Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for the development of cardiovascular events and hypertension. Mean platelet volume (MPV), an indicator of platelet activation and aggregation, is closely related with cardiovascular diseases (CVDs). We aimed to show the relationship between OSAS and MPV with CVD. The medical records of 205 patients who were admitted to the sleep study were evaluated. OSAS was diagnosed by polysomnography if the apnea-hypopnea index (AHI) was greater than 5. MPV was calculated from blood samples. According to AHI, individuals in whom AHI was less than 5 were recruited as the control group, those in whom AHI was 5-15 as the mild OSAS group, those in whom AHI was equal to 15-30 as the moderate OSAS group, and those in whom AHI was greater than 30 as the severe OSAS group. Of the patients, 137 (67%) were men and 68 (33%) were women; the mean age was 53.0±14.1 years. There were 35 (17%), 20 (10.2%), 42 (20.4%), and 108 (52.6%) participants in groups 1, 2, 3, and 4, respectively. There were significant differences in terms of coronary artery disease and hypertension between all groups (P<0.05). There was a significant association between the severity of OSAS and MPV in groups 3 and 4, whereas there was not any association in groups 1 and 2 (group 1=9.3±0.7, group 2=9.4±0.8, group 3=9.5±1.1, group 4=10.2±1.2; P for trend 0.03). We showed that MPV was significantly increased in patients with OSAS, which is an independent risk factor for CVD. Therefore, MPV could be used as a marker to predict CVD in OSAS.

Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A 1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that selfreported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.

In the light of the present study, we speculate that OSAS is an independent risk factor for the progression of chronic kidney disease, which is a growing health problem. Further randomized-multicenter prospective studies are warranted to evaluate this relationship.

No abstract

Gamma glutamyl transferase (GGT) is a new marker for predicting myocardial infarction, stroke, cardiac death and inflammation. There is also a strong relationship between Obstructive Sleep Apnea Syndrome (OSAS) and cardiovascular disease. This study was designed to investigate the association between serum GGT levels and cardiovascular disease in patients with OSAS, and relationship between severity of OSAS and serum GGT level. We evaluated the medical records of 166 subjects who were admitted for sleep study. OSAS was diagnosed by polysomnography if Apnea-Hypopnea Index (AHI) > 5. According to AHI, individuals in whom AHI< 5 were recruited as group 1 (OSAS negative group), AHI = 5-15: group 2 (mild OSAS group), AHI = 15-30: group 3 (moderate OSAS group), AHI >30: group 4 (severe OSAS group). Cardiovascular disease was defined if the patients had heart failure, coronary artery disease or arrhythmia. Of the subjects, 112 (67.5%) were male and the mean age was 54.3 ± 12.2 years. There were 22 patients (13.2%), 17 patients (10.2%), 34 patients (20.4%) and 93 patients (56.2%) in group 1, 2, 3 and 4, respectively. There is a significant increase in serum GGT levels while AHI score increases (group 1 = 28.0 ± 10.1, group 2 = 33.8 ± 13.2, group 3 = 35.2 ± 8.5, group 4 = 40.0 ± 22.0; p for trend = 0.024). However, serum C-reactive protein (CRP), alanine aminotransferase and aspartate aminotransferase levels were similar in all groups (p > 0.05). There was a significant independent association between serum GGT levels and the severity of OSAS. Moreover, serum GGT levels were significantly high in patients with cardiovascular disease compared with patients without cardiovascular disease in severe-moderate-mild OSAS (p < 0.05) and OSAS negative groups while CRP levels were not. This was a significant independent association. The present study suggests that high serum GGT level, regardless of the other traditional risk factors, is an independent predictor of cardiovascular disease in patients with OSAS. The results should be confirmed with other randomized prospective studies.

BACKGROUND AND AIM:Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease. Recent studies showed endothelial dysfunction and pentraxin-3 both of an early marker for development of cardiovascular disease. The aim of the study was to evaluate the relationship between severity of OSAS and endothelial dysfunction and inflammatory markers including pentraxin-3 and high-sensitivity C-reactive protein (hs-CRP).METHODS:This was a cross-sectional study in which patients who had undergone a polysomnographic study for diagnosis of OSAS were recruited. Included patients were grouped according to apnea-hypopnea index (AHI) as mild (AHI between 5 and 14.9) and moderate-severe OSAS (AHI ⩾ 15). Patients with AHI < 5 served as control group. Endothelial function was evaluated by flow-mediated dilatation (FMD). Serum pentraxin-3 and hs-CRP levels were measured.RESULTS:Eighty-three patients enrolled for the study. We found a significant increment in pentraxin-3 and hs-CRP levels and a significant decrement in FMD as the severity of OSAS increased. There was a negative correlation between FMD and AHI, pentraxin, and hs-CRP.CONCLUSION:OSAS patients have significantly elevated pentraxin-3 levels and endothelial dysfunction. Furthermore, both pentraxin-3 and endothelial dysfunction were independently associated with severity of OSAS defined by AHI.

The subcutaneous implantable cardioverter-defibrillator (S-ICD) system is an established therapy for prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator (ICD) system in selected patients. Since introduction of S-ICD in 2010, the device has undergone further development. Based on the unique feature of an entirely extracardiac implantation, S-ICD is able to reduce the known common perioperative and long-term complications of conventional transvenous implanted ICD systems. Especially for patients with a complex anatomy and no option of an endovascular lead implantation, the S-ICD offers a potential alternative. Initial uncertainty existed, questioning whether this ICD approach would be reliable in detecting and terminating ventricular arrhythmias. Multiple clinical studies, however, provided evidence for an effective treatment. Based on obvious advantages compared to conventional ICD systems, the question arises whether the S-ICD should actually be the first choice in the majority of all primary prevention patients in the future. Recent data from large registries show that S-ICD indications are also expanding in secondary prevention patients. As a consequence, the S-ICD was listed in the 2015 ESC guidelines as an alternative therapeutic option with a class-IIa recommendation in patients with an ICD indication not requiring pacing for bradycardia, cardiac resynchronization therapy or anti-tachycardia pacing (ATP). In addition, the American Heart Association guidelines refer to class-I recommendation for patients with a complex anatomy and venous access problems or at a high risk for infections who need ICD therapy. Limitations with respect to the not available pacing option of S-ICD might be also overcome by a potential combination with a leadless pacemaker in the near future. This article provides an overview of recent developments of S-ICD and reviews the most recent literature and ongoing studies.

Impaired renal function in patients undergoing DES stenting carries an independent risk factor for restenosis and bleeding.