No pós-transplante hepático (pós-TxHep), complicações da doença cardiovascular (CV) têm sido cada vez mais prevalentes e aparecem entre as principais causas de morte nessa população. Sabe-se que alterações metabólicas e nutricionais podem estar associadas ao aumento de risco CV. Assim, o objetivo deste trabalho foi avaliar o risco CV e suas associações com o estado nutricional, ingestão alimentar e o perfil metabólico em pacientes pós-TxHep. Este estudo transversal incluiu pacientes adultos pós-TxHep. Pacientes transplantados há menos de 1 ano e com histórico de insuficiência hepática fulminante, perda de enxerto hepático ou insuficiência renal crônica pós-TxHep não foram incluídos. Os pacientes passaram por avaliação clínica, nutricional e laboratorial. A avaliação nutricional compreendeu a ingestão alimentar, através de Registro Alimentar de três dias, antropometria e dinamometria. A medida da espessura da camada íntima-média carotídea (EIMC) foi avaliada por ultrassonografia Doppler e considerada alterada quando maior que 1 milímetro. Foram avaliados 69 pacientes transplantados há 2,8 (1,4 - 6,3) anos, sendo a maioria do sexo masculino (61%). Encontrou-se alta prevalência de desnutrição e sarcopenia, apresentada por 45% dos pacientes com área muscular do braço abaixo do percentil 15, e 71% com força do aperto de mão abaixo do percentil 30. Em contraste, 72% dos pacientes estavam com excesso de peso e 35% apresentaram Índice de Massa Corporal (IMC) maior que 30 kg/m2. Pacientes com EIMC alterada (54%) apresentaram maior LDL colesterol (P = 0,01), maior proporção de proteína-C reativa ultrassensível (PCR-us) maior que 1mg/L (P = 0.02) e maior ingestão de ácidos graxos saturados e trans (P = 0.01). Em conclusão, este estudo mostrou alta prevalência de EIMC alterada em uma amostra de pacientes pós-TxHep com sobrepeso e sarcopenia, associada a níveis mais elevados de LDL colesterol, PCR-us maior que 1mg/L e maior ingestão de ácidos graxos saturados e trans. Este estudo reforça que é necessário fornecer medidas preventivas, incluindo a melhoria da qualidade dietética, para todos os pacientes pós-transplante hepático, a fim de minimizar o risco CV. / In post-liver transplantation (post-LT), complications of cardiovascular (CV) disease have been increasingly prevalent and have become one of the main causes of death in this population. It is known that metabolic and nutritional imbalance may be associated with increased CV risk. Thus, the aim of this study was to evaluate CV risk and its associations with nutritional status, food intake and metabolic profile in post-LT patients. This cross-sectional study included adult post-LT patients, who underwent clinical, nutritional and laboratory evaluation. Patients who have undergone LT for less than 1 year, and with history of fulminant hepatic failure, loss of liver graft or chronic renal failure after LT were not included. The nutritional evaluation included food intake, through a three-day Food Record, anthropometry and dynamometry. The carotid intima-media thickness (CIMT) was assessed by Doppler ultrasonography and considered abnormal when greater than 1 millimeter. A total of 69 patients transplanted 2.8 (1.4 - 6.3) years ago were evaluated, being the majority male (61%). There was a high prevalence of malnutrition and sarcopenia, presented by 45% of patients with arm muscle area below the 15th percentile, and 71% with handgrip strength below the 30th percentile. In contrast, 72% of the patients were overweight and 35% had Body Mass Index greater than 30 kg/m2. Patients with altered CIMT (54%) had higher LDL cholesterol (P = 0.01), higher proportion of high-sensitive C-reactive protein (hs-CRP) greater than 1mg/L (P = 0.02) and higher intake of saturated and trans fatty acids (P = 0.01). In conclusion, this study showed a high prevalence of abnormal CIMT in a sample of post-LT patients with overweight and sarcopenia, associated with higher levels of LDL cholesterol, hs-CRP greater than 1mg/L, and higher intake of saturated and trans fatty acids. This study reinforces that it is necessary to provide preventive measures, including improvement of dietary quality, for all patients after liver transplantation, in order to minimize CV risk.

