Search

INTRODUCTION    Patients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. OBJECTIVES    The aim of the study was to identify factors related to control of hypercholesterolemia in patients after hospitalization for CAD. PATIENTS AND METHODS    The study included consecutive patients from 5 hospitals with cardiology departments serving one city in southern Poland. Patients were hospitalized for an acute coronary syndrome or for a myocardial revascularization procedure. Interviews and examinations were conducted 6 to 18 months after hospitalization. RESULTS    Overall, 83.6% of the patients were taking statins; 2.1%, fibrates; and 0.5%, ezetimibe. A statin at a high dose (≥40 mg of atorvastatin or ≥20 mg of rosuvastatin) was taken by 36.1% of the participants. Younger age and index hospitalization in a teaching hospital were significantly associated with a higher probability of taking a statin. Overall, 28.1% of the patients had good control of hypercholesterolemia (low-density lipoprotein [LDL] cholesterol levels <1.8 mmol/l), whereas 71.9%, 38.6%, 24.4%, and 10.3% had LDL cholesterol levels of 1.8 mmol/l or higher, 2.5 mmol/l or higher, 3.0 mmol/l or higher, and 4.0 mmol/l or higher, respectively. Younger age, high blood pressure, and high fasting glucose levels were related to a higher probability of having LDL cholesterol levels of 1.8 mmol/l or higher, while younger age, shorter period of education, professional inactivity, lack of cardiac rehabilitation, and high blood pressure were related to the probability of LDL cholesterol levels of 4.0 mmol/l or higher. CONCLUSIONS    The frequency of statin use is affected by age and health care-related factors, while control of hypercholesterolemia after hospitalization due to CAD is dependent mainly on patient-related and clinical factors.

Introduction: Central and peripheral blood pressure (BP) and periodontal disease (PD) are considered to be related to the risk of cardiovascular disease. However, there is scarce evidence on the association between chronic PD and BP., Objectives: The aim of the study was to assess the relation between chronic PD, antibodies against Porphyromonas gingivalis (P.g.) gingipains and central and peripheral BP in high-risk patients with previous myocardial infarction., Patients and Methods: We examined 99 patients (71 men and 28 women) 6 to 18 months after myocardial infarction. The periodontal status was assessed using the Community Periodontal Index (CPI). BP was measured noninvasively using the Mobil-O-Graph device. Antibody titers against P.g. gingipains were determined by an enzyme-linked immunosorbent assay. The association between CPI and BP was assessed using logistic regression models., Results: The mean age of participants was 60.5 ±8.7 years. After the adjustment for age, sex, smoking, diabetes, number of antihypertensive drugs, hypercholesterolemia, body mass index, and left ventricular ejection fraction, an association was found between central and peripheral BP and the CPI. Patients from the CPI 3 + 4 group were found to have almost 3 times higher odds of central BP of 130/90 mmHg or higher and more than 3 times higher odds of peripheral BP of 140/90 mmHg or higher compared with patients from the CPI 1 + 2 group., Conclusions: The severity of PD was associated with increased central and peripheral BP. The association between BP and PD may partially explain the cardiovascular risk related to chronic PD. Proteolytic activity of P.g. gingipains was not associated with BP.

Introduction: Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. Recently, a U-shaped relation between sodium intake and cardiovascular risk has been suggested., Objectives: The aim of the study was to evaluate the relationship between intima-media thickness (IMT) and central and peripheral BP as well as the effect of 24-hour urinary sodium excretion on this relationship., Patients and Methods: The study included 182 subjects (mean age, 37.3 ±14.0 years, 92 men and 90 women) who were members of families randomly selected from one of the gminas (administrative regions) in southern Poland. In all patients, peripheral and central BP (using applanation tonometry), IMT, and 24-hour sodium excretion were measured., Results: Hypertension was observed in 44.5% of the participants. The mean urinary sodium excretion was 243 ±81 mmol/d. IMT was significantly more correlated with central pulse pressure (PP) compared with peripheral PP (r = 0.54 vs r = 0.27; P <0.01). After multivariate adjustments, IMT remained significantly related to central systolic BP and central and peripheral PP. When the study group was divided according to the tertiles of sodium excretion, central PP was related to IMT only in the second and third tertiles. When the study group was divided according to sex and sex-specific median values of sodium excretion, IMT was associated with central PP only in subjects with sodium excretion exceeding the median values (both in men and women)., Conclusions: IMT is more correlated with central than with peripheral BP. The association between IMT and central PP may be modulated by sodium intake. This hypothesis should be tested in larger studies.

