Abdominal obesity and low-grade systemic inflammation as markers of subclinical organ damage in type 2 diabetes

AimThis study aimed to explore the associations between abdominal obesity, inflammatory markers and subclinical organ damage in 740 middle-aged patients with type 2 diabetes.MethodsWaist circumference (WC) and sagittal abdominal diameter (SAD) were measured, and blood samples were analyzed for C-reactive protein (CRP) and IL-6. Carotid intima–media thickness (IMT) was evaluated by ultrasonography, and aortic pulse wave velocity (PWV) measured with applanation tonometry.ResultsAbdominal obesity as determined by SAD and WC was significantly correlated with IL-6 (WC: r = 0.27, P < 0.001; SAD: r = 031, P < 0.001), CRP (WC: r = 0.29, P < 0.001; SAD: r = 0.29, P < 0.001), IMT (WC: r = 0.09, P = 0.013; SAD: r = 0.11, P = 0.003) and PWV (WC: r = 0.18, P < 0.001; SAD: r = 0.21, P < 0.001). In multiple linear regressions with IMT and PWV as dependent variables, and age, gender, statin use, systolic blood pressure (SBP), body mass index (BMI), CRP and HbA_1c as independent variables, both SAD and WC remained associated with IMT and PWV. On stepwise linear regression and entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.ConclusionBoth SAD and WC are feasible measures of obesity, and both provide information on inflammation, atherosclerosis and arterial stiffness in type 2 diabetes, while SAD appears to be slightly more robustly associated with subclinical organ damage than WC.     

Lipoprotein-associated phospholipase A2 and arterial stiffness evaluation in patients with inflammatory bowel diseases

Background and aimsThe association between inflammatory bowel diseases (IBD) and cardiovascular disease (CVD) remains equivocal. Arterial stiffness, as assessed by pulse wave velocity (PWV), and lipoprotein-associated phospholipase A2 (Lp-PLA2) are surrogates of CVD risk.AimThe aim of this study was to assess carotid–femoral PWV and Lp-PLA2 in patients with IBD without history of CVD.MethodsEstablished CVD risk factors, IBD characteristics, PWV and Lp-PLA2 activity were assessed in 44 patients with IBD, 29 with Crohn's disease (CD) and 15 with ulcerative colitis (UC), and 44 matched controls.ResultsIBD patients had lower total and low density lipoprotein cholesterol (LDL-C) levels. There was no difference in PWV between patients and controls (6.8 vs 6.4 m/s), but patients with CD had higher PWV compared to those with UC (7 vs 6.3 m/s; p = 0.044), and to controls. Smoking rates were significantly higher among CD patients. Factors associated with PWV were age, mean arterial pressure and smoking. Lp-PLA2 activity was significantly lower in patients with IBD (46.8 vs 53.9 nmol/mL/min; p = 0.011). There was no difference in Lp-PLA2 between CD and UC patients. LDL-C was the only significant predictor of Lp-PLA2.ConclusionsOur study showed lower Lp-PLA2 activity in patients with IBD compared with controls, reflecting lower LDL-C in the former. There was no difference in PWV between the two groups. Arterial stiffness was higher in patients with CD, which is likely related to higher smoking rates. These findings challenge a possible association between IBD and CVD, but further studies are required.     

Arterial stiffness,carotid atherosclerosis and left ventricular diastolic dysfunction in postmenopausal women

BackgroundPostmenopausal women have an increased cardiovascular morbidity that may be due to the increase in classical cardiovascular risk factors and also to the arterial structure and function alterations. The aim of our study was to evaluate the association of aortic pulse wave velocity (PWV), and carotid intima–media thickness (IMT), with left ventricular diastolic dysfunction (LVDD) in postmenopausal women.Patients and methodsIn 96 women without overt cardiovascular disease (age 62 ± 7.7 years), and with normal left ventricular systolic function, aortic PWV was assessed by using an oscillometric device, intima–media thickness was measured by B-mode ultrasonography and the parameters of left ventricular diastolic function were evaluated by a transthoracic echocardiographic study.ResultsLVDD, defined as an E/A ratio ≤ 1 was found in 50 patients (52%). All of them had mild LVDD. In these patients we found significant increase in age (p < 0.001), aortic PWV (p < 0.001), carotid IMT (p = 0.002) and plaque score (p = 0.004) when compared with patients without LVDD. In a logistic regression analyzed, after adjusting for age, only aortic PWV was a significant predictor of LVDD (2.15, 95% CI 1.39–3.31, p = 0.0006).ConclusionsThis study among postmenopausal women provides evidence that increased arterial stiffness as measured by aortic PWV and not carotid IMT may be a marker or a risk factor for LVDD, independent of other classical risk factors.     

