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Larsson J, Auscher S, Madsen FS, Overgaard KS, Pararajasingam G, Heinsen LJ, Andersen TR, Lindholt JS, Lambrechtsen J, Egstrup K. Left Ventricular Systolic Function in Asymptomatic Men Aged 65-75 Years, Relation to Insulin Resistance and Pre-Diabetes: A DANCAVAS Cross-Sectional Sub-Study. J Cardiovasc Dev Dis 2025; 12:180. [PMID: 40422951 DOI: 10.3390/jcdd12050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 05/02/2025] [Accepted: 05/07/2025] [Indexed: 05/28/2025] Open
Abstract
AIM Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes. METHOD All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups. RESULTS In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (-17.9% vs. -18.7%, p < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (p-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1-11.1, p = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not. CONCLUSIONS In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement.
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Affiliation(s)
- Johanna Larsson
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Søren Auscher
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Freja Sønder Madsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Katrine Schultz Overgaard
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital Odense, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700 Svendborg, Denmark
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Rroji M, Spahia N, Figurek A, Spasovski G. Targeting Diabetic Atherosclerosis: The Role of GLP-1 Receptor Agonists, SGLT2 Inhibitors, and Nonsteroidal Mineralocorticoid Receptor Antagonists in Vascular Protection and Disease Modulation. Biomedicines 2025; 13:728. [PMID: 40149704 PMCID: PMC11940462 DOI: 10.3390/biomedicines13030728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/03/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Abstract
Atherosclerosis is a closely related complication of diabetes mellitus (DM), driven by endothelial dysfunction, inflammation, and oxidative stress. The progression of atherosclerosis is accelerated by hyperglycemia, insulin resistance, and hyperlipidemia. Novel antidiabetic agents, SGLT2 inhibitors, and GLP-1 agonists improve glycemic control and offer cardiovascular protection, reducing the risk of major adverse cardiovascular events (MACEs) and heart failure hospitalization. These agents, along with nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), promise to mitigate metabolic disorders and their impact on endothelial function, oxidative stress, and inflammation. This review explores the potential molecular mechanisms through which these drugs may prevent the development of atherosclerosis and cardiovascular disease (CVD), supported by a summary of preclinical and clinical evidence.
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Affiliation(s)
- Merita Rroji
- Department of Nephrology, University of Medicine Tirana, 1001 Tirana, Albania
- Department of Nephrology, University Hospital Center Mother Tereza, 1001 Tirana, Albania;
| | - Nereida Spahia
- Department of Nephrology, University Hospital Center Mother Tereza, 1001 Tirana, Albania;
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, 8057 Zurich, Switzerland;
| | - Goce Spasovski
- Department of Nephrology, University Sts. Cyril and Methodius, 1000 Skopje, North Macedonia;
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Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Gorter TM, Hanssen H, Marx N, McDonagh TA, Mingrone G, Rosengren A, Prescott EB. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur J Prev Cardiol 2025; 32:184-220. [PMID: 39210708 DOI: 10.1093/eurjpc/zwae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
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Affiliation(s)
- Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital-INSELSPITAL, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Emeline M Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium
- Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthias Blüher
- Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, RWTH Aachen University, Aachen, Germany
| | - Theresa A McDonagh
- Cardiology Department, King's College Hospital, London, UK
- King's College, London, UK
| | - Geltrude Mingrone
- Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli & Catholic University, Rome, Italy
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital/Ostra, Västra Götaland Region, Gothenburg, Sweden
| | - Eva B Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
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Andersen TR, Overgaard KS, Heinsen LJ, Mohamed RA, Madsen FS, Precht H, Lambrechtsen J, Auscher S, Egstrup K. High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study. J Cardiovasc Dev Dis 2025; 12:37. [PMID: 39997471 PMCID: PMC11856177 DOI: 10.3390/jcdd12020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/09/2025] [Accepted: 01/15/2025] [Indexed: 02/26/2025] Open
Abstract
Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm3) compared with NGT (12.66 ± 9.72 mm3, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction.
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Affiliation(s)
- Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Katrine Schultz Overgaard
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Roda Abdulkadir Mohamed
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Freja Sønder Madsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
| | - Helle Precht
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Health Sciences Research Centre, UCL University College, 5230 Odense, Denmark
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, 6000 Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
- Discipline of Medical Imaging and Radiation Therapy, University College Cork, T12 K8AF Cork, Ireland
| | - Jess Lambrechtsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren Auscher
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, 5700 Svendborg, Denmark; (T.R.A.); (K.S.O.); (L.J.H.); (R.A.M.); (F.S.M.); (H.P.); (J.L.); (S.A.)
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
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Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Gorter TM, Hanssen H, Marx N, McDonagh TA, Mingrone G, Rosengren A, Prescott EB. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J 2024; 45:4063-4098. [PMID: 39210706 DOI: 10.1093/eurheartj/ehae508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
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Affiliation(s)
- Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital-INSELSPITAL, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Emeline M Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium
- Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthias Blüher
- Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, RWTH Aachen University, Aachen, Germany
| | - Theresa A McDonagh
- Cardiology Department, King's College Hospital, London, UK
- King's College, London, UK
| | - Geltrude Mingrone
- Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli & Catholic University, Rome, Italy
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital/Ostra, Västra Götaland Region, Gothenburg, Sweden
| | - Eva B Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
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Bulut M, Celik FB, Guvenc TS, Yilmaz Y, Celik M, Ozyildirim S, Gocer K, Asik M, Kul S, Caliskan M. Usefulness of triglyceride-glucose index and homeostatic model assessment for predicting coronary microvascular dysfunction. J Clin Lipidol 2024; 18:e764-e772. [PMID: 38955587 DOI: 10.1016/j.jacl.2024.04.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/21/2024] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest triglyceride-glucose (TyG) index is a superior marker of IR that had a better accuracy to predict type 2 diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD. RESULTS TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (odds ratio [OR]:1.38, 95% confidence interval [CI]:1.14-1.67, p = 0.001) but not TyG index (OR:1.48, 95% CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95% CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95% CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF10:3507) but not for TyG index(BF10:0.66). CONCLUSIONS HOMA-IR, but not TyG index, is closely associated with CMD.
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Affiliation(s)
- Mustafa Bulut
- Sultanbeyli State Hospital, Department of Cardiology, Istanbul, Turkey (Dr Bulut)
| | - Fatma Betul Celik
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
| | - Tolga Sinan Guvenc
- Istinye University School of Medicine, Department of Cardiology, Istanbul, Turkey (Dr Guvenc)
| | - Yusuf Yilmaz
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan).
| | - Mehmet Celik
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey (Dr Celik)
| | - Serhan Ozyildirim
- Istanbul University-Cerrahpasa, Department of Cardiology, Cardiology Institute, Istanbul, Turkey (Dr Ozyildirim)
| | - Kemal Gocer
- Necip Fazil State Hospital, Department of Cardiology, Kahramanmaras, Turkey
| | - Murat Asik
- Istanbul Medeniyet University School of Medicine (Dr Asik), Department of Radiology, Istanbul, Turkey
| | - Seref Kul
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
| | - Mustafa Caliskan
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
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Zeng M, Sun E, Zhu L, Deng L. Influence of prediabetes on the prognosis of patients with myocardial infarction: a meta-analysis. Diabetol Metab Syndr 2024; 16:160. [PMID: 38997776 PMCID: PMC11241782 DOI: 10.1186/s13098-024-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/12/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Previous studies evaluating the association between prediabetes the prognosis of patients with acute myocardial infarction (AMI) showed inconsistent results. The aim of the meta-analysis was to compare the long-term incidence of major adverse cardiovascular events (MACEs) between AMI patients with prediabetes and normoglycemia. METHODS Relevant prospective cohort studies were obtained by searching Medline, Web of Science, and Embase databases. Only studies with follow-up duration of at least one year were included. A random-effects model was utilized to pool the results by incorporating the influence of heterogeneity. RESULTS Twelve studies with 6972 patients with AMI were included. Among them, 2998 were with prediabetes and 3974 were with normoglycemia. During a mean follow-up of 52.6 months, 2100 patients developed MACEs. Compared to those with normoglycemia, AMI patients with prediabetes were associated with a higher incidence of MACEs (risk ratio [RR]: 1.30, 95% confidence interval: 1.07 to 1.58, p = 0.008; I2 = 67%). Subgroup analysis showed a stronger association between prediabetes and MACEs in studies of patients with mean age ≥ 60 years compared to < 60 years (RR: 1.66 versus 1.10, p for subgroup difference = 0.04), with proportion of men < 75% compared to ≥ 75% (RR: 1.87 versus 1.08, p for subgroup difference = 0.01), and in prediabetes evaluated at or after discharge compared to that evaluated within three days of AMI onset (RR: 1.39 versus 0.78, p for subgroup difference = 0.01). CONCLUSIONS Prediabetes may be associated with a higher risk of MACEs in patients with AMI.
