Vorarlberg Institute for Vascular Investigation and Treatment VIVIT


Vorarlberg Institute for Vascular Investigation and Treatment VIVIT

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Leiter L.A.,Li Ka Shing Knowledge Institute | Lundman P.,Karolinska Institutet | da Silva P.M.,Hospital Of Santa Marta | Drexel H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 2 more authors.
Diabetic Medicine | Year: 2011

Aim: To assess the prevalence of persistent lipid abnormalities in statin-treated patients with diabetes with and without the metabolic syndrome. Methods This was a cross-sectional study of 22063 statin-treated outpatients consecutively recruited by clinicians in Canada and 11 European countries. Patient cardiovascular risk factors, risk level, lipid measurements and lipid-modifying medication regimens were recorded. Results Of the 20129 subjects who had documented diabetes and/or metabolic syndrome status, 41% had diabetes (of whom 86.8% also had the metabolic syndrome). Of those with diabetes, 48.1% were not at total cholesterol target compared with 58% of those without diabetes. Amongst those with diabetes, 41.6 and 41.3% of those with and without the metabolic syndrome, respectively, were not at their LDL cholesterol goal relative to 54.2% of those with metabolic syndrome and without diabetes, and 52% of those with neither condition. Twenty per cent of people with diabetes but without the metabolic syndrome were not at the optimal HDL cholesterol level compared with 9% of those with neither condition. Of people with diabetes and the metabolic syndrome, 49.9% were not at optimal triglyceride level relative to 13.5% of people with neither diabetes nor the metabolic syndrome. Simvastatin was the most commonly prescribed statin (>45%) and the most common statin potency was 20-40mg/day (simvastatin equivalent). Approximately 14% of patients were taking ezetimibe alone or in combination with a statin. Conclusions Despite evidence supporting the benefits of lipid modification and international guideline recommendations, statin-treated patients with diabetes had a high prevalence of persistent lipid abnormalities. There is frequently room to optimize therapy through statin dose up-titration and/or addition of other lipid-modifying therapies. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Sourij H.,Medical University of Graz | Saely C.H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Saely C.H.,Academic Teaching Hospital Feldkirch | Saely C.H.,University of Liechtenstein | And 11 more authors.
European Heart Journal | Year: 2010

Aims The prevalence of post-challenge hyperglycaemia in coronary patients is high. Until now, it is unclear whether post-challenge hyperglycaemia is associated with an increased risk for future macrovascular events in this clinically important patient population. Methods and results We enrolled 1040 patients undergoing coronary angiography for the evaluation of suspected or established coronary artery disease. In patients without previously established diabetes mellitus, an oral glucose tolerance test (oGTT) was performed. Prospectively, mortality and macrovascular events were recorded over a mean follow-up period of 3.8 years. From our patients, 394 had normal glucose tolerance (NGT), 280 post-challenge hyperglycaemia (this subgroup includes both impaired glucose tolerance and post-challenge diabetes) and 366 had conventional diabetes. The incidence of macrovascular events was significantly higher in patients with post-challenge hyperglycaemia as well as in patients with conventional diabetes than in subjects with NGT (23.6 and 29.5 vs. 18.5; P = 0.013 and P < 0.001, respectively). Adjusted hazard ratios were 1.46 (95 CI 1.03-2.07, P = 0.033) for patients with post-challenge hyperglycaemia and 1.73 (1.25-2.37, P = 0.001) for patients with conventional diabetes. Conclusion Post-challenge hyperglycaemia is associated with future macrovascular events in patients undergoing coronary angiography for the evaluation of stable coronary artery disease (CAD). Oral glucose tolerance tests in this high-risk population thus identify patients with a particularly unfavourable prognosis. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010.

Saely C.H.,Academic Teaching Hospital Feldkirch | Saely C.H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Saely C.H.,University of Liechtenstein | Geiger K.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 5 more authors.
Gerontology | Year: 2012

Background: Brown adipose tissue (BAT) is abundant in small mammals and in newborns and helps them to survive cold temperatures. In adults, it had long been considered to be absent or at least of no relevance. Recent investigations, however, have fuelled interest in adult BAT. Objective: We aimed at (1) summarizing structural and physiological characteristics of BAT versus white adipose tissue (WAT); (2) discussing the development of the two adipose tissue types; (3) reviewing the data available from human studies on BAT, and (4) discussing the impact of aging. Methods: We summarize recent descriptions of BAT and WAT based on the original literature and reviews in the field, with emphasis on human BAT. Results: WAT and BAT have essentially antagonistic functions: WAT stores excess energy as triglycerides and BAT is specialized in the dissipation of energy through the production of heat. Considerable amounts of BAT are present in a substantial proportion of adult humans and relatively high quantities of BAT are associated with lower body weight. With increasing age, BAT decreases and body weight increases. Conclusions: Although the available cross-sectional data do not allow definite conclusions to be drawn concerning a causal relationship between loss of BAT and increasing body weight with advancing age or obesity-related metabolic disorders of older age, stimulation of BAT appears to be an attractive novel candidate target for the treatment of age-related obesity. Copyright © 2010 S. Karger AG, Basel.

Leiherer A.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Leiherer A.,University of Liechtenstein | Leiherer A.,Medical Central Laboratories | Mundlein A.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 5 more authors.
Vascular Pharmacology | Year: 2013

Type 2 diabetes mellitus is an inflammatory disease and the mechanisms that underlie this disease, although still incompletely understood, take place in the adipose tissue of obese subjects. Concurrently, the prevalence of obesity caused by Western diet's excessive energy intake and the lack of exercise escalates, and is believed to be causative for the chronic inflammatory state in adipose tissue. Overnutrition itself as an overload of energy may induce the adipocytes to secrete chemokines activating and attracting immune cells to adipose tissue. But also inflammation-mediating food ingredients like saturated fatty acids are believed to directly initiate the inflammatory cascade. In addition, hypoxia in adipose tissue as a direct consequence of obesity, and its effect on gene expression in adipocytes and surrounding cells in fat tissue of obese subjects appears to play a central role in this inflammatory response too.In contrast, revisiting diet all over the world, there are also some natural food products and beverages which are associated with curative effects on human health. Several natural compounds known as spices such as curcumin, capsaicin, and gingerol, or secondary plant metabolites catechin, resveratrol, genistein, and quercetin have been reported to provide an improved health status to their consumers, especially with regard to diabetes, and therefore have been investigated for their anti-inflammatory effect. In this review, we will give an overview about these phytochemicals and their role to interfere with inflammatory cascades in adipose tissue and their potential for fighting against inflammatory diseases like diabetes as investigated in vivo. © 2012 Elsevier Inc.

Saely C.H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Saely C.H.,Academic Teaching Hospital Feldkirch | Saely C.H.,University of Liechtenstein | Drexel H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 3 more authors.
Vascular Pharmacology | Year: 2013

The concept of diabetes as a coronary heart risk (CHD) equivalent postulates that patients with diabetes who do not yet have CHD are at an equally high cardiovascular risk as non-diabetic patients with CHD. This implies important therapeutic, psychological, and economical consequences. However, whereas several reports support the concept of diabetes as a CHD risk equivalent, others refute it, and several investigations find that the cardiovascular risk conferred by diabetes is strongly modulated by sex (with diabetes conferring a greater risk increase in women), diabetes duration, concomitant risk factors, or the presence of subclinical atherosclerosis. A detailed review of the literature shows that the concept of diabetes as a CHD risk equivalent is overly simplistic, because not all patients with diabetes are at the same cardiovascular risk. An individualized approach to cardiovascular risk estimation and management appears mandatory in patients with diabetes. © 2013 Elsevier Inc.

PubMed | Vorarlberg Institute for Vascular Investigation and Treatment VIVIT and University of Liechtenstein
Type: Journal Article | Journal: Nutrients | Year: 2016

Obesity is characterized by the rapid expansion of visceral adipose tissue, resulting in a hypoxic environment in adipose tissue which leads to a profound change of gene expression in adipocytes. As a consequence, there is a dysregulation of metabolism and adipokine secretion in adipose tissue leading to the development of systemic inflammation and finally resulting in the onset of metabolic diseases. The flavonoid quercetin as well as other secondary plant metabolites also referred to as phytochemicals have anti-oxidant, anti-inflammatory, and anti-diabetic effects known to be protective in view of obesity-related-diseases. Nevertheless, its underlying molecular mechanism is still obscure and thus the focus of this study was to explore the influence of quercetin on human SGBS (Simpson Golabi Behmel Syndrome) adipocytes gene expression. We revealed for the first time that quercetin significantly changed expression of adipokine (Angptl4, adipsin, irisin and PAI-1) and glycolysis-involved (ENO2, PFKP and PFKFB4) genes, and that this effect not only antagonized but in part even overcompensated the effect mediated by hypoxia in adipocytes. Thus, these results are explained by the recently proposed hypothesis that the protective effect of quercetin is not solely due to its free radical-scavenging activity but also to a direct effect on mitochondrial processes, and they demonstrate that quercetin might have the potential to counteract the development of obesity-associated complications.

Zitt E.,Academic Teaching Hospital Feldkirch | Zitt E.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Sprenger-Mahr H.,Academic Teaching Hospital Feldkirch | Sprenger-Mahr H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 5 more authors.
Vaccine | Year: 2012

Vitamin D deficiency is highly prevalent in patients suffering from chronic kidney disease. At present it is not known whether this condition is associated with poor response to hepatitis B vaccination in these patients. We performed a retrospective analysis of 200 patients with chronic kidney disease stages 3-5D, who had undergone hepatitis B vaccination with three 40 μg recombinant hepatitis B vaccine doses in a single centre. Anti-HBs antibody titres and 25-hydroxyvitamin D (25(OH)D) levels were measured by chemiluminescence immunoassays. Vitamin D deficiency with serum levels <10. ng/mL was found in 35.5% of patients. These patients had a lower seroconversion rate than did patients with levels ≥10. ng/mL (45% vs 64%; P= 0.011) and their median (25th, 75th percentile) anti-HBs antibody titres were lower (0 (0, 117). IU/L vs 48 (0, 236.5). IU/L). Non-responders had lower 25(OH)D concentrations than did responders (12.9 ± 6.5. ng/mL vs 15.1 ± 7.4. ng/mL; P= 0.034). Treatment with a vitamin D receptor activator had no influence on the immune response. In a multiple logistic regression analysis vitamin D deficiency (OR 0.480; P= 0.023) and diabetes (OR 0.496; P= 0.038) remained independent and significant negative predictors of seroconversion. In conclusion, in patients with chronic kidney disease vitamin D deficiency is associated with a poor antibody formation upon hepatitis B vaccination. © 2011 Elsevier Ltd.

Sturm G.,Innsbruck Medical University | Lamina C.,Innsbruck Medical University | Zitt E.,Academic Teaching Hospital Feldkirch | Zitt E.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 6 more authors.
PLoS ONE | Year: 2011

Background: Improved glycemic control reduces complications in patients with diabetes mellitus (DM). However, it is discussed controversially whether patients with diabetes mellitus and end-stage renal disease benefit from strict glycemic control. Methods: We followed 78 patients with DM initiating dialysis treatment of the region of Vorarlberg in a prospective cohort study applying a time-dependent Cox regression analysis using all measured laboratory values for up to more than seven years. This resulted in 880 HbA1c measurements (with one measurement every 3.16 patient months on average) during the entire observation period. Non-linear P-splines were used to allow flexible modeling of the association with mortality and cardiovascular disease (CVD) events. Results: We observed a decreased mortality risk with increasing HbA1c values (HR = 0.72 per 1% increase, p = 0.024). Adjustment for age and sex and additional adjustment for other CVD risk factors only slightly attenuated the association (HR = 0.71, p = 0.044). A non-linear P-spline showed that the association did not follow a fully linear pattern with a highly significant non-linear component (p = 0.001) with an increased risk of all-cause mortality for HbA1c values up to 6-7%. Causes of death were associated with HbA1c values. The risk for CVD events, however, increased with increasing HbA1c values (HR = 1.24 per 1% increase, p = 0.048) but vanished after extended adjustments. Conclusions: This study considered the entire information collected on HbA1c over a period of more than seven years. Besides the methodological advantages our data indicate a significant inverse association between HbA1c levels and all-cause mortality. However, for CVD events no significant association could be found. © 2011 Sturm et al.

Zitt E.,Academic Teaching Hospital Feldkirch | Zitt E.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Woess E.,Academic Teaching Hospital Feldkirch | Mayer G.,Innsbruck Medical University | And 2 more authors.
Transplantation | Year: 2011

Background. The calcimimetic cinacalcet has recently been increasingly used for persistent hyperparathyroidism after renal transplantation. The present study investigated the short-term effects of cinacalcet on urinary electrolyte concentration and arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism. Methods. In a prospective controlled single-center cross-over study, we examined 10 stable kidney transplant patients (mean estimated glomerular filtration rate 51±10 mL/min/1.73 m) who received cinacalcet daily for persistent hyperparathyroidism. Urine specimens were collected at baseline and every 2 hr for a total study period of 6 hr after ingestion of 30 mg cinacalcet and without cinacalcet. Intact parathyroid hormone was determined at baseline and 2 hr later. Using ambulatory blood pressure measurement, arterial blood pressure was determined every 15 min. Results. Intact parathyroid hormone was significantly reduced with cinacalcet as compared with controls (-37±27.7% vs. -9.6±10.3%, P=0.009). With cinacalcet, urinary calcium and magnesium concentration were increased (P=0.042 and P=0.007, respectively) and differed significantly as compared with the control phase without cinacalcet. After 4 hr, an increased urinary sodium concentration was also found compared with the control phase (P=0.039). Systolic blood pressure was reduced with cinacalcet (P<0.001) and differed significantly from control phase (-13.7±9.9 mm Hg vs. -3.2±5.2 mm Hg after 2 hr, P=0.009; -18.1±10.8 mm Hg vs. -1.9±5.2 mm Hg after 4 hr, P=0.001). Conclusion. In the short term, cinacalcet increases the urinary concentration of calcium, magnesium, and sodium. The observed antihypertensive effect might be beneficial in patients with a high cardiovascular risk after kidney transplantation. © 2011 Lippincott Williams & Wilkins.

Biller K.,Medical Central Laboratories | Fae P.,Academic Teaching Hospital | Germann R.,Academic Teaching Hospital | Drexel H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | And 2 more authors.
Shock | Year: 2014

Serum cholesterol procalcitonin (PCT) and C-reactive protein (CRP) levels were measured consecutively in 76 critically ill patients at admission to the intensive care unit. The presence of infection was defined according to the CDC (Centers for Disease Control and Prevention) criteria; in-house mortality, underlying diseases, and severity of sepsis were monitored. Nonsurvivors had significantly lower cholesterol levels compared with survivors (69 mg/dL [range, 37-88 mg/dL] vs. 96 mg/dL [range, 71-132 mg/dL], P = 0.006) whereas no significant differences were noted for serum PCT and CRP levels. In a cohort of patients with cholesterol levels of 50 mg/dL or less, 82% did not survive as compared with patients with cholesterol levels of 100 mg/dL or greater (mortality, 21%). In a control group without infection, no difference of cholesterol, PCT, or CRP was found between survivors and nonsurvivors. Our data show that low cholesterol levels in patients with infectious disease have a prognostic value and may be useful markers to identify high-risk patients already at admission. Copyright © 2014 by the Shock Society.

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