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Rowe IA, Allen AM. Hepatic steatosis provides the terroir that promotes the development of cardiovascular risk factors and disease. Hepatology 2023; 77:1843-1845. [PMID: 36738088 DOI: 10.1097/hep.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Ian A Rowe
- Leeds Institute for Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Wan EYF, Yu EYT, Mak IL, Youn HM, Chan KS, Chan EWY, Wong ICK, Lam CLK. Diabetes with poor-control HbA1c is cardiovascular disease 'risk equivalent' for mortality: UK Biobank and Hong Kong population-based cohort study. BMJ Open Diabetes Res Care 2023; 11:e003075. [PMID: 36634978 PMCID: PMC9843200 DOI: 10.1136/bmjdrc-2022-003075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/10/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) has traditionally been considered a coronary heart disease 'risk equivalent' for future mortality, but significant heterogeneity exists across people with T2DM. This study aims to determine the risk of all-cause mortality of patients with cardiovascular disease (CVD) and T2DM in UK and Hong Kong, with stratifications for hemoglobin A1 (HbA1c) concentrations, compared with those without CVD and diabetes mellitus. RESEARCH DESIGN AND METHODS This is a retrospective cohort study of 3 839 391 adults from Hong Kong and a prospective cohort study of 497 779 adults from the UK Biobank. Individuals were divided into seven disease groups: (1) no T2DM and CVD, (2) T2DM only with HbA1c <7%, (3) T2DM only with HbA1c 7%-7.9%, (4) T2DM only with HbA1c 8%-8.9%, (5) T2DM only with HbA1c ≥9%, (6) CVD only, and (7) T2DM and CVD. Differences in all-cause mortality between groups were examined using Cox regression. RESULTS After around 10 years of median follow-up, 423 818 and 19 844 deaths were identified in the Hong Kong cohort and UK Biobank, respectively. Compared with individuals without T2DM and CVD, the adjusted HR for all-cause mortality in the other six disease groups for the Hong Kong cohort was 1.25 (95% CI 1.23 to 1.27) for T2DM only with HbA1c <7%, 1.21 (95% CI 1.19 to 1.23) for T2DM only with HbA1c 7%-7.9%, 1.36 (95% CI 1.33 to 1.39) for T2DM only with HbA1c 8%-8.9%, 1.82 (95% CI 1.78 to 1.85) for T2DM only with HbA1c ≥9%, 1.37 (95% CI 1.36 to 1.38) for CVD only, and 1.83 (95% CI 1.81 to 1.85) for T2DM and CVD, and for the UK Biobank the HR was 1.45 (95% CI 1.33 to 1.58), 1.50 (95% CI 1.32 to 1.70), 1.72 (95% CI 1.43 to 2.08), 2.51 (95% CI 2.05 to 3.08), 1.67 (95% CI 1.59 to 1.75) and 2.62 (95% CI 2.42 to 2.83), respectively. This indicates that patients with T2DM had an increased risk of mortality compared with those without T2DM and CVD, and in those with HbA1c ≥9% an even higher risk than people with CVD. CONCLUSIONS Patients with T2DM with poor HbA1c control (8%-8.9% and ≥9%) were associated with similar and higher risk of mortality compared with patients with CVD, respectively. Optimal HbA1c, controlled for risk reduction and prevention of mortality and complications in diabetes management, remains important.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Hin Moi Youn
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kam Suen Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Esther W Y Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong, Hong Kong
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, People's Republic of China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong, Hong Kong
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, People's Republic of China
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Salinero-Fort MA, Mostaza J, Lahoz C, Cárdenas-Valladolid J, Vicente-Díez JI, Gómez-Campelo P, de Miguel-Yanes JM. All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease. BMC Geriatr 2022; 22:224. [PMID: 35303825 PMCID: PMC8931574 DOI: 10.1186/s12877-022-02893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. Methods We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). Results Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). Conclusions In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02893-z.
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Affiliation(s)
- M A Salinero-Fort
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Subdirección General de Investigación y Documentación, Consejería de Sanidad, Madrid, Spain.
| | - J Mostaza
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - C Lahoz
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - J Cárdenas-Valladolid
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Sistemas de Información, Madrid, Spain.,Universidad Alfonso X El Sabio, Madrid, Spain
| | - J I Vicente-Díez
- Centro de Salud Monóvar, Comunidad de Madrid Servicio Madrileño de Salud, Madrid, Spain
| | - P Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain
| | - J M de Miguel-Yanes
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Bullock-Palmer RP, Peix A, Aggarwal NR. Nuclear Cardiology in Women and Underrepresented Minority Populations. Curr Cardiol Rep 2022; 24:553-566. [PMID: 35262873 DOI: 10.1007/s11886-022-01673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To outline sex-specific features of coronary artery disease (CAD) that should be considered in the assessment of women, including those from ethnic minority populations with suspected stable ischemic heart disease (IHD). Second, to determine the latest nuclear imaging tools available to assess microvascular CAD. RECENT FINDINGS Latest studies indicate that women are more likely to have ischemia with no obstructive coronary arteries (INOCA) and paradoxically have worse outcomes. Therefore, the evaluation of women with suspected IHD should include assessing microvascular and epicardial coronary circulation. The prevalence of CAD is increasing in younger women due to the increased cardiovascular disease (CVD) risk burden. CAD is often underrecognized in these patients. There is increasing recognition that INOCA is not benign and should be accurately diagnosed and managed. Nuclear imaging assesses the full spectrum of CAD from microvascular CAD to multivessel obstructive epicardial CAD. Further research on myocardial blood flow (MBF) assessment with PET MPI is needed.
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Affiliation(s)
- Renee P Bullock-Palmer
- Department of Cardiology, Deborah Heart and Lung Center, Trenton Road, Browns Mills, NJ, 08015, USA.
| | - Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Havana, Cuba
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, 55902, USA
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Tanaka S, Nakano T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, Ooboshi H, Tsuruya K, Kitazono T. Impact of Multivascular Disease on Cardiovascular Mortality and Morbidity in Patients Receiving Hemodialysis: Ten-Year Outcomes of the Q-Cohort Study. J Atheroscler Thromb 2020; 28:385-395. [PMID: 32684556 PMCID: PMC8147568 DOI: 10.5551/jat.54098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Multivascular disease, indicating concurrent arteriosclerotic lesions in a number of different vascular beds, is an independent risk factor for recurrent ischemic events in the general population. However, the impact of multivascular disease on the risk of developing cardiovascular disease has not been fully evaluated in patients receiving hemodialysis. METHODS A total of 3,504 hemodialysis patients were prospectively followed for 10 years. In this study, multivascular disease was defined as the coexistence of coronary artery disease and stroke. We examined the relationship between multivascular disease and the occurrence of composite cardiovascular endpoint, consisting of cardiovascular death, nonfatal coronary artery disease, nonfatal stroke, and peripheral artery disease. RESULTS The proportion of participants with multivascular disease was 5.7% (n=200) at baseline. During follow-up (median, 106.6 months; interquartile range, 50.1-121.8 months), 1,311 patients experienced the composite endpoint, which was defined as at least one of the following: cardiovascular death (n=620), nonfatal coronary artery disease (n=318), nonfatal stroke (n=340), and peripheral artery disease (n=257). Compared with the group with no history of cardiovascular disease, the risk of experiencing the composite endpoint increased significantly with higher numbers of injured vascular beds in patients with single vascular disease (hazard ratio, 1.68; 95% confidence interval, 1.49-1.89) and in those with multivascular disease (hazard ratio, 2.11; 95% confidence interval, 1.71-2.60). In a multivariable analysis, multivascular disease was an independent predictor of cardiovascular events, in addition to diabetes, aging, and hypertension. CONCLUSIONS This study clearly demonstrated that multivascular disease was a powerful predictor for cardiovascular mortality and morbidity in patients receiving hemodialysis.
