PubMed Health⌕ Search

Biomedical subjects

R Chadarevian

Publications and source records attributed to R Chadarevian.

14 recordsLinked to original sources
PubMed2006

[Patient education and patient at risk. A new approach in cardiology].

For more than 10 years, preventive cardiology has obtained many positive results. Cardiologists can alter the prognosis of cardiovascular disease in primary and secondary prevention. In primary prevention or during the chronic phases of coronary artery disease, prevention is mainly based on drugs. However, prevention can be achieved only if patients have a good understanding of their disease, fair relationships with their physicians and a strict compliance with their treatments. Patient education is useful for the patient in order to control cardiovascular risk. In France, the PEGASE program evaluates the efficacy of an educational program in high risk patients. The final objective of this program is to spread this educational program for high risk patients to cardiologists all over the country.

Cardiovascular Agents↗
PubMed2005

Effect of levothyroxine replacement therapy on coagulation and fibrinolysis in severe hypothyroidism.

OBJECTIVE: We previously demonstrated that patients suffering from moderate hypothyroidism were at increased risk of thrombosis contrasting with the bleeding tendency of those presenting severe hypothyroidism. The latter state is associated with hemostatic anomalies including von Willebrand type 1 disease and increased fibrinolytic capacity. With the exception of von Willebrand type 1 disease, reversibility of hemostatic changes is not established after levothyroxine replacement therapy. Therefore our objective was to analyze the reversibility of these anomalies. MATERIALS AND METHODS: We analyzed the impact of levothyroxine treatment on lipid parameters, fibrinogen, platelet count, D-dimers, alpha2 antiplasmin activity, plasminogen activity, tissue plasminogen activator antigen (t-PA Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and coagulation factors (factor VIII coagulant, von Willebrand factor antigen, von Willebrand factor and factor IX) in 23 patients with severe hypothyroidism (TSH level > 50 mU/ I). RESULTS: Mean fibrinogen levels increased by 14.2% while t-PA Ag and PAI-1 Ag increased by 42.6 and 69%, respectively, after correction of hypothyroidism. Interestingly, post-treatment PAI-1 Ag levels tended to be higher in patients with normal-high final TSH levels than in patients with normal-low final TSH levels. Our results suggest that normalization of fibrinolysis is obtained after a transient decrease of fibrinolytic activity. We also confirmed the correction of coagulation factor abnormalities upon levothyroxine replacement therapy. CONCLUSIONS: We demonstrated that the coagulation disorders and the hyperfibrinolytic status of severe hypothyroid patients were corrected upon levothyroxine therapy. However, the clinical consequences of the transient decrease of the fibrinolytic activity during the course of TSH normalization need further studies.

Adult↗
PubMed2002

A comprehensive endocrine description of Kennedy's disease revealing androgen insensitivity linked to CAG repeat length.

Our study aims to provide a comprehensive view of the endocrine features in Kennedy's disease (KD). Twenty-two men with KD underwent detailed endocrine investigations. Clinical signs of partial androgen resistance were present in more than 80% of the patients, with gynecomastia being the most prominent. Gynecomastia was postpubertal but appeared before muscular weakness in most cases. Thirteen patients had alteration of testicular exocrine function. Hormonal profile of partial androgen resistance was present in 86% of the patients, with an elevated testosterone level in 68%. Androgen insensitivity seems to appear later in life in KD, similar to the development of neurological signs. Although we confirm the previously reported correlation between the CAG repeat length and the early onset of the neurological disease, we describe a significant correlation between repeat length and the age of onset of gynecomastia as well as biological indexes of androgen insensitivity. This is supported by numerous in vitro data correlating variations in the CAG tract with androgen receptor activity; the longer the CAG repeats, the weaker the receptor transactivation. Ours is the first study to show such a clear and prominent pattern of androgen insensitivity in KD. In clinical practice, KD patients are often misdiagnosed as having amyotrophic lateral sclerosis. Careful examination of the endocrine component could avoid such a deleterious misdiagnosis.

Adult↗
PubMed2001

Components of the fibrinolytic system are differently altered in moderate and severe hypothyroidism.