Introduction:  Patients with resistant hypertension (RHT) are at high risk for coronary artery disease (CAD) and cerebrovascular disease (CVD), compared with the general hypertensive population., Objectives:  The aim of the study was to evaluate factors associated with RHT in a large sample of hypertensive patients under the care of general practitioners and specialists in Poland., Patients and Methods:  We included 12 375 patients (mean age, 64.0 ±12.3 years; age range, 18-98 years; women, 59%) with hypertension treated for at least 1 year. Patients were divided into 3 groups: with controlled hypertension, uncontrolled hypertension (not fulfilling the criteria for RHT), and RHT., Results:  Controlled hypertension, uncontrolled hypertension, and RHT were found in 47.3%, 27.9%, and 24.7% of the patients, respectively. The RHT rate was higher in patients visiting specialist offices (29.8%) and in patients with diabetes (32.5%), CAD (31.5%), CVD (33.3%), and impaired renal function (31.9%). Patients with RHT were characterized by the highest rate of high (23.5%) and very high (60.5%) added cardiovascular risk. An underuse of preferred antihypertensive drug combinations and aldosterone antagonists in patients with uncontrolled hypertension and RHT was observed. In a multivariate analysis, RHT was independently associated with male sex, higher pulse pressure, metabolic syndrome, diabetes, CAD, CVD, diseases requiring treatment with nonsteroidal anti-inflammatory drugs and an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2., Conclusions:  The vast majority of patients with RHT carry a high or very high cardiovascular risk. In addition, the underuse of preferred antihypertensive drug combinations and aldosterone antagonists has been observed.

Obesity is a significant public health problem, associated with several comorbidities and complications. At the same time, the results of studies suggest that the relationship between obesity and survival in subjects diagnosed with cardiovascular disease is a U-shaped curve with a significantly worse prognosis among underweight and morbidly obese individuals. The association between overweight or grade I obesity and cardiovascular mortality is not clear, and numerous studies have shown an unexpected and paradoxical inverse relationship with better prognosis in this patient group, the so-called "obesity paradox". In the current review, we discuss the most important and most reliable studies regarding the prognosis and clinical course in patients with overweight or grade I obesity and essential hypertension, coronary artery disease, or heart failure, focusing on data for and against the obesity paradox.

Introduction: Hypertension and its complications are more common in postmenopausal women than before menopause. However, whether this is due to the effect of age or menopause is still unknown., Objectives: The aim of the study was to assess the effect of menopause on blood pressure (BP), left ventricular and vascular structure and function, as well as kidney function in perimenopausal women., Patients and Methods: The study involved 192 women aged 40 to 60 years (mean age, 51.73 ±1.82 years), including 152 with newly diagnosed essential hypertension and 40 normotensive controls matched for age. In all subjects, 24-hour BP monitoring was performed. Echocardiographic examination with the assessment of left ventricular mass (LVM) and systolic and diastolic function,as well as carotid ultrasound with the measurement of intima-media thickness (IMT) in the common carotid artery were performed. Carotid-femoral pulse wave velocity (PWV) was measured. Glomerular filtration rate (eGFR) was calculated and urinary albumin-creatinine ratio (UACR) was measured., Results: The study group was divided according to hypertension and menopausal status into 4 subgroups: normotensive premenopausal, normotensive postmenopausal, hypertensive premenopausal, and hypertensive postmenopausal women. Menopause did not affect BP or LVM. Differences in LVM between pre- and postmenopausal women were dependent on age and the body mass index. Hypertensive postmenopausal compared with hypertensive premenopausal women had significantly higher IMT (0.72 ±0.34 mm vs. 0.59 ±0.30 mm, P = 0.001) and a lower ratio of early to late mitral inflow velocity (E/A, 1.04 ±0.32 vs. 1.32 ±0.33, P = 0.01). PWV was higher in hypertensives compared to controls (9.7 ±1.6 m/s vs. 8.4 ±1.2 m/s, P = 0.001), without differences between premenopausal and postmenopausal women. Menopause did not affect eGFR and UACR either in the hypertensive or normotensive group., Conclusions: Left ventricular diastolic function and carotid IMT are independently associated with menopausal status in both normo- and hypertensive women. Menopause per se did not affect BP in the examined group.