan Bosevski 1, *, Golubinka Bosevska 1, Lily Stojanovska 2, Vasso Apostolopoulos 2, * 1 University
More informationPrevalence of Type 2 diabetes in patients admitted with acute coronary syndrome: The role of easily reproducible noninvasive
Prevalence of Type 2 diabetes in patients admitted with acute coronary syndrome: The role of easily reproducible noninvasive screening methods A thesis submitted to the Birmingham University for the degree
More informationOral Anticoagulant Drugs
Oral Anticoagulant Drugs Spoiled sweet clover caused hemorrhage in cattle(1930s). Substance identified as bishydroxycoumarin. Initially used as rodenticides, still very effective, more than strychnine.
More informationDiabetes and Heart Failure
Diabetes and Heart Failure A common and fatal combination A Aspects on epidemiology, prognosis diagnosis and therapy Lars Rydén Department of Medicine Karolinska Institutet Stockholm, Sweden Diabetes and
More informationPATHOPHYSIOLOGY OF ACUTE CORONARY SYNDROMES
PATHOPHYSIOLOGY OF ACUTE CORONARY SYNDROMES Brian R. Holroyd, MD, FACEP, FRCPC Professor and Director, Division of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
More informationTHE CARDIOVASCULAR INFLAMMATORY CONTINUUM DR AB MAHARAJ
THE CARDIOVASCULAR INFLAMMATORY CONTINUUM DR AB MAHARAJ Disclosures: On National Advisory Boards of: (1) Pfizer Pharmaceuticals (2) MSD (3) Roche Pharmaceuticals (4) Abbott International: AfME Rheumatology
More informationWhat are blood clots?
What are blood clots? Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service GP Partner Westcliffe Medical Group Created 5/31/18 Dr. Matthew
More informationCho et al., 2009 Journal of Cardiology (2009), 54:
Endothelial Dysfunction, Increased Carotid Artery Intima-media Thickness and Pulse Wave Velocity, and Increased Level of Inflammatory Markers are Associated with Variant Angina Cho et al., 2009 Journal
More informationMULTIFACTORIAL ANALYSIS OF CARDIOVASCULAR RISK FACTORS IN A GROUP OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 21(4):327-333 doi: 10.2478/rjdnmd-2014-0040 MULTIFACTORIAL ANALYSIS OF CARDIOVASCULAR RISK FACTORS
More informationSubclinical inflammation and peripheral artery disease. Luigi M Biasucci, M.D. Institute of Cardiology Catholic University Rome, ITALY
Subclinical inflammation and peripheral artery disease Luigi M Biasucci, M.D. Institute of Cardiology Catholic University Rome, ITALY ESC Congress 2010 Conflict of interest Research grants:sanofi-aventis,
More informationPHASES OF HAEMOSTASIS
HAEMOSTASIS Maintains the integrity of a closed, highpressure circulatory system after vascular damage Vessel Wall Injury events in the vessel wall and in the blood which seal breach Delicate balance exists
More informationThe interaction between CD40 and CD40 ligand (CD40L,
Soluble CD40 Ligand, Soluble P-Selectin, Interleukin-6, and Tissue Factor in Diabetes Mellitus Relationships to Cardiovascular Disease and Risk Factor Intervention Hoong Sern Lim, MRCP; Andrew D. Blann,
More informationDisseminated Intravascular Coagulation. M.Bahmanpour MD Assistant professor IUMS
به نام خدا Disseminated Intravascular Coagulation M.Bahmanpour MD Assistant professor IUMS Algorithm for Diagnosis of DIC DIC Score factor score Presence of known underlying disorder No= 0 yes=2 Coagolation
More informationEDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION
EDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationhttp://noodlemaz.wordpress.com/category/science/cancer/ Outline Introduction Serious nature of Cardiovascular Disease (CVD) How to prevent CVD? The disease process Damage and plaque development Current
More informationEugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG
Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System
More informationIndex. Note: Page numbers of article titles are in boldface type.
Heart Failure Clin 2 (2006) 101 105 Index Note: Page numbers of article titles are in boldface type. A ACE inhibitors, in diabetic hypertension, 30 31 Adipokines, cardiovascular events related to, 6 Advanced
More informationGenomic Particularities of the Thrombophilic Status in Type 2 Diabetic Patients
Genomic Particularities of the Thrombophilic Status in Type 2 Diabetic Patients Received for publication, March, 23, 2016 Accepted, June, 23, 2016 IRIS BARARU¹, MARIA CRISTINA VLĂDEANU (APĂVĂLOAIE)¹*,
More informationHemostasis and Thrombosis
Hemostasis Hemostasis and Thrombosis Normal hemostasis is a consequence of tightly regulated processes that maintain blood in a fluid state in normal vessels, yet also permit the rapid formation of a hemostatic
More informationAntiplatelet agents treatment
Session III Comprehensive management of diabetic patients Antiplatelet agents treatment Chonnam National University Hospital Department of Internal Medicine Dong-Hyeok Cho CONTENTS Introduction Prothrombotic
More informationCoagulation activation and cerebral vasculopathy in Sickle Cell Disease
Coagulation activation and cerebral vasculopathy in Sickle Cell Disease Dr.Raffaella Colombatti Clinic of Pediatric Hematology Oncology Department of Child and Maternal Health Azienda Ospedaliera-Univerisità
More information4/14/2018 DYSLIPIDEMIA CASES. Mary Malloy, MD. I have nothing to disclose
DYSLIPIDEMIA CASES Mary Malloy, MD I have nothing to disclose 1 Case 1 A 24 year old healthy, slender woman is referred because she has a family history of premature CAD (mother, age 59, had onset of angina
More informationBerries and Cardiovascular Health
Berries and Cardiovascular Health Britt Burton-Freeman, PhD Institute for Food Safety and Health Illinois Institute of Technology bburton@iit.edu Berry Health Benefits Symposium Westlake Village CA, 2011
More informationTHE EFFECT OF VITAMIN-C THERAPY ON HYPERGLYCEMIA, HYPERLIPIDEMIA AND NON HIGH DENSITY LIPOPROTEIN LEVEL IN TYPE 2 DIABETES
Int. J. LifeSc. Bt & Pharm. Res. 2013 Varikasuvu Seshadri Reddy et al., 2013 Review Article ISSN 2250-3137 www.ijlbpr.com Vol. 2, No. 1, January 2013 2013 IJLBPR. All Rights Reserved THE EFFECT OF VITAMIN-C
More informationHEART HEALTH WEEK 2 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease ATHEROSCLEROSIS. Fatty deposits can narrow and harden the artery
WEEK 2 SUPPLEMENT HEART HEALTH A Beginner s Guide to Cardiovascular Disease ATHEROSCLEROSIS FIGURE 1 Atherosclerosis is an inflammatory process where cholesterol is deposited in the wall of arteries and
More information3/20/2011. Body Mass Index (kg/[m 2 ]) Age at Issue (*BMI > 30, or ~ 30 lbs overweight for 5 4 woman) Mokdad A.H.
