Nowadays low paraoxonase activity is generally recognized as an independent risk factor of cardiovascular diseases involved in pathologic remodeling of the heart and vessels as well as thrombosis in the general population. But the role of paraoxonase activity in RA patients is unknown. Based on the above, the aim of the work was to study serum paraoxonase activity in patients with rheumatoid arthritis, to evaluate its association with clinical course and structural and functional status of the cardiovascular system. 67 patients with RA, 18 males and 49 females were studied. The control group consisted of 25 apparently healthy individuals. Rheumatoid arthritis was diagnosed according to international classification criteria ACR 2012. The indices of total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) in blood serum were determined by standard conventional methods. Low density lipoprotein cholesterol (LDLC) values were calculated by Friedwald formula. Serum paraoxonase activity was measured by spectrophotometric method. High resolution ultrasound and Doppler ultrasonography of the brachial artery were performed to study endothelium function. Sonographic B-mode scanning and pulsed Doppler ultrasound of heart and blood flow spectra were done on ultrasound scanner. Serum paraoxonase activity was found to be about 18.8% lower in the patients with RA than in the control group. Serum paraoxonase activity was shown to decrease proportionally to the increase of the age in RA patients. In the group of patients over 45, the level of the enzyme was 13.0% lower than in the patients over 30. The study established that the increase of systolic and diastolic arterial pressure is associated with decrease of serum paraoxonase activity in RA patients. The patients with RA combined with arterial hypertension had significantly (by 10.9%) lower activity of the studied enzyme than those with no arterial hypertension. However, no significant relationship between paraoxonase activity and duration of the disease, obesity and smoking was revealed. Paraoxonase activity in RA patients was demonstrated to be dependent on lipid levels. The lowest paraoxonase activity was recorded in individuals with the highest levels of TC, LDLC and the lowest HDLC indices. Paraoxonase activity in RA patients is associated not only with atherosclerotic vascular damage (IMT, decreased FMDBA) but also with structural and functional heart status (systolic and diastolic functions, left ventricular myocardial hypertrophy). Decreased serum paraoxonase level is suggested to be the predictor of early development of cardiovascular complications in RA patients.
The aim: Was to evaluate the effect of 6-month pathogenetic treatment in combination with atorvastatinum on the endothelium function, lipid and adipokine levels, paroxonase activity and activity of inflammatory process in RA patients. Materials and methods: The study included 55 patients with RA, dividing into two groups depending on the intended therapy. The first group included 33 patients with “traditional” treatment by methotrexate, glucocorticoids, and non-steroid anti-inflammatory drugs. The second group included 22 patients with “traditional” treatment and additionally prescribed of atorvastatinum 20 mg/day. The lipid profile, leptin, adipokine, paroxonase activity. C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) levels, FMDBA and IMT of carotid artery were determined in all participants of the study. Control parameters were recorded before the start, after 1 and 6 months of treatment. Results: The FMDBA has increased by 32% in the second group, compared by only 10.9% in the first group. The dynamics of IMT in the first group was also twice lower than in group with the additional use of atorvastatinum. The leptin levels in the second group significantly decreased by 27% and adiponectin levels increased by 12.8%, than in the first group – by 12.8% and by 7% respectively. The appointment of statins over 6 months resulted in DAS28, TNF-α, ESR and CRP reduction by 15%, 31%, 25% and 21.5% respectively. In the first group the dynamics of indicate rates ranged from 7.8% to 22.5%, and was significantly lower than in the second group. Conclusions: As a result of the study, it was found that the appointment of atorvastatinum 20 mg/day during 6 months not only reduces dyslipidemia, but also significantly reduces the inflammatory process and adipokine dysregulation, normalizes serum paraoxonase activity and improves the endothelium function.