INTRODUÇÃO: A aterosclerose nas artérias carótidas pode determinar um prognóstico ruim em indivíduos após a ocorrência da síndrome coronariana aguda (SCA). Assim, buscamos avaliar a mortalidade associada à espessura médio-intimal carotídea (EMIC) nos participantes do estudo da Estratégia de Registro de síndrome coronariana aguda (ERICO). MÉTODOS: A EMIC foi avaliada por ultrassonografia modo B para avaliação do risco de mortalidade em 180 dias, 1, 2 e 3 anos. Realizamos as curvas de sobrevivência de Kaplan-Meier e os modelos de regressão logística de Cox para avaliar a mortalidade de todas as causas, doença cardiovascular (DCV) e doença arterial coronariana (DAC) por tercis da EMIC em modelos brutos, ajustados por idade e sexo e ajustes multivariados. RESULTADOS: Entre 644 indivíduos com SCA (idade média de 61 anos), observamos uma EMIC mediana de 0,74 mm (0,40-1,90). Além do envelhecimento, menor escolaridade, hipertensão, diabetes e dislipidemia foram associadas aos maiores valores de EMIC (3º tercil: 0,81-1,90 mm). Durante 3 anos de acompanhamento, observamos 65 mortes (10,1%), as taxas brutas de mortalidade por casos foram progressivamente maiores nos tercis EMIC em todos os períodos, sendo as taxas mais altas observadas em participantes com maior EMIC (3º tercil) (180 dias: 6,6% vs. 1 ano: 9,0% vs. 2 anos: 12,3% vs. 3 anos: 16,0%, P < 0,05). Nas análises brutas, as taxas de sobrevivência mais baixas (todas as causas, DCV e DAC, p log-rank valores < 0,005) e maiores razões de risco de morte para todas as causas e DCV (de 1 a 3 anos) e para DAC (2 e 3 anos) foram observados. No entanto, não mantivemos resultados significativos após ajuste para a idade. CONCLUSÃO: A EMIC foi influenciada principalmente pelo envelhecimento. A EMIC não foi um bom preditor de mortalidade por todas as causas, DCV ou DAC no estudo ERICO / BACKGROUND: Atherosclerotic in carotids can determinate a poor prognosis in individuals after acute coronary syndrome (ACS). Thus, we aimed to evaluate mortality associated to carotid intima media thickness (CIMT) in the participants from in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. METHODS: CIMT was evaluated by B-mode ultrasound for mortality risk assessment in 180 days, 1-3 years. We performed Kaplan-Meier survival curves and Cox logistic regression models to evaluate all-cause, cardiovascular (CVD) and coronary heart disease (CHD) mortality by CIMT tertiles in crude, age and sex- and multivariate models. RESULTS: Among 644 ACS individuals (median age 61y-old), we observed a median CIMT of 0.74 mm (0.40-1.90). Besides ageing, low education, hypertension, diabetes and dyslipidemia were associated with the highest values of CIMT (3rd tertile: 0.81-1.90 mm). During 3 years of follow-up, we observed 65 deaths (10.1 %), crude case-fatality rates were progressively higher across the CIMT tertiles in all periods, being the highest rates observed in participants with the highest CIMT (3rd tertile) (180-d: 6.6% vs. 1-y: 9.0% vs. 2-y:12.3% vs. 3-y:16.0%, P < 0.05). In crude analyses, lowest survival rates (all- cause, CVD and CHD, p log-rank values < 0.005) and higher hazard ratios of dying for all-cause and CVD (from 1 to 3 years) and for CHD (2 and 3 years) were observed. However, we kept no significant results after adjusting for age. CONCLUSION: CIMT was mainly influenced by ageing. CIMT was not a good predictor of all-cause, CVD or CHD mortality in the ERICO study

INTRODUÇÃO: A Doença Arterial Periférica dos membros inferiores (DAP) é um acometimento relacionado à obstrução arterial desses membros, causada pela doença aterosclerótica, uma doença sistêmica. Por essa razão, a DAP costuma associar-se ao aumento da espessura íntima-média (EIM) carotídea e ao prejuízo cognitivo. No entanto, não se sabe qual o papel da EIM no prejuízo cognitivo observado na DAP. OBJETIVOS: Avaliar as funções cognitivas de pacientes com DAP, associá-las ao grau de prejuízo da circulação periférica e avaliar o papel da EIM nessa associação. CASUÍSTICA E MÉTODO: Foram selecionados 26 pacientes com DAP (68,57+8,34 anos; 65,4% do sexo masculino) e 40 indivíduos-controle (67,17+8,24 anos; 62,5% do sexo masculino). Todos participantes foram submetidos a uma avaliação sócio-demográfica, que coletou dados de caracterização do indivíduo e antecedentes clínicos; a uma investigação clínica, composta pela avaliação do índice tornozelo-braquial (ITB), pela medida da espessura íntima-média (EIM) carotídea, e pelo teste de caminhada de seis minutos (TC6\'); e a uma avaliação neuropsicológica, que consistiu nos seguintes instrumentos: Vocabulário (WAIS-III), Cubos (WAIS-III), Dígitos (WAIS-III), Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT), FAS (COWAT), Animais (COWAT), Teste do Desenho do Relógio e Mini-Mental State Examination (MMSE). RESULTADOS: O grupo DAP apresentou pior desempenho na memória verbal tardia, na amplitude da atenção, na memória operacional, na atenção, no grau de abstração, na flexibilidade mental, na velocidade de processamento da informação, no controle inibitório/impulsividade, no vocabulário, na fluência verbal fonêmica, na fluência verbal semântica, na praxia construtiva e na função cognitiva global em relação ao grupo controle. Após ajuste para escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos, o desempenho do grupo DAP se manteve pior na flexibilidade mental e na fluência verbal fonêmica. O grau de prejuízo da circulação periférica, avaliado pelo ITB, apresentou associação com a memória visual tardia, com a memória operacional, com a atenção, com o grau de abstração, com a velocidade de processamento da informação, com o controle inibitório/impulsividade, com o vocabulário, com a fluência verbal fonêmica e com a função