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Affiliation(s)
- Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Kosuke Masutani
- Department of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University
| | | | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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High arrhythmic risk in antero-septal acute myocardial ischemia is explained by increased transmural reentry occurrence. Sci Rep 2019; 9:16803. [PMID: 31728039 PMCID: PMC6856379 DOI: 10.1038/s41598-019-53221-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial ischemia is a precursor of sudden arrhythmic death. Variability in its manifestation hampers understanding of arrhythmia mechanisms and challenges risk stratification. Our aim is to unravel the mechanisms underlying how size, transmural extent and location of ischemia determine arrhythmia vulnerability and ECG alterations. High performance computing simulations using a human torso/biventricular biophysically-detailed model were conducted to quantify the impact of varying ischemic region properties, including location (LAD/LCX occlusion), transmural/subendocardial ischemia, size, and normal/slow myocardial propagation. ECG biomarkers and vulnerability window for reentry were computed in over 400 simulations for 18 cases evaluated. Two distinct mechanisms explained larger vulnerability to reentry in transmural versus subendocardial ischemia. Macro-reentry around the ischemic region was the primary mechanism increasing arrhythmic risk in transmural versus subendocardial ischemia, for both LAD and LCX occlusion. Transmural micro-reentry at the ischemic border zone explained arrhythmic vulnerability in subendocardial ischemia, especially in LAD occlusion, as reentries were favoured by the ischemic region intersecting the septo-apical region. ST elevation reflected ischemic extent in transmural ischemia for LCX and LAD occlusion but not in subendocardial ischemia (associated with mild ST depression). The technology and results presented can inform safety and efficacy evaluation of anti-arrhythmic therapy in acute myocardial ischemia.
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Tian P, Zheng X, Li M, Li W, Niu Q. Long-term prognostic value of coronary computed tomography angiography for asymptomatic patients with CAD in type 2 diabetes mellitus. Exp Ther Med 2019; 18:747-754. [PMID: 31258710 DOI: 10.3892/etm.2019.7593] [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: 06/16/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022] Open
Abstract
The present study was performed to investigate the prognostic value of coronary computed tomography angiography (CTA) results for asymptomatic patients with coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM). A total of 164 asymptomatic patients with T2DM were enrolled at Weifang Traditional Chinese Hospital (Weifang, China). Coronary plaques and stenosis severity were evaluated after CTA. Structures >1 mm2 adjacent to or within the coronary artery lumen that could be clearly separated from the vessel lumen, was scored as a coronary plaque. Stenosis of ≥50% was considered as being obstructive. CAD was defined as the presence of any coronary plaque or a coronary artery calcium (CAC) score of >0. A CAC score of 0 and no coronary plaques was considered to indicate the absence of CAD. A 5-year follow-up was performed to determine the impact of the CTA findings and various clinicopathological characteristics on the prognosis of all participants. The primary end-point was any cardiac event. Event-free survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Based on the coronary CTA results, the patients were classified into 3 groups according to the extent of stenosis: Normal coronary arteries, obstructive CAD and non-obstructive CAD. Significant differences in 5-year event-free survival were identified among the groups with normal coronary arteries, non-obstructive CAD and obstructive CAD (P=0.026). Further analysis indicated that the event-free survival rate of patients with 1-vessel CAD was 94.11%, that of patients with 2-vessel CAD was 73.68% and that associated with 3-vessel CAD was 61.54%. Multivariate Cox regression analysis revealed that non-obstructive as well as obstructive CAD diagnosed by coronary CTA are prognostic indicators for asymptomatic T2DM patients [hazard ratio (HR)=11.132, 95% confidence interval (CI): 1.857-66.742, P=0.008; HR=7.792, 95% CI: 1.750-34.698, P=0.007, respectively]. In conclusion, the present study suggests that coronary CTA may predict the prognosis of asymptomatic patients with T2DM.
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Affiliation(s)
- Peigang Tian
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Xiangyang Zheng
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Mingzhi Li
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Weiwei Li
- Department of Radiology, Tai'an Central Hospital Branch, Tai'an, Shandong 271000, P.R. China
| | - Qingliang Niu
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
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Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation. Coron Artery Dis 2019; 31:174-183. [PMID: 31219843 DOI: 10.1097/mca.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)]. PATIENTS AND METHODS From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation. RESULTS After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR) = 0.94, 95% confidence interval (CI) = 0.55-1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03-2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04-4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI. CONCLUSION Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients.
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Rutters F, Nijpels G, Elders P, Stehouwer CDA, van der Heijden AA, Groeneveld L, 't Hart LM, Dekker JM, Beulens JWJ. Cohort Profile: The Hoorn Studies. Int J Epidemiol 2019; 47:396-396j. [PMID: 29244153 DOI: 10.1093/ije/dyx227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Femke Rutters
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Petra Elders
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Amber A van der Heijden
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Lenka Groeneveld
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leen M 't Hart
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Department of Molecular Cell Biology.,Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
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Miranda-Machado P, Salcedo-Mejía F, Wilches JP, Fernandez-Mercado J, De la Hoz-Restrepo F, Alvis-Guzmán N. First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor Colombian population: a cohort study. BMC Cardiovasc Disord 2019; 19:8. [PMID: 30621603 PMCID: PMC6323759 DOI: 10.1186/s12872-018-0993-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/26/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. METHODS We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan-Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. RESULTS Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of follow-up. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43-2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45-2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18-2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21-1.53; p < 0.001), 1.52 (1.12-2.08; p 0.004), and 1.20 (1.21-1.53; p < 0.001), respectively. CONCLUSION Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.
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11
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Simó R, Bañeras J, Hernández C, Rodríguez-Palomares J, Valente F, Gutierrez L, González-Alujas T, Ferreira I, Aguadé-Bruix S, Montaner J, Seron D, Genescà J, Boixadera A, García-Arumí J, Planas A, Simó-Servat O, García-Dorado D. Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study. BMJ Open Diabetes Res Care 2019; 7:e000845. [PMID: 31908800 PMCID: PMC6936469 DOI: 10.1136/bmjdrc-2019-000845] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Detection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD. RESEARCH DESIGN AND METHODS Prospective case-control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima-media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography. RESULTS Type 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis. CONCLUSIONS The presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate-severe degree.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - Jordi Bañeras
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - José Rodríguez-Palomares
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Filipa Valente
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Laura Gutierrez
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Teresa González-Alujas
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Ignacio Ferreira
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Santiago Aguadé-Bruix
- Medical and Metabolic Research Area, Nuclear Medicine, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- REDinREN, ISCIII, Madrid, Spain
| | - Joan Genescà
- Liver Unit, Department of Medicine, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBEREHD, ISCIII, Madrid, Spain
| | - Anna Boixadera
- Ophthalmology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - José García-Arumí
- Ophthalmology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Planas
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - David García-Dorado
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
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12
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Chen HF, Ho CA, Li CY. Risk of heart failure in a population with type 2 diabetes versus a population without diabetes with and without coronary heart disease. Diabetes Obes Metab 2019; 21:112-119. [PMID: 30091215 DOI: 10.1111/dom.13493] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/27/2018] [Accepted: 08/04/2018] [Indexed: 01/08/2023]
Abstract
AIMS To conduct a population-based study comparing age- and sex-specific risk estimates of heart failure (HF) between people with type 2 diabetes and people without diabetes, and to investigate the risks of HF in association with type 2 diabetes in people with various coronary heart diseases (CHDs). MATERIALS AND METHODS We used a nationally representative sample (one million people) selected from Taiwan's National Health Insurance (NHI) system. A total of 34 291 patients with type 2 diabetes were identified from ambulatory care claims in 2000, and the same number of age- and sex-matched controls were randomly selected from the registry of NHI beneficiaries in the same year. All study subjects were linked to inpatient claims (2000-2013) to identify the possible admissions for HF. Using a Cox proportional hazard regression model, we compared the relative hazards of HF in relation to type 2 diabetes according to various age and sex stratifications. We also compared the relative hazard of HF between type 2 diabetes and controls, with and without histories of various CHDs and coronary revascularization procedures. RESULTS Compared with absence of diabetes (control group), type 2 diabetes was significantly associated with an increased hazard of HF (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.40-1.54]. In both sexes, those with type 2 diabetes aged <45 years had the highest increased hazard of HF, with an aHR of 2.54 (95% CI 1.62-3.98) and 4.12 (95% CI 2.35-7.23) for men and women, respectively. Compared with the control subjects without any CHD, people with type 2 diabetes without prior CHD had increased hazards of HF (aHR 1.54, 95% CI 1.41-1.68, in men and aHR 1.56, 95% CI 1.43-1.71, in women), which were similar to the aHRs for people without diabetes who had histories of heart diseases (aHR 1.60 and 1.55 for men and women, respectively). CONCLUSIONS Diabetes mellitus may increase the risk of HF in both men and women, as well as in all age groups, especially in young people. People with type 2 diabetes without CHD had a similarly increased risk of HF to that of control subjects with CHD. Certain coronary revascularization procedures and CHDs, including percutaneous transluminal coronary angiography, coronary artery bypass surgery and acute myocardial infarction, were found to greatly increase risk of HF in people with type 2 diabetes.
