Cardiovascular endocrinology最新文献

英文中文

Relevance of low testosterone to non-alcoholic fatty liver disease. 低睾酮与非酒精性脂肪肝的相关性

Cardiovascular endocrinology

Pub Date : 2015-09-01 DOI: 10.1097/XCE.0000000000000057

Avni Mody, Donna White, Fasiha Kanwal, Jose M Garcia

Non-alcoholic fatty liver disease (NAFLD) is a condition where there is excess accumulation of triglycerides in the liver in the absence of excess alcohol consumption. It ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NAFLD, one of the most common causes of chronic liver disease in Western populations, is the hepatic component of the metabolic syndrome (MetS) and is associated with increased visceral adipose tissue (VAT), insulin resistance, and dyslipidemia. Studies have also shown that testosterone deficiency is associated with increased VAT and insulin resistance in males while hyperandrogenemia has been associated with increased risk of insulin resistance and VAT in females. Thus, the aims of this review are to discuss the available experimental and epidemiological data evaluating the association between testosterone and NAFLD, to discuss the potential clinical relevance of these data, and to identify gaps in the literature.

非酒精性脂肪性肝病(NAFLD)是在没有过量饮酒的情况下肝脏中甘油三酯过量积累的一种疾病。其范围从单纯性脂肪变性到非酒精性脂肪性肝炎(NASH)，后者可发展为纤维化、肝硬化和肝细胞癌(HCC)。NAFLD是西方人群慢性肝病最常见的病因之一，是代谢综合征(MetS)的肝脏组成部分，与内脏脂肪组织(VAT)增加、胰岛素抵抗和血脂异常有关。研究还表明，睾酮缺乏与男性的VAT增加和胰岛素抵抗有关，而高雄激素血症与女性胰岛素抵抗和VAT风险增加有关。因此，本综述的目的是讨论评估睾酮与NAFLD之间关系的现有实验和流行病学数据，讨论这些数据的潜在临床相关性，并确定文献中的空白。

引用次数: 39

Effects of testosterone replacement on glucose and lipid metabolism 睾酮替代对糖脂代谢的影响

Cardiovascular endocrinology

Pub Date : 2015-09-01 DOI: 10.1097/XCE.0000000000000061

I. Errázuriz, S. Dube, A. Basu, R. Basu

Testosterone levels have become a much more available and frequent screening test in clinical practice. There is greater awareness of testosterone deficiency symptoms both among the medical community and among the patients themselves. Several studies have described the effects of testosterone on carbohydrate and lipid metabolism and the disturbances that occur in patients with hypogonadism. However, whether testosterone replacement reverts such alterations is less clear. In this article, we review the effects of testosterone replacement therapy on glucose and lipid metabolism.

在临床实践中，睾酮水平已成为一种更为有效和频繁的筛查测试。医学界和患者本身对睾酮缺乏症状的认识都有所提高。一些研究描述了睾酮对碳水化合物和脂质代谢的影响，以及性腺功能减退患者出现的紊乱。然而，睾酮替代是否能恢复这种改变尚不清楚。本文就睾酮替代疗法对糖脂代谢的影响作一综述。

引用次数: 3

Testosterone replacement therapy: the controversies of cardiovascular risk 睾酮替代疗法:心血管风险的争议

Cardiovascular endocrinology

Pub Date : 2015-09-01 DOI: 10.1097/XCE.0000000000000058

V. Surampudi, R. Swerdloff

Over the past decade there has been an increase in awareness of the clinical syndrome of male hypogonadism and its association with comorbid conditions. This article reviews studies focusing on recent trials of testosterone replacement therapy on cardiovascular risk.

在过去的十年中，人们对男性性腺功能减退的临床综合征及其与合并症的关系的认识有所增加。本文综述了近期睾酮替代疗法对心血管风险的影响。

引用次数: 0

Testosterone, metabolism, and cardiovascular disease 睾丸素，新陈代谢和心血管疾病

Cardiovascular endocrinology

Pub Date : 2015-09-01 DOI: 10.1097/XCE.0000000000000054

K. Yuen, A. Krentz

Swedish Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington, Profil Institute for Clinical Research, Chula Vista, California, USA and Foundation for Diabetes Research in Older People, Diabetes Frail, UK Correspondence to Kevin C.J. Yuen, MD, FRCP(UK), Swedish Pituitary Center, Swedish Neuroscience Institute, Seattle, 550 17th Ave Suite 400, Washington 98122, USA Tel: + 1 206 320 4844; fax: + 1 206 32

美国华盛顿州西雅图瑞典神经科学研究所瑞典脑垂体中心，美国加利福尼亚州丘拉维斯塔瑞典临床研究所和英国老年糖尿病研究基金会。美国华盛顿98122，美国西雅图，瑞典神经科学研究所瑞典脑垂体中心，英国FRCP, Kevin C.J. Yuen医学博士电话:+ 1 206 320 4844;传真:+ 1 206 32

引用次数: 0

Testosterone replacement and cardiovascular disease risk: what do endocrinologists need to know? 睾酮替代与心血管疾病风险:内分泌学家需要知道什么?

Cardiovascular endocrinology

Pub Date : 2015-09-01 DOI: 10.1097/XCE.0000000000000051

Joshua R. Gonzalez, I. Goldstein

Testosterone deficiency (or hypogonadism) affects millions of men worldwide. Consensus regarding an appropriate biochemical cutoff for the definition and treatment of hypogonadism has been challenging. Several recent, well-publicized studies have called into question the long recognized benefits of testosterone replacement therapy. The aim of the current article is to review the data on testosterone treatment, paying specific attention to the potential cardiovascular effects of this increasingly common therapy. We examine some of the most common cardiovascular diseases including hypertension, metabolic syndrome, coronary artery disease, atherosclerosis, congestive heart failure, myocardial infarction, and stroke. This review will also investigate the potential effect of testosterone replacement therapy on cardiovascular and all-cause mortality and address a growing fear among the medical community about the safety of testosterone replacement.

睾酮缺乏(或性腺功能减退)影响着全世界数百万的男性。关于性腺功能减退症的定义和治疗的适当生化分界线的共识一直具有挑战性。最近几项广为宣传的研究对长期以来公认的睾酮替代疗法的益处提出了质疑。这篇文章的目的是回顾睾酮治疗的数据，特别关注这种日益普遍的治疗对心血管的潜在影响。我们研究了一些最常见的心血管疾病，包括高血压、代谢综合征、冠状动脉疾病、动脉粥样硬化、充血性心力衰竭、心肌梗死和中风。本综述还将调查睾酮替代疗法对心血管和全因死亡率的潜在影响，并解决医学界对睾酮替代安全性日益增长的担忧。

引用次数: 1

The components of metabolic syndrome in women: ‘Is the whole really greater than the sum of its parts?’ 女性代谢综合征的组成部分:“整体真的大于部分之和吗?””

Cardiovascular endocrinology

Pub Date : 2015-06-01 DOI: 10.1097/XCE.0000000000000052

P. Patel, Shaista Malik

Psychologist Kurt Koffka termed the phrase ‘the whole is other than the sum of its parts’. Often incorrectly translated as ‘the whole is greater than the sum of the parts’, such a phrase can also describe the debate on the properties of metabolic syndrome (MetS). There continues to be discussion as to whether this syndrome is a distinct pathophysiologic gestalt, or something that reflects the association of its various clinical, physiological, and biochemical cardiovascular risk factors [1–3].

心理学家库尔特·科夫卡将这句话称为“整体而不是部分的总和”。这句话经常被错误地翻译为“整体大于部分的总和”，也可以用来描述关于代谢综合征(MetS)特性的争论。关于该综合征是一种独特的病理生理完形，还是反映了其各种临床、生理和生化心血管危险因素的关联，仍有讨论[1-3]。

引用次数: 0

Blood pressure and body size preference in traditional communities of Ilorin metropolis, Nigeria 尼日利亚伊洛林大都市传统社区的血压和体型偏好

Cardiovascular endocrinology

Pub Date : 2015-06-01 DOI: 10.1097/XCE.0000000000000048

E. Okoro, E. Etebu, B. Oyejola

BackgroundOur previous work showed that many individuals with type 2 diabetes and in the background population may prefer larger body sizes. This prompted us to study the interaction between body size, body size perception and blood pressure. MethodsAnthropometric variables, body size perception and blood pressure were measured in adults of three Nigerian communities. The results were subjected to tests of correlation and regression to determine any association/functional relationship between predictor variables and blood pressure. ResultsParticipants with elevated blood pressure were older (52.75 vs. 39.58 years) and had a higher BMI (24.50 vs. 22.84), waist circumference (86.69 vs. 81.57) and hip circumference (95.23 vs. 92.49) compared with normotensives. There were significant (P<0.05) correlations between systolic blood pressure and age (0.401), weight (0.13), BMI (0.182), waist circumference (0.231), hip circumference (0.132), height (0.15), current body size perception (0.181), preferred body size (0.119) and preferred body size of the opposite gender (0.14). For normotensives, a 1 cm increment in waist circumference was associated with an increase in systolic blood pressure by 0.35 mmHg in those younger than 50 years of age. In older participants, an increase in BMI by 1 kg/m2 led to an increase in systolic blood pressure by 1.1 mmHg. Thirty-two per cent of the participants had hypertension. Less than 10% of the interindividual differences in blood pressure resulted from variations in body dimensions/or body size perception. Significantly, 66.5 versus 51.9% of hypertensive and normotensive individuals, respectively, desired a larger body size for self/spouse. ConclusionThe results indicated a dominant preference for larger body sizes, whereas body dimension predicted blood pressure only to a very limited degree.

我们之前的研究表明，许多2型糖尿病患者和背景人群可能更喜欢大体型。这促使我们研究体型、体型感知和血压之间的相互作用。方法对尼日利亚3个社区的成年人进行人体测量变量、体型感知和血压测量。结果进行相关性和回归测试，以确定预测变量与血压之间的关联/功能关系。结果与血压正常者相比，血压升高的受试者年龄较大(52.75 vs 39.58)， BMI (24.50 vs 22.84)、腰围(86.69 vs 81.57)和臀围(95.23 vs 92.49)均较高。收缩压与年龄(0.401)、体重(0.13)、BMI(0.182)、腰围(0.231)、臀围(0.132)、身高(0.15)、当前体型感知(0.181)、偏好体型(0.119)、异性偏好体型(0.14)之间存在显著相关(P<0.05)。对于血压正常者，50岁以下腰围每增加1厘米，收缩压增加0.35 mmHg。在老年参与者中，BMI每增加1 kg/m2会导致收缩压增加1.1 mmHg。32%的参与者患有高血压。不到10%的个体间血压差异是由身体尺寸或体型感知的差异造成的。值得注意的是，66.5%的高血压患者和51.9%的正常高血压患者希望自己/配偶有更大的体型。结论研究结果表明，人们更倾向于选择体型较大的人，而体型尺寸对血压的预测作用非常有限。

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引用次数: 0

Bariatric surgery in obese older people: useful or not? 肥胖老年人的减肥手术:有用还是没用?

Cardiovascular endocrinology

Pub Date : 2015-06-01 DOI: 10.1097/XCE.0000000000000045

Susan Reijntjes, A. Viljoen, A. Wierzbicki, T. Hardman

ObjectiveThe aim of this study was to determine whether older (≥65 years) obese people would benefit from bariatric surgery, considering the prevalence of multiple comorbidities and frailty in this group. MethodsA PubMed search was carried out for studies on the use of bariatric surgery in older obese people published in the database from 1980 to the present (August 2014). ResultsA total of 244 citations were obtained on searching; 182 of these publications were selected for manual checking and 10 studies were identified as containing useable data on this patient cohort. Published data were available for efficacy in 641 patients. Substantial improvement was observed in diabetes (76%), hypertension (68%) and sleep apnoea (67%) following bariatric surgery. Laparoscopic adjustable gastric banding (n=456) was the most frequently reported procedure. Similar findings but with greater weight loss and fewer complications were found in the small numbers of patients undergoing other procedures. Data from four large registry studies (n=6837) showed mortality and complications associated with bariatric surgery to be increased in older compared with younger people especially in those undergoing gastric bypass surgery. The elderly had longer hospital stays, and patients with cardiac, pulmonary or renal comorbidities generally had a worse prognosis. ConclusionBariatric surgery in older people is effective in reducing complications of obesity, but is also associated with increased rates of complications compared with those seen in younger patients. The few reported studies in the elderly are retrospective, generally small, primarily describe findings of laparoscopic adjustable gastric banding as the surgical intervention option and lack long-term follow-up. More trials and registry data, especially for sleeve gastrectomy and gastric bypass, are required to better address the utility of bariatric surgery in the elderly and to define long-term clinical outcomes.

本研究的目的是确定老年(≥65岁)肥胖者是否会从减肥手术中获益，考虑到该组中多种合并症和虚弱的患病率。方法通过PubMed检索数据库中自1980年至今(2014年8月)发表的关于老年肥胖患者使用减肥手术的研究。结果检索到文献共244篇;其中182份出版物被选中进行人工检查，其中10项研究被确定为包含该患者队列的可用数据。已发表的641例患者的疗效数据。减肥手术后，糖尿病(76%)、高血压(68%)和睡眠呼吸暂停(67%)均有显著改善。腹腔镜可调节胃束带(n=456)是最常报道的手术。在少数接受其他手术的患者中发现了类似的结果，但体重减轻幅度更大，并发症更少。来自四项大型登记研究(n=6837)的数据显示，与年轻人相比，老年人与减肥手术相关的死亡率和并发症增加，特别是在接受胃分流手术的人群中。老年人住院时间较长，有心脏、肺部或肾脏合并症的患者通常预后较差。结论老年人减肥手术可有效减少肥胖并发症，但与年轻患者相比，其并发症发生率也有所增加。少数报道的老年人研究是回顾性的，通常规模较小，主要描述了腹腔镜可调节胃束带作为手术干预选择的结果，缺乏长期随访。需要更多的试验和注册数据，特别是袖式胃切除术和胃旁路手术，以更好地解决减肥手术在老年人中的效用，并确定长期临床结果。

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引用次数: 2

Diiodothyropropionic acid in the management of cardiovascular disease 二碘甲丙酸在心血管疾病治疗中的应用

Cardiovascular endocrinology

Pub Date : 2015-05-26 DOI: 10.1097/XCE.0000000000000046

S. Arora, M. Agrawal, J. Iqbal, P. Bhandari, J. Mechanick

ObjectiveCardiovascular disease is the leading cause of morbidity and mortality in the USA. Thyroid analogs have emerged as a potential new therapeutic agent for cardiovascular disease. Thyroid hormones beneficially influence cardiac contractility and serum lipids but can also confer harmful effects on cardiac tissue and bone. To circumvent these harmful effects of thyroid hormones, several thyroid analogs have been studied since the 1960s. This review focuses on one such thyroid analog, diiodothyropropionic acid (DITPA), which has shown promise in the management of heart failure. Materials and methodsWe conducted a systematic review of the literature using evidence-based criteria. ResultsStrong laboratory data exist supporting the role of DITPA in heart failure by improving systolic and diastolic heart function. DITPA significantly alters the myosin heavy chain ratio in the heart muscle to improve ventricular contractility. There is increasing evidence in support of the improvement in lipid profile in patients on DITPA. No proarrhythmogenic adverse effects were noted with the use of DITPA. ConclusionDITPA appears to be promising in enhancing cardiac output and hemodynamic stability for heart failure patients, with possible synergistic implications when combined with other heart failure medications. However, extensive human trials are needed to establish its role in the management of heart failure and establish its safety profile.

目的心血管疾病是美国发病率和死亡率的主要原因。甲状腺类似物已成为一种潜在的新型心血管疾病治疗剂。甲状腺激素对心脏收缩力和血脂有有益影响，但对心脏组织和骨骼也有有害影响。为了避免甲状腺激素的这些有害影响，自20世纪60年代以来，人们研究了几种甲状腺类似物。这篇综述的重点是一种甲状腺类似物，二碘甲状丙酸(DITPA)，它在治疗心力衰竭方面显示出前景。材料和方法我们使用循证标准对文献进行了系统的综述。结果强有力的实验室数据支持DITPA通过改善心脏收缩和舒张功能在心力衰竭中的作用。DITPA显著改变心肌肌球蛋白重链比，改善心室收缩力。越来越多的证据支持DITPA患者血脂水平的改善。使用DITPA未发现致心律失常的不良反应。结论ditpa在提高心力衰竭患者的心输出量和血流动力学稳定性方面具有良好的前景，与其他心力衰竭药物联合使用时可能具有协同作用。然而，需要广泛的人体试验来确定其在心力衰竭管理中的作用并确定其安全性。

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引用次数: 1

A novel application of salivary testosterone in systolic heart failure: relationship with exercise capacity, quality of life and cardiac mechanics 唾液睾酮在收缩期心力衰竭中的新应用:与运动能力、生活质量和心脏力学的关系

Cardiovascular endocrinology

Pub Date : 2015-03-01 DOI: 10.1097/XCE.0000000000000047

M. Stout, K. Pearce, S. Williams

Introduction There is an association between heart failure (HF) and testosterone deficiency. Salivary testosterone (ST) has been described as a marker of the free fraction of testosterone in healthy populations and has not commonly been utilized clinically. This study aimed to assess the clinical utility of ST in a HF population with a broad range of testosterone concentrations compared with more traditional serum parameters. Methods A total of 40 men with HF were recruited. Traditional serum testosterone measures and ST measures were collected on two separate occasions. Patients performed a 6-min walk, underwent echocardiography and completed quality of life questionnaires. Bland–Altman plots were constructed to assess the agreement between ST and free testosterone (FT) levels, and to assess the repeatability between traditional and ST measures. Pearson’s correlation was used to determine the relationship between ST levels, traditional serum testosterone parameters and important health outcomes. Results There was excellent agreement between ST and FT measures [bias 0.087 nmol/l, SD 0.056 nmol/l, 95% limits of agreement (LoA) of +2 SD 0.104 nmol/l and −2 SD −0.122 nmol/l]. ST and FT measures show excellent reproducibility (bias 0.0137 nmol/l, SD 0.021 nmol/l, 95% LoA +2 SD 0.041 nmol/l and −2 SD −0.041 nmol/l for ST, and bias 0.004 nmol/l, SD ±0.0025 nmol/l, 95% LoA ±2 SD +0.055 nmol/l and −0.046 nmol/l). There are similar levels of moderately strong positive correlation between ST levels, other testosterone fractions and endurance capacity/physical domains of quality of life assessed using the Short Form-36 questionnaire. Conclusion ST can be used as an alternative marker of traditional testosterone parameters in HF without semi-invasive blood sampling. There is a correlation between exercise capacity and physical quality of life domains with all testosterone fractions.

心衰(HF)与睾酮缺乏之间存在关联。唾液睾酮(ST)被认为是健康人群游离睾酮含量的标志，但在临床上并不常用。本研究旨在评估ST在与更传统的血清参数相比睾酮浓度范围更广的心衰人群中的临床应用。方法招募40例HF男性患者。传统血清睾酮测定和ST测定分别在两个不同的场合采集。患者散步6分钟，接受超声心动图检查，并完成生活质量问卷调查。构建Bland-Altman图来评估ST和游离睾酮(FT)水平之间的一致性，并评估传统测量和ST测量之间的可重复性。Pearson’s correlation用于确定ST水平、传统血清睾酮参数与重要健康结局之间的关系。结果ST和FT测量结果具有良好的一致性[偏差0.087 nmol/l，标准差0.056 nmol/l, 95%的一致性限(LoA)为+2 SD 0.104 nmol/l和- 2 SD - 0.122 nmol/l]。ST和FT测量结果具有良好的重现性(ST偏差0.0137 nmol/l, SD 0.021 nmol/l, 95% LoA +2 SD 0.041 nmol/l和- 2 SD - 0.041 nmol/l，以及偏差0.004 nmol/l, SD±0.0025 nmol/l, 95% LoA±2 SD +0.055 nmol/l和- 0.046 nmol/l)。使用Short Form-36问卷评估的ST水平、其他睾酮组分和耐力能力/生活质量的物理领域之间存在类似水平的中等强正相关。结论ST可作为心衰患者传统睾酮指标的替代指标，无需半创采血。运动能力和身体生活质量与所有睾酮水平之间存在相关性。

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