cognitiva global. Após ajuste para escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos, o ITB manteve associação com a fluência verbal fonêmica. Após ajuste para EIM, o ITB manteve associação com o vocabulário. CONCLUSÃO: O grupo de pacientes com DAP apresentou desempenho cognitivo prejudicado, quando comparado ao grupo controle, independente de escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos. O grau de prejuízo da circulação periférica associou-se ao desempenho cognitivo, mas a EIM carotídea pareceu exercer um papel importante nessa associação / BACKGROUND: Peripheral arterial disease of the lower limbs (PAD) is related to arterial obstruction of these limbs, caused by atherosclerosis, a systemic disease. Therefore, PAD is usually associated with increased carotid intima-media thickness (IMT) and cognitive impairment. However, the role of IMT in cognitive impairment observed in PAD is unknown. OBJECTIVES: To evaluate the cognitive functions of patients with PAD, to associate them with the degree of impairment of peripheral circulation and to evaluate the role of IMT in this association. METHODS: 26 patients with PAD (68.57+8.34 years, 65.4% male) and 40 control subjects (67.17+8.24 years, 62.5 % male) were selected. All participants underwent a socio-demographic assessment, which collected data on individual\'s characteristics and medical history; a clinical investigation, consisting of the evaluation of the ankle-brachial index (ABI), the measurement of carotid intima-media thickness (IMT) and the six-minute walk test (6MWT); and a neuropsychological evaluation, which consisted of the following instruments: Vocabulary (WAIS - III), Block Design (WAIS - III), Digit Span (WAIS - III), Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT) , FAS (COWAT) Animals (COWAT) , Clock Drawing Test and Mini - Mental State Examination (MMSE). RESULTS: The PAD group scored worse on delayed verbal memory, attention span, working memory, attention, degree of abstraction, mental flexibility, information processing speed, inhibitory control/impulsivity, vocabulary, phonemic verbal fluency, semantic verbal fluency, constructive praxis and global cognitive function compared to the control group. After adjustment for education, socioeconomic status, IQ and psychiatric symptoms, the performance of the PAD group remained worse in mental flexibility and phonemic verbal fluency. The degree of impairment of peripheral circulation, assessed by ABI, was associated with delayed visual memory, with working memory, with attention, with degree of abstraction, with information processing speed, with the inhibitory control/impulsivity, with vocabulary, with phonemic verbal fluency, and with global cognitive function. After adjustment for education, socioeconomic status, IQ and psychiatric symptoms, ABI remained associated with phonemic verbal fluency. After adjustment for IMT, ABI remained associated with the vocabulary. CONCLUSION: The group of patients with PAD showed impaired cognitive performance, when compared to the control group, regardless of education, socioeconomic status, IQ and psychiatric symptoms. The degree of impairment of peripheral circulation was associated with cognitive performance, but carotid IMT appeared to play an important role in this association

Introduction: Prostate cancer is the most common malignancy in Brazilian males and androgen deprivation therapy (ADT) is generally employed in its treatment. However, ADT is associated with negative outcomes, like increased incidence of obesity, insulin resistance, diabetes, dyslipidemia and cardiovascular diseases. Many of these side effects are closely related to atherosclerosis. Carotid intima-media thickness (CIMT) is an important biomarker of atherosclerosis, and is employed as risk predictor for cardiovascular and cerebrovascular disease. Objectives: The study aimed to analyze the carotid intima-media thickness in patients with prostate cancer, inspect for the presence of plaque in their carotid arteries, and investigate the relationship between carotid plaques with ADT duration and cardiovascular risk factors. Methods: A cross-sectional study of 65 men diagnosed with prostate cancer undergoing ADT for, at least three months, was conducted from July to November 2013. Patients were matched for age, comorbidities, treatment type, duration and stage of the neoplasm. The presence of plaque was defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding intima-media thickness value or demonstrates a thickness >1.5. Results: Seventy participants were enrolled, but five were excluded due to incomplete data collection. The mean age (±SD) was 73.9 (±9.4) years, 34% were receiving maximum androgen blockade (peripheral and central associated) and patients were under ADT for 34.8 (±31.5) months. The LDL-c, HDL-c and triglycerides had values outside the normal range in 26%, 65% and 48% patients, respectively. Thirty-nine (60%) patients had carotid plaques. The average thickness of the carotid intima-media in patients without plaques was 1.24 (±0.18) mm. Statistically significant relationship between the intima-media thickness and age, diastolic blood pressure and body mass index (BMI) was found (p = 0.002; p = 0.015 and p = 0.007, respectively). About the laboratory tests, statistical significance was found between atherosclerosis in this population and SHBG (sex hormone-binding globulin) and quantitative CRP (C-reactive protein), p = 0.033 and p = 0.011, respectively. Patients under maximum androgen blockade had significantly higher risk for the presence of carotid plaques in comparison to patients under exclusive central androgen blockage (p = 0.01). Conclusion: Among the 65 men tested, the average thickness