Study of main arteries stiffness in patients with coronary heart disease depending on prevalence of atherosclerosis

ObjectiveTo study the vascular wall stiffness in patients with coronary artery disease based on the prevalence of atherosclerotic lesion.Materials and methodsThe study involved 90 patients diagnosed with unstable angina class II B, the control group consisted of 27 healthy individuals. By using the SphygmoCor (AtCor Medical, Australia) apparatus, stiffness indicators, like pulse wave velocity (PWV) and augmentation index (AIx) were studied by means of the applanation tonometry method. Coronary angiography was performed on the Allura CV-20 (Philips, The Netherlands) unit, the state of the carotid arteries was studied by duplex ultrasonography, involvement of femoral arteries was evaluated based on ankle-brachial index <0.9. In case of doubt, the patients underwent ultrasound duplex scanning. In the main group, patients were divided into 3 subgroups: subgroup A covered patients with isolated coronary lesion; subgroup B covered patients with bifocal atherosclerosis (combined lesion of coronary and carotid arteries or coronary and femoral arteries); subgroup C was represented by multifocal atherosclerosis patients who had atherosclerosis lesion in three vascular basins: carotid, coronary and femoral arteries.ResultsValues of PWV (11.2 ± 1.5 m/s) and AIx (19.8 ± 5.0%) in patients with coronary heart disease were 1.5 (p < 0.001) and 2.4 (p < 0.001) times higher than in those in healthy individuals. During the analysis carried out within the groups, the PWV in all three subgroups was accelerated with maximal values in the subgroup C (13.3 ± 1.5 m/s), which with sufficient level of confidence exceeds the value of this index in the subgroups A (10.1 ± 0.6, p < 0.01) and B (11.0 ± 0.9, p < 0.05). The value of augmentation index AIx was also highest in the subgroup C (26.8 ± 6.4%), relative to the subgroups A (13.7 ± 2.9%, p < 0.001) and B (18.9 ± 4.3%, p < 0.01).ConclusionPatients with coronary heart disease, have demonstrated growing vascular wall stiffness, which is manifested in higher pulse wave velocity (p < 0.001) and augmentation index (p < 0.001) compared with healthy individuals. Whereas in the multifocal atherosclerosis (coronary, carotid and peripheral arteries) were higher AA (p < 0.05), AIx (p < 0.001), PWV (p < 0.01) and the age of patients (p < 0.01). That allows to consider the studied parameters of vascular stiffness as surrogate markers to assess prevalence and progression of atherosclerosis, as well as the effectiveness of pharmacological interventions.     

Microalbuminuria,but not reduced eGFR,is associated with cardiovascular subclinical organ damage in type 2 diabetes

AimThis study explored the association between reduced estimated glomerular filtration rate (eGFR) and microalbuminuria vs. subclinical organ damage in patients with type 2 diabetes.MethodsData from middle-aged patients with type 2 diabetes (n = 706) treated in primary care were analyzed for microalbuminura, defined as a urinary albumin/creatinine ratio (uACR) ≥ 3.0 mmol/mol, and reduced eGFR, defined as < 60 mL/min/1.73 m², in relation to blood pressure, pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima–media thickness (IMT) and lumen diameter (LD).ResultsPatients with microalbuminuria had significantly higher 24-h ambulatory systolic blood pressure (ASBP) compared with subjects with uACR < 3 mg/mmol: 137 vs. 128 mmHg (P < 0.001). There were no differences in ASBP in patients with eGFR < 60 mL/min/1.73 m². However, patients with vs. without microalbuminuria had increased PWV (11.4 vs. 10.1 m/s; P < 0.001), LVMI (134.4 vs. 118.6 g/m²; P < 0.001), LD (7.01 ± 0.93 vs. 6.46 ± 0.74 mm; P < 0.001) and IMT (0.78 vs. 0.74 mm; P = 0.047), respectively. The associations between uACR vs. PWV and LVMI were more robust after adjusting for age, diabetes duration, ASBP, HbA_1c, LDL-cholesterol, and antihypertensive and lipid-lowering therapy compared with uACR vs. IMT. There were no statistically significant differences in PWV, LVMI or IMT between patients with reduced (< 60 mL/min/1.73 m²) vs. normal eGFR.ConclusionLevels of urinary albumin excretion, but not reduced eGFR, were associated with increased arterial stiffness, left ventricular mass and atherosclerosis in patients with type 2 diabetes.     