T(4) levels are determinant of several components of the fibrinolytic system. However, relationships between hypothyroidism and alteration of fibrinolytic capacity are not well established, and published data remain conflicting. As the impact of hypothyroidism on both degradation and synthesis of proteins may vary according to the severity of the disease, we measured fibrinolytic activity across varying states of hypothyroidism. We measured fibrinogen, D-dimers (DDI), alpha(2)-antiplasmin activity, tissue plasminogen activator antigen (t-PA Ag), plasminogen, plasminogen activator inhibitor antigen (PAI-1 Ag), and factor XII (FXII) of the coagulation. We prospectively included 76 middle-aged female subjects: 25 controls, 24 patients displaying moderate hypothyroidism (TSH, 10--50 mU/L), and 27 patients with severe hypothyroidism (TSH, >50 mU/L). Blood pressure, body mass index, smoking habits, total cholesterol as well as high and low density lipoprotein subfractions, triglyceride, fasting glycemia, and insulinemia were recorded. We found a different pattern of fibrinolytic abnormalities according to the severity of hypothyroidism. Compared with controls, patients with moderate hypothyroidism displayed a decreased fibrinolytic activity, as reflected by lower DDI levels, higher alpha(2)-antiplasmin activities, and higher levels of t-PA and PAI-1 Ag. In sharp contrast, patients with severe hypothyroidism exhibited higher DDI levels, lower alpha(2)-antiplasmin activities, and lower t-PA and PAI-1 Ag levels. These results were not accounted for by confounding factors such as age, smoking, and components of the insulin resistance syndrome. Free T(4) was significantly associated with fibrinogen, alpha(2)-antiplasmin, PAI-1 Ag, total cholesterol, and triglyceride and was negatively associated with DDI. The main hypotheses underlying the mechanisms by which thyroid status may affect the fibrinolytic system remain to be established. In conclusion, patients with moderate hypothyroidism, who were consistently shown to be at high risk for cardiovascular disease, have decreased fibrinolytic activity. Subjects with severe hypothyroidism have a tendency toward increased fibrinolytic activity, and these modifications may participate to the bleeding tendency observed in such patients.

Adult↗
PubMed1999

Relationship between triglycerides and factor VIIc and plasminogen activator inhibitor type-1: lack of threshold value.

Increased factor VIIc (FVIIc) and plasminogen activator inhibitor type 1 (PAI-1) levels may lead to a thrombotic state and subsequently to a higher risk of myocardial infarction. The relationships between triglycerides and plasma levels of both PAI-1 and FVIIc were established in previous studies. However, there is no data assessing whether there is a threshold value of triglycerides above which FVIIc and PAI-1 levels increase or whether the relationship is continuous. Therefore, we measured triglycerides, FVIIc, and PAI-1 levels in a large group of 1254 asymptomatic patients with hyperlipoproteinemia. Our results showed that both FVIIc and PAI-1 levels increase linearly in parallel to triglyceride levels (p=0.0001). In the multiple regression analysis, the relationship between log triglycerides and FVIIc was significantly independent of total cholesterol, body mass index, fasting glycemia, gender, and age; the relationship between log triglycerides and PAI-1 was significantly independent of body mass index, fasting glycemia, gender, and age. Interestingly, we found that the correlation coefficients between triglycerides and the haemostatic parameters measured were almost identical in different subgroups of subjects: males, females, nonobese, and normoglycemic, as well as nonalcoholic. We conclude that the relationships between triglyceride levels and FVIIc, as well as PAI-1, are continuous without threshold value of triglycerides.

Adsorption↗
PubMed1999

Relationship between thyroid hormones and fibrinogen levels.