of the carotid intima-media was 1.24 mm. Carotid-artery plaque was present in 60% of the individuals, although no statistical significance was found between the presence of carotid plaques and duration of androgen treatment. On the other hand, a significant relationship between CIMT and age, BMI, diastolic blood pressure, maximum androgen blockade, SHBG and CRP was observed, that should be considered for risk-benefit discussion related to ADT and future studies. / Introdução: O câncer de próstata é a neoplasia maligna mais comum no homem brasileiro e o tratamento antiandrogênico (TAA) é frequentemente utilizado. No entanto, seu uso está relacionado a uma série de efeitos adversos, como obesidade, resistência à insulina, diabetes mellitus, dislipidemia e doenças cardiovasculares. Muitos desses efeitos colaterais guardam relação bem estabelecida com o processo de aterosclerose. A espessura íntima-média carotídea (EIMC) é um importante marcador diagnóstico de aterosclerose subclínica e é utilizada como preditor de risco para doença cardiovascular (DCV) e cerebrovascular. Objetivos: Analisar a EIMC em pacientes portadores de câncer de próstata, verificar a presença de placas nas artérias carótidas, relacionar a presença de placas carotídeas à duração do TAA e aos fatores de risco de DCV. Casuística e métodos: Estudo transversal envolvendo 65 homens com diagnóstico de câncer de próstata em TAA há pelo menos três meses, no período de julho a novembro de 2013. Os pacientes foram pareados por idade, comorbidades, tipo de tratamento, duração e estágio da neoplasia. Considerou-se como placa uma alteração focal que se projeta para a luz arterial em pelo menos 0,5 mm ou 50% do valor adjacente da EIMC, ou uma medida da EIMC > 1,5 mm. Resultados: Setenta pacientes foram entrevistados, porém cinco foram excluídos por desistência. A média da idade foi de 73,9 (±9,4) anos, 34% recebiam bloqueio androgênico combinado (castração associada a bloqueio periférico) e os pacientes encontravam-se em média há 34,8 (±31,5) meses sob TAA. O LDL-c, o HDL-c e os triglicerídeos apresentaram valores fora da normalidade em 26%, 65% e 48% dos pacientes, respectivamente. Trinta e nove (60%) pacientes apresentaram placas carotídeas. A espessura média da íntima-média carotídea nos pacientes sem placas foi de 1,24 (±0,18) mm. Foi encontrada significância estatística, quanto à presença de espessamento médio-intimal com relação à idade, à pressão arterial diastólica (PAD) e ao índice de massa corpórea (IMC), com p=0,002; p=0,015 e p=0,007, respectivamente. Quanto aos exames laboratoriais, houve significância estatística entre a presença de aterosclerose e os valores encontrados na análise sérica de SHBG (globulina transportadora de hormônio sexual) e PCR (proteína C reativa) quantitativa, com p=0,033 e p=0,011, respectivamente. Os pacientes em uso de bloqueio hormonal combinado apresentaram significativamente maior risco para placas carotídeas que os pacientes em castração exclusiva (p=0,01). Conclusão: Dentre os 65 homens analisados, a espessura média da íntima-média carotídea foi de 1,24 mm. Foi observada presença de placas nas artérias carótidas de 60% da amostra, porém não foi encontrada significância estatística entre a presença de placas carotídeas e a duração do tratamento antiandrogênico. Por outro lado encontrou-se relação significativa entre EIMC e idade, IMC, PAD, bloqueio androgênico combinado, SHBG e PCR, que devem ser levados em consideração na discussão do risco-benefício do TAA e em futuros estudos.

INTRODUÇÃO: A Hipersensibilidade do seio carotídeo (HSC) é a exacerbação do reflexo normal e foi definida como ocorrência de pausa ventricular 3 segundos ou redução da pressão arterial sistólica (PAS) 50 mmHg em resposta à massagem do seio carotídeo (MSC). Fenômeno relacionado à idade, raramente diagnosticado em pacientes com menos de 50 anos, tem recebido especial atenção como causa de síncope e quedas inexplicadas nos idosos, nas últimas décadas, com relatos de taxas de prevalências superiores a 45%. Entretanto, ainda não estão claras as implicações diagnósticas da HSC na síncope, com resultados controversos na literatura. OBJETIVOS: Determinar a prevalência da HSC em pacientes com sintomas de síncope e pré-síncope e comparar com indivíduos assintomáticos. Correlacionar a resposta à MSC com a rigidez aórtica e os parâmetros anatômicos e funcionais carotídeos. MÉTODOS: Foram avaliados em estudo prospectivo 99 pcts sintomáticos, com síncope ou pré-síncope a esclarecer (idade média de 69 anos, 41,4% homens), e 66 pcts assintomáticos para controle (idade média de 73 anos, 34,8% homens). Excluíram-se pacientes com cardiopatia estrutural ou com contraindicações para MSC. A MSC foi realizada no ponto com maior impulsão carotídea por 5 segundos, com o registro contínuo e não invasivo da pressão arterial (PA) e eletrocardiograma, com o paciente em postura ortostática a 70º. Foram consideradas respostas anormais: cardioinibitória (CI): assistolia 3 segundos e vasodepressora (VD): redução da PAS 50 mmHg. O índice da rigidez arterial foi obtido por meio de medida da velocidade de onda de pulso carotídeo-femoral (VOP). As características anatômicas e funcionais da carótida foram determinadas por medidas de diâmetro, espessura íntima-média carotídea (EIMC) e índice de distensibilidade. RESULTADOS: Não foram constatadas diferenças nas respostas obtidas na MSC entre os grupos, com 67,7% e 60,6% de respostas fisiológicas; 24,2% e 25,8% de respostas CI; 8,1% e 13,6% de respostas VD em grupo sintomáticos e assintomáticos, respectivamente (p=0,466). Não foram observadas correlações entre a resposta à MSC, tanto com a VOP como com a EMIC, a distensibilidade e o diâmetro carotídeo. CONCLUSÕES: 1- A prevalência de HSC e resposta hemodinâmica à MSC em pacientes com sintomas de síncope e pré-síncope foram semelhantes a pacientes assintomáticos provenientes da mesma instituição, com características clínicas semelhantes. 