BackgroundIt is known that endothelin-1 is one of the leading factors in the development of coronary artery disease, acute myocardial infarction, atherosclerosis of cerebral and peripheral vessels, pulmonary hypertension, ischemic lesion of the brain vessels etc. Patients with rheumatic diseases also have an elevetaion of endothelin-1 in serum. But it remains unclear whether the endothelin-1 level may reflect endothelium dysfunction in patients with antiphospholipid syndrome (APS) and serve as an early marker of atherosclerosis.ObjectivesThe aim of the study was to evaluate the endothelin-1 concentration, its association with antiphospholipid antibodies and atherosclerotic vascular lesions in patients with APS.MethodsAccording to our observation, there were 82 patients, among which 34 (41.6%) with primary antiphospholipid syndrome (PAPS) and 48 (58.4%) with secondary antiphospholipid syndrome (SAPS). The control group consisted of 37 practically healthy persons. The groups of patients were comparable by age, sex, and duration of the disease. The APS diagnosis was established according to the international classification criteria (2006). The content of the anticardiolipin antibodies IgG, anti-beta2-glycoprotein-1 antibodies IgG, IgA, IgM and endothelin-1 were determined by the immune enzyme method using commercial sets of Trinity Biotech Captia USA - Ireland, ORGenTec GmbH Germany and «Endothelin-1» (Cormay, England). All patients were assessed for the level of endothelium-dependent vasodilation (EDVD), the thickness of the intima-media complex of the common carotid artery (IMT), the presence of atherosclerotic plaque (AP) and clinical manifestations of vascular involvement.ResultsThe analysis of endothelin-1 levels has showed that its content was in 2.3 times higher in patients with APS than in the control group. The proportion of people with optimal endothelin-1 content was twice lower, and the proportion of people with extremely high and high rates was 1.6 and 5.3 times higher, respectively, among patients with APS, than in the control group. Also differences in the endothelin-1 level have been established depending on the type of APS. The content of endothelin-1 was significantly higher (1.3 times) in patients with SAPS, than in PAPS. Among the patients with SAPS, the proportion of patients with an optimal level of endothelin-1 was 1.7 times lower, and the proportion of patients with high levels was 1.6 times higher than in patients with PAPS. The significantly lower endothelin-1 level was recorded in patients with highly positive antibodies to cardiolipin and beta-2 glycoprotein-1. Correlation analysis has showen direct correlation between anticardiolipin antibodies of the IgG class and anti-beta2-glycoprotein-1 antibodies and endothelin-1 concentration (r=0.35 and 0.34). High endothelin-1 level was an adverse factor of structural and functional atherosclerotic changes of the heart and blood vessels in patients with APS. IMT increasing and EDVD decreasing were from 1.7 to 6.6 times more frequent among patients...
BackgroundIn a patient with rheumatoid arthritis (RA) manifestations of coronary heart disease occur gradually, at the same time “painless” myocardial ischemia is detected in 50 - 70% of cases according to the literature. According to modern ideas, the formation of endothelial dysfunction, development of early atherosclerosis and vascular thrombosis are closely associated with the increase level of von Willebrand factor (VWF) and inflammatory markers.ObjectivesThe aim of this study was to investigate the frequency and duration of painless myocardial ischemia and its association with VWF levels and inflammatory markers in patients with RA.Methods63 patients with RA (44 women) aged 27 - 65 years (mean age - 46.8 ± 9.8 years) and 69 ages and sex-matched controls were examined. Serum levels of VWF, CRP and TNF-α were determined by enzyme-linked immunosorbent assays. Daily (Holter) ECG monitoring was performed by Holter ECG monitoring systems “DiaCard”, registrar: model 02100, software version 1.0.40, developed by JSC “Solveig” (Ukraine).ResultsIt was found, that the part of patients with painless myocardial ischemia among patients with RA was significantly higher (58.7%) than in the control group (13%). At the same time, in patients with RA the duration of painless myocardial ischemia was in averaged 10.9 ± 8.1 minutes per day. It was significantly more than in the control group 2.88±1.25 minutes per day (p <0,05). It was found, that in patients with RA there was an increased levels of VWF (162.2 ± 9.3% vs. 86.2 ± 2.7% in control). It was found, that the duration of painless myocardial ischemia had close correlations with VWF (r = 0.28), CRP (r = 0.41) and TNF-α (r = 0.40).ConclusionThe severity the duration of painless myocardial ischemia in RA patients is associated with elevated levels of VWF, CRP, and TNF-α, indicating the possible involvement of VWF and inflammatory markers in cardiovascular disease in RA patients.References[1]Hannawi, S., Hannawi, H., Al Salmi I. (2020). Cardiovascular disease and subclinical atherosclerosis in rheumatoid arthritis. Hypertension Research, 43, 982–984Disclosure of InterestsNone declared.