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Affiliation(s)
- Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, Fujen Catholic University, New Taipei City, Taiwan
| | - Ching-An Ho
- Department of Surgery, Catholic Mercy Hospital, Hsinchu County, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan
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13
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Shahi N, Tobe SW. Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence? Can J Diabetes 2017; 42:166-172. [PMID: 29273294 DOI: 10.1016/j.jcjd.2017.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Hypertension and diabetes are common comorbidities and are both modifiable risk factors for cardiovascular disease and death. Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes. The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80 mmHg and above and to target blood pressure to below 130/80 mmHg. We have reviewed the studies supporting these recommendations and others, and they appear to be at odds with the guidelines, including those for elderly people and patients with pre-existing cardiovascular disease.
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Affiliation(s)
- Niharika Shahi
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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14
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Sun X, Du T. Trends in cardiovascular risk factors among U.S. men and women with and without diabetes, 1988-2014. BMC Public Health 2017; 17:893. [PMID: 29166886 PMCID: PMC5700686 DOI: 10.1186/s12889-017-4921-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/16/2017] [Indexed: 01/14/2023] Open
Abstract
Background Studies evidenced that reduction in cardiovascular disease (CVD) mortality in diabetic patients can be attributed to improvements in major CVD risk factors and evidence-based treatments. Furthermore, studies showed that the relative risk of CVD mortality associated with diabetes compared with non-diabetes is stronger in women than in men. Hence, we aimed to examine trends in CVD risk factors and intervention measures by sex and diabetic status. Methods Analysis of 5 distinct cross-sectional National Health and Nutrition Examination Surveys, 1988–1994, 1999–2002, 2003–2006, 2007–2010, and 2010–2014. Since detailed information on nontraditional risk factors such as sleep apnea was not available in each NHANES survey, traditional CVD risk factors including obesity, hypertension, and dyslipidemia were assessed in the study. To assess whether changes throughout the 27-year period differed by diabetes status, a logistic regression analysis was utilized to examine potential interaction effects between survey and diabetes. The similar process was repeated for sex. Results Means of all risk factors except body mass index and waist circumference decreased and the prevalence of antihypertensive and lipid-lowering medication use increased over time among diabetic and non-diabetic men and women. For both men and women, survey × diabetes status interaction terms for changes in HDL-cholesterol and triglyceride levels were not statistically significant, while the prevalence of antihypertensive and lipid-lowering medication use increased more in diabetic than in non-diabetic persons (all P < 0.001). For women, survey × diabetes status interaction terms indicated that compared with the first survey, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol fallen more in diabetic than in non-diabetic persons (all P < 0.001). In the diabetic state, men experienced similar changes in means of all CVD risk factors and the prevalence of antihypertensive and lipid-lowering medication use as women (all P for interactions between survey and sex were >0.01). Conclusions The major traditional CVD risk factors in diabetic men decreased to the same extent that they did for non-diabetic men. The magnitude of changes in the favorable trends in diabetic women was of similar or greater compared with those among non-diabetic women. Diabetic women had as good an improvement in CVD risk factors as diabetic men. Electronic supplementary material The online version of this article (10.1186/s12889-017-4921-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xingxing Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, People's Republic of China.
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15
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Chun KH, Im E, Kim BK, Shin DH, Kim JS, Ko YG, Choi D, Jang Y, Hong MK. Incidence, Predictors, and Clinical Outcomes of New-Onset Diabetes Mellitus after Percutaneous Coronary Intervention with Drug-Eluting Stent. J Korean Med Sci 2017; 32:1603-1609. [PMID: 28875603 PMCID: PMC5592173 DOI: 10.3346/jkms.2017.32.10.1603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/01/2017] [Indexed: 11/20/2022] Open
Abstract
We investigated the incidence, predictors, and long-term clinical outcomes of new-onset diabetes mellitus (DM) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). A total of 6,048 patients treated with DES were retrospectively reviewed and divided into three groups: 1) known DM (n = 2,365; fasting glucose > 126 mg/dL, glycated hemoglobin > 6.5%, already receiving DM treatment, or previous history of DM at the time of PCI); 2) non-DM (n = 3,247; no history of DM, no laboratory findings suggestive of DM at PCI, and no occurrence of DM during follow-up); and 3) new-onset DM (n = 436; non-DM features at PCI and occurrence of DM during follow-up). Among 3,683 non-DM patients, 436 (11.8%) patients were diagnosed with new-onset DM at 3.4 ± 1.9 years after PCI. Independent predictors for new-onset DM were high-intensity statin therapy, high body mass index (BMI), and high level of fasting glucose and triglycerides. The 8-year cumulative rate of major adverse cardiac events (a composite of cardiovascular death, myocardial infarction, stent thrombosis, or any revascularization) in the new-onset DM group was 19.5%, which was similar to 20.5% in the non-DM group (P = 0.467), but lower than 25.0% in the known DM group (P = 0.003). In conclusion, the incidence of new-onset DM after PCI with DES was not low. High-intensity statin therapy, high BMI, and high level of fasting glucose and triglycerides were independent predictors for new-onset DM. Long-term clinical outcomes of patients with new-onset DM after PCI were similar to those of patients without DM.
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Affiliation(s)
- Kyeong Hyeon Chun
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Im
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ho Shin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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16
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Mwita JC, Magafu MGMD, Omech B, Tsima B, Dewhurst MJ, Goepamang M, Mashalla Y. Undiagnosed and diagnosed diabetes mellitus among hospitalised acute heart failure patients in Botswana. SAGE Open Med 2017; 5:2050312117731473. [PMID: 28932397 PMCID: PMC5598792 DOI: 10.1177/2050312117731473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/21/2017] [Indexed: 12/22/2022] Open
Abstract
Objective: The objective of this study was to determine the burden of diagnosed and undiagnosed type 2 diabetes mellitus among patients hospitalised with acute heart failure in Botswana. Methods: The study enrolled 193 consecutive patients admitted with acute heart failure to the medical wards at Princess Marina Hospital in Gaborone. Patients were classified as previously known diabetics, undiagnosed diabetics (glycated haemoglobin ≥ 6.5%) or as non-diabetics (glycated haemoglobin < 6.5%). Data on other comorbid conditions such as hypertension, atrial fibrillation, ischaemic heart disease, stroke, and renal failure were also collected. Results: The mean (SD) age of the participants was 54.2 (17.1) years and 53.9% were men. The percentage of known and undiagnosed diabetes mellitus was 15.5% and 12.4%, respectively. Diabetic patients were significantly more likely to have hypertension (77.8% vs 46.0%, p < 0.001), ischaemic heart disease (20.4% vs 5.0%, p < 0.001), chronic kidney disease (51.3% vs 23.0%, p < 0.001), and stroke (20.4% vs 5.8%, p < 0.01). In addition, diabetics were older than non-diabetics (61.0 years vs 51.6 years, p < 0.001). Conclusion: About 27.9% of patients admitted with acute heart failure in Botswana had diabetes, and almost half of them presented with undiagnosed diabetes. These findings indicate that all hospitalised patients should be screened for diabetes.