2- Não foi observada correlação significativa entre a rigidez arterial, medida por meio da VOP, EIMC, distensibilidade e diâmetro carotídeo e a resposta à MSC / The carotid sinus hypersensitivity (CSH) is the exaggeration of the normal reflex and was defined by occurrence of asystole 3 seconds or fall in systolic BP 50 mmHg in response to carotid sinus massage (CSM). Phenomenon related to age, rarely diagnosed in patients younger than 50 years, has gained importance as a cause of syncope and unexplained falls in the elderly in recent decades with reported prevalence rates above 45%. However, the correlation between CSH and syncope etiology is still controversial. OBJECTIVE: To determine the prevalence of CSH in patients with syncope and near syncope of unknown origin and compare with asymptomatic individuals; to evaluate the correlation between CSM responses and arterial stiffness. METHODS: We studied prospectively 99 symptomatic pts with syncope or near syncope (mean age 69 years, 41.4% men) and 66 asymptomatic controls (mean age 73 years, 34.8% men). Patients with significant structural heart disease or with contraindications to CSM were excluded. The CSM was performed at the point with maximal carotid pulsation, for 5 seconds with continuous and noninvasive blood pressure and electrocardiogram recording at 70° in upright posture. Were considered abnormal responses: cardioinhibitory (CI): asystole 3 seconds and vasodepressor (VD): decrease in systolic BP 50 mmHg. The aortic stiffness was determined by aortic pulse wave velocity (PWV). The anatomical and functional characteristics of the carotid were determined by measurements of diameter, intima-media thickness (IMT) and distensibility index. RESULTS: There were no differences in the responses obtained in the CSM between the groups, being 67.7 % and 60.6% physiological responses, 24.2% and 25.8% CI responses and 8.1% and 13.6% VD responses in symptomatic and asymptomatic groups, respectively (p=0.466). There were no correlations between response to the CSM with VOP, IMT, carotid diameter and distensibility. CONCLUSIONS: The prevalence of CSH in patients with symptoms of syncope and near syncope was similar to asymptomatic patients from the same institution with similar clinical characteristics. There was no significant correlation between arterial stiffness, measured by PWV, IMT, carotid diameter and distensibility with the response to CSM

Bakgrund: Ateroskleros är en känd bakomliggande orsak till hjärt-och kärlsjukdomar. Progressionen av ateroskleros är en långsam process som börjar redan i unga år. En accepterad subklinisk markör för utvecklingen av ateroskleros är carotis intima-media tjockleken. Syfte: Syftet med studien var att undersöka om det föreligger en statistisk signifikant skillnad på carotis intima-media tjockleken mellan unga kvinnor och män utan någon känd kardiovaskulär riskfaktor. Metod: I studien undersöktes 38 friska studiedeltagare med medelåldern 24,5 år. Carotis intima-media tjockleken undersöktes med ultraljud. Resultat: Resultatet påvisade ingen statistisk signifikant skillnad på carotis intima-media tjockleken mellan unga kvinnor och män. Diskussion: Resultatet kan påverkas av liten provstorlek och för att kunna dra mer generella slutsatser bör en större population undersökas. / Background: Atherosclerosis is a known underlying cause of cardiovascular disease. The progression of atherosclerosis is a slow process that begins at an early age. An accepted subclinical marker for the development of atherosclerosis is carotid intima media thickness. Purpose: The purpose of the study was to investigate whether there is a statistically significant difference in intima-media thickness in the carotid artery between young women and men without any known cardiovascular risk factor. Method: The study examined 38 healthy participants with a mean age of 24.5 years. Carotid intima-media thickness was measured by ultrasound. Results: The results showed no statistically significant difference in carotid intima-media thickness between young women and men. Discussion: The result can be affected by the small sample size and in order to be able to draw more general conclusions, a larger population should be examined.

This study examined racial/ethnic differences in pre-clinical disease, social support, and tested whether social support was a moderator of racial/ethnic differences in subclinical atherosclerosis. Participants were NHWs, NHBs, and Latinos (n = 283) from the baseline and cross-sectional sample of the North Texas Heart Study. Results from unadjusted models showed no significant racial/ethnic differences for common or bifurcation intima-media thickness (cIMT). However, unadjusted models for cIMT showed a main effect for race/ethnicity F(2, 229) = 3.12, p = .046, partial η2 = .027, with Latinos demonstrating significantly greater internal cIMT compared to NHB but not NHWs. In minimally adjusted models, there was a main effect for race/ethnicity, F(2, 227) = 3.10, p = .047, partial η2 = .027, with significantly greater internal cIMT in Latinos compared to NHBs but not NHWs. In fully adjusted models, racial/ethnic differences in cIMT were attenuated. Contrary to study hypotheses, no racial/ethnic differences in social support were found and social support was not a moderator of racial/ethnic differences in subclinical disease. In the North Texas Heart Study, few racial/ethnic differences emerged, with fully adjusted risk factor models accounting for these differences.