BackgroundMany studies have been conducted to determine the role of genetic polymorphism in the occurrence of cardiovascular diseases. The pathogenetic significance of MTHFR polymorphism is the subject of intensive research, especially its connexion with lesions of the cardiovascular system. The frequency of C677T polymorphism in the 5,10-MTHF gene is poorly known in patients with antiphospholipid syndrome (APS), and its relationship with vascular lesions has not been studied yet.ObjectivesThe present study aimed to analyse the C677T mutation of the MTHFR gene and its association with endothelial dysfunction and clinical manifestations of cardiovascular lesions in APS.MethodsWe studied 82 patients with APS, including 34 (41.6%) with primary antiphospholipid syndrome (PAPS) and 48 (58.4%) with secondary antiphospholipid syndrome (SAPS). The analysis of the MTHFR C677T mutation was performed by PCR followed by digestion according to Frosst et al. All patients were assessed for the endothelium-dependent vasodilatation of brachial artery (EDVD), the thickness of the intima-media of the common carotid artery (IMT), the presence of atherosclerotic plaque (AP) and clinical manifestations of cardiovascular lesionsResultsThere were 10.8% of homozygotes (677-TT), 37.8% of heterozygotes (677-CT) and 51.4% of homozygotes (677-CC) in the control group, and the frequency of T-alleles amounted to 29.7%. The incidence of T-alleles was higher among the patients with APS than in the control group and was 35.4%. The prevalence of of homozygotes (677-TT), heterozygotes (677-CT) and homozygotes (677-CC) was not significantly different between the PAPS and SAPS groups (44,1%, 38,2%, 17,7% and 45,8%, 39,6%, 14,6% respectively p<0,05). The frequency of T-alleles was higher in PAPS group than in SAPS group (36,8% against 34,4%, respectively p<0,05). The analysis of structural and functional vascular lesions in homozygotes (677-CC), homozygotes (677-TT) and heterozygotes (677-CT) did not reveal significant differences in both mean values and the proportion of individuals with IMT thickness (0,86±0,03 mm, 0,88±0,05 mm, 0,90±0,03 and 35,3%, 38,5%, 51,7% respectively p<0,05) with decrease of EDVD (7,09±0,49, 6,32±1,0, 6,92±0,58 and 47,0%, 53,8%, 48,3% respectively p<0,05) and the presence of AP (26,5%, 23,1%, 48,3% respectively p<0,05). Although there was a tendency of IMT thickness increase and EDVD decrease for T-carriers. The proportion of persons with IMT thickness (>0.90 mm) and the decrease of EDVD BA (≤8.0%) among the homozygote 677-TT was 3%–6.5% higher than that of the 677-CC homozygote. The frequency of clinical manifestations of cardiovascular lesions (myocardial infarction, stroke, TIA) was in 1,2–1,8 times more often among the homozygotes 677-TT than 677-CC homozygote.ConclusionsThe mutation of the C677T of the MTHFR gene is not a risk factor for the development of atherosclerotic vascular damage in patients with APS, due to the lack of associative interrelationships between the decrease of EDVD, increase of IMT, clinical manifes...
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