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Affiliation(s)
| | | | - Bernard Omech
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Billy Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Matthew J Dewhurst
- Department of Cardiology, University Hospital Hartlepool, Hartlepool, UK
| | | | - Yohana Mashalla
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
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17
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Engelen SE, van der Graaf Y, Stam-Slob MC, Grobbee DE, Cramer MJ, Kappelle LJ, de Borst GJ, Visseren FLJ, Westerink J. Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes. Int J Cardiol 2017; 248:301-307. [PMID: 28802735 DOI: 10.1016/j.ijcard.2017.07.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Diabetes mellitus is associated with an increased risk for cardiovascular morbidity and mortality. The vascular burden in terms of incidence of cardiovascular events (CVE) and vascular interventions is however poorly quantified. In this study we evaluated the incidence rates of CVE and vascular interventions in patients with type 2 diabetes (T2DM) with and without cardiovascular disease (CVD) in comparison to patients without type 2 diabetes. RESEARCH DESIGN AND METHODS In a cohort of 9.808 high-risk patients with and without cardiovascular disease and type 2 diabetes originated from the ongoing, single-center prospective SMART (Second Manifestations of ARTerial disease) cohort, the number and incidence rates of CVE and interventions were calculated. The incidence rates were adjusted for confounders using Poisson regression models. CVE were defined as vascular death, stroke and myocardial infarction (MI). Interventions were defined as percutaneous coronary intervention, coronary artery bypass grafting, percutaneous transluminal angioplasty or stenting of the peripheral arteries and amputation. RESULTS Patients with T2DM and CVD had a 4-fold higher incidence rate of CVE and a 8-fold higher incidence rate of vascular interventions compared to high-risk patients without T2DM and CVD after adjusting for confounders. The incidence rate for the composite of non-fatal MI, non-fatal stroke and vascular death was 5.8 per 1000person-years in patients without T2DM or CVD at baseline, 15.2 per 1000person-years in patients with T2DM but without CVD at baseline, 26.0 per 1000person-years in patients without T2DM but with CVD and 40.7 per 1000person-years in patients with both T2DM and CVD at baseline. A similar increasing incidence rate was seen for all vascular interventions from patients without T2DM or CVD to patients with both T2DM and CVD. CONCLUSIONS Patients with type 2 diabetes or CVD are subject to an increased incidence of cardiovascular events and interventions compared to high-risk patients without type 2 diabetes or vascular disease. Patients with type 2 diabetes and CVD have the highest incidence of new cardiovascular diseases and vascular interventions when compared to patients without type 2 diabetes and CVD. These results underline the need for optimal risk factor treatment as well as the need for new prevention and treatment strategies in this very high risk population.
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Affiliation(s)
- Suzanne E Engelen
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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18
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Burggraaf B, Castro Cabezas M. Interventions in type 2 diabetes mellitus and cardiovascular mortality-An overview of clinical trials. Eur J Intern Med 2017; 42:1-15. [PMID: 28554780 DOI: 10.1016/j.ejim.2017.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/22/2017] [Accepted: 04/28/2017] [Indexed: 01/12/2023]
Abstract
Diabetes mellitus type 2 (T2DM) has been associated with an increased cardiovascular risk. Improving glycaemia or other traditional cardiovascular risk factors may reduce cardiovascular risk in patients with T2DM. However, single risk intervention in T2DM has not provided convincing evidence in the reduction of cardiovascular risk. The aim of this paper is to provide an overview of clinical trials involving reduction of cardiovascular outcomes in patients with T2DM. Trials with glucose lowering therapies have shown conflicting results. Intensive therapy to reduce glycaemia has shown some benefit on composite cardiovascular endpoints but these benefits take a longer period to emerge. Recent studies with empagliflozin and glucagon-like peptide-1 (GLP-1) agonists show promising results, but the mechanisms are most likely not mediated by improved glycaemia, given the relatively rapid effects. Both LDL-cholesterol and blood pressure reduction have been proven by large meta-analysis to reduce both cardiovascular events and mortality in all patients with T2DM. Treatment of microalbuminuria and anti-platelet therapy have only been proven in diabetic patients with increased cardiovascular risk. Classical lifestyle interventions have been disappointing with respect to cardiovascular outcome, possibly due to limited weight reduction. So far, the strongest evidence lies on bariatric surgery and a multifactorial intervention to reduce mortality and cardiovascular events in the long term.
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Affiliation(s)
- Benjamin Burggraaf
- Department of Internal Medicine, Center for Diabetes and Vascular Medicine; Franciscus Gasthuis, Rotterdam, The Netherlands.
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Center for Diabetes and Vascular Medicine; Franciscus Gasthuis, Rotterdam, The Netherlands
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19
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Alberty R, Studenčan M, Kovář F. Prevalence of Conventional Cardiovascular Risk Factors in Patients with Acute Coronary Syndromes in Slovakia. Cent Eur J Public Health 2017; 25:77-84. [PMID: 28399360 DOI: 10.21101/cejph.a4351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a major health problem and the leading cause of death and disability in Slovakia. This is the first study to describe the prevalence rate of conventional cardiovascular risk factors in patients hospitalized for ACS. METHODS Hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking were documented in 1,567 cases (mean age, SD: 66.1±12.0 years, 34.8% of females) enrolled in the SLOVAKS registry from August 2011 through September 2011. RESULTS Overall, 83.5% (95% CI, 81.6-85.2%) of the patients with ACS had hypertension, 65.0% (62.5-67.2%) had a hyperlipidemic profile, 32.6% (30.3-34.9%) were diagnosed with diabetes, and 27.6% (25.1-29.8%) were smokers at the time of a heart-related event. Only 5% of patients with ACS lacked any of the 4 conventional risk factors. Higher prevalence rates of all major risk factors, except smoking, were detected in women than in men, in older (≥65 years of age) than younger patients, and in rural (<2,000 inhabitants) than in urban areas. Premature ACS (<45 years of age) was associated with smoking in men, and smoking and hypertension in women. Smoking, in all risk factor combinations, reduced the age at the time of a heart-related event, on average, by 10.0 years in men and by 12.4 years in women. CONCLUSION The results of this study suggest an appreciable burden of major cardiovascular risk factors and also highlight differences that may aid the targeting of public health interventions.
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Affiliation(s)
- Roman Alberty
- Department of Biology and Ecology, Faculty of Natural Sciences, Matej Bel University, Banská Bystrica, Slovakia
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20
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Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Mehta VS, Rosenthal M, Nair D, Cohen M, Darko D, Lahiri A, Rakhit R. Relationship between carotid atherosclerosis and coronary artery calcification in asymptomatic diabetic patients: A prospective multicenter study. Clin Cardiol 2017; 40:752-758. [PMID: 28543093 DOI: 10.1002/clc.22727] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The value of screening sub-clinical atherosclerosis in asymptomatic patients with type 2 diabetes mellitus (T2DM) remains controversial. HYPOTHESIS An integrated model incorporating carotid intima-media thickness (CIMT) and carotid plaque with traditional risk factors can be used to predict prevalence and severity of coronary artery calcification in asymptomatic T2DM patients. METHODS A cohort of 262 asymptomatic T2DM patients were prospectively studied with carotid ultrasound to evaluate CIMT and carotid plaque and also a computed tomography coronary artery calcium (CT-CAC) scan. RESULTS Carotid plaque was detected in 124 (47%) patients and mean CIMT was 0.75±0.14 mm. Two hundred (76%) patients had a CAC score >0, of whom 57 (22%) had severe coronary atherosclerosis (>400 Au). In this group, carotid plaque was present in 40 (70%) patients (p<0.001). Univariable analysis revealed significant associations between non-zero CAC score and age (p<0.001), hypertension (p=0.01), gender (p=0.003) and duration of diabetes (p=0.004). Carotid plaque and mean CIMT were also significantly associated with non-zero CAC score (odds ratios [95% CI], 3.12 [1.66 -5.85] and 2.98 [0.24 -7.17], respectively). After adjusting for traditional risk factors, carotid plaque continued to be predictive of non-zero CAC score (2.59 [1.17 -5.74]) and CIMT was borderline significant (p=0.05). When analysed with binary logistical regression, the prevalence of carotid plaque significantly predicted severe CAC burden (CAC >400 Au; 3.26 [2.05 -5.19]). Upper CIMT quartiles showed a similar association (2.55 [1.33 -4.87]). CONCLUSION Carotid plaque is more predictive of underlying silent coronary atherosclerosis prevalence, severity and extent in asymptomatic T2DM patients.