Motivation - The burden of cardiovascular diseases (CVD) is increasing in developing countries worldwide, but even more so in sub-Saharan Africa. Due to rapid urbanisation, black populations experience lifestyle changes (e.g. unhealthy diet, increased access to alcohol and tobacco) that predispose them to increased obesity and cardiovascular risk. In this study, attention will be given to cardiovascular alterations, specifically arterial calcification, in lean and overweight/obese women nearing or already experiencing menopause. These include elevated blood pressure, large artery stiffness (indicated by increased central pulse pressure (cPP)) and carotid intima-media thickness (CIMT). Other factors linked to arterial calcification include the level of obesity as well as low bone mineral density. Ectopic calcification plays a significant role in cardiovascular morbidity and mortality, especially in renal failure patients, osteoporotic and elderly women. Factors contributing to the development and progression of arterial calcification include calciotropic hormones and altered bone metabolism, particularly in older postmenopausal women. This is due to the lack of protective effects of oestrogen against vascular alterations and bone loss after menopause. Previous studies have shown that increased bone resorption indicated by elevated levels of c-telopeptide of type I collagen (CTX), parathyroid hormone (PTH), low 25- hydroxycholecalciferol (25(OH)D3) and parathyroid hormone to 25-hydroxycholecalciferol ratio (PTH:25(OH)D3) are independently linked to arterial stiffening, CIMT and vascular calcification. Knowledge on the contribution of altered bone metabolism and associated calciotropic hormones on cardiovascular health in Africans is limited. Previous studies on ectopic calcification in South Africans focused on men and renal failure patients. This study will explore the possible role of altered calcium regulation and bone metabolism in the development of arterial calcification and CVD in older African women. Aim - The aim of this study was to investigate the associations of brachial and central pressures and CIMT with PTH, PTH:25(OH)D3 and CTX, a marker of bone resorption, in lean and overweight/obese African women older than 46 years. Methodology - This sub-study forms part of the Prospective Urban Rural Epidemiology (PURE) study. A total of 434 urban and rural women older than 46 years were included in the study. Women infected with the human immunodeficiency virus (HIV) were excluded from the study. The study was reviewed and approved by the Ethics Committee of the North-West University (Potchefstroom campus) and all participants signed an informed consent form prior to enrolment into the project. Field workers administered demographic, general health and physical activity questionnaires in the participants’ home language. Anthropometric measurements included weight, height and waist circumference, while body mass index (BMI) was calculated in kg/m2. Cardiovascular measurements included brachial and central systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), brachial and central pulse pressure (PP) as well as CIMT and carotid cross-sectional wall area (CSWA). Blood pressure measurements were performed on the right arm with the participant in the sitting position. Blood was drawn after an overnight fasting period. We performed biochemical analyses from serum and plasma samples for follicle stimulating hormone (FSH), PTH, 25(OH)D3, and CTX. HIV testing was performed according to standardised procedures. Since interactions existed for BMI with regards to associations of CIMT and cPP with PTH:25(OH)D3, the study population was divided into the lean (BMI <25 kg/m2) and overweight/obese (BMI ≥25 kg/m2) groups. We performed independent T-tests to compare means and used the chi-square test to compare proportions. Single and multiple regression analyses were performed to investigate the associations of markers of vascular structure and function with CTX and calciotropic hormones. Results - In this study, 90% of the women displayed an FSH concentration exceeding the cut-off value of 35 mIu/mL, indicating a postmenopausal state. When comparing lean and overweight/obese African women, we found that lean women had higher levels of CTX and 25(OH)D3 (both p<0.001), while the overweight/obese group was older (p=0.007) and presented with higher PTH and PTH:25(OH)D3 levels (both p<0.001). Brachial and central pressures did not differ between the groups (p≥0.23), except for DBP being higher in the overweight/obese group (p=0.017). Overweight/obese women had higher CIMT (p<0.001) and CSWA (p=0.001) as compared to their lean counterparts. A larger proportion of lean women smoked (63%) and self-reported on alcohol use (37%) than overweight/obese women (41% and 18%, respectively) (both p<0.001). Forty-one percent of overweight/obese women used antihypertensive medication, opposed to 25% in the lean group (p=0.001). In multivariate regression analyses, an independent positive association existed between CIMT and PTH:25(OH)D3 (R2=0.22; β=0.26; p=0.003) in lean women. In the overweight/obese group independent positive associations were confirmed between brachial SBP and PTH (p=0.013) and CTX (p=0.038), and between DBP and PTH (p=0.030). Brachial PP and central SBP remained positively associated with CTX (p=0.016 and p=0.024, respectively), while cPP was independently associated with PTH:25(OH)D3 (R2=0.20; β=0.17; p=0.017) and CTX (R2=0.20; β=0.17; p=0.025). Conclusion - Our results indicate that in older African women, large artery structure and function are associated with calciotropic hormones and bone resorption, suggesting that altered bone metabolism and associated calciotropic hormones play a role in the development of vascular calcification. The different associations in lean and overweight/obese women suggest different mechanisms at work regarding arterial calcification in states of low and high adiposity. These findings need confirmation in larger prospective and experimental studies. / MSc (Physiology), North-West University, Potchefstroom Campus, 2014

