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Showing papers by "Andrzej Rynkiewicz published in 2020"


Journal ArticleDOI
TL;DR: PA is effective for the improvement of exercise tolerance, lipid concentrations, blood pressure, and it may also reduce the serum glucose level and risk of thrombosis, thus should be advocated concomitant to, or in some cases instead of, traditional drug-therapy.
Abstract: Background Physical inactivity and resultant lower energy expenditure contribute unequivocally to cardiovascular diseases, such as coronary artery disease and stroke, which are considered major causes of disability and mortality worldwide. Aim The aim of the study was to investigate the influence of physical activity (PA) and exercise on different aspects of health - genetics, endothelium function, blood pressure, lipid concentrations, glucose intolerance, thrombosis, and self - satisfaction. Materials and. Methods In this article, we conducted a narrative review of the influence PA and exercise have on the cardiovascular system, risk factors of cardiovascular diseases, searching the online databases; Web of Science, PubMed and Google Scholar, and, subsequently, discuss possible mechanisms of this action. Results and Discussion Based on our narrative review of literature, discussed the effects of PA on telomere length, nitric oxide synthesis, thrombosis risk, blood pressure, serum glucose, cholesterol and triglycerides levels, and indicated possible mechanisms by which physical training may lead to improvement in chronic cardiovascular diseases. Conclusion PA is effective for the improvement of exercise tolerance, lipid concentrations, blood pressure, it may also reduce the serum glucose level and risk of thrombosis, thus should be advocated concomitant to, or in some cases instead of, traditional drug-therapy.

30 citations


Journal ArticleDOI
TL;DR: In this article, a systematic review of available evidence on the benefits and harms of DPP4i, GLP-1RA, and SGLT2i in people with established CVD, using network meta-analysis is presented.
Abstract: Background: Cardiovascular disease (CVD) is a leading cause of death globally Recently, dipeptidyl peptidase‐4 inhibitors (DPP4i), glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) were approved for treating people with type 2 diabetes mellitus Although metformin remains the first‐line pharmacotherapy for people with type 2 diabetes mellitus, a body of evidence has recently emerged indicating that DPP4i, GLP‐1RA and SGLT2i may exert positive effects on patients with known CVD Objectives: To systematically review the available evidence on the benefits and harms of DPP4i, GLP‐1RA, and SGLT2i in people with established CVD, using network meta‐analysis Search methods: We searched CENTRAL, MEDLINE, Embase, and the Conference Proceedings Citation Index on 16 July 2020 We also searched clinical trials registers on 22 August 2020 We did not restrict by language or publication status Selection criteria: We searched for randomised controlled trials (RCTs) investigating DPP4i, GLP‐1RA, or SGLT2i that included participants with established CVD Outcome measures of interest were CVD mortality, fatal and non‐fatal myocardial infarction, fatal and non‐fatal stroke, all‐cause mortality, hospitalisation for heart failure (HF), and safety outcomes Data collection and analysis: Three review authors independently screened the results of searches to identify eligible studies and extracted study data We used the GRADE approach to assess the certainty of the evidence We conducted standard pairwise meta‐analyses and network meta‐analyses by pooling studies that we assessed to be of substantial homogeneity; subgroup and sensitivity analyses were also pursued to explore how study characteristics and potential effect modifiers could affect the robustness of our review findings We analysed study data using the odds ratios (ORs) and log odds ratios (LORs) with their respective 95% confidence intervals (CIs) and credible intervals (Crls), where appropriate We also performed narrative synthesis for included studies that were of substantial heterogeneity and that did not report quantitative data in a usable format, in order to discuss their individual findings and relevance to our review scope Main results: We included 31 studies (287 records), of which we pooled data from 20 studies (129,465 participants) for our meta‐analysis The majority of the included studies were at low risk of bias, using Cochrane's tool for assessing risk of bias Among the 20 pooled studies, six investigated DPP4i, seven studied GLP‐1RA, and the remaining seven trials evaluated SGLT2i All outcome data described below were reported at the longest follow‐up duration 1 DPP4i versus placebo: Our review suggests that DPP4i do not reduce any risk of efficacy outcomes: CVD mortality (OR 100, 95% CI 091 to 109; high‐certainty evidence), myocardial infarction (OR 097, 95% CI 088 to 108; high‐certainty evidence), stroke (OR 100, 95% CI 087 to 114; high‐certainty evidence), and all‐cause mortality (OR 103, 95% CI 096 to 111; high‐certainty evidence) DPP4i probably do not reduce hospitalisation for HF (OR 099, 95% CI 080 to 123; moderate‐certainty evidence) DPP4i may not increase the likelihood of worsening renal function (OR 108, 95% CI 088 to 133; low‐certainty evidence) and probably do not increase the risk of bone fracture (OR 100, 95% CI 083 to 119; moderate‐certainty evidence) or hypoglycaemia (OR 111, 95% CI 095 to 129; moderate‐certainty evidence) They are likely to increase the risk of pancreatitis (OR 163, 95% CI 112 to 237; moderate‐certainty evidence) 2 GLP‐1RA versus placebo: Our findings indicate that GLP‐1RA reduce the risk of CV mortality (OR 087, 95% CI 079 to 095; high‐certainty evidence), all‐cause mortality (OR 088, 95% CI 082 to 095; high‐certainty evidence), and stroke (OR 087, 95% CI 077 to 098; high‐certainty evidence) GLP‐1RA probably do not reduce the risk of myocardial infarction (OR 089, 95% CI 078 to 101; moderate‐certainty evidence), and hospitalisation for HF (OR 095, 95% CI 085 to 106; high‐certainty evidence) GLP‐1RA may reduce the risk of worsening renal function (OR 061, 95% CI 044 to 084; low‐certainty evidence), but may have no impact on pancreatitis (OR 096, 95% CI 068 to 135; low‐certainty evidence) We are uncertain about the effect of GLP‐1RA on hypoglycaemia and bone fractures 3 SGLT2i versus placebo: This review shows that SGLT2i probably reduce the risk of CV mortality (OR 082, 95% CI 070 to 095; moderate‐certainty evidence), all‐cause mortality (OR 084, 95% CI 074 to 096; moderate‐certainty evidence), and reduce the risk of HF hospitalisation (OR 065, 95% CI 059 to 071; high‐certainty evidence); they do not reduce the risk of myocardial infarction (OR 097, 95% CI 084 to 112; high‐certainty evidence) and probably do not reduce the risk of stroke (OR 112, 95% CI 092 to 136; moderate‐certainty evidence) In terms of treatment safety, SGLT2i probably reduce the incidence of worsening renal function (OR 059, 95% CI 043 to 082; moderate‐certainty evidence), and probably have no effect on hypoglycaemia (OR 090, 95% CI 075 to 107; moderate‐certainty evidence) or bone fracture (OR 102, 95% CI 088 to 118; high‐certainty evidence), and may have no impact on pancreatitis (OR 085, 95% CI 039 to 186; low‐certainty evidence) 4 Network meta‐analysis: Because we failed to identify direct comparisons between each class of the agents, findings from our network meta‐analysis provided limited novel insights Almost all findings from our network meta‐analysis agree with those from the standard meta‐analysis GLP‐1RA may not reduce the risk of stroke compared with placebo (OR 087, 95% CrI 075 to 10; moderate‐certainty evidence), which showed similar odds estimates and wider 95% Crl compared with standard pairwise meta‐analysis Indirect estimates also supported comparison across all three classes SGLT2i was ranked the best for CVD and all‐cause mortality Authors' conclusions: Findings from both standard and network meta‐analyses of moderate‐ to high‐certainty evidence suggest that GLP‐1RA and SGLT2i are likely to reduce the risk of CVD mortality and all‐cause mortality in people with established CVD; high‐certainty evidence demonstrates that treatment with SGLT2i reduce the risk of hospitalisation for HF, while moderate‐certainty evidence likely supports the use of GLP‐1RA to reduce fatal and non‐fatal stroke Future studies conducted in the non‐diabetic CVD population will reveal the mechanisms behind how these agents improve clinical outcomes irrespective of their glucose‐lowering effects

12 citations


Journal ArticleDOI
TL;DR: The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and hsCRP values in patients with AHF, suggesting that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patientswith AHF.
Abstract: Background: Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data. Methods: 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department. Results: During the mean 193 ± 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe’) were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02–1.09), p < 0.005, 1.40 (95% CI 1.22–1.60), p < 0.001, and 0.77 (95% CI 0.63–0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized b = –0.233, p < 0.001), mean corpuscular volum (standardized b = –0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized b = –0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized b = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized b = 0.179, p < 0.006), whereas MVe’ was correlated with atrial fibrillation (standardized b = 0.269, p < 0.001). Conclusions: The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe’ are also independently associated with total mortality risk.

12 citations


Journal ArticleDOI
TL;DR: It is hypothesized that among patients with coronary atherosclerosis, the CYBA c.214TT genotype contributes to atherosclerotic plaque stability by altering the course of CAD towards chronic coronary syndrome, thereby lowering the incidence of fatal CAD-related events.
Abstract: The CYBA gene encodes the regulatory subunit of NADPH oxidase, which maintains the redox state within cells and in the blood vessels. That led us to investigate the course of coronary artery disease (CAD) with regards to CYBA polymorphisms. Thus, we recruited 1197 subjects with coronary atherosclerosis and observed them during 7-year follow-up. Three CYBA polymorphisms: c.214C>T (rs4673), c.-932G>A (rs9932581), and c.*24G>A (1049255) were studied for an association with death, major adverse cardiovascular events (MACE) and an elective percutaneous coronary intervention or coronary artery bypass grafting (PCI/CABG). We found an association between the CYBA c.214C>T polymorphism and two end points: death and PCI/CABG. CYBA c.214TT genotype was associated with a lower risk of death than C allele (9.5% vs. 21%, p < 0.05) and a higher risk of PCI/CABG than C allele (69.3% vs. 51.7%, p < 0.01). This suggests that the CYBA c.214TT genotype may be a protective factor against death OR = 0.47 (95%CI 0.28–0.82; p < 0.01), while also being a risk factor for an elective PCI/CABG OR = 2.36 (95%CI 1.15–4.82; p < 0.05). Thus, we hypothesize that among patients with coronary atherosclerosis, the CYBA c.214TT genotype contributes to atherosclerotic plaque stability by altering the course of CAD towards chronic coronary syndrome, thereby lowering the incidence of fatal CAD-related events.

8 citations


Journal ArticleDOI
18 Sep 2020-Life
TL;DR: It is suggested that GRS might occur as a more valuable component in adding a predictive value to the genetic background of atherosclerosis in addition to the Gensini score.
Abstract: Oxidative stress is believed to play a critical role in atherosclerosis initiation and progression. In line with this, in a group of 1099 subjects, we determined eight single nucleotide polymorphisms (SNPs) related to oxidative stress (PON1 c.575A>G, MPO c.−463G>A, SOD2 c.47T>C, GCLM c.−590C>T, NOS3 c.894G>T, NOS3 c.−786T>C, CYBA c.214C>T, and CYBA c.−932A>G) and assessed the extent of atherosclerosis in coronary arteries based on Gensini score. An increased risk of having a Gensini score in the higher half of the distribution was observed for the PON1 c.575G allele (odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.004–1.617, p = 0.046). Next, the genetic risk score (GRS) for the additive effect of the total number of pro-oxidative alleles was assessed. We noted an increase in the risk of having a Gensini score above the median with the maximum number of risk alleles (OR = 2.47, 95% CI: 1.19–5.23, p = 0.014). A univariate Spearman’s test revealed significant correlation between the total number of pro-oxidant alleles (GRS) and the Gensini score (ρ = 0.068, p = 0.03). In conclusion, the PON1 c.575A>G variant and the high number of risk alleles (GRS) were independent risk factors for a high Gensini score. We suggest, however, that GRS might occur as a more valuable component in adding a predictive value to the genetic background of atherosclerosis.

3 citations


Journal ArticleDOI
04 Nov 2020-Life
TL;DR: Data show that statin therapy in children with FH allow for the reduction of the degree of atherosclerotic vessel changes and a significant decrease in the carotid beta index stiffness and an insignificant decreases in the IMT in the group of patients treated with statins.
Abstract: Familial hypercholesterolemia (FH) is the most common monogenic autosomal dominant disorder. FH results in an increased cardiovascular mortality rate. However, cardiovascular risk control factors enable the avoidance of approximately 80% of strokes and cardiovascular diseases. Therefore, early detection and implementation of lipid-lowering treatment is essential. In the present study, 57 pediatric patients aged 9.57 ± 3.26 years with FH were enrolled in the study. Researchers checked the lipid profile and performed the ultrasound imaging including intima-media thickness (IMT) measurement and echo (e)-tracking in the study group. Patients were treated with a low-cholesterol diet solely or along with pharmacological treatment with statins. Subsequently, patients were monitored for 12 months. The positive results of dietary treatment were observed in 40 patients. The efficacy of 12 months of nutritional therapy along with pharmacological treatment was reported in 27 patients. We observed a significant decrease in the carotid beta index stiffness and an insignificant decrease in the IMT in the group of patients treated with statins. The obtained data show that statin therapy in children with FH allow for the reduction of the degree of atherosclerotic vessel changes.

1 citations