Publications by authors named "Niki Katsiki"

348 Publications

New Antidiabetic Therapies: A Paradigm Shift in Type 2 Diabetes Management.

Curr Pharm Des 2021 ;27(8):1007

Division of Endocrinology and Metabolism - Diabetes Center, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA, University Hospital, St. Kiriakidi Street, 54636, Thessaloniki, Greece.

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http://dx.doi.org/10.2174/138161282708210308141311DOI Listing
January 2021

Trend of perceived quality of life and functional capacity in outpatients with chronic heart failure and in treatment with sacubitril/valsartan: a real-life experience.

Minerva Cardiol Angiol 2021 Apr 7. Epub 2021 Apr 7.

Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

Background: Despite the use of optimal medical therapy, HFrEF remains a leading cause of morbidity, mortality and health care costs. The introduction of angiotensin receptor/neprilysin inhibitors (ARNIs) had a revolutionary impact on the treatment of patients with heart failure and reduced left ventricular ejection fraction (HFrEF).

Methods: The aim of the study was to monitor over time the perceived quality of life, the physical performance, the trend of BNP and NT-ProBNP and the NYHA functional class in patients with HFrEF during treatment with sacubitril/valsartan. We enrolled 37 patients (63 ± 10 years old, 76% men) who underwent a total of one year follow-up. All patients underwent clinical evaluation, 6MWT, blood analysis (in particular NT-pro-BNP and BNP, renal function test); Kansas City Cardiomyopathy Questionnaire (KCCQ) and the NYHA functional class assessment were also performed, at the beginning of the study and after 3, 6 and 12 months of therapy.

Results: We observed at each follow-up a significant improvement of KCCQ score, 6MWT, NTProBNP, BNP and of NYHA class. However, analyzing the Δ % of variation of each single parameter, the improvement was not uniform in time. We also observed that only 37% of patients tolerated the full recommended dose of sacubitril/valsartan (97/103 mg b.i.d.); of the remaining, 40% tolerated the intermediate dose (49/51 mg b.i.d.) and 23% the minimum (24/26 md b.i.d.).

Conclusions: Sacubitril/valsartan therapy improves significantly quality of life, physical effort resistance, BNP and NT-ProBNP and NYHA functional class in patients with HFrEF. Although not all the patients tolerated the maximum recommended dose, the beneficial effects were significant even at lower doses.
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http://dx.doi.org/10.23736/S2724-5683.20.05494-8DOI Listing
April 2021

Effects of Sacubitril/Valsartan in Patients with High Arrhythmic Risk and an ICD: A Longitudinal Study.

Clin Drug Investig 2021 Feb 23;41(2):169-176. Epub 2021 Jan 23.

Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

Purpose: Patients affected by heart failure with reduced ejection fraction (HFrEF) receive clinical and functional beneficial effects from treatment with sacubitril/valsartan. However previous studies have shown that patients with an implantable cardioverter defibrillator (ICD) could obtain even greater benefit, but only make up a only a small proportion of patients. In the current study we evaluated the effect of sacubitril/valsartan in patients with an ICD.

Methods: Thirty-five outpatients with HFrEF (aged 60 ± 11 years, 28 were males), on optimal medical therapy were studied. All patients received an ICD at least 6 months before enrollment or were non-responders to ICD plus resynchronization (CRT-D). An open-label sacubitril/valsartan treatment was established at the maximum tolerated dose. Clinical assessment, 6-min walk test (6MWT) and echocardiography, were performed during follow-up at 90, 180, and 360 days. Quality of life score and perceived fatigue on exercise were assessed.

Results: Clinical conditions dramatically improved in most patients, especially within the first 6 months of therapy (76 % were in NYHA-I and 24 % in NYHA-II at the end of study vs 71 % NYHA-II and 29 % NYHA III at enrollment, p < 0.001). Quality of life and exercise performance significantly improved according to N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels lowering. Walking distance at 6MWT increased from 274 ± 97 to 389 ± 53 m and walking speed from 0.74 ± 0.27 to 1.07 ± 0.15 m/s (p < 0.001), while oxygen saturation did not differ significantly (from 90 ± 1 % to 91 ± 2 %). More gradual was left ventricular reverse remodeling. Ejection fraction improved mildly (+ 5 points %, p < 0.001). Global longitudinal strain and diastolic function were also assessed over time.

Conclusion: Sacubitril/valsartan therapy for HFrEF may lead to significant clinical and functional improvements even in patients with ICD at greater arrhythmic risk. Clinical improvement is obtained within the first 6 months of treatment while reverse remodeling needs more time.
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http://dx.doi.org/10.1007/s40261-020-00995-3DOI Listing
February 2021

Thrombosis and Haemostasis challenges in COVID-19 - Therapeutic perspectives of heparin and tissue-type plasminogen activator and potential toxicological reactions-a mini review.