Motivation - The burden of cardiovascular diseases (CVD) is increasing in developing countries worldwide, but even more so in sub-Saharan Africa. Due to rapid urbanisation, black populations experience lifestyle changes (e.g. unhealthy diet, increased access to alcohol and tobacco) that predispose them to increased obesity and cardiovascular risk. In this study, attention will be given to cardiovascular alterations, specifically arterial calcification, in lean and overweight/obese women nearing or already experiencing menopause. These include elevated blood pressure, large artery stiffness (indicated by increased central pulse pressure (cPP)) and carotid intima-media thickness (CIMT). Other factors linked to arterial calcification include the level of obesity as well as low bone mineral density. Ectopic calcification plays a significant role in cardiovascular morbidity and mortality, especially in renal failure patients, osteoporotic and elderly women. Factors contributing to the development and progression of arterial calcification include calciotropic hormones and altered bone metabolism, particularly in older postmenopausal women. This is due to the lack of protective effects of oestrogen against vascular alterations and bone loss after menopause. Previous studies have shown that increased bone resorption indicated by elevated levels of c-telopeptide of type I collagen (CTX), parathyroid hormone (PTH), low 25- hydroxycholecalciferol (25(OH)D3) and parathyroid hormone to 25-hydroxycholecalciferol ratio (PTH:25(OH)D3) are independently linked to arterial stiffening, CIMT and vascular calcification. Knowledge on the contribution of altered bone metabolism and associated calciotropic hormones on cardiovascular health in Africans is limited. Previous studies on ectopic calcification in South Africans focused on men and renal failure patients. This study will explore the possible role of altered calcium regulation and bone metabolism in the development of arterial calcification and CVD in older African women. Aim - The aim of this study was to investigate the associations of brachial and central pressures and CIMT with PTH, PTH:25(OH)D3 and CTX, a marker of bone resorption, in lean and overweight/obese African women older than 46 years. Methodology - This sub-study forms part of the Prospective Urban Rural Epidemiology (PURE) study. A total of 434 urban and rural women older than 46 years were included in the study. Women infected with the human immunodeficiency virus (HIV) were excluded from the study. The study was reviewed and approved by the Ethics Committee of the North-West University (Potchefstroom campus) and all participants signed an informed consent form prior to enrolment into the project. Field workers administered demographic, general health and physical activity questionnaires in the participants’ home language. Anthropometric measurements included weight, height and waist circumference, while body mass index (BMI) was calculated in kg/m2. Cardiovascular measurements included brachial and central systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), brachial and central pulse pressure (PP) as well as CIMT and carotid cross-sectional wall area (CSWA). Blood pressure measurements were performed on the right arm with the participant in the sitting position. Blood was drawn after an overnight fasting period. We performed biochemical analyses from serum and plasma samples for follicle stimulating hormone (FSH), PTH, 25(OH)D3, and CTX. HIV testing was performed according to standardised procedures. Since interactions existed for BMI with regards to associations of CIMT and cPP with PTH:25(OH)D3, the study population was divided into the lean (BMI <25 kg/m2) and overweight/obese (BMI ≥25 kg/m2) groups. We performed independent T-tests to compare means and used the chi-square test to compare proportions. Single and multiple regression analyses were performed to investigate the associations of markers of vascular structure and function with CTX and calciotropic hormones. Results - In this study, 90% of the women displayed an FSH concentration exceeding the cut-off value of 35 mIu/mL, indicating a postmenopausal state. When comparing lean and overweight/obese African women, we found that lean women had higher levels of CTX and 25(OH)D3 (both p<0.001), while the overweight/obese group was older (p=0.007) and presented with higher PTH and PTH:25(OH)D3 levels (both p<0.001). Brachial and central pressures did not differ between the groups (p≥0.23), except for DBP being higher in the overweight/obese group (p=0.017). Overweight/obese women had higher CIMT (p<0.001) and CSWA (p=0.001) as compared to their lean counterparts. A larger proportion of lean women smoked (63%) and self-reported on alcohol use (37%) than overweight/obese women (41% and 18%, respectively) (both p<0.001). Forty-one percent of overweight/obese women used antihypertensive medication, opposed to 25% in the lean group (p=0.001). In multivariate regression analyses, an independent positive association existed between CIMT and PTH:25(OH)D3 (R2=0.22; β=0.26; p=0.003) in lean women. In the overweight/obese group independent positive associations were confirmed between brachial SBP and PTH (p=0.013) and CTX (p=0.038), and between DBP and PTH (p=0.030). Brachial PP and central SBP remained positively associated with CTX (p=0.016 and p=0.024, respectively), while cPP was independently associated with PTH:25(OH)D3 (R2=0.20; β=0.17; p=0.017) and CTX (R2=0.20; β=0.17; p=0.025). Conclusion - Our results indicate that in older African women, large artery structure and function are associated with calciotropic hormones and bone resorption, suggesting that altered bone metabolism and associated calciotropic hormones play a role in the development of vascular calcification. The different associations in lean and overweight/obese women suggest different mechanisms at work regarding arterial calcification in states of low and high adiposity. These findings need confirmation in larger prospective and experimental studies. / MSc (Physiology), North-West University, Potchefstroom Campus, 2014

<p>S obzirom na visoku prevalencu metaboličkog sindroma (10-40% u svetskoj populaciji) i na činjenicu da prisustvo metaboličkog sindroma duplira rizik od nastanka aterosklerotske bolesti kardiovaskularnog sistema jasna je potreba za identifikacijom indivudualnih parametara koji doprinose njenom razvoju. Metabolički sindrom je klaster faktora rizika metaboličkog porekla koji je udružen sa povećanim rizikom za nastanak aterosklerotske bolesti kardiovaskularnog sistema i dijabetes melitusa tipa 2. Insulinska rezistencija, abdominalna gojaznost, aterogena dislipidemija, hipertenzija, proinflamatorno i protrombotično stanje su faktori koji su u osnovi metaboličkog sindroma a često su i praćeni nagomilavanjem masti u jetri. Cilj rada je bio da se utvrdi odnos između markera disfunkcije hepatocita (AST, ALT, GGT), serumskog nivoa inflamatornih biomarkera (broj leukocita, elektroforeza serumskih proteina, CRP, fibrinogen, TNF-&alpha;), biomarkera endotelne disfunkcije (ADMA i homocistein), kao i nivoa serumskih adipokina (leptin i adiponektin) i debljine intima-medija kompleksa (IMT) karotidne arterije kao pokazatelja prisustva aterosklerotskog procesa. Ispitivanje je dizajnirano kao studija preseka. U ispitivanje je uključeno 58 ispitanika oba pola sa karakteristikama metaboličkom sindroma (NCEP:ATP III kriterijumi). Odabir ispitanika je vr&scaron;en u Odeljenju za pravilnu ishranu i zdravstvenu bezbednost hrane, Instituta za javno zdravlje Vojvodine. Kontrolnu grupu su sačinjavale 30 klinički i biohemijski zdravih ispitanika nepu&scaron;ača koji su prema polnoj i dobnoj strukturi odgovarali ispitivanim grupama bolesnika. Iz ispitivanja su isključene osobe koje konzumiraju vi&scaron;e od 20g/dan alkohola, pu&scaron;ači, koji imaju dijagnostikovan virusni hepatitis B ili C ili pozitivan Hbs antigen, anti-Hbs antitela i anti-HCV antitela, osobe koje imaju verifikovana oboljenja kardiovaskularnog sistema, bubrega, CNS-a, infektivna, maligna i autoimuna oboljenja kao i druga oboljenja jetre i žučnih puteva, osobe koje su pod medikamentoznom terapijom koja može uticati na nivo serumskih biomarkera endotelne disfunckije, lipidni i lipoproteinski status, glikoregulaciju kao i menstruacioni ciklus. Sve laboratorijske analize su urađene u Centru za laboratorijsku medicinu, Kliničkog centra Vojvodine. Doppler ultrasonografski pregled karotidnih arterija i ultrazvuk abdomena i jetre je urađen u Centru za radiologiju Kliničkog centra Vojvodine. Signifikantna pozitivna korelacija niskog stepena je utvrđena između IMT zajedničke karotidne arterije i serumskih koncentracija GGT, hsCRP i leptina kao i odnosa neutrofili/limfociti. Prema prvom konstruisanom regresionom modelu u kojem je zavisna varijabla bila IMT preko 0,09 cm statistički značajan uticaj na predviđanje debljine IMT zajedničke karotidne arterije imaju hsCRP (Exp (B) 1,112 i glikemija (Exp (B) 1,973). Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju glikemija, AST i fibrinogen. Prema drugom konstruisanom regresionom modelu gde su zavisne varijable bile IMT zajedničke karotidne arterije preko 0,09 cm i prisutnost hepatične steatoze najveću mogućnost predviđanja imaju leptin Exp (B) 1,1022 i ALT Exp (B) 1,053. Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju ALT, ADMA i leptin.</p> / <p>Given the high prevalence of metabolic syndrome (10-40% in the world population) and the fact that the presence of metabolic syndrome doubles the risk of atherosclerotic disease of the cardiovascular system, there is a clear need to identify individual parameters that contribute to its development. Metabolic syndrome is a cluster of the risk factors of metabolic origin that is associated with an increased risk for the onset of atherosclerotic disease of the cardiovascular system and type 2 diabetes mellitus. Insulin resistance, abdominal obesity, atherogenic dyslipidemia, hypertension, proinflammatory and prothrombotic conditions are the factors at the base of the metabolic syndrome and are often accompanied by fat accumulation in the liver. The aim of this work was to determine the relation between markers of hepatic dysfunction (AST, ALT and GGT), serum levels of inflammatory biomarkers (white blood cell count, electrophoresis of serum proteins, CRP, fibrinogen, TNF-&alpha;), biomarkers of endothelial dysfunction (ADMA and homocysteine) as well as levels of serum adipokines (leptin and adiponectin) and intima-media thickness of carotid artery as indicators of atherosclerotic process in the patients with metabolic syndrome. Study was cross-sectional. It included 58 participants with metabolic syndrome (NCEP:ATP III criteria) as well as 30 clinically and biochemically healthy nonsmokers, age and gender matched controls. Participants were selected in the Department for Nutrition and Food Safety, Center of Hygiene and Human Ecology Institute of Public Health of Vojvodina. Patients that consumed alcohol more than 20g/day were excluded. Participants with positive HBsAg, anti-HBs-antibodies or anti- HCV antibodies were excluded also. Smokers were also excluded. Patients with cardiovascular diseases, renal diseases, infective, hepatic, malignant and autoimmune diseases were excluded from this study. Subjects which used drugs that could affect biomarker levels of endothelial dysfunction, lipid metabolism, glucose metabolism and menstrual cycle were also excluded. All laboratory analyzes were done in Centre for Laboratory Medicine, Clinical Centre of Vojvodina. Doppler ultrasonography of carotid arteries and ultrasound of abdomen and liver were done in Centre for Radiology, Clinical Centre of Vojvodina. Significant positive correlation of low degree was determined between IMT of common carotid artery and serum concentrations between GGT, hsCRP and leptin and relationship neutrophils/lymphocytes. According to the first constructed regression model where dependent variable was IMT of common carotid artery above 0.09 cm statistically significant influence on foreseeing IMT of common carotid artery have hsCRP (Exp (B) 1.112 and glycaemia (Exp (B) 1.973). According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have glycaemia, AST and fibrinogen. According to the second constructed regression model where dependent variable was IMT above 0.09 cm and present hepatic steatosis greatest probability for foreseeing IMT have leptin Exp (B) 1.1022 and ALT Exp (B) 1.053. According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have ALT, ADMA and leptin.</p>