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Li S, Tang X, Luo Y, Wu B, Huang Z, Li Z, Peng L, Ling Y, Zhu J, Zhong J, Liu J, Chen Y. Impact of long-term glucose variability on coronary atherosclerosis progression in patients with type 2 diabetes: a 2.3 year follow-up study. Cardiovasc Diabetol 2020; 19:146. [PMID: 32977802 PMCID: PMC7517679 DOI: 10.1186/s12933-020-01126-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Glycemic variability (GV) confers a risk of cardiovascular events. In this study, we aimed to investigate whether long-term GV has an impact on coronary atherosclerosis progression in patients with type 2 diabetes mellitus (T2DM). Methods A total of 396 patients with T2DM who had coronary computed tomography angiography and laboratory data available at baseline and for follow-up evaluations [median 2.3 (1.8–3.1) years] were included. Fasting plasma glucose (FPG) was measured every 1–3 months, and HbA1c was measured quarterly. The coefficient of variation (CV) of HbA1c and FPG were calculated as measures of GV. Quantitative assessment of coronary plaques was performed by measuring the annual change and progression rate of total plaque volume (TPV). Significant progression was defined as annual TPV progression ≥ 15%. Multivariable regression analyses were used to assess the effects of GV on atherosclerosis progression. Results In the 396 patients, the annual change in TPV was 12.35 ± 14.23 mm3, and annual progression rate was 13.36 ± 12.69%. There were 143 (36.11%) patients with significant progression, and they had a significantly higher CV-HbA1c (P < 0.001) and CV-FPG (P < 0.001) than those without significant progression. In multivariable regression analyses, both CV-HbA1c and CV-FPG were independent predictors of annual change in TPV [CV-HbA1c: β = 0.241 (0.019–0.462), P = 0.034; CV-FPG: β = 0.265 (0.060–0.465), P = 0.012], annual TPV progression [CV-HbA1c: β = 0.214 (0.023–0.405), P = 0.029; CV-FPG: β = 0.218 (0.037–0.399), P = 0.019], and significant atherosclerosis progression [CV-HbA1c: odds ratio [OR] = 1.367 (1.149–1.650), P = 0.010; CV-FPG: OR = 1.321 (1.127–1.634), P = 0.013]. Conclusions Long-term GV is associated with accelerated progression of coronary atherosclerosis independent of conventional risk factors in patients with T2DM. Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015; retrospectively registered
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Affiliation(s)
- Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xixiang Tang
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Zhuoshan Huang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Zexiong Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Long Peng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yesheng Ling
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Junlin Zhong
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Jinlai Liu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Yanming Chen
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
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Leskelä RL, Torvinen A, Rissanen TT, Virtanen V, Herse F, Nuutinen M, Mustonen J, Laatikainen T. Outcomes of lipid control in secondary prevention of coronary artery disease in Finland: A 24-month follow-up after acute coronary syndrome. Atherosclerosis 2020; 296:4-10. [PMID: 31999985 DOI: 10.1016/j.atherosclerosis.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/20/2019] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Ischemic heart diseases are the main cause of death worldwide, therefore secondary prevention and treatment of coronary artery disease (CAD) are highly significant for public health and mortality. The objective of this study is to evaluate LDL cholesterol (LDL-C) levels as outcomes of secondary prevention of CAD in Finland up to 24 months after being diagnosed with acute coronary syndrome (ACS). This retrospective analysis of patients with ACS was conducted in two areas of Finland that have a combined population of 400,000. METHODS The data used in the study covered all outpatient visits, inpatient episodes, prescriptions and LDL-C results for ACS patients during 2011-2015. To evaluate the outcome of the prevention, three separate measurements of patients' LDL-C levels were considered: baseline, first follow-up and final follow-up. The factors associated with reaching treatment goal were identified using logistic regression analysis. RESULTS 32% of ACS patients achieved the treatment goal (LDL-C <1.8 mmol/l) at the end of the 24-month follow-up period, but 21% of patients fluctuated between being on and above target. CONCLUSION Two thirds of CAD patients with ACS and on statin therapy do not achieve LDL-C treatment target recommended by the guidelines. Since LDL-C levels fluctuate in the follow-up, a low level during the first 12 months after the acute event does not guarantee the maintenance of the results in the long term. Hence, LDL-C levels should be monitored at least on an yearly basis on follow-ups, and treatment adapted accordingly.
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Affiliation(s)
| | - Anna Torvinen
- Nordic Healthcare Group, Vattuniemenranta 2, 00210, Helsinki, Finland
| | - Tuomas T Rissanen
- Heart Center, North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Vesa Virtanen
- Tampere University Hospital, Biokatu 6 PO Box 2000, 33521, Tampere, Finland
| | - Fredrik Herse
- Nordic Healthcare Group, Vattuniemenranta 2, 00210, Helsinki, Finland
| | - Mikko Nuutinen
- Nordic Healthcare Group, Vattuniemenranta 2, 00210, Helsinki, Finland
| | - Juha Mustonen
- Heart Center, North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Joensuu, Finland; National Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland; Joint Municipal Authority for North Karelia Social and Health Care Services (Siun Sote), Joensuu, Finland
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Roth C, Berger R, Kuhn M. The role of the socio-economic environment on medical outcomes after ST-segment elevation myocardial infarction. BMC Public Health 2019; 19:630. [PMID: 31122225 PMCID: PMC6533747 DOI: 10.1186/s12889-019-6966-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background According to the World Health Organization, coronary artery disease (CAD), including ST-segment elevation myocardial infarction (STEMI), is the most common cause of death worldwide as well as in Europe and Austria. There is valid data on the impact of conventional risk factors on the medical outcomes for STEMI patients. However, only few studies examine the role of the socio-economic environment for medical outcomes. The main task of this study is to investigate if the socio-economic environment of patients who underwent percutaneous coronary intervention (PCI) after STEMI has an impact on the distribution of risk factors and medical outcomes. Methods The study focuses on the population of the City of Vienna, Austria, and includes 870 STEMI patients, who underwent PCI at the General Hospital of Vienna (AKH Wien) between 2008 and 2012. The following data were collected: conventional risk factors (hypertension, hyperlipidemia, diabetes, overweight, smoking, family history and vascular disease) and socio-economic indicators of the patient’s residential district (number of residents, income pre-tax, residents per general practitioner, residents per internal specialist, compulsory education only, academic degree and rate of unemployment). Cox regressions were performed to evaluate the impact of socio-economic environment and conventional risk factors on survival. Results Most of the conventional risk factors show a significant difference between deceased and surviving patients. The study revealed significant differences across districts in relation to the socio-economic background of STEMI patients. Surprisingly, medical outcomes, as measured by the survival of patients, are significantly related to a patient’s district of residence (p-Value = 0.028) but not in a systematic way as far as the socio-economic environment of these districts is concerned. Conclusions The study provides intuitive evidence for a hitherto understudied Central European context on the link between socio-economic environment and conventional risk factors at population level and the link between conventional risk factors and survival both at the population at the individual level. While this is in line with previous evidence and suggestive of the incorporation of measures of socio-economic status (SES) into policy & guidelines toward the management of CAD, more data on the SES – STEMI nexus are needed at individual level.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Rudolf Berger
- Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Johannes von Gott-Platz 1, 7000, Eisenstadt, Austria
| | - Michael Kuhn
- Wittgenstein Centre (WU, VID/ÖAW, IIASA), Institute for Applied Systems Analysis and Vienna Institute of Demography, Welthandelsplatz 2/Level 2, 1020, Vienna, Austria
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Unraveling the Cardiovascular PROSPECTs of Patients With Prediabetes. JACC Cardiovasc Imaging 2019; 12:742-744. [DOI: 10.1016/j.jcmg.2017.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 11/19/2022]
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Deseive S, Straub R, Kupke M, Broersen A, Kitslaar PH, Stocker TJ, Massberg S, Hadamitzky M, Hausleiter J. Impact of diabetes on coronary artery plaque volume by coronary CT angiography and subsequent adverse cardiac events. J Cardiovasc Comput Tomogr 2019; 13:31-37. [DOI: 10.1016/j.jcct.2018.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/27/2018] [Accepted: 09/29/2018] [Indexed: 11/28/2022]
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Tan B, Liu L, Yang Y, Liu Q, Yang L, Meng F. Low CPNE3 expression is associated with risk of acute myocardial infarction: A feasible genetic marker of acute myocardial infarction in patients with stable coronary artery disease. Cardiol J 2018; 26:186-193. [PMID: 29297177 DOI: 10.5603/cj.a2017.0155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/28/2017] [Accepted: 12/15/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gene COPINE III may be related to a phosphoprotein with intrinsic kinase activity and belongs to an unconventional kinase family. The CPNE3 gene may be used as a biomarker for assess- ment of occurrence and prognosis of various tumors. METHODS Peripheral blood was collected from 87 stable coronary artery disease (CAD) patients and 91 acute myocardial infarction (AMI) patients. Real-time quantitative polymerase chain reaction test and the western blot method were adopted to measure expression quantity of CPNE3 gene at the mRNA level and the protein level. RESULTS The expression of the CPNE3 gene in peripheral blood of AMI patients was significantly lower than those in peripheral blood of stable CAD patients. Low expression of CPNE3 gene was found to be unrelated to level of fasting blood glucose and serum blood lipid of patients, quantity of cardiac troponin and time of onset but was found to be correlated to the Gensini score for coronary artery. When the ex- pression of CPNE3 gene at the mRNA level in peripheral blood was used as the criterion for diagnosing AMI, its sensitivity, specificity, positive predictive value and negative predictive value were 69%, 64.8%, 68.6% and 65.2%, respectively. CONCLUSIONS Compared to stable CAD patients, AMI patients have a lower expression of CPNE3 gene in their peripheral blood. Patients who have low CPNE3 expression in peripheral blood are more likely to suffer from AMI than those with stable CAD. Low expression of CPNE3 gene serves as an potential independent risk factor of AMI.
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Affiliation(s)
- Buchuan Tan
- Cardiology Department of the China-Japan Union Hospital of Jilin University, Changchun, China
| | - Long Liu
- Cardiology Department of the China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yushuang Yang
- Cardiology Department of the China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qian Liu
- Cardiology Department of the China-Japan Union Hospital of Jilin University, Changchun, China
| | - Liping Yang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Fanbo Meng
- Cardiology Department of the China-Japan Union Hospital of Jilin University, Changchun, China.
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Kovarnik T, Chen Z, Mintz GS, Wahle A, Bayerova K, Kral A, Chval M, Kopriva K, Lopez J, Sonka M, Linhart A. Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology. Cardiovasc Diabetol 2017; 16:156. [PMID: 29212544 PMCID: PMC5719721 DOI: 10.1186/s12933-017-0637-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Coronary atherosclerosis progresses faster in patients with diabetes mellitus (DM) and causes higher morbidity and mortality in such patients compared to non-diabetics ones (non-DM). We quantify changes in plaque volume and plaque phenotype during lipid-lowering therapy in DM versus non-DM patients using advanced intracoronary imaging. Methods We analyzed data from 61 patients with stable angina pectoris included to the PREDICT trial searching for prediction of plaque changes during intensive lipid-lowering therapy (40 mg rosuvastatin daily). Geometrically correct, fully 3-D representation of the vascular wall surfaces and intravascular ultrasound virtual histology (IVUS-VH) defined tissue characterization was obtained via fusion of two-plane angiography and IVUS-VH. Frame-based indices of plaque morphology and virtual histology analyses were computed and averaged in 5 mm long baseline/follow-up registered vessel segments covering the entire length of the two sequential pullbacks (baseline, 1-year). We analyzed 698 5-mm-long segments and calculated the Liverpool active plaque score (LAPS). Results Despite reaching similar levels of LDL cholesterol (DM 2.12 ± 0.91 mmol/l, non-DM 1.8 ± 0.66 mmol/l, p = 0.21), DM patients experienced, compared to non-DM ones, higher progression of mean plaque area (0.47 ± 1.15 mm2 vs. 0.21 ± 0.97, p = 0.001), percent atheroma volume (0.7 ± 2.8% vs. − 1.4 ± 2.5%, p = 0.007), increase of LAPS (0.23 ± 1.66 vs. 0.13 ± 1.79, p = 0.018), and exhibited more locations with TCFA (Thin-Cap Fibro-Atheroma) plaque phenotype in 5 mm vessel segments (20.3% vs. 12.5%, p = 0.01). However, only non-DM patients reached significant decrease of LDL cholesterol. Plaque changes were more pronounced in PIT (pathologic intimal thickening) compared to TCFA with increased plaque area in both phenotypes in DM patients. Conclusion Based on detailed 3D analysis, we found advanced plaque phenotype and further atherosclerosis progression in DM patients despite the same reached levels of LDLc as in non-DM patients. Trial registration ClinicalTrials.gov identifier: NCT01773512
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic.
| | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, USA
| | - Andreas Wahle
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Kristyna Bayerova
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Faculty of Education, Charles University in Prague, Prague, Czech Republic
| | - Karel Kopriva
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - John Lopez
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
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Usefulness of CHADS2 score for prognostic stratification of patients with coronary artery disease: A systematic review and meta-analysis of cohort studies. Int J Cardiol 2017; 228:906-911. [DOI: 10.1016/j.ijcard.2016.11.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022]
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Role of Intravascular Ultrasound in the Detection of Cardiovascular Disease in Diabetes and Metabolic Syndrome in Latin America. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakanishi R, Ceponiene I, Osawa K, Luo Y, Kanisawa M, Megowan N, Nezarat N, Rahmani S, Broersen A, Kitslaar PH, Dailing C, Budoff MJ. Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study. Atherosclerosis 2016; 255:73-79. [PMID: 27835741 DOI: 10.1016/j.atherosclerosis.2016.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS We aimed at investigating whether diabetes is associated with progression in coronary plaque components. METHODS We identified 142 study subjects undergoing serial coronary computed tomography angiography. The resulting propensity score was applied 1:1 to match diabetic patients to non-diabetic patients for clinical risk factors, prior coronary stenting, coronary artery calcium (CAC) score and the serial scan interval, resulting in the 71 diabetes and 71 non-diabetes patients. Coronary plaque (total, calcified, non-calcified including fibrous, fibrous-fatty and low attenuation plaque [LAP]) volume normalized by total coronary artery length was measured using semi-automated plaque software and its change overtime between diabetic and non-diabetic patients was evaluated. RESULTS The matching was successful without significant differences between the two groups in all matched variables. The baseline volumes in each plaque also did not differ. During a mean scan interval of 3.4 ± 1.8 years, diabetic patients showed a 2-fold greater progression in normalized total plaque volume (TPV) than non-diabetes patients (52.8 mm3vs. 118.3 mm3, p = 0.005). Multivariable linear regression model revealed that diabetes was associated with normalized TPV progression (β 72.3, 95%CI 24.3-120.3). A similar trend was observed for the non-calcified components, but not calcified plaque (β 3.8, 95%CI -27.0-34.7). Higher baseline CAC score was found to be associated with total, non-calcified and calcified plaque progression. However, baseline non-calcified volume but not CAC score was associated with LAP progression. CONCLUSIONS The current study among matched patients indicates diabetes is associated with a greater plaque progression. Our results show the need for strict adherence of diabetic patients to the current preventive guidelines.
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Affiliation(s)
- Rine Nakanishi
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
| | - Indre Ceponiene
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Kazuhiro Osawa
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Yanting Luo
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Mitsuru Kanisawa
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Nichelle Megowan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Negin Nezarat
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Sina Rahmani
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | | | - Pieter H Kitslaar
- Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands; Medis Medical Systems bv, Leiden, 2316 XG, The Netherlands
| | - Christopher Dailing
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
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Munnur RK, Nerlekar N, Wong DTL. Imaging of coronary atherosclerosis in various susceptible groups. Cardiovasc Diagn Ther 2016; 6:382-95. [PMID: 27500095 DOI: 10.21037/cdt.2016.03.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process. Insights from pathological observations and advances in cellular and molecular biology have helped us understand the process of plaque formation, progression and rupture leading to events. Several intravascular imaging techniques such as intravascular ultrasound (IVUS), Virtual histology IVUS (VH-IVUS) and optical coherence tomography (OCT) allow in vivo assessment of plaque burden, plaque morphology and response to therapy. In addition, non invasive assessment using coronary artery calcium (CAC) score allows risk stratification and plaque burden assessment whilst computed tomography coronary angiography (CTCA) allows evaluation of luminal stenosis, plaque characterisation and quantification. This review aims to summarise the results of invasive and non-invasive imaging studies of coronary atherosclerosis seen in various high-risk populations including DM, metabolic syndrome, obesity, CKD and, gender differences and ethnicity. Understanding the phenotype of plaques in various susceptible groups may allow potential development of personalised therapies.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
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Ndrepepa G, Iijima R, Kufner S, Braun S, Cassese S, Byrne RA, Sorges J, Schulz-Schüpke S, Hoppmann P, Fussaro M, Laugwitz KL, Schunkert H, Kastrati A. Association of progression or regression of coronary artery atherosclerosis with long-term prognosis. Am Heart J 2016; 177:9-16. [PMID: 27297844 DOI: 10.1016/j.ahj.2016.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The association between coronary atherosclerosis progression or regression and long-term prognosis remains poorly defined. We assessed the association of atherosclerosis progression or regression with long-term mortality and factors that promote angiographic progression or regression of coronary atherosclerosis in patients with angiographically proven coronary artery disease. METHODS The study included 605 patients with coronary artery disease who underwent coronary angiography at baseline and at 2 years later. Pan-coronary artery tree quantitative coronary angiography was performed. Of 6259 coronary segments (10.3 lesions per patient) analyzed, 1790 non-stented segments with ≥25% diameter stenosis at baseline were included. Atherosclerosis progression or regression was defined as a decrease or increase in the mean minimal lumen diameter (MLD) of the non-stented segments of ≥0.2 mm in the 2-year angiography compared to baseline angiography. The primary outcome was all-cause mortality. RESULTS Based on the change in mean MLD between baseline and 2-year angiography, patients were divided into 3 groups: the group with progression of atherosclerosis (n=53; 8.8%), the group with no progression or regression of atherosclerosis (n=472; 78.0%) and the group with regression of atherosclerosis (n=80; 13.2%). There were 126 deaths over 8-year follow-up: 17 deaths among patients with progression, 103 deaths among patients with no progression/regression and 6 deaths among patients with regression (Kaplan-Meier estimates of mortality, 37.5%, 25.2% and 8.9%, respectively; adjusted hazard ratio=1.16, 95% confidence interval 1.05 to 1.29, P=.004 for 0.1 mm reduction in mean MLD). CONCLUSIONS Progression or regression of coronary atherosclerosis in non-treated coronary segments was significantly associated with 8-year mortality.
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Bortoletto MSS, Souza RKTD, Cabrera MAS, González AD. Síndrome metabólica, componentes e fatores associados em adultos de 40 anos ou mais de um município da Região Sul do Brasil. ACTA ACUST UNITED AC 2016. [DOI: 10.1590/1414-462x201600010123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Resumo Objetivo Estimar a prevalência de síndrome metabólica (SM), de seus componentes e fatores associados em adultos de 40 anos ou mais. Métodos Estudo transversal, de base populacional, com 1.180 residentes em um município brasileiro de médio porte da Região Sul. Realizaram-se entrevistas domiciliares, avaliações antropométricas e exames laboratoriais. A SM foi definida de acordo com o critério harmonizado de 2009. Foram analisadas variáveis sociodemográficas, comportamentais e de utilização de serviços de saúde. Utilizaram-se o teste de qui-quadrado, exato de Fisher e teste de Wald na análise de múltiplos fatores pela regressão de Poisson. Resultados Entre os entrevistados, 959 (81,3%) realizaram exames laboratoriais e medidas antropométricas. A prevalência de SM foi de 53,7%, mais elevada em mulheres e em idades mais avançadas. A presença de cinco componentes da SM foi observada em 12% dos participantes (15,8% mulheres e 7,3% homens). Após ajustes, apenas a idade se associou à SM. Conclusão A elevada prevalência de SM e de seus componentes, distinta em cada sexo e grupo etário, aponta a necessidade de ações de enfrentamento com abordagens coletivas e estabelecimento de metas terapêuticas individuais.
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Kania M, Maniewski R, Kobylecka M, Zaczek R, Królicki L, Opolski G, Janusek D. Prognostic value of the total cosine R to T measured in high resolution body surface potential mapping during exercise test. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kataoka Y, St John J, Wolski K, Uno K, Puri R, Tuzcu EM, Nissen SE, Nicholls SJ. Atheroma progression in hyporesponders to statin therapy. Arterioscler Thromb Vasc Biol 2015; 35:990-5. [PMID: 25722430 DOI: 10.1161/atvbaha.114.304477] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lowering low-density lipoprotein cholesterol (LDL-C) with statins has been demonstrated to slow plaque progression. This antiatherosclerotic effect in patients with minimal LDL-C lowering has not been investigated. APPROACH AND RESULTS Six hundred forty-seven patients with angiographic coronary artery disease who were commenced on statin therapy underwent serial imaging with intravascular ultrasound. Responders were defined as a percentage reduction in LDL-C of <15%. Disease progression was compared in responders (n=517) and hyporesponders (n=130) to statin therapy. Twenty percentage of patients demonstrated minimal changes in LDL-C, despite commencement of statin therapy. Statin hyporesponders were younger (55 versus 57 years; P=0.01), more likely to be male (79% versus 66%; P=0.005), and obese (body mass index, 31.5 ± 6.1 versus 30.3 ± 5.9 kg/m(2); P=0.04) and less likely to have a history of dyslipidemia (50% versus 66%; P<0.001). Baseline levels of systolic blood pressure (127 ± 15 versus 132 ± 17 mm Hg; P=0.01) and LDL-C (2.5 ± 0.6 versus 3.4 ± 0.8 mmol/L; P<0.001) were lower in statin hyporesponders. Baseline percent atheroma volume was similar between statin hyporesponders and responders (36.9 ± 9.8% versus 38.3 ± 9.2%; P=0.13). On serial evaluation, greater progression of percent atheroma volume (1.19 ± 0.48% versus 0.09 ± 0.43%; P=0.003) was observed in statin hyporesponders. After adjusting for baseline clinical characteristics and measures of plaque burden, statin hyporesponders still exhibited greater atheroma progression (+0.83 ± 0.58% versus -0.21 ± 0.52%; P=0.006). CONCLUSIONS A substantial proportion of patients with coronary artery disease fail to achieve effective reductions in LDL-C, despite prescription of statin therapy. Greater progression of atherosclerosis is observed in these patients. Our current study underscores monitoring LDL-C level after the commencement of statin to ensure adequate response to statin therapy.
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Affiliation(s)
- Yu Kataoka
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Julie St John
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Kathy Wolski
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Kiyoko Uno
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Rishi Puri
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - E Murat Tuzcu
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Steven E Nissen
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH
| | - Stephen J Nicholls
- From the South Australian Health and Medical Research Institute, Heart Health Theme, University of Adelaide, Adelaide, Australia (Y.K., S.J.N.); and C5 Research (J.S.J., K.W., K.U., R.P., S.E.N.) and Department of Cardiovascular Medicine, Heart and Vascular Institute (R.P., E.M.T., S.E.N.), Cleveland Clinic, OH.
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Paul Taggart D, van der Wall EE, Vrints CJ, Luis Zamorano J, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Anton Sirnes P, Luis Tamargo J, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, González-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Dalby Kristensen S, Lancellotti P, Pietro Maggioni A, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Anton Sirnes P, Gabriel Steg P, Timmis A, Wijns W, Windecker S, Yildirir A, Luis Zamorano J. Guía de Práctica Clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía isquémica estable. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34:2949-3003. [PMID: 23996286 DOI: 10.1093/eurheartj/eht296] [Citation(s) in RCA: 2878] [Impact Index Per Article: 261.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Low Wang CC, Lu L, Leitner JW, Sarraf M, Gianani R, Draznin B, Greyson CR, Reusch JEB, Schwartz GG. Arterial insulin resistance in Yucatan micropigs with diet-induced obesity and metabolic syndrome. J Diabetes Complications 2013; 27:307-15. [PMID: 23558108 PMCID: PMC3696427 DOI: 10.1016/j.jdiacomp.2013.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 01/29/2013] [Accepted: 02/21/2013] [Indexed: 12/11/2022]
Abstract
AIM Metabolic syndrome affects a large proportion of the population and increases cardiovascular disease risk. Because metabolic syndrome often co-exists clinically with atherosclerosis, it is difficult to distinguish the respective contributions of the components to vascular abnormalities. Accordingly, we utilized a porcine dietary model of metabolic syndrome without atherosclerosis to investigate early abnormalities of vascular function and signaling. METHODS Thirty-two Yucatan micropigs were fed either a high-fat, high-simple-sugar, high-calorie (HFHS) or standard chow diet (STD) for 6 months. Neither diet contained added cholesterol. Blood pressure and flow-mediated vasodilatation were assessed at baseline and 6 months. Aortas were harvested at 6 months to assess histology, insulin signaling, and endothelial nitric oxide (eNOS) phosphorylation. RESULTS HFHS pigs developed characteristics of metabolic syndrome including obesity, dyslipidemia, and insulin resistance, but without histologic evidence of atherosclerosis. Although arterial intima-media thickness did not differ between groups, vascular dysfunction in HFHS was manifest by increased blood pressure and impaired flow-mediated vasodilation of the femoral artery. Compared with STD, aortas from HFHS exhibited increased p85α expression and Ser307 IRS-1 phosphorylation, and blunted insulin-stimulated IRS-1-associated phosphatidylinositol (PI) 3-kinase activity. In the absence of insulin stimulation, aortic Akt Ser473-phosphorylation was greater in HFHS than in STD. With insulin stimulation, Akt phosphorylation increased in STD, but not HFHS. Insulin-induced Ser1177-phosphorylation of eNOS was decreased in HFHS, compared with STD. CONCLUSIONS Pigs with metabolic syndrome develop early vascular dysfunction and aortic insulin signaling abnormalities, and could be a useful model for early human vascular abnormalities in this condition.
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Affiliation(s)
- Cecilia C Low Wang
- Endocrine Section, VA Medical Center, Denver, and University of Colorado Anschutz Medical Campus/School of Medicine, Aurora, CO, USA.
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Timóteo AT, Mota Carmo M, Cruz Ferreira R. Does metabolic syndrome predict significant angiographic coronary artery disease? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Timóteo AT, Mota Carmo M, Cruz Ferreira R. Does metabolic syndrome predict significant angiographic coronary artery disease? Rev Port Cardiol 2012; 31:769-78. [PMID: 23158962 DOI: 10.1016/j.repc.2012.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/01/2012] [Accepted: 03/08/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Metabolic syndrome (MS) is an independent predictor of acute cardiovascular events. However, few studies have addressed the relationship between MS and stable angiographic coronary artery disease (CAD), which has a different pathophysiological mechanism. We aimed to study the independent predictors for significant CAD, and to analyze the impact of MS (by the AHA/NHLBI definition) on CAD. METHODS We prospectively included 300 patients, mean age 64±9 years, 59% male, admitted for elective coronary angiography (suspected ischemic heart disease), excluding patients with known cardiac disease. All patients underwent assessment of demographic, anthropometric, and laboratory data and risk factors, and subsequently underwent coronary angiography. RESULTS In the study population, 23.0% were diabetic, 40.5% had MS (and no diabetes) and 36.7% had neither diagnosis. Significant CAD was present in 51.3% of patients. CAD patients were older and more frequently male and diabetic, with increased triglycerides and glucose and lower HDL cholesterol. Abdominal obesity was also less prevalent. MS was not associated with the presence of CAD (OR 0.94, 95% CI 0.59-1.48, p=0.778). Of the MS components, the most important predictors of CAD were increased glucose and triglycerides. Abdominal obesity was associated with a lower risk of CAD. In a multivariate logistic regression model for CAD, independent predictors of CAD were age, male gender, glucose and triglycerides. Body mass index had a protective effect. CONCLUSIONS Although MS is associated with cardiovascular events, the same was not found for stable angiographically proven CAD. Age, gender, diabetes and triglycerides are the most influential factors for CAD, with abdominal obesity as a protective factor.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, EPE, Lisboa, Portugal.
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Du L, Heaney AP. Regulation of adipose differentiation by fructose and GluT5. Mol Endocrinol 2012; 26:1773-82. [PMID: 22827929 DOI: 10.1210/me.2012-1122] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adipose tissue is an important metabolic organ that is crucial for whole-body insulin sensitivity and energy homeostasis. Highly refined fructose intake increases visceral adiposity although the mechanism(s) remain unclear. Differentiation of preadipocytes to mature adipocytes is a highly regulated process that is associated with characteristic sequential changes in adipocyte gene expression. We demonstrate that fructose treatment of murine 3T3-L1 cells incubated in standard differentiation medium increases adipogenesis and adipocyte-related gene expression. We further show that the key fructose transporter, GluT5, is expressed in early-stage adipocyte differentiation but is not expressed in mature adipocytes. GluT5 overexpression or knockdown increased and decreased adipocyte differentiation, respectively, and treatment of 3T3-L1 cells with a specific GluT5 inhibitor decreased adipocyte differentiation. Epidymal white adipose tissue was reduced in GluT5-/- mice compared with wild-type mice, and mouse embryonic fibroblasts derived from GluT5-/- mice exhibited impaired adipocyte differentiation. Taken together, these results demonstrate that fructose and GluT5 play an important role in regulating adipose differentiation.
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Affiliation(s)
- Li Du
- David Geffen School of Medicine, Division of Endocrinology, 9240-P Factor Building, Los Angeles, California 90095, USA
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Ozawa M, Okamura A, Date M, Higuchi Y, Nagai H, Shibuya M, Ryusuke K, Inoue K, Koyama Y, Iwakura K, Fujii K. Third in-stent restenosis in sirolimus eluting stents. Catheter Cardiovasc Interv 2012; 79:91-6. [DOI: 10.1002/ccd.22916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/22/2010] [Indexed: 01/09/2023]
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Lack of pharmacokinetic interactions between dapagliflozin and simvastatin, valsartan, warfarin, or digoxin. Adv Ther 2012; 29:163-77. [PMID: 22271159 DOI: 10.1007/s12325-011-0098-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Coronary heart disease, stroke, and peripheral vascular disease are the most common causes of mortality in patients with type 2 diabetes mellitus (T2DM). The aim of these studies was to assess the potential for pharmacokinetic interaction between dapagliflozin, a sodium glucose co-transporter-2 inhibitor being developed for the treatment of T2DM, and four medications commonly prescribed in patients with T2DM and cardiovascular disease: simvastatin, valsartan, warfarin, and digoxin. METHODS Potential pharmacokinetic interactions between 20 mg dapagliflozin, 40 mg simvastatin, or 320 mg valsartan were assessed in an open-label, randomized, five-period, five-treatment, unbalanced crossover study in 24 healthy subjects. In a second study, the effects of steady-state dapagliflozin on the pharmacokinetics of 25 mg warfarin or 0.25 mg digoxin were assessed in an open-label, randomized, two-period, two-treatment crossover study in 30 healthy subjects divided into two cohorts. The potential pharmacodynamic interaction between dapagliflozin and warfarin was also evaluated. RESULTS All treatments were well tolerated. Neither simvastatin nor valsartan had any clinically meaningful effect on the pharmacokinetics of dapagliflozin. Dapagliflozin increased the area under the curve for simvastatin, simvastatin acid, and valsartan by approximately 19%, 30%, and 6%, respectively, and decreased the maximum observed plasma concentration of valsartan by approximately 6%. These effects were not considered clinically meaningful. In addition, dapagliflozin had no effect on the pharmacokinetics of either digoxin or warfarin. The pharmacodynamics of warfarin were also unaffected by dapagliflozin. CONCLUSION In these studies the co-administration of dapagliflozin and simvastatin, valsartan, warfarin, or digoxin was well tolerated without clinically meaningful drug-drug interaction.
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Is prediction of cardiovascular disease and all-cause mortality genuinely driven by the metabolic syndrome, and independently from its component variables? The Dubbo study. Heart Lung Circ 2011; 20:214-9. [PMID: 21353637 DOI: 10.1016/j.hlc.2010.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/17/2010] [Accepted: 12/18/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Metabolic Syndrome (MetS) predicts an increased risk of cardiovascular disease and all-cause mortality. Is this prediction genuinely driven by the syndrome and independently from its component variables? METHODS A longitudinal cohort study in Dubbo, Australia of 2805 men and women ≥60 years followed for 16 years from 1988. Cox proportional hazards models were calculated for coronary heart disease (CHD), ischaemic stroke and all-cause mortality with MetS as an independent variable. Separate models included the MetS variable, with or without the presence of one of its five component variables. RESULTS MetS was present in 33% of subjects. Obesity was present in 43% of those with MetS, high blood pressure in 99%, elevated triglycerides in 83%, low HDL-C in 75% and glycaemia in 48%. With respect to CHD and all-cause mortality, prediction by MetS was similar in the presence or absence of individual component factors (e.g. hazard ratio (95% CI) for CHD by MetS when low HDL-C present 1.60(1.39-1.84) and 1.67(1.37-2.04) when low HDL-C absent). With stroke, prediction by MetS was lost in the absence of elevated triglycerides or glycaemia factors (e.g. hazard ratio for stroke by MetS when glycaemia present 1.59(1.24-2.05) and 1.08(0.82-1.42) when glycaemia absent). CONCLUSIONS The findings suggest that prediction of CHD and all-cause mortality is genuinely driven by the MetS and independently of its component variables. Prediction of ischaemic stroke is more complex, with some components providing prediction independently from the MetS.
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