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Affiliation(s)
- Mengya Zeng
- Department of Cardiovascular disease, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570216, China
| | - Eyu Sun
- Directly Affiliated Government Kindergartens of Chenzhou, Chenzhou, 423000, China
| | - Li Zhu
- Department of Cardiovascular Medicine, The Affiliated Chenzhou Hospital, University of South China, Chenzhou, 423000, China
| | - Lingzhi Deng
- Department of Cardiovascular Medicine, Chenzhou First People's Hospital of Hunan Province, No. 102, Luojiajing, Beihu District, Chenzhou, Hunan Province, 423000, China.
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Song J, Ma R, Yin L. Associations between estimated glucose disposal rate and arterial stiffness and mortality among US adults with non-alcoholic fatty liver disease. Front Endocrinol (Lausanne) 2024; 15:1398265. [PMID: 38779449 PMCID: PMC11109450 DOI: 10.3389/fendo.2024.1398265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background The estimated glucose disposal rate (eGDR), an effective indicator of insulin resistance, has been related to acute coronary syndrome, ischemic stroke and heart failure. This study aims to explore the relationship between eGDR and arterial stiffness, all-cause mortality and cardiovascular mortality in patients with non-alcoholic fatty liver disease (NAFLD). Methods Participants with NAFLD were chosen from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. The main outcomes are arterial stiffness (represented by estimated pulse wave velocity, ePWV), all-cause and cardiovascular mortality. Multiple cox regression models, restricted cubic spline, sensitivity analysis and subgroup analysis were carried out to investigate the correlation between the insulin resistance indicators and mortality and arterial stiffness. Furthermore, receiver operating characteristic curves were used to compare the predictive value of the eGDR with the triglyceride-glucose (TyG) index and the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality. Results In this study, a total of 4,861 participants were included for analysis. After adjusting confounding factors in the multivariate weighted cox regression model, the eGDR was inversely associated with the all-cause mortality (Q4 vs. Q1, HR =0.65 (0.48-0.89, P=0.01) and cardiovascular mortality (Q4 vs. Q1, HR =0.35 (0.19-0.65, P<0.001). Compared with TyG index and HOMA-IR, the eGDR shows excellent predictive value in all-cause mortality (0.588 vs. 0.550 vs. 0.513, P < 0.001) and cardiovascular mortality (0.625 vs. 0.553 vs. 0.537, P < 0.001). In addition, we found a significant negative correlation between eGDR and arterial stiffness (β=-0.13(-0.14-0.11, P< 0.001). However, TyG index and HOMA-IR showed no significant correlation to arterial stiffness. Conclusions Low eGDR (an indicator of insulin resistance) levels are related to an increased risk of arterial stiffness and mortality in NAFLD patients in the United States.
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Affiliation(s)
- Junting Song
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ruicong Ma
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lin Yin
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Larsson J, Auscher S, Pararajasingam G, Heinsen LJ, Andersen TR, Lambrechtsen J, Egstrup K. Reply to: "Insulin resistance is an important index to assess glucose and insulin metabolism, but not a biological risk factor for high-risk coronary artery plaque composition". Atherosclerosis 2024; 392:117524. [PMID: 38523001 DOI: 10.1016/j.atherosclerosis.2024.117524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Johanna Larsson
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark.
| | - Søren Auscher
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
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Berisha-Muharremi V, Majnaric-Trtica L, Mujaj B. Insulin resistance is an important index to assess glucose and insulin metabolism, but not a biological risk factor for high-risk coronary artery plaque composition. Atherosclerosis 2024; 392:117484. [PMID: 38433071 DOI: 10.1016/j.atherosclerosis.2024.117484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Venera Berisha-Muharremi
- Department of Endocrinology University Clinical Center, University of Prishtina, Faculty of Medicine, Bulevardi i Dëshmorëve PN, 10000, Prishtina, Republic of Kosovo
| | - Ljiljana Majnaric-Trtica
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000, Osijek, Croatia
| | - Blerim Mujaj
- Alliance Institute for the Promotion of Preventive Medicine (APPREMED), Leopoldstraat 59, 2800, Mechelen, Belgium; General Practice, Huisartsenpraktijk, Bremtstraat 116, 9320, Aalst, Belgium.
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