Hypothyroid patients may have several haemostatic abnormalities such as modification of the coagulation proteins and a bleeding tendency. However, conflicting data have been reported, although in some reports, the groups of patients studied were small. We previously reported in a large population that plasma D-dimers and free thyroxine (FT4) levels were inversely correlated. Since D-dimers are also associated with fibrinogen levels, we analysed the relationship between fibrinogen and FT4 levels. The population consisted of 959 patients (61% men and 39% women), 28% of whom were current smokers. We showed that fibrinogen and FT4 levels were inversely correlated (r = -0.12, P = 0.0001) in the overall population, in the non-smoker subgroup (r = -0.13, P = 0.0007) and in the subgroup of patients with strictly normal FT4 levels (r = -0.11, P = 0.0006). The relationship between FT4 and fibrinogen levels was independent of age, sex and smoking habits. Furthermore, there was a significant difference between the mean fibrinogen levels in the patients in the lowest FT4 subgroup and those in the highest FT4 subgroup, which was similar to the difference previously observed in patients with or without evidence of atherosclerotic disease in epidemiological studies. In conclusion, we found a negative and independent relationship between fibrinogen and FT4. These results are consistent with our previous findings of a tendency to a more coagulable state in patients with normal-low FT4 levels compared with those with normal-high FT4 levels.

Adult↗
PubMed1999

Low free-thyroxine levels are a risk factor for subclinical atherosclerosis in euthyroid hyperlipidemic patients.

BACKGROUND: Patients displaying overt and subclinical hypothyroidism have more cardiovascular risk factors. Consequently, they are more likely to develop atherosclerosis and cardiovascular diseases. OBJECTIVE: To analyze whether low free-thyroxine levels (FTL) would also be associated with atherosclerosis in euthyroid patients. METHODS: We selected a group of 1434 healthy euthyroid male patients without known histories of thyroid disease and with levels of thyroid-stimulating hormone values within the normal range (mean 1.70+/-0.76 mUl/l, range 0.13-4.01 mUl/l). Mean age of these patients who had been referred for assessment of hyperlipidemia was 44.6 years and mean FTL was 14.25+/-3.06 pmol/l. We divided the population according to the degree of atherosclerosis in the carotid arteries. RESULTS: Mean age, body mass index, systolic blood pressure, cigarettes/day, blood level of glucose, cholesterol levels, and fibrinogen levels were significantly higher for the patients with atherosclerotic lesions whereas mean FTL was lower for patients with carotid atherosclerosis (P = 0.0002). The relationship between FTL and carotid atherosclerosis was independent from the following cardiovascular risk factors: age, hypertension, amount of excess weight, cholesterol level, fibrinogen level, smoking status, and presence versus absence of diabetes mellitus. CONCLUSIONS: Low FTL is a risk factor for atherosclerosis in male euthyroid hyperlipidemic patients.

Adult↗
PubMed1999

Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases.

BACKGROUND: The goal of this study was to evaluate the complication rate of secondary thyroidectomy in patients with prior thyroid surgery for benign disease. METHODS: Over an 8-year period, 203 thyroid reoperations were performed on 202 patients. All information relating to operative procedures, pathology, and complications was recorded prospectively. RESULTS: There were 24 men and 178 women with a mean age of 52 years. Prior surgery was unilateral in 136 cases (67%) and bilateral in 67 cases (33%), and 14 patients (6.9%) had more than 1 previous thyroid operation. For euthyroid or pretoxic recurrent nodular goiter, 190 reoperations were performed and 13 reoperations were performed for recurrent thyrotoxicosis. Twenty-three cancers were found in a specimen (11.4%). Completion thyroidectomy was done in 143 patients. Postoperative complications occurred in 21 patients (10.4%): recurrent laryngeal nerve palsy (7 patients), hypocalcemia (8 patients), hematoma requiring surgical evacuation (5 patients), and wound infection (1 patient). Complications remained permanent in 4 patients (2%). CONCLUSIONS: The permanent complication rate is higher in thyroid reoperations than in primary thyroid operations. However, we believe that this 2% rate is low enough to allow reoperation whenever it is necessary, provided precise operative rules are respected.

Adult↗
PubMed1998

[Lipids/hemostasis interactions. A new approach to cardiovascular risk factors].

NEW CARDIOVASCULAR RISK FACTORS: A causal link would appear to exist between hemostasis and cardiovascular disease. This is particularly true for fibrinogen which is an independent risk factor. MULTIPLE INTERACTIONS: There is an association between elevated triglyceride and FVIIc (pro-coagulant) levels and hypofibrinolytic PAI-1. In addition, an association exists between elevated cholesterol and FVIIc and platelet activation. LIPID LOWERING DRUGS AFFECT HEMOSTASIS: The hemostasis equilibrium is modulated by diet. In addition, fibrinogen levels are lowered by fibrates and platelet activation and thrombin generation are decreased by statins. These modifications have a potential clinical interest. Such observations remain to be confirmed by cardiovascular prevention studies with the specific objective of evaluating the effect of lipid lowering drugs on hemostasis parameters.

Blood Coagulation Factors↗
PubMed1998

Relationship between thyroid hormones and plasma D-dimer levels.

High serum levels of cholesterol and triglycerides are risk factors for coronary heart disease and are strongly related to several haemostatic parameters. Thyroid disorders are a frequent feature in hyperlipidemic patients and are also associated with a variety of haemostatic abnormalities. Therefore, we analysed the relationships between free T4 (fT4) levels and Factor VII and VIII activities (FVIIc and FVIIc), D-Dimers (DDI) and Plasminogen Activator Inhibitor type 1 (PAI-1), in a group of 472 healthy patients referred for hyperlipidemia. Fourty patients were found to have primary hypothyroidism. A negative correlation was found in the whole study population between fT4 and DDI (p = 0.0001, r = -0.21) and the same results were found after exclusion of the patients with fT4 below the normal range (p = 0.0007, r = -0.17). In a multivariate regression analysis, the relationship between DDI and fT4 was independent of age, Body Mass Index (BMI), gender and total cholesterol. Less impressive correlation coefficients were found with FVIIc (r = -0.10), FVIIIc (r = -0.09) and PAI-1 (r = -0.09). These results suggest that fT4 may play a physiological role in the regulation of the haemostatic equilibrium in hyperlipidemic patients and that low levels of fT4 are associated with a hypercoagulable state.

Adolescent↗
PubMed1997

[Hypolipemic agents and prevention of coronary disease].

Hypercholesterolemia, particularly high levels of LDL-cholesterol, is a well established risk factor for coronary heart disease. Lipid-lowering therapies are associated with a reduction in cardiovascular morbidity and mortality in secondary as well as primary prevention. These trials are consistent with epidemiological studies and emphasize the importance of the benefit in terms of the number of cardiovascular events avoided per 1000 patients treated. However, extrapolation of the data to general practice must be cautions, as most of the trials were conducted in populations displaying a high absolute risk level, including few women, and excluding persons older than 75 years. However, subgroup analysis showed that the beneficial effect is independent of age and pretreatment lipid levels in the range studied. The precise lipid pattern should be considered before any treatment is started. Diet is the first step approach and should be continued even after introduction of lipid-lowering drug therapy. Statins are treatments of choice in case of hypercholesterolemia type IIa. The target level of LDL-cholesterol is less than 1.30 g/l in patients with known coronary heart disease. Fibrates may be useful in patients with hypertriglyceridemia, and/or low HDL-cholesterol level or in the case of intolerance to statins.

Coronary Disease↗
PubMedDate not supplied

[Hepatotoxicity of a synthetic cortisol antagonist: OP'DDD (mitotane)].

The adrenolytic agent, Op'DDD (Mitotane) has been employed for almost 50 years for treatment of Cushing's syndrome. Despite clinical observations of elevation of hepatic enzymes encountered in patients taking the drug, there are few published data regarding the frequency, time course and factors that might influence hepatic toxicity of Mitotane. We analysed 10 patients consecutively treated with Mitotane for Cushing's syndrome. We measured hepatic transaminase and gamma glutamyl transferase before, during and after treatment. The study population included 6 women and 4 males, with a mean age of 41 years. Seven patients presented Cushing's disease while two had adrenal tumours and one had an undetermined origin of Cushing's syndrome. After a progressive increase, patients were being treated with a mean dosage of 9 g per day. All patients had elevation of either GGT or ALAT and all but one had elevation of transaminase (the maximum increase was sixfold the basal value). The only variable correlated with hepatic increase was the body mass index. In contrast, the severity of the disease, alcohol intake, and other biological characteristics were not correlated with transaminase elevations. We conclude that transaminase increase is encountered in the vast majority of patients treated with Mitotane. Levels at which the drug should be withdrawn remain to be established.

Adverse Drug Reaction Reporting Systems↗