U.S. Adults: 1988 Nineteen states with 10-14% 14% Prevalence of Obesity (*BMI > 30, or ~ 30 lbs overweight for 5 4 woman) Metabolic John P. Cello, MD Professor of Medicine and Surgery, University of California,
More informationFrequency of Dyslipidemia and IHD in IGT Patients
Frequency of Dyslipidemia and IHD in IGT Patients *Islam MS, 1 Hossain MZ, 2 Talukder SK, 3 Elahi MM, 4 Mondal RN 5 Impaired glucose tolerance (IGT) is often associated with macrovascular complications.
More informationEicosapentaenoic Acid and Docosahexaenoic Acid: Are They Different?
Eicosapentaenoic Acid and Docosahexaenoic Acid: Are They Different? Trevor A Mori, Ph.D., Professor, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth,
More informationSupplementary table to Bennett et al. Peripheral arterial disease and Virchow s triad (Thromb Haemost 2009; 101.6)
Supplementary table to ennett et al. Peripheral arterial disease and Virchow s triad (Thromb Haemost 2009; 101.6) Supplementary Table 1: Examples of Recent studies reporting positive associations between
More informationAn amino acid for a healthy heart
AOR CODE: AOR04054 Premium Arginine An amino acid for a healthy heart A natural nitric oxide precursor Protects the heart from high blood sugar levels Helps in cellular energy production Gluten Free Vegan
More informationWelcome and Introduction
Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for
More informationThe Impact of Smoking on Acute Ischemic Stroke
Smoking The Impact of Smoking on Acute Ischemic Stroke Wei-Chieh Weng, M.D. Department of Neurology, Chang-Gung Memorial Hospital, Kee-Lung, Taiwan Smoking related mortality Atherosclerotic vascular disease
More informationDiabetes and the Heart
Diabetes and the Heart Association of Specialty Professors April 4, 2013 Jorge Plutzky, MD Co-Director, Preventive Cardiology Director, The Lipid Clinic Cardiovascular Division Brigham and Women s Hospital
More informationMETABOLISM of ADIPOSE TISSUE
METABOLISM of ADIPOSE TISSUE 2. LF UK Prof. Rudolf Poledne, PhD. TYPES OF ADIPOSE TISSUE brown adipose tissue subcutaneous adipose tissue visceral adipose tissue ADIPOSE TISSUE FUNCTIONS: thermal isolation
More informationAnticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT
Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet
More informationVulnerable Plaque. Atherothrombosis
Vulnerable Plaque Nuove acquisizioni sull'aterosclerosi: placca vulnerabile Marina Camera Dip. Scienze Farmacologiche, Facoltà di Farmacia, Università degli Studi di Milano & Laboratorio di Biologia Cellulare
More informationOverview of effects of alcohol intake on cardiovascular disease
Beverage specific effects Overview of effects of alcohol intake on cardiovascular disease Dr. Ramon Estruch Department of Internal Medicine, Barcelona University, Spain. CIBER OBN Institute of Health Carlos
More informationPart 1 Risk Factors and Atherosclerosis. LO1. Define the Different Forms of CVD
Week 3: Cardiovascular Disease Learning Outcomes: 1. Define the difference forms of CVD 2. Describe the various risk factors of CVD 3. Describe atherosclerosis and its stages 4. Describe the role of oxidation,
More informationChild born in year /3 will die before parents in US (diabetes)
Child born in year 2000-1/3 will die before parents in US (diabetes) ATP III identified 6 components of the metabolic syndrome that relate to CVD 1. Abdominal obesity 2. Atherogenic dyslipidemia (elevated
More informationControversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
More informationHSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME
HSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME What does the term Metabolic Syndrome describe? Metabolic syndrome describes a cluster of cardio-metabolic conditions that increase one's risk of developing
More informationAssociation between Plasma Homocysteine Concentrations and Carotid Intima-Media Thickness in Patients with Coronary Artery Disease
Association between Plasma Homocysteine Concentrations and Carotid Intima-Media Thickness in Patients with Coronary Artery Disease ROXANA BUZAŞ, CORINA ŞERBAN, IOANA SUCEAVA, DANIEL LIGHEZAN University
More informationHyperglycemia in ACS. Dr. Imhemed Eljazwi
Hyperglycemia in ACS 2012-5-8 Dr. Imhemed Eljazwi Percentage of Population (n = 1181) Prevalence of Hyperglycemia in 181 Cardiac Patients Without Known Diabetes 100% 75% 50% 66% of AMI patients have
More information