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Affiliation(s)
- Anand Jeevarethinam
- Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, United Kingdom
| | - Shreenidhi Venuraju
- Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, United Kingdom
| | - Alain Dumo
- British Cardiac Research Trust, Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom
| | - Sherezade Ruano
- British Cardiac Research Trust, Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom
| | - Vishal S Mehta
- Royal Free and UCL Medical School, London, United Kingdom
| | - Miranda Rosenthal
- Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom
| | - Devaki Nair
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom
| | - Mark Cohen
- Department of Diabetes and Endocrinology, Barnet Hospital, London, United Kingdom
| | - Daniel Darko
- The Jeffrey Kelson Centre for Diabetes and Endocrinology, Central Middlesex Hospital, London, United Kingdom
| | - Avijit Lahiri
- Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom.,Imperial College of Medicine, Imperial College London, UK.,Healthcare Science, Middlesex University, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free Hospital, London, United Kingdom
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Characteristics of the Relationship of Kidney Dysfunction with Cardiovascular Disease in High Risk Patients with Diabetes. Int J Nephrol 2016; 2016:7180784. [PMID: 27885341 PMCID: PMC5112327 DOI: 10.1155/2016/7180784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/03/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022] Open
Abstract
We aimed at comparing the relationship of reduced estimated glomerular filtration rate (eGFR) with cardiovascular disease (CVD) and mortality between high risk patients with and without type 2 diabetes mellitus (T2DM). The cross-sectional study evaluated 16,298 participants (1,627 T2DM) acutely admitted to hospital. The longitudinal study comprised 7,508 patients (673 with diabetes and 6,835 without). eGFR was categorized into 6 stages from >90 to <15 mL/min/1.73 m2. Kidney dysfunction was defined by an eGFR < 60 mL/min/1.73 m2. Patients with T2D showed a higher prevalence of CVD (37.9% versus 23.6%; P < 0.001) and kidney dysfunction (25% versus 13.2%; P < 0.001) than in the general population. An association with CVD was found with eGFR stages from 30 to 90 mL/min/1.73 m2 in T2D and from <15 to 90 mL/min/1.73 m2 in general population, in whom the association of eGFR with coronary heart disease was in an inverse relationship (P < 0.01 for trend). Survival, in diabetes, was lower (P = 0.037) but not associated with kidney dysfunction. Conclusions. In a high risk population, patients admitted to hospital, the relationship of kidney function with CVD is different between T2D and the general population. Competing mortality and the presence of other major risk factors in diabetes may be responsible for this difference.
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Sabe MA, Claggett B, Burdmann EA, Desai AS, Ivanovich P, Kewalramani R, Lewis EF, McMurray JJV, Olson KA, Parfrey P, Solomon SD, Pfeffer MA. Coronary Artery Disease Is a Predictor of Progression to Dialysis in Patients With Chronic Kidney Disease, Type 2 Diabetes Mellitus, and Anemia: An Analysis of the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). J Am Heart Assoc 2016; 5:e002850. [PMID: 27108247 PMCID: PMC4859277 DOI: 10.1161/jaha.115.002850] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/26/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although clear evidence shows that chronic kidney disease is a predictor of cardiovascular events, death, and accelerated coronary artery disease (CAD) progression, it remains unknown whether CAD is a predictor of progression of chronic kidney disease to end-stage renal disease. We sought to assess whether CAD adds prognostic information to established predictors of progression to dialysis in patients with chronic kidney disease, diabetes, and anemia. METHODS AND RESULTS Using the previously described Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) population, we compared baseline characteristics of patients with and without CAD. Cox proportional hazards models were used to assess the association between CAD and the outcomes of end-stage renal disease and the composite of death or end-stage renal disease. Of the 4038 patients, 1791 had a history of known CAD. These patients were older (mean age 70 versus 65 years, P<0.001) and more likely to have other cardiovascular disease. CAD patients were less likely to have marked proteinuria (29% versus 39%, P<0.001), but there was no significant difference in estimated glomerular filtration rate between the 2 groups. After adjusting for age, sex, race, estimated glomerular filtration rate, proteinuria, treatment group, and 14 other renal risk factors, patients with CAD were significantly more likely to progress to end-stage renal disease (adjusted hazard ratio 1.20 [95% CI 1.01-1.42], P=0.04) and to have the composite of death or end-stage renal disease (adjusted hazard ratio 1.15 [95% CI 1.01-1.30], P=0.03). CONCLUSIONS In patients with chronic kidney disease, diabetes, and anemia, a history of CAD is an independent predictor of progression to dialysis. In patients with diabetic nephropathy, a history of CAD contributes important prognostic information to traditional risk factors for worsening renal disease.
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Affiliation(s)
- Marwa A Sabe
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brian Claggett
- Cardiovascular Division, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
| | - Emmanuel A Burdmann
- Division of Nephrology, Department of Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Akshay S Desai
- Cardiovascular Division, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
| | - Peter Ivanovich
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL
| | | | - Eldrin F Lewis
- Cardiovascular Division, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Kurt A Olson
- Division of Research and Development, Amgen Inc, Thousand Oaks, CA
| | - Patrick Parfrey
- Division of Nephrology, Department of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Scott D Solomon
- Cardiovascular Division, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
| | - Marc A Pfeffer
- Cardiovascular Division, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
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Pedro-Botet J, Chillarón JJ, Benaiges D, Flores-Le Roux JA. [Cardiovascular prevention in diabetes mellitus: A multifactorial challenge]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 28:154-63. [PMID: 26655375 DOI: 10.1016/j.arteri.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 12/21/2022]
Abstract
Patients with type2 diabetes mellitus have a high to very high cardiovascular risk, and often have other associated risk factors, such as hypertension, obesity and dyslipidaemia. Cardiovascular disease is the leading cause of morbidity and mortality in this population. An integrated control of all risk factors in patients with diabetes is essential for minimising the risk of macrovascular complications. Given the benefits of the multifactorial intervention strategies for cardiovascular prevention in diabetic patients, a review is presented on the therapeutic goals established for each risk factor in diabetes and the benefits of their control.
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Affiliation(s)
- Juan Pedro-Botet
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Juan J Chillarón
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - David Benaiges
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juana A Flores-Le Roux
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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Bayındır Çevik A, Özcan Ş, Satman İ. Sensitivity of FRAMINGHAM, PROCAM and SCORE models in Turkish people with Type 2 diabetes: comparison of three cardiovascular risk calculations. Contemp Nurse 2015; 50:183-95. [PMID: 26503421 DOI: 10.1080/10376178.2015.1111153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine the cardiovascular risk factors according to the Framingham, PROCAM and SCORE models, to evaluate the 10-year cardiovascular disease (CVD) risk factors, and to compare the suitability of different models in Turkish Type 2 diabetes patients. METHODS Risk factors and the 10-year CVD risk in 265 patients were evaluated using three risk models. Measurements included blood pressure, weight, height, waist and hip circumferences. Cholesterol, triglycerides, fasting and postprandial plasma glucose and HbA1c were measured. Low-, moderate- and high-risk groups were determined according to the three risk calculations. RESULTS Hypertension, obesity and no exercise, dyslipidemia and high HbA1c in women, and excessive cigarette/alcohol consumption, increased weight, dyslipidemia and high HbA1c in men were crucial. Men were in the moderate-risk group according to three risk models. Women were in the medium-risk group according to the Framingham and PROCAM risks and in the low-risk group according to the SCORE. CONCLUSION Results estimating the 10-year CVD according to the three risk models were inconsistent. More sensitive CVD risk calculators are needed. Discussion and practice implications: Our results could guide diabetes specialists in identifying gender-specific risks and designing preventive interventions.