Arterial stiffness and the autonomic nervous system during the development of Zucker diabetic fatty rats

AimThis study aimed to investigate the role played by sympathovagal balance in arterial stiffness, a common feature of insulin resistance and type 2 diabetes.MethodsWe investigated the relationship between autonomic nervous system activity and arterial stiffness in Zucker diabetic fatty rats (ZDF: Gmi-fa/fa) and their age-matched controls (lean: ?/fa). Using simultaneous catheterization of the proximal and distal aorta, we measured intra-arterial blood pressure (BP), heart rate (HR), their variability (spectral analysis) and aortic pulse wave velocity (PWV) in a series of at least six conscious rats aged 6, 12, 18 and 24 weeks.ResultsBP and PWV increased with age (P < 0.001) in both strains with no differences between strains, despite the insulin resistance already present at 6 weeks in ZDF rats. HR was significantly lower (P < 0.001) in ZDF than in lean rats. In ZDF compared with lean rats, the low-frequency (LF) component of the systolic BP variations and the LF/high-frequency (HF) component of the pulse interval (PI) variation ratio were reduced (P < 0.01 and P < 0.05, respectively), while the HF component of the PI (HF-PI) variation was raised (P < 0.05). PWV was negatively correlated with HF-PI (r = −0.37, P < 0.01), but not with biochemical parameters. HF-PI was an independent variable explaining the variation in PWV.ConclusionDuring the development of disease of ZDF rats, sympathovagal balance might account for the lack of increase in PWV.     

Prévalence et facteurs déterminants de l’épaisseur intima-media carotidienne élevée dans une population de 1203 hypertendus noirs africains

ObjectivesTo evaluate the prevalence and determinants of increased carotid intima-media thickness (IMT) in a population of black hypertensive patients and it influence of on the assessment of their overall cardiovascular risk.Patients and methodsThis was a 16-month, cross-sectional study conducted in the outpatient unit of the cardiology department of the Campus teaching hospital of Lome, and included 1203 hypertensive patients, both sexes, aged 35 years and more. Each patient benefited from a carotid IMT measure. Carotid IMT was increased if it was > 0.9 mm and the plaque was defined as a carotid IMT > 1.2 mm.ResultsThe mean age of our patients was 53.3 ± 10.4 years with a sex ratio of 1.6 in favor of women. The duration of hypertension was less than 5 years in 56.7% and hypertension was grade 1 in 47.7% of cases. The mean carotid IMT was 0.89 mm ± 0.20. The prevalence of the increased carotid IMT was 45.8% and that of an atheroma plaque was 15.8%. Carotid IMT was correlated with age (P ˂ 0.0001), duration of arterial hypertension (P = 0.01), history of stroke (P ˂ 0.0001), and presence of left ventricular hypertrophy to cardiac ultrasound (P = 0.01). The overall cardiovascular risk was modified after taking into account the carotid IMT. An increase in cardiovascular risk was observed in 30.5% of hypertensive patients.ConclusionIncreased carotid intima-media thickness is frequent in Togolese hypertension. The determining factors are age, duration of arterial hypertension, left ventricular hypertrophy and stroke. The systematic measurement of the carotid intima-media thickness would better evaluate the overall cardiovascular risk for our patients.     

Intra-renal hemodynamics and carotid intima-media thickness in the metabolic syndrome

AimsMetabolic syndrome (MetS) is associated with increased cardiovascular risk. We hypothesize that early vascular changes are already present at the time of diagnosis of MetS. The relationship of different measures of early vascular impairment with body fat distribution and the natural progression of MetS was examined in newly diagnosed subjects non-pharmacologically treated.Methods246 consecutively enrolled subjects were categorized according to the presence of MetS and type 2 diabetes (T2D). Intra-renal Doppler flow was used to ascertain resistive (RI) and pulsatility (PI) indices as markers of vascular resistance. Carotid intima-media thickness (IMT), cutis-rectis (CR) and rectis-aorta (RA) thicknesses were measured by ultrasonography; RA/CR ratio was used as measure of body fat distribution. Pro-inflammatory cytokines, C-reactive protein, oxidative markers insulin and adiponectin blood concentrations were also measured.ResultsBaseline characteristics demonstrated increasing trends in biochemical, inflammatory, and oxidative parameters from MetS−, MetS+, to MetS+/T2D (p < 0.001). After adjusting for age, the same increasing trends across the groups were observed in both sexes in IMT (p < 0.001), RI (p < 0.001) and PI (p < 0.001). IMT correlated with RI (r = 0.25; p < 0.001), PI (r = 0.26; p < 0.001), and RA/CR ratio (r = 0.43; p < 0.001).ConclusionsCarotid IMT and intra-renal resistances are elevated at an early stage in MetS and are associated with a dysregulated production of fat-derived hormones and cytokines.     

Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study

BackgroundArterial stiffness (AS) is an independent predictor of cardiovascular risk, and could be used as a surrogate marker of improvement in cardiovascular risk following bariatric surgery. The aim of this study was to compare AS before and after surgery.MethodsOne hundred and thirty-four patients undergoing bariatric surgery between May 2016 and January 2019 were prospectively included. AS was measured on pulse wave velocity (PWV) with the pOpmètre® device pre- and postoperatively. The main endpoint was change in PWV between baseline and 3 months post-surgery.ResultsOverall, mean PWV was 6.87 m/s preoperatively and 6.71 m/s at 3 months (P = 0.7148). Patients with pathologic PWV (> 2 standard deviations from expected value for age) showed significant improvement at 3 months (31 patients; 10.1 m/s preoperatively vs 7.5 m/s at 3 months; P = 0.007). These results did not correlate with improvement in other clinical or biological parameters following surgery (excess weight loss, mean blood pressure, fasting blood glucose, waist circumference, body composition).ConclusionThese results suggest that pathological arterial stiffness may resolve following bariatric surgery independently of the other factors influencing cardiovascular risk in obesity.     

The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome

ObjectiveMetabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS.MethodsEighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) ≥15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters.ResultsFifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS?OSA). Compared with MS?OSA patients, MS+OSA patients had higher levels of IMT (661 ± 117 vs. 767 ± 140 μm), PWV (9.6 ± 1.0 vs. 10.6 ± 1.6 m/s), and CD (6705 ± 744 vs. 7811 ± 862 μm) (P < 0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R² = 0.42); AHI and systolic blood pressure (R² = 0.38); and AHI, age, abdominal circumference and systolic blood pressure (R² = 0.45), respectively. The R² of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively.ConclusionsOSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.     

Relation entre la rigidité artérielle et la sévérité du statut coronaire après un syndrome coronaire aigu

BackgroundThe association between arterial stiffness (AS) and stable coronary artery disease (CAD) has been previously demonstrated. Whether increased arterial stiffness is associated with severe CAD in patients with acute coronary syndrome (ACS) is less explored.AimWe aim to investigate the relationship between AS parameters and the extent and severity of CAD in patients with ACS.MethodsThe study population consisted of 275 patients with ACS. We measured various AS parameters including pulse wave velocity (PWV), augmentation index (AIx), and central pulse pressure (cPP). CAD extent and severity was evaluated by the number of vessels with greater than 70% stenosis.ResultsThe study population was predominantly men (77, 5%) with an average age of 56, 4 ± 10, 6 years. One hundred and fifteen patients were diabetic and 97 were hypertensive. One hundred fifty patients were admitted for ST elevation myocardial infarction (54, 5%) and 37, 5% for non ST elevation myocardial infarction. Thirty six percent of patients had single vessel disease and 47, 6% of the study population had multivessel disease. At the multivariate analysis, a positive correlation was observed between the number of coronary vessels disease and PWV. PWV (OR = 1,272; IC95% [1,090; 1,483]; p = 0,002) and cPP (OR = 1,071; IC95% [1,024; 1,121]; p = 0,003) were also independent predictors of multivessel disease.ConclusionIn patient with ACS, PWV is correlated with the extent of coronary artery disease, as measured by the number of vessels disease. PWV and cPP were also independent predictors of multivessel disease.     

Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth

Our understanding of the natural history of atherosclerosis in childhood and its response to cardiovascular (CV) risk factor reduction have been hampered by the lack of a reliable, non-invasive measure of atherosclerosis. Carotid intima media thickness (IMT), a surrogate marker of atherosclerosis in adults, is increased in youth heterozygous for familial hypercholesterolemia (FH) and declines with lipid lowering pharmacotherapy. The age at which vascular changes can be reliably identified using IMT and the influence of CV risk factors beyond FH on IMT remains unclear.ObjectiveTo examine the influence of demographic, family history, anthropometric characteristics and traditional CV risk factors on IMT in children 5–16 years of age (mean age 11 year).MethodsIn a cross-sectional study, we assessed IMT in 148 children (51 with elevated low density lipoprotein (LDL)-cholesterol, 44 with overweight and 53 controls). Measures included: family history of premature coronary heart disease (CHD), physical activity, pubertal stage, smoking history, fasting glucose, insulin, lipid profile, apolipoproteins A1 and B, anthropometry, blood pressure and IMT.ResultsThe groups were similar for age and family history of premature CHD. Compared to controls, average maximum IMT (0.403 ± 0.04 vs 0.387 ± 0.029) and average mean IMT were elevated in the hyperlipidemia group (p < 0.05), but not in the overweight group (max IMT 0.393 ± 0.034; p vs control = 0.17). Using multiple regression modelling, age, family history of premature CHD and apoliprotein A1 and B predicted 17% of the variability in IMT. No measure of adiposity predicted IMT.ConclusionAge is an important predictor of IMT in youth. Among traditional CV risk factors, dyslipidemia and family history of premature CHD are independent predictors of IMT.     

Relationship between tissue glycation measured by autofluorescence and pulse wave velocity in young and elderly non-diabetic populations

ObjectiveAdvanced glycation end-products (AGEs) and pulse wave velocity (PWV) are pivotal indices of the processes of arterial ageing and damage accumulation. The aim of the present study was to investigate the impact of AGEs, as measured by a non-invasive skin autofluorescence method, on arterial stiffness, estimated by PWV, in two different age groups of non-diabetic subjects.Methods and patientsA total of 116 non-diabetic subjects were classified into two groups, with 55 subjects in the group aged < 65 years and 61 in the group aged ≥ 65 years. AGEs were measured by skin autofluorescence while carotid–femoral PWV was assessed by tonometry.ResultsA significant (positive) association was observed between PWV and AGE skin autofluorescence in the younger age group (r = 0.51; P < 0.0001). However, this association was no longer significant after further adjustments for age and other factors on multiple regression analyses. In contrast, this correlation was not found in the elderly group (r = 0.098; P = 0.454).ConclusionYounger non-diabetic subjects exhibit a different correlation profile between AGEs accumulated in skin and cfPWV as an index of arterial stiffness compared with elderly subjects. AGEs were significantly associated with cfPWV in younger individuals, but not in the elderly. A further study with a larger number of subjects is proposed to confirm the contribution of AGEs, the formation of which is manageable, as a determinant of arterial stiffness in younger subjects.     

Insulin resistance as a risk factor for subclinical atherosclerosis in rheumatoid arthritis

BackgroundInsulin resistance (IR) is strongly associated with systemic inflammation. Insulin resistance is known to be increased in patients with rheumatoid arthritis (RA) and has been shown to be a risk factor for both clinical cardiovascular disease and subclinical atherosclerosis.Aim of the workTo study the relationship between insulin resistance, disease activity and subclinical atherosclerosis in RA patients.Patients and methodsForty RA patients and twenty age and sex matched healthy individuals as controls were included. Patients with diabetes mellitus, obesity and hypertension were excluded. Fasting plasma sugar and serum insulin were done, RA disease activity was assessed using the disease activity score (DAS28) and IR was evaluated by the homeostasis model assessment (HOMA2). Carotid artery intima media thickness (IMT) was evaluated using ultrasound.ResultsRA patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) positivity, fasting plasma sugar and fasting serum insulin, HOMA2-IR levels than the controls. IR was present in 33 (82.5%) RA patients while it was present in only one (10%) of the controls (p = 0.001). RA patients with IR had significantly longer disease duration (p = 0.003), higher disease activity (p = 0.000), greater carotid IMT (p = 0.000), and more carotid plaques (p = 0.043) than those without insulin resistance. RA patients with increased IMT had significantly longer disease duration (p = 0.002), higher DAS28 score (p = 0.000) and higher HOMA2-IR (p = 0.000) than those with normal IMT.ConclusionsIn RA patients, IR significantly correlated with both disease activity and disease duration. Our study pointed out a significant association between IR and subclinical atherosclerosis in RA.     

Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the Cardiovascular Risk in Young Finns Study and the Health 2000 Survey

ObjectiveIncreased arterial pulse wave velocity (PWV) is a strong predictor of cardiovascular events and mortality. The data regarding the relationships between PWV and other indices of vascular damage is limited and partly controversial. We conducted the present study to examine PWV in relation to non-invasive measures of early atherosclerosis (brachial flow-mediated dilation [FMD], carotid intima-media thickness [IMT]) and local arterial stiffness (carotid artery distensibility [Cdist]).MethodsThe study population consisted of 1754 young adults (aged 30–45 years, 45.5% males) participating in the Cardiovascular Risk in Young Finns Study (YFS), and of 336 older adults (aged 46–76 years, 43.2% males) participating in the Health 2000 Survey. FMD was measured only in the YFS cohort. FMD, IMT and Cdist were assessed by ultrasound, and PWV was measured using the whole-body impedance cardiography device.ResultsIn young adults, FMD and IMT were not associated with PWV independently of cardiovascular risk factors. Moreover, FMD status was not found to modulate the association between cardiovascular risk factors and PWV. In older adults, PWV and IMT were directly and independently associated (β = 1.233, p = 0.019). In both cohorts, PWV was inversely related with Cdist, and this relation remained significant (p < 0.04) in models adjusted for cardiovascular risk factors.ConclusionsThe current findings suggest that PWV reflects a different aspect of vascular damage than FMD or IMT in young adults, whereas in older adults the information provided by PWV and IMT may be, to some extent, similar as regards subclinical vascular damage. The present observations also suggest that PWV and Cdist represent, at least in part, a similar adverse vascular wall process.     

5-Aminosalicylates and renal function monitoring in inflammatory bowel disease: A nationwide survey

Background and aim5-Aminosalicylates (ASA) are widely used in inflammatory bowel disease (IBD). Nephrotoxicity has been described in some IBD patients treated with 5-ASA. Whether physicians managing these patients are monitoring renal function in daily practice is unknown. The aims of this paper were to investigate how private gastroenterologists monitor renal function and manage renal failure in IBD patients treated with oral 5-ASA therapy.MethodsThis was a web-based cross sectional national survey which was conducted among private gastroenterologists.ResultsA total of 249 practitioners completed the survey. Eighty two percent (n = 205) of responders declared that they always monitor renal function. The respondents monitored twice a year Glomerular Filtration Rate (eGFR) using Modification of Diet in Renal Disease (MDRD) [90% (n = 225)] and Creatinine Clearance (CCr) using a 24-hour urine collection [51% (n = 126)]. Blood electrolytes, 24-hour urinary protein rate and dipsticks are performed by 41%, 39% and 22% of practitioners, respectively. Before oral 5-ASA initiation, 59% (n = 148) of respondents screen for renal failure. In case of elevated serum creatinine, a nephrologist's opinion is asked by 80% (n = 200) of responders and by 76% (n = 189) of respondents before treatment initiation.ConclusionsMost gastroenterologists are monitoring renal function once or twice a year in IBD patients on 5-ASA. Less than two thirds of them screen for renal failure before treatment initiation. MDRD is mainly used, but a wide range of parameters is evaluated.     

MCP-1 gene A-2518G polymorphism and carotid artery atherosclerosis in patients with type 2 diabetes

AimsCardiovascular diseases are the major cause of mortality in patients with diabetes mellitus. Monocyte chemoattractant protein-1 (MCP-1) is a potent chemokine and plays an important role in cardiovascular diseases. The objective of this study was to evaluate the relation between the genotypes of the MCP-1 A-2518G polymorphism and the development of carotid atherosclerosis in patients with type 2 diabetes.MethodsThe subjects were 303 unrelated patients who were diagnosed with type 2 diabetes mellitus. To evaluate macroangiopathy, we measured carotid artery intima-media thickness (IMT) by ultrasonography. The MCP-1 A-2518G polymorphism was determined by TaqMan PCR method.ResultsIMT in patients with the MCP-1 −2518 AG or GG genotype was significantly greater than the AA-genotype (P = 0.007). Simple regression analysis showed that age, systolic blood pressure, LDL-cholesterol, the MCP-1 −2518 AG + GG polymorphism, and HbA1c level were correlated with IMT (P < 0.0001, <0.0001, 0.006, 0.007, 0.025, respectively). In multiple regression analysis, the MCP-1 −2518 AG + GG polymorphism was the third strongest independent determinant of IMT in patients with type 2 diabetes (P = 0.021), subsequent to age and systolic blood pressure.ConclusionAssessment of the MCP-1 A-2518G polymorphism would be useful in identifying the risk of developing carotid atherosclerosis in patients with type 2 diabetes.     

Detection of liver injury in IBD using transient elastography

BackgroundUp to 5% of inflammatory bowel disease (IBD) patients are thought to have clinically significant liver disease due to multifactorial causes, however, this figure may be an underestimate due to reliance on abnormal liver tests (LTs) and/or liver biopsies.AimsOur aim was to evaluate the prevalence of clinically significant liver disease in IBD patients as defined by an increased liver stiffness measurement (LS) ≥ 8 kPa using transient elastography (TE).Methods110 IBD patients, and 55 non-IBD control subjects, had their LS recorded using FibroScan® (EchoSense, Paris, France) by a single blinded operator trained in TE.Results71 Crohn's disease and 39 ulcerative colitis subjects were included. All demographic variables were similar between the IBD and control groups apart from a significantly higher proportion of IBD patients who smoked (17.3% vs 3.6%, P = 0.013). Seven IBD patients (6.4%) had an LS over 8 kPa and 3 had persistently elevated LS 6 months later. One patient had compensated cirrhosis. No significant differences in overall LS were observed between the IBD and control groups. Increased BMI and age, however, were independently associated with a higher LS in the IBD but not in the control group (P < 0.001 and 0.010 respectively).ConclusionUsing TE, the prevalence of clinically significant liver disease in IBD patients is low. The association of increased BMI and age with increased LS in IBD suggests fatty liver disease being the prevailing aetiology in these patients.     

Maternal inflammatory bowel disease has short and long-term effects on the health of their offspring: A multicenter study in Israel

BackgroundThere are concerns about the effect of inflammatory bowel diseases (IBD) on fertility, pregnancy and pregnancy outcomes, but no long-term data on the health of offspring born to IBD mothers. The aims were to assess the short- and long-term effects of maternal IBD on the morbidity and development of their offspring.MethodsFemale IBD patients and controls completed questionnaires on their pregnancy outcome, and their offspring's short- and long-term health and development.ResultsIBD and control mothers (159 and 175, respectively) were recruited. Medical data of 412 IBD and 417 control offspring were recorded. IBD mothers had significantly more singleton pregnancies, their offspring's birth weight was significantly lower, and they breastfed significantly less compared to controls (P = 0.028, 0.007, and < 0.0001, respectively). There were significantly more congenital anomalies (mainly limb deformities) among the IBD offspring (P < 0.035). Offspring born post-maternal IBD diagnosis, compared to pre-diagnosis, tended to have more neurodevelopmental problems (e.g., gross motor delay, P = 0.03). IBD was significantly more prevalent in the offspring of IBD mothers, while allergies and atopic dermatitis were more frequent in offspring of control mothers. More offspring of IBD mothers taking medications during pregnancy were born preterm and had lower birth weights compared to offspring of IBD mothers not taking medications during pregnancy. Children of mothers taking steroids had the lowest birth weights, compared to those of IBD mothers taking 5ASAs or immunomodulators.ConclusionsMaternal IBD affects pregnancy and the offspring's immediate and long-term morbidity, specifically, congenital anomalies and neurodevelopmental problems.