Food Chem Toxicol 2021 Feb 6;148:111974. Epub 2021 Jan 6.

Oncology Department, Elias Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

The coronavirus disease (COVID)-19 pandemic is a major challenge for the health systems worldwide. Acute respiratory distress syndrome (ARDS), is one of the most common complications of the COVID-19 infection. The activation of the coagulation system plays an important role in the pathogenesis of ARDS. The development of lung coagulopathy involves thrombin generation and fibrinolysis inhibition. Unfractionated heparin and its recently introduced counterpart low molecular weight heparin (LMWH), are widely used anticoagulants with a variety of clinical indications allowing for limited and manageable physio-toxicologic side effects while the use of protamine sulfate, heparin's effective antidote, has made their use even safer. Tissue-type plasminogen activator (tPA) is approved as intravenous thrombolytic treatment. The present narrative review discusses the use of heparin and tPA in the treatment of COVID-19-induced ARDS and their related potential physio-toxicologic side effects. The article is a quick review of articles on anticoagulation in COVID infection and the potential toxicologic reactions associated with these drugs.
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http://dx.doi.org/10.1016/j.fct.2021.111974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837001PMC
February 2021

Emerging Cardiovascular Risk Factors and Specific Patient Populations at Increased Cardiovascular Risk.

Curr Vasc Pharmacol 2021 ;19(3):241-242

Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.

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http://dx.doi.org/10.2174/157016111903201231115755DOI Listing
January 2021

Serum uric acid and diabetes: from pathophysiology to cardiovascular disease.

Curr Pharm Des 2021 Jan 4. Epub 2021 Jan 4.

Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London NW3 2QG. United Kingdom.

Hyperuricemia, has been traditionally related to nephrolithiasis and gout. However, it has also been associated with the development of type 2 diabetes mellitus (T2DM) and cardiometabolic and cardiovascular diseases. Pathophysiologically, elevated serum uric acid (SUA) levels may be associated with abnormal lipid and glucose metabolism. In this narrative review, we consider the associations between hyperuricemia, hyperglycemia, atherosclerosis and thrombosis. Furthermore, we comment on the available evidence linking elevated SUA levels with the incidence and outcomes of coronary heart disease, stroke, peripheral artery disease and non-alcoholic fatty liver in subjects with T2DM. The effects of antidiabetic drugs (e.g. metformin, pioglitazone, sulfonylureas, dipeptidyl peptidase 4 inhibitors, glucagonlike peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors and insulin) on SUA concentrations are also reviewed.
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http://dx.doi.org/10.2174/1381612827666210104124320DOI Listing
January 2021

Metabolic Syndrome and Abnormal Peri-Organ or Intra-Organ Fat (APIFat) Deposition in Chronic Obstructive Pulmonary Disease: An Overview.

Metabolites 2020 Nov 15;10(11). Epub 2020 Nov 15.

Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK.

Chronic obstructive pulmonary disease (COPD) is a common disorder with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Systemic inflammation is involved in the pathogenesis of COPD and can also predispose to metabolic disorders (e.g., metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD)). Such comorbidities can negatively affect COPD outcomes, cardiovascular risk, and quality of life. Apart from NAFLD, abnormal peri-organ or intra-organ fat (APIFat) could be considered as markers for cardiometabolic diseases and even for COPD. The present narrative review considers the associations of COPD with MetS, NAFLD, and other APIFat, including epicardial, perirenal, peripancreatic, and intramuscular adipose tissue. Further research is needed to define these relationships and identify any potential clinical implications.
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http://dx.doi.org/10.3390/metabo10110465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696438PMC
November 2020

Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society.

Int J Stroke 2020 Nov 17:1747493020971970. Epub 2020 Nov 17.

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, 37796University of Ioannina, Ioannina, Greece.

This document presents the consensus recommendations of the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society for lipid modification in patients with ischemic stroke or transient ischemic attack. This clinical guide summarizes the current literature on lipid management and can be of assistance to the physicians treating stroke patients in clinical practice.
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http://dx.doi.org/10.1177/1747493020971970DOI Listing
November 2020

Diabetes and carotid artery disease: a narrative review.

Ann Transl Med 2020 Oct;8(19):1280

Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.