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Affiliation(s)
- Ayfer Bayındır Çevik
- a School of Health, Department of Nursing , Recep Tayyip Erdoğan University , Rize , Turkey
| | - Şeyda Özcan
- b School of Nursing , Koc University , Istanbul , Turkey
| | - İlhan Satman
- c Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey
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Jung CH, Seo GH, Suh S, Bae JC, Kim MK, Hwang YC, Kim JH, Lee BW. The Population-Based Risk of Need for Coronary Revascularization According to the Presence of Type 2 Diabetes Mellitus and History of Coronary Heart Disease in the Korean Population. PLoS One 2015; 10:e0128627. [PMID: 26053222 PMCID: PMC4459959 DOI: 10.1371/journal.pone.0128627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether diabetic patients without a history of coronary heart disease (CHD) have the same risk of CHD events as non-diabetic patients with a history of CHD remains controversial. This study aimed to determine whether type 2 diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the need for coronary revascularization procedures (RVs) in the Korean population. METHODOLOGY/PRINCIPAL FINDINGS We followed 2,168,698 subjects who had oral anti-diabetic drugs (OADs)-taking T2DM in 2008 and/or CHD in 2007-2008 (i.e., recent CHD). We used systematic datasets from the nationwide claims database of the Health Insurance Review and Assessment service of Korea, which is representative of the whole population of Korea, from January 2007 to December 2012. The primary study endpoint was the development of need for RVs (i.e., incident CHD) after January 2009 among three groups based on their status of T2DM and recent CHD, i.e., T2DM only, recent CHD only, and both T2DM and recent CHD. After adjustment for age and sex, patients with recent CHD only had 2.14 times the risk of incident CHD (95% CI, 2.11-2.18, P<0.001) compared with patients with T2DM only. Patients with both T2DM and recent CHD demonstrated approximately 2-fold increased risk of incident CHD compared with subjects with recent CHD only (95% CI, 1.75-1.82), while 4-fold increased risk compared with subjects with T2DM only (95% CI, 3.71-3.87). The risk of incident CHD also differed according to sex and age. CONCLUSIONS/SIGNIFICANCE This analysis of data from the nationwide claims database revealed that T2DM did not have a recent CHD equivalent risk in the Korean population. These results suggest that an appropriate strategy for the CHD risk stratification in diabetic patients should be adopted to manage this population.
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Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Korea
| | - Sunghwan Suh
- Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea
| | - Ji Cheol Bae
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - You-Cheol Hwang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (JHK); (BWL)
| | - Byung-Wan Lee
- Department of Internal Medicine, Severance Hospital, University of Yonsei University College of Medicine, Seoul, Korea
- * E-mail: (JHK); (BWL)
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Ballotari P, Ranieri SC, Luberto F, Caroli S, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in cardiovascular mortality in diabetics and nondiabetic subjects: a population-based study (Italy). Int J Endocrinol 2015; 2015:914057. [PMID: 25873959 PMCID: PMC4385659 DOI: 10.1155/2015/914057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 01/14/2023] Open
Abstract
The objective of this study is to assess the impact of diabetes on cardiovascular mortality, focusing on sex differences. The inhabitants of Reggio Emilia province on December 31, 2009, aged 20-84 were followed up for three years for mortality. The exposure was determined using Reggio Emilia diabetes register. The age-adjusted death rates were estimated as well as the incidence rate ratios using Poisson regression model. Interaction terms for diabetes and sex were tested by the Wald test. People with diabetes had an excess of mortality, compared with nondiabetic subjects (all cause: IRR = 1.68; 95%CI 1.60-1.78; CVD: IRR = 1.61; 95%CI 1.47-1.76; AMI: IRR = 1.59; 95%CI 1.27-1.99; renal causes: IRR = 1.71; 95%CI 1.22-2.38). The impact of diabetes is greater in females than males for all causes (P = 0.0321) and for CVD, IMA, and renal causes. Further studies are needed to investigate whether the difference in cardiovascular risk profile or in the quality of care delivered justifies the higher excess of mortality in females with diabetes compared to males.
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Affiliation(s)
- Paola Ballotari
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Sofia Chiatamone Ranieri
- Laboratorio Analisi Chimico Cliniche ed Endocrinologia, IRCCS Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Ferdinando Luberto
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Stefania Caroli
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Marina Greci
- Dipartimento Cure Primarie, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Valeria Manicardi
- Dipartimento di Medicina Interna, Ospedale di Montecchio, Azienda Unità Sanitaria Locale, Via Barilla 16, 42027 Montecchio, Italy
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27
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Anagnostis P, Majeed A, Johnston DG, Godsland IF. Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men? Eur J Endocrinol 2014; 171:R245-55. [PMID: 25117464 DOI: 10.1530/eje-14-0401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The relative risk for cardiovascular disease (CVD) events and mortality in diabetic women (in comparison with non-diabetic women) is believed to be greater than that in diabetic men. However, the absolute risk for CVD mortality and morbidity does not appear to be higher in women. In general, there is heterogeneity between studies, and whether there is any definite difference in the CVD risk between sexes at any level of glycaemia is not known. The same arguments also apply when comparing the CVD risk factors, such as lipid profiles and systemic inflammation indices, which seem to be worse in women than in men with diabetes mellitus (DM). The same questions emerge at any given glycaemic state: are women at worse risk and do they have a worse risk factor profile than men? These issues have yet to be resolved. Similar, though less extensive, data have been reported for prediabetes. Furthermore, women with DM are suboptimally treated compared with men regarding lipid and blood pressure targets. Large prospective studies representative of the general population are therefore needed to define the differences between sexes regarding CVD events and mortality at a given glucose level and after adjusting for any other confounders.
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Affiliation(s)
- Panagiotis Anagnostis
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Azeem Majeed
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Desmond G Johnston
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Ian F Godsland
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
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A prospective two-center study on the associations between microalbuminuria, coronary atherosclerosis and long-term clinical outcome in asymptomatic patients with type 2 diabetes mellitus: evaluation by coronary CT angiography. Int J Cardiovasc Imaging 2014; 31:193-203. [DOI: 10.1007/s10554-014-0541-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Roche MM, Wang PP. Factors associated with a diabetes diagnosis and late diabetes diagnosis for males and females. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014; 1:77-84. [PMID: 29159087 PMCID: PMC5685052 DOI: 10.1016/j.jcte.2014.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 01/12/2023]
Abstract
Aims To examine the factors associated with diabetes, a late diabetes diagnosis, and whether these factors are different for males and females. Methods Cross-sectional study including 7101 individuals aged ≥25 years in Newfoundland and Labrador, Canada (466 with diabetes; 332 diagnosed late). Logistic regression analysis was used to determine the factors associated with a diabetes diagnosis and late diabetes diagnosis. Results For males, overweight/obesity (HR, 1.35; 95% CI, 1.06-1.72) was positively associated with diabetes while being a regular/occasional drinker (HR, 0.53; 95% CI, 0.32-0.88) was inversely associated with diabetes. Living in a rural area (HR, 1.47; 95% CI, 1.01-2.15), receiving social assistance (HR, 2.80; 95% CI, 1.52-5.15), having poor self perceived health (HR, 2.06; 95% CI, 1.32-3.21), and considering most days stressful (HR, 1.45; 95% CI, 1.01-2.10) were positively associated with diabetes for females. No factors were significantly associated with a late diabetes diagnosis for males. Having a low education (OR, 0.33; 95% CI, 0.11-0.99) was inversely associated with a late diabetes diagnosis for females. Conclusions Different factors are associated with diabetes for males and females. Disadvantaged females appear to be at the greatest risk. The factors associated with a late diabetes diagnosis were also different for males and females. Females with lower education levels are diagnosed with diabetes earlier than females with higher education levels. Certain risk factors appear to impact males and females differently and more research is needed on how males and females develop diabetes and when they are diagnosed.