Diabetes mellitus (DM) has been linked to an increased prevalence and severity of carotid artery disease, as well as polyvascular disease. Carotid disease is also associated with obesity and abnormal peri-organ and intra-organ fat (APIFat) deposition (i.e., excess fat accumulation in several organs such as the liver, heart and vessels). In turn, DM is associated with APIFat. The coexistence of these comorbidities confers a greater risk of vascular events. Clinicians should also consider that carotid bruits may predict cardiovascular risk. DM has been related to a greater risk of adverse outcomes after carotid endarterectomy or stenting. Whether modifying risk factors (e.g., glycaemia and dyslipidaemia) in DM patients can improve the outcomes of these procedures needs to be established. Furthermore, DM is a risk factor for contrast-induced acute kidney injury (CI-AKI). The latter should be recorded in DM patients undergoing carotid stenting since it can influence both short- and long-term outcomes. From a pathophysiological perspective, functional changes in the carotid artery may precede morphological ones. Furthermore, carotid plaque characteristics are increasingly being studied in terms of vascular risk stratification and monitoring short-term changes attributed to treatment. The present narrative review discusses the recent (2019) literature on the associations between DM and carotid artery disease. Physicians and vascular surgeons looking after patients with carotid disease and DM should consider these links that may influence outcomes. Further research in this field is also needed to optimise the treatment of such patients.
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http://dx.doi.org/10.21037/atm.2019.12.153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607073PMC
October 2020

NLRP3 Inflammasome Biomarker-Could Be the New Tool for Improved Cardiometabolic Syndrome Outcome.

Metabolites 2020 Nov 6;10(11). Epub 2020 Nov 6.

Internal Medicine Department, Ovidius University, 900470 Constanta, Romania.

Metabolomics, the research area studying chemical processes involving metabolites, finds its utility in inflammasome biomarker discovery, thus representing a novel approach for cardiometabolic syndrome pathogeny acknowledgements. Metabolite biomarkers discovery is expected to improve the disease evolution and outcome. The activation of abundantly expressed NLRP3 inflammasome represents the background process of the diabetes mellitus disturbances like hyperglycemia and insulin resistance, as well as for myocardial cell death and fibrosis, all of them being features characteristic for cardiometabolic syndrome. Many molecules like troponins, brain natriuretic protein (BNP), ST2/IL-33, C-reactive protein (CRP), TNF, IL-1β, and IL-18 cytokines have been already examined as molecular markers for diagnosing or predicting different cardiac disturbances like myocardial infarction, heart failure, or myocarditis. In addition, metabolomics research comes with new findings arguing that NLRP3 inflammasome becomes a promising molecular tool to use for clinical and therapeutical management providing new targets for therapies in cardiometabolic syndrome. Inflammasome markers analyses, along with other molecular or genetic biomarkers, will result in a better understanding of cardiometabolic syndrome pathogenesis and therapeutic targets. Screening, diagnostic, and prognostic biomarkers resulted from inflammasome biomarker research will become standard of care in cardiometabolic syndrome management, their utility becoming the first magnitude.
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http://dx.doi.org/10.3390/metabo10110448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694742PMC
November 2020

More Good News on Statins and COVID-19.

Am J Cardiol 2021 01 23;138:127-128. Epub 2020 Oct 23.

Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK.

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http://dx.doi.org/10.1016/j.amjcard.2020.10.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583589PMC
January 2021

The Role of microRNAs in the Development of Type 2 Diabetes Complications.

Curr Pharm Des 2020 ;26(46):5969-5979

Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.

MicroRNAs represent a class of small (19-25 nucleotides) single-strand pieces of RNA that are noncoding ones. They are synthesized by RNA polymerase II from transcripts that fold back on themselves. They mostly act as gene regulatory agents that pair with complementary sequences on mRNA and produce silencing complexes, which, in turn, suppress coding genes at a post-transcriptional level. There is now evidence that microRNAs may affect insulin secretion or insulin action, as they can alter pancreatic beta cells development, insulin production, as well as insulin signaling. Any molecular disorder that affects these pathways can deteriorate insulin resistance and lead to type 2 diabetes mellitus (T2DM) onset. Furthermore, the expression of several microRNAs is up- or down-regulated in the presence of diabetic microvascular complications (i.e., peripheral neuropathy, nephropathy, retinopathy, foot ulcers), as well as in patients with coronary heart disease, stroke, and peripheral artery disease. However, more evidence is needed, specifically regarding T2DM patients, to establish the use of such microRNAs as diagnostical biomarkers or therapeutic targets in daily practice.
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http://dx.doi.org/10.2174/1381612826666201102102233DOI Listing
January 2020

Monounsaturated Fatty Acid Levels May Not Affect Cardiovascular Events: Results From a Mendelian Randomization Analysis.

Front Nutr 2020 2;7:123. Epub 2020 Sep 2.

Department of Hypertension, Medical University of Lodz, Łódz, Poland.

Several observational studies evaluated the links between serum monounsaturated fatty acids (MUFAs) and cardiovascular events with controversial results. In the present study, Mendelian randomization (MR) analysis was applied to obtain unconfounded estimates of the causal associations of genetically determined serum MUFAs with coronary heart disease (CHD), myocardial infarction (MI), cardioembolic stroke (CS), and ischemic stroke (IS). Four MUFAs were studied (i.e., 10-heptadecenoate, myristoleic, oleic, and palmitoleic acid). Data from the largest genome-wide association studies on MUFAs, CHD, MI, and stroke were analyzed. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger, as well as MR-pleiotropy residual sum and outlier were applied. To rule out the impact of single-nucleotide polymorphism (SNP), the leave-one-out method was also performed. Genetically higher-serum 10-heptadecenoate levels did not affect the risk of CHD (IVW = Beta: -0.304, = 0.185), MI (IVW = Beta: -0.505, = 0.066), CS (IVW = Beta: -0.056, = 0.945), and IS (IVW = Beta: -0.121, = 0.767). Similarly, no significant associations were observed for myristoleic acid (CHD: IVW = Beta: 0.008; MI: IVW = Beta: 0.041; CS: IVW = Beta: 0.881; IS: IVW = Beta: 0.162), oleic acid (CHD: IVW = Beta: -0.2417; MI: IVW = Beta: -0.119; CS: IVW = Beta: 1.059; IS: IVW = Beta: 0.008491), and palmitoleic acid (CHD: IVW = Beta: -0.06957; MI: IVW = Beta: -0.01255; CS: IVW = Beta: 1.042; IS: IVW = Beta: -0.1862). A low likelihood of heterogeneity and pleiotropy was reported, and the observed associations were not driven by single SNPs. In the present MR analysis, serum MUFA levels were not associated with the risk of CHD, MI, CS, and IS. Further research, evaluating more MUFAs, is required to elucidate the links between MUFAs and CVD to contribute to health policy decisions in reducing CVD risk.
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http://dx.doi.org/10.3389/fnut.2020.00123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492609PMC
September 2020

Longer sleep duration may negatively affect renal function.

Int Urol Nephrol 2021 Feb 24;53(2):325-332. Epub 2020 Sep 24.

Department of Hypertension, Chair of Nephrology and Hypertension, WAM University Hospital, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.

Background: Observational studies evaluating the link between sleep duration and kidney function reported controversial results. In the present study, Mendelian randomization analysis was applied to obtain unconfounded estimates of the casual association of genetically determined sleep duration with estimated glomerular filtration rate and the risk of chronic kidney disease.

Methods: Data from the largest genome-wide association studies on self-reported and accelerometer-derived sleep duration, estimated glomerular filtration rate and chronic kidney disease were analysed in total, as well as separately in diabetic and non-diabetic individuals. Inverse variance weighted (IVW) method, weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) were applied, as well as the leave-one-out method to rule out the impact of single single-nucleotide polymorphism.

Results: Individuals with genetically longer self-reported sleep duration had a higher chronic kidney disease risk (IVW: β = 0.358, p = 0.047). Furthermore, in non-diabetics, longer self-reported sleep duration was negatively associated with estimated glomerular filtration rate (IVW: β = - 0.024, p = 0.020). Similarly, accelerometer-derived sleep duration was negatively related to estimated glomerular filtration rate in the total population (IVW: β = - 0.019, p = 0.047) and then on-diabetic individuals. No significant association was found between self-reported sleep duration and estimated glomerular filtration rate in the whole population and type-2 diabetes mellitus patients. None of the estimated associations was subjected to a significant level of heterogeneity. MR-PRESSO analysis did not show any chance of outliers for all estimates. The pleiotropy test also indicated low chance of pleiotropy. The leave-one-out method demonstrated that the links were not driven by single-nucleotide polymorphisms.

Conclusions: For the first time, the present study shed a light on the potential harmful effects of longer sleep duration (measured both objectively and subjectively) on kidney function. This finding was observed in the total population and in non-diabetic individuals, but not in those with diabetes. Further research is needed to elucidate the links between sleep duration, estimated glomerular filtration rate and the risk of chronic kidney disease.
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http://dx.doi.org/10.1007/s11255-020-02624-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862211PMC
February 2021

Mitochondrial dysfunction in cardiovascular disease: Current status of translational research/clinical and therapeutic implications.

Med Res Rev 2021 01 21;41(1):275-313. Epub 2020 Sep 21.

First Department of Internal Medicine, Division of Endocrinology and Metabolism, Diabetes Center, Medical School, AHEPA University Hospital, Thessaloniki, Greece.

Mitochondria provide energy to the cell during aerobic respiration by supplying ~95% of the adenosine triphosphate (ATP) molecules via oxidative phosphorylation. These organelles have various other functions, all carried out by numerous proteins, with the majority of them being encoded by nuclear DNA (nDNA). Mitochondria occupy ~1/3 of the volume of myocardial cells in adults, and function at levels of high-efficiency to promptly meet the energy requirements of the myocardial contractile units. Mitochondria have their own DNA (mtDNA), which contains 37 genes and is maternally inherited. Over the last several years, a variety of functions of these organelles have been discovered and this has led to a growing interest in their involvement in various diseases, including cardiovascular (CV) diseases. Mitochondrial dysfunction relates to the status where mitochondria cannot meet the demands of a cell for ATP and there is an enhanced formation of reactive-oxygen species. This dysfunction may occur as a result of mtDNA and/or nDNA mutations, but also as a response to aging and various disease and environmental stresses, leading to the development of cardiomyopathies and other CV diseases. Designing mitochondria-targeted therapeutic strategies aiming to maintain or restore mitochondrial function has been a great challenge as a result of variable responses according to the etiology of the disorder. There have been several preclinical data on such therapies, but clinical studies are scarce. A major challenge relates to the techniques needed to eclectically deliver the therapeutic agents to cardiac tissues and to damaged mitochondria for successful clinical outcomes. All these issues and progress made over the last several years are herein reviewed.
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http://dx.doi.org/10.1002/med.21732DOI Listing
January 2021

Hypoglycaemia and Cardiovascular Disease Risk in Patients with Diabetes.

Curr Pharm Des 2020 ;26(43):5637-5649

Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom.

Hypoglycaemia represents an important side effect of insulin therapy and insulin secretagogues. It can occur in both type 1 and type 2 diabetes mellitus patients. Also, some associations between hypoglycaemia and cardiovascular (CV) risk have been reported. Several mechanisms may be involved, including the sympathoadrenal system, hypokalaemia, endothelial dysfunction, coagulation, platelets, inflammation, atherothrombosis and impaired autonomic cardiac reflexes. This narrative review discusses the associations of hypoglycaemia with CV diseases, including coronary heart disease (CHD), cardiac arrhythmias, stroke, carotid disease and peripheral artery disease (PAD), as well as with dementia. Severe hypoglycaemia has been related to CHD, CV and all-cause mortality. Furthermore, there is evidence supporting an association between hypoglycaemia and cardiac arrhythmias, potentially predisposing to sudden death. The data linking hypoglycaemia with stroke, carotid disease and PAD is limited. Several factors may affect the hypoglycaemia-CV relationships, such as the definition of hypoglycaemia, patient characteristics, co-morbidities (including chronic kidney disease) and antidiabetic drug therapy. However, the association between hypoglycaemia and dementia is bilateral. Both the disorders are more common in the elderly; thus, glycaemic goals should be carefully selected in older patients. Further research is needed to elucidate the impact of hypoglycaemia on CV disease.
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http://dx.doi.org/10.2174/1381612826666200909142658DOI Listing
January 2020

Anti-inflammatory properties of antidiabetic drugs: A "promised land" in the COVID-19 era?

J Diabetes Complications 2020 12 26;34(12):107723. Epub 2020 Aug 26.

C.N.R. Institute of Clinical Physiology, Pisa, Italy. Electronic address:

Inflammation is implicated in the development and severity of the coronavirus disease 2019 (COVID-19), as well as in the pathophysiology of diabetes. Diabetes, especially when uncontrolled, is also recognized as an important risk factor for COVID-19 morbidity and mortality. Furthermore, certain inflammatory markers [i.e. C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin] were reported as strong predictors of worse outcomes in COVID-19 positive patients. The same biomarkers have been associated with poor glycemic control. Therefore, achieving euglycemia in patients with diabetes is even more important in the era of the COVID-19 pandemic. Based on the above, it is clinically interesting to elucidate whether antidiabetic drugs may reduce inflammation, thus possibly minimizing the risk for COVID-19 development and severity. The present narrative review discusses the potential anti-inflammatory properties of certain antidiabetic drugs (i.e. metformin, pioglitazone, sitagliptin, linagliptin, vildagliptin, alogliptin, saxagliptin, liraglutide, dulaglutide, exenatide, lixisenatide, semaglutide, empagliflozin, dapagliflozin, canagliflozin), with a focus on CRP, IL-6 and ferritin.
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http://dx.doi.org/10.1016/j.jdiacomp.2020.107723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448766PMC
December 2020

Empagliflozin effects on cardiac remodeling: re-shaping the future of heart failure prevention.

Expert Rev Cardiovasc Ther 2020 11 16;18(11):841-842. Epub 2020 Sep 16.

Hypertension-24h ABPM ESH Centre of Excellence, 3rd Department of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece.

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http://dx.doi.org/10.1080/14779072.2020.1822069DOI Listing
November 2020

NAFLD and Statins.

Dig Dis Sci 2020 10 14;65(10):3052-3053. Epub 2020 Aug 14.

Department of Clinical Biochemistry, Royal Free Hospital, University College London, London, UK.

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http://dx.doi.org/10.1007/s10620-020-06505-xDOI Listing
October 2020

A Greater Flavonoid Intake Is Associated with Lower Total and Cause-Specific Mortality: A Meta-Analysis of Cohort Studies.

Nutrients 2020 Aug 6;12(8). Epub 2020 Aug 6.

Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 93-338 Lodz, Poland.

The links between flavonoid intake and mortality were previously evaluated in epidemiological studies. The aim of the present study was to perform a systematic review and meta-analysis of cohort studies evaluating the link of flavonoid consumption with total and cause-specific mortality. Prospective cohort studies reporting flavonoid intake and mortality data published up to 30th April 2019 (without language restriction) were searched using PubMed, Scopus and EMBASE database. Generic inverse variance methods and random effects models were used to synthesize pooled and quantitative data. Sensitivity analysis was also performed by a leave-one-out method. Overall, 16 articles met the inclusion criteria (nine studies were performed in Europe, five in the USA, one in Asia and one in Oceania); a total of 462,194 participants (all adults aged >19 years) with 23,473 mortality cases were included in the final analysis. The duration of follow-up ranged from 4.8 to 28 years. Most of the studies assessed flavonoid intake using food frequency questionnaires, whereas four studies used interviews and 1 study used 4-day food records. The meta-analysis showed that flavonoid consumption was inversely and significantly associated with total (relative risk (RR): 0.87, 95% confidence interval (CI) = 0.77-0.99) and cardiovascular disease mortality risk (RR: 0.85, 95%CI = 0.75-0.97), but not cancer (0.86, 95%CI = 0.65-1.14) mortality risk. These findings remained robust in sensitivity analyses. The present findings highlight the potential protective role of flavonoids against total and cause-specific mortality. These results support the recommendations for flavonoid-rich foods intake to prevent chronic diseases.
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http://dx.doi.org/10.3390/nu12082350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469069PMC
August 2020

Making progress towards a better pathophysiological understanding and more promising therapeutic options for treating non-alcoholic steatohepatitis (NASH)/DASH (dysmetabolism associated steatohepatitis).

Metabolism 2021 01 6;114:154333. Epub 2020 Aug 6.

Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA. Electronic address:

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http://dx.doi.org/10.1016/j.metabol.2020.154333DOI Listing
January 2021

Lipoprotein Apheresis and Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Patients With Heterozygous Familial Hypercholesterolemia: A One Center Study.

J Cardiovasc Pharmacol Ther 2021 Jan 30;26(1):51-58. Epub 2020 Jul 30.

Metropolitan Hospital, Cardiometabolic Center, Lipoprotein Apheresis and Lipid Disorders Clinic, Athens, Greece.

Aim: We evaluated the lipid-lowering (LL) effect of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with heterozygous familial hypercholesterolemia (HeFH) treated with LL-drugs and lipoprotein apheresis (LA).

Patients And Methods: The PCSK9i treatment (evolocumab 420 mg/4 weeks, alirocumab 150 mg/2 weeks, or alirocumab 75 mg/2 weeks: 9, 6, and 2 patients, respectively) was initiated in patients with HeFH (n = 17; aged 35-69 years, 10 men, previously treated with statins + ezetimibe ± colesevelam and LA sessions for 2-12 years). A lipid profile was obtained before and immediately after the LA session and before, 1 and 2 months after switching to PCSK9i treatment. The duration of PCSK9i therapy ranged from 3 to 18 months.

Results: Median total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) levels before LA were 268, 198, 46, and 126 mg/dL, respectively, and decreased (at the end of the LA session) to 117, 50, 40, and 51 mg/dL, respectively ( < .001 for TC and = .001 for all other comparisons). The median time-averaged LDL-C levels following LA were 155 (121, 176; median [25th, 75th percentile]) mg/dL. Median TC, LDL-C, and TG levels before PCSK9i therapy were 269, 190, and 127 mg/dL and decreased to 152, 100, and 95 mg/dL, respectively ( = .002, < .002, and < .03, respectively). Steady LDL-C levels with PCSK9i treatment were significantly lower compared with time-averaged LDL-C levels following LA (median value: 100 vs 155 mg/dL; = .008). With PCSK9i, from 13 patients with CHD, 6 (46.1%) patients achieved LDL-C <70 mg/dL, and 2 patients (15.4%) achieved LDL-C <100 mg/dL. Lipoprotein apheresis was discontinued in all patients except for 2 who continued once monthly.

Conclusions: PCSK9i can reduce LDL-C more consistently over time compared with a transient decrease following LA in HeFH patients. PCSK9i therapy may reduce the frequency of LA. Larger trials are required to establish the clinical implications of PCSK9i in patients previously on LA.
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http://dx.doi.org/10.1177/1074248420943079DOI Listing
January 2021

Α higher ratio of serum uric acid to serum creatinine could predict the risk of total and cause specific mortality- insight from a US national survey.

Int J Cardiol 2021 Mar 11;326:189-193. Epub 2020 Jun 11.

Department of Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.

Introduction: The link between serum uric acid to serum creatinine ratio (SUA/SCr) and mortality has not been studied yet.

Methods: We prospectively evaluated the association between SUA/SCr and risk of total and cause specific [cardiovascular disease (CVD) and cancer] mortality by applying on the National Health and Nutrition Examination Surveys (NHANES, 1999-2010). Vital status through December 31, 2011 was ascertained. Adjusted Cox proportional hazard regression models were performed to determine the links between SUA/SCr and mortality.

Results: Overall, 20,209 individuals were included (mean age = 47.5 years, 48.9% men) and 3523 deaths occurred during the 76.4 months of follow-up. In a fully adjusted model, individuals in the fourth (Q4) and third (Q3) quartile of SUA/SCr had a 44 and 35% greater risk of total mortality [risk ratio (RR): 1.44 (95% confidence interval, 95%CI: 1.05-1.98) and 1.35 (1.10-1.66), respectively], as well as a 69 and 47% higher risk of CVD death [RR: 1.69 (1.09-2.62) and 1.47 (1.14-1.89), respectively] compared with the lowest (Q1) quartile. With regard to SUA/SCr and cancer mortality, a significant association was found only between participants in Q4 and those in Q1 [RR: 1.12 (1.06-1.19)] in the partially adjusted model, whereas this relationship became non-significant after further adjustments [RR: 1.15 (0.96-1.39)].

Conclusions: This is the first time that SUA/SCr has been associated with total and cause specific mortality in a large, representative sample of US adults. Further studies are needed to confirm these findings and establish their clinical implications.
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http://dx.doi.org/10.1016/j.ijcard.2020.05.098DOI Listing
March 2021

Dietary habits, lipoprotein metabolism and cardiovascular disease: From individual foods to dietary patterns.

Crit Rev Food Sci Nutr 2020 Jun 9:1-19. Epub 2020 Jun 9.

Lipids and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain.

Cardiovascular disease (CVD) remains the first cause of mortality in Western countries. Among cardiometabolic risk factors, dyslipidemia, and especially high low-density lipoprotein cholesterol (LDL-C) concentrations, have been extensively linked to the development and progression of atherosclerosis and to CVD events. Recent evidence has shown that the prevention of unhealthy dietary habits and sedentarism is crucial in the management of dyslipidemia. In this sense, a number of scientific societies recommend the adherence to certain healthy dietary patterns (DPs), such as the Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH), the Portfolio diet, the Vegetarian diet, the Nordic diet and low-carbohydrate diets, as well as increased physical activity between others. This nutritional and lifestyle advice could be adopted by government bodies and implemented in different health programs as a reliable way of providing health-care professionals with efficient tools to manage cardiometabolic risk factors and thus, prevent CVD. In this narrative review, we will discuss recent data about the effects of nutrition on dyslipidemia, mainly focusing on high LDL-C concentrations and other lipid particles related to atherogenic dyslipidemia such as triglycerides (TG) and non-high density lipoprotein cholesterol (non-HDL-C), that are related to CVD. On the other hand, we also comment on other cardiometabolic risk factors such as type 2 diabetes mellitus (T2DM), high blood pressure (HBP), inflammation and endothelial dysfunction. This review includes food groups as well as different healthy DPs.
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http://dx.doi.org/10.1080/10408398.2020.1764487DOI Listing
June 2020

Achieving low-density lipoprotein cholesterol targets as assessed by different methods in patients with familial hypercholesterolemia: an analysis from the HELLAS-FH registry.

Lipids Health Dis 2020 May 28;19(1):114. Epub 2020 May 28.

Department of Internal Medicine, Faculty of Medicine, University of Ioannina, Ioannina, Greece.

Background: Familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels and increased cardiovascular disease (CVD) risk. FH patients often have increased lipoprotein(a) [Lp(a)] levels, which further increase CVD risk. Novel methods for accurately calculating LDL-C have been proposed.

Methods: Patients with FH were recruited by a network of Greek sites participating in the HELLAS-FH registry. LDL-C levels were calculated using the Friedewald (LDL-C) and the Martin/Hopkins (LDL-C) equations as well as after correcting LDL-C for Lp(a) levels [LDL-C]. The objective was to compare LDL-C levels and target achievement as estimated by different methods in FH patients.

Results: This analysis included 1620 patients (1423 adults and 197 children). In adults at diagnosis, LDL-C and LDL-C levels were similar [235 ± 70 mg/dL (6.1 ± 1.8 mmol/L) vs 235 ± 69 mg/dL (6.1 ± 1.8 mmol/L), respectively; P = NS], while LDL-C levels were non-significantly lower than LDL-C [211 ± 61 mg/dL (5.5 ± 1.6 mmol/L); P = 0.432]. In treated adults (n = 966) both LDL-C [150 ± 71 mg/dL (3.9 ± 1.8 mmol/L)] and LDL-C levels [151 ± 70 mg/dL (6.1 ± 1.8 mmol/L); P = 0.746] were similar, whereas LDL-C levels were significantly lower than LDL-C [121 ± 62 mg/dL (3.1 ± 1.6 mmol/L); P < 0.001]. Target achievement as per latest guidelines in treated patients using the LDL-C (2.5%) and especially LDL-C methods (10.7%) were significantly different than LDL-C (2.9%; P < 0.001). In children, all 3 formulas resulted in similar LDL-C levels, both at diagnosis and in treated patients. However, target achievement by LDL-C was lower compared with LDL-C and LDL-C methods (22.1 vs 24.8 vs 33.3%; P < 0.001 for both comparisons).

Conclusion: LDL-C results in significantly lower values and higher target achievement rate in both treated adults and children. If validated in clinical trials, LDL-C may become the method of choice to more accurately estimate 'true' LDL-C levels in FH patients.
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http://dx.doi.org/10.1186/s12944-020-01289-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257219PMC
May 2020

Diabetes mellitus and comorbidities: A bad romance.

Hellenic J Cardiol 2020 Jan - Feb;61(1):23-25. Epub 2020 May 23.

First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.hjc.2020.02.009DOI Listing
October 2020

WITHDRAWN: Α higher ratio of serum uric acid to serum creatinine could predict the risk of total and cause specific mortality - Insight from a US national survey.

Int J Cardiol 2019 Dec 17. Epub 2019 Dec 17.

Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.

This article has been withdrawn at the request of the Publisher. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https: //www.elsevier.com/about/our-business/policies/article-withdrawal.
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http://dx.doi.org/10.1016/j.ijcard.2019.12.029DOI Listing
December 2019

Lipid-lowering therapy and renin-angiotensin-aldosterone system inhibitors in the era of the COVID-19 pandemic.

Arch Med Sci 2020 14;16(3):485-489. Epub 2020 Apr 14.

Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK.

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http://dx.doi.org/10.5114/aoms.2020.94503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212217PMC
April 2020

Non-traumatic and non-drug-induced rhabdomyolysis.

Arch Med Sci Atheroscler Dis 2019 2;4:e252-e263. Epub 2019 Dec 2.

Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.

Rhabdomyolysis (RM), a fortunately rare disease of the striated muscle cells, is a complication of non-traumatic (congenital (glycogen storage disease, discrete mitochondrial myopathies and various muscular dystrophies) or acquired (alcoholic myopathy, systemic diseases, arterial occlusion, viral illness or bacterial sepsis)) and traumatic conditions. Additionally, RM can occur in some individuals under specific circumstances such as toxic substance use and illicit drug abuse. Lipid-lowering drugs in particular are capable of causing RM. This comprehensive review will focus on non-traumatic and non-drug-induced RM. Moreover, the pathology of RM, its clinical manifestation and biochemical effects, and finally its management will be discussed.
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http://dx.doi.org/10.5114/amsad.2019.90152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191942PMC
December 2019

Abnormal Peri-organ-Intra-organ Fat (APIFat) and Rheumatoid Arthritis: An Under-investigated Link for Increased Cardiovascular Risk?

Curr Vasc Pharmacol 2020 ;18(3):249-253

Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.

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http://dx.doi.org/10.2174/1570161117999190802150857DOI Listing
October 2020