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Affiliation(s)
- Madonna M Roche
- Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, 70 O'Leary Avenue, St. John's, NL A1B 2C7, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Louwers YV, Roest-Schalken ME, Kleefstra N, Roeters van Lennep J, van den Berg M, Fauser BCJM, Bilo HJG, Sijbrands EJG, Laven JSE. Excess mortality in mothers of patients with polycystic ovary syndrome. Hum Reprod 2014; 29:1780-6. [DOI: 10.1093/humrep/deu107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Status of hypertension and coronary stenosis in asymptomatic type 2 diabetic patients: analysis from Coronary Computed Tomographic Angiography Registry. Int J Cardiol 2014; 174:282-7. [PMID: 24767751 DOI: 10.1016/j.ijcard.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/28/2014] [Accepted: 04/01/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited data exist regarding the prevalence of coronary artery disease (CAD) as well as clinical outcomes in asymptomatic diabetic patients with normotension, controlled hypertension, and uncontrolled hypertension. METHODS We enrolled 935 consecutive asymptomatic type 2 diabetic patients without known CAD. Coronary computed tomography angiography was used to evaluate the prevalence and severity of CAD. Blood pressure was measured at baseline. Patients were assigned to one of the three groups: normotension (n=314), controlled hypertension (systolic blood pressure (SBP)< 140 mm Hg with treatment, n=458), or uncontrolled hypertension (SBP ≥ 140 mm Hg with or without treatment, n=163). RESULTS Obstructive CAD (≥ 50% stenosis) increased from the prevalence in normotensive patients (33%) to that in patients with controlled (40%) or uncontrolled hypertension (52%) (p=0.003). The incidence of obstructive CAD in multivessel or left main CAD also increased across the three groups (13%, 21%, 32%, respectively, p<0.001). A multivariate logistic regression analysis showed that uncontrolled hypertension was an independent predictor of obstructive CAD (adjusted odds ratio, 2.13; 95% confidence interval (CI), 1.42 to 3.21, p<0.001). During a median follow-up of 3.1 years, uncontrolled hypertension was associated with increased risk of cardiac death or myocardial infarction compared to the risk in normotensive patients (hazard ratio, 6.11; 95% CI, 1.65 to 22.6, p=0.007). CONCLUSION In asymptomatic type 2 diabetic patients, uncontrolled hypertension was associated with increased risk of CAD and poor clinical outcomes.
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Chinda K, Sanit J, Chattipakorn S, Chattipakorn N. Dipeptidyl peptidase-4 inhibitor reduces infarct size and preserves cardiac function via mitochondrial protection in ischaemia-reperfusion rat heart. Diab Vasc Dis Res 2014; 11:75-83. [PMID: 24357666 DOI: 10.1177/1479164113516134] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM We hypothesized that dipeptidyl peptidase (DPP)-4 inhibitor (vildagliptin) reduces fatal arrhythmias, cardiac dysfunction and infarct size caused by ischaemia-reperfusion (I/R) injury via its attenuation of cardiac mitochondrial dysfunction. METHODS In total, 26 rats were randomized to receive either 1 mL normal saline solution or 2.0 mg/kg vildagliptin intravenously (n = 13/group) 30 min prior to a 30-min left anterior descending coronary artery occlusion, followed by a 120-min reperfusion. Arrhythmia scores, cardiac functions, infarct size and mitochondrial function were evaluated. RESULTS Vildagliptin reduced the infarct size by 44% and mitigated cardiac dysfunction by preserving cardiac function without altering the incidence of cardiac arrhythmias. Vildagliptin increased expression of Bcl-2 and pro-caspase3 in the ischaemic area, whereas Bax and phosphorylated-connexin43/total-connexin43 were not altered. Vildagliptin attenuated cardiac mitochondrial dysfunction by reducing the reactive oxygen species level and mitochondrial swelling. CONCLUSIONS DPP-4 inhibitor provides cardioprotection by reducing the infarct size and ameliorating cardiac dysfunction in I/R hearts by attenuating cardiac mitochondrial dysfunction and cardiomyocyte apoptosis.
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Affiliation(s)
- Kroekkiat Chinda
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Kwon SK. Women are diagnosed with type 2 diabetes at higher body mass indices and older ages than men: Korea national health and nutrition examination survey 2007-2010. Diabetes Metab J 2014; 38:74-80. [PMID: 24627831 PMCID: PMC3950198 DOI: 10.4093/dmj.2014.38.1.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/06/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many epidemiologic studies have shown that women with type 2 diabetes have an increased risk of developing cardiovascular disease compared with men with diabetes. The aim of this study is to elucidate whether disparities of adiposity, age and insulin resistance (IR) at the time of diabetes diagnosis exist between women and men in the adult Korean population. METHODS Data from The Korea National Health and Nutrition Examination Survey, performed in Korea from 2007 to 2010, were used. In the survey, anthropometric data and blood samples were obtained during a fasting state. IR and β-cell function were calculated using the homeostasis model assessment (HOMA-IR and HOMA-β, respectvely). RESULTS The mean age of diabetes diagnosis was 58.5 years in women and was 55.1 years in men (P=0.015). The mean body mass index (BMI) of newly diagnosed diabetes subjects was 26.1 kg/m(2) in women and 25.0 kg/m(2) in men (P=0.001). The BMI was inversely related to age in both genders, and the higher BMI in women than men was consistent throughout all age groups divided by decade. The HOMA-IR in women with diabetes is higher than in men with diabetes (7.25±0.77 vs. 5.20±0.32; P=0.012). CONCLUSION Korean adult women are diagnosed with type 2 diabetes at higher BMI and older age than men and are more insulin-resistant at the time of diabetes diagnosis. This may help explain why women with diabetes have an increased risk of developing cardiovascular disease after the diagnosis of diabetes, compared to men.
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Affiliation(s)
- Su Kyoung Kwon
- Department of Endocrinology and Metabolism, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Franch-Nadal J, Mata-Cases M, Vinagre I, Patitucci F, Hermosilla E, Casellas A, Bolivar B, Mauricio D. Differences in the Cardiometabolic Control in Type 2 Diabetes according to Gender and the Presence of Cardiovascular Disease: Results from the eControl Study. Int J Endocrinol 2014; 2014:131709. [PMID: 25328520 PMCID: PMC4189942 DOI: 10.1155/2014/131709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/07/2014] [Indexed: 11/17/2022] Open
Abstract
The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher (without CVD) than men, LDL-cholesterol levels were remarkably uncontrolled in both women with and women without CVD. The results stress the need to implement measures to better prevent and treat CVRF in the subgroup of diabetic women, specifically with more intensive statin treatment in those with CVD.
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Affiliation(s)
- Josep Franch-Nadal
- Primary Health Care Center Raval, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, Avenida Drassanes 17-21, 08001 Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- *Josep Franch-Nadal: and
| | - Manel Mata-Cases
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, C/Mar s/n, Sant Adrià de Besòs, 08930 Barcelona, Spain
| | - Irene Vinagre
- Department of Endocrinology and Nutrition, Diabetes Unit, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
| | - Flor Patitucci
- Primary Health Care Center Raval, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, Avenida Drassanes 17-21, 08001 Barcelona, Spain
| | - Eduard Hermosilla
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Aina Casellas
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Bonaventura Bolivar
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Dídac Mauricio
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- Department of Endocrinology & Nutrition, Health Sciences Research Institute and Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Spain
- *Dídac Mauricio:
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Kalyani RR, Lazo M, Ouyang P, Turkbey E, Chevalier K, Brancati F, Becker D, Vaidya D. Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care 2014; 37:830-8. [PMID: 24178997 PMCID: PMC3931379 DOI: 10.2337/dc13-1755] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Controversy exists about the coronary artery disease (CAD) risk conveyed by diabetes in young and middle-aged women. We investigated sex differences in CAD by diabetes status among healthy individuals with different underlying risks of heart disease. RESEARCH DESIGN AND METHODS We examined subjects aged <60 years without CAD at enrollment in the high-risk GeneSTAR Study (n = 1,448; follow-up ∼12 years), Multi-Ethnic Study of Atherosclerosis (MESA; n = 3,072; follow-up ∼7 years), and National Health and Nutrition Examination Survey III (NHANES III) Mortality Follow-up Study (n = 6,997; follow-up ∼15 years). Diabetes was defined by report, hypoglycemic use, and/or fasting glucose ≥126 mg/dL. The outcome was any CAD event during follow-up (fatal CAD in NHANES). RESULTS In the absence of diabetes, CAD rates were lower among women in GeneSTAR, MESA, and NHANES (4.27, 1.66, and 0.40/1,000 person-years, respectively) versus men (11.22, 5.64, and 0.88/1,000 person-years); log-rank P < 0.001 (GeneSTAR/MESA) and P = 0.07 (NHANES). In the presence of diabetes, CAD event rates were similar among women (17.65, 7.34, and 2.37/1,000 person-years) versus men (12.86, 9.71, and 1.83/1,000 person-years); all log-rank P values > 0.05. Adjusting for demographics, diabetes was associated with a significant four- to fivefold higher CAD rate among women in each cohort, without differences in men. In meta-analyses of three cohorts, additionally adjusted for BMI, smoking, hypertension, HDL, and non-HDL cholesterol, antihypertensive and cholesterol-lowering medication use, the hazard ratio of CAD in men versus women among nondiabetes was 2.43 (1.76-3.35) and diabetes was 0.89 (0.43-1.83); P = 0.013 interaction by diabetes status. CONCLUSIONS Though young and middle-aged women are less likely to develop CAD in the absence of diabetes, the presence of diabetes equalizes the risk by sex. Our findings support aggressive CAD prevention strategies in women with diabetes and at similar levels to those that exist in men.
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Verhagen SN, Wassink AMJ, van der Graaf Y, Visseren FLJ. C-reactive protein and incident diabetes in patients with arterial disease. Eur J Clin Invest 2013; 43:1052-9. [PMID: 23919838 DOI: 10.1111/eci.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 07/09/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Systemic low-grade inflammation, as measured by high-sensitive C-reactive protein (hsCRP), may contribute to the risk of type 2 diabetes in patients with manifest arterial disease. METHODS Cohort study in 4072 patients with manifest arterial disease without diabetes. The relation between quartiles of hsCRP and type 2 diabetes was assessed with Cox regression analyses, taking age, smoking and blood pressure-lowering medication and lipid-lowering medication into account. Insulin resistance was estimated with homeostasis model of insulin resistance (HOMA-IR). In exploratory models, adjustments were performed for body mass index (BMI) and visceral and subcutaneous adipose tissue thickness. RESULTS During a median follow-up of 5·0 (IQR 2·5-8·2) years, 288 subjects developed diabetes. High hsCRP was independently associated with incident diabetes (Q4 vs. Q1 males: HR 1·62; 95% CI 1·06-2·48; females: HR 3·12; 95% CI 1·57-6·21). HOMA-IR at baseline is related to hsCRP plasma levels (Q4 vs. Q1: males: β 0·27; 95% CI 0·19-0·36; females: β 0·35; 95% CI 0·22-0·48). The risk of diabetes associated with hsCRP was abolished in males (Q4 vs. 1 HR 1·23; 95% CI 0·80-1·88) and attenuated in females (Q4 vs. 1 HR 2·32; 95% CI 1·14-4·75) after adding BMI to the model, but not modified by statin use (P for interaction: 0·61). CONCLUSIONS Patients with manifest arterial disease with high hsCRP plasma levels are at increased risk to develop type 2 diabetes and are more insulin resistant as compared to those with low hsCRP levels. This increase in risk is more pronounced in females than in males and is not modified by statin use.
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Affiliation(s)
- Sandra N Verhagen
- Department of Vascular Medicine, University Medical Centre Utrecht (UMC Utrecht), Utrecht, The Netherlands
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Roche MM, Wang PP. Sex differences in all-cause and cardiovascular mortality, hospitalization for individuals with and without diabetes, and patients with diabetes diagnosed early and late. Diabetes Care 2013; 36:2582-90. [PMID: 23564923 PMCID: PMC3747934 DOI: 10.2337/dc12-1272] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare risk of all-cause mortality, cardiovascular disease (CVD) mortality, acute myocardial infarction (AMI) mortality, stroke mortality, and hospitalizations for males and females with and without diabetes and those with diabetes diagnosed early and late. RESEARCH DESIGN AND METHODS We conducted a population-based retrospective cohort study including 73,783 individuals aged 25 years or older in Newfoundland and Labrador, Canada (15,152 with diabetes; 9,517 with late diagnoses). RESULTS Males and females with diabetes had an increased risk of all-cause mortality, CVD mortality, AMI mortality, and CVD hospitalizations compared with individuals without diabetes, and the risk was stronger in females than in males. For females, risks of all-cause mortality (hazard ratio [HR] 1.85 [95% CI 1.74-1.96]) and CVD hospitalizations (2.57 [2.24-2.94]) were significantly higher compared with their male counterparts (1.59 [1.51-1.69] and 1.92 [1.72-2.14]). Females with diabetes diagnosed late had an increased risk of CVD mortality (6.54 [4.80-8.91]) and CVD hospitalizations (5.22 [4.31-6.33]) compared with females without diabetes, and both were significantly higher compared with their male counterparts (3.44 [2.47-4.79]) and (3.33 [2.80-3.95]). CONCLUSIONS Females with diabetes have a greater risk of mortality than males with diabetes. CVD has a greater impact on females with diabetes than males, especially when diagnosed at a later stage. Different management strategies should be considered for males and females and those with early and late diagnoses of diabetes.
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Affiliation(s)
- Madonna M Roche
- Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, St. John's, Newfoundland and Labrador, Canada.
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Cardioprotective effect of dipeptidyl peptidase-4 inhibitor during ischemia–reperfusion injury. Int J Cardiol 2013; 167:451-7. [DOI: 10.1016/j.ijcard.2012.01.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/30/2011] [Accepted: 01/06/2012] [Indexed: 12/23/2022]
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Saely CH, Drexel H. Is type 2 diabetes really a coronary heart disease risk equivalent? Vascul Pharmacol 2013; 59:11-8. [DOI: 10.1016/j.vph.2013.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 11/26/2022]
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Abstract
Type 2 diabetes increases the risk of cardiovascular disease (CVD) from two- to four-fold. In our large Finnish population-based study published in 1998 subjects with medication for type 2 diabetes had as high a risk of fatal and nonfatal myocardial infarction (MI) during the 7- year follow-up as non-diabetic subjects with a prior MI, suggesting that type 2 diabetes is a CVD equivalent. In another large study, including all 3.3 million residents of Denmark, subjects requiring glucose-lowering therapy exhibited a CVD risk similar to that of non-diabetic subjects with a prior MI. Subsequent studies have not systematically replicated aforementioned results. Some studies have supported the concept that type 2 diabetes is a CVD equivalent only in some subgroups, and many studies have reported negative findings. This is likely to be due to many differences across the studies published, for example ethnicity, gender, age and other demographic factors of the populations involved, study design, validation of diabetes status and CVD events, statistical analyses (adjustments for confounding factors), duration of diabetes, and treatment of hyperglycemia among diabetic participants. Varying results reflect the fact that not all diabetic patients are at a similar risk for CVD. Therefore, CVD risk assessment and the tailoring of preventive measures should be done individually, taking into consideration each patient's long-term risk of developing cardiovascular events.
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Affiliation(s)
- Johanna Kuusisto
- Department of Medicine, Centre for Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, P.O.B. 1777, 70211 Kuopio, Finland.
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Pan C, Wang X. Profile of vildagliptin in type 2 diabetes: efficacy, safety, and patient acceptability. Ther Clin Risk Manag 2013; 9:247-57. [PMID: 23818788 PMCID: PMC3694507 DOI: 10.2147/tcrm.s30071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Indexed: 12/26/2022] Open
Abstract
Vildagliptin is a selective and potent dipeptidyl peptidase-4 inhibitor that improves glycemic
control by inhibiting the degradation of both endogenous glucagon-like peptide-1 and
glucose-dependent insulinotropic peptide. This article is a comprehensive review of the safety and
efficacy of vildagliptin in patients with type 2 diabetes. Clinical evidence has proven that it
effectively decreases hemoglobin A1c with a low risk of hypoglycemia and is weight
neutral. The addition of vildagliptin to metformin improves glucose control and significantly
reduces gastrointestinal adverse events, particularly in patients inadequately controlled with
metformin monotherapy. Its long-term advantages include preservation of β-cell function,
reduction in total cholesterol, decrease in fasting lipolysis in adipose tissue, and triglyceride
storage in non-fat tissues. Vildagliptin is well tolerated with a low incidence of AEs, and it does
not increase the risk of cardiovascular/cerebrovascular (CCV) events. It can be taken before or
after meals, and has little drug interaction, thus it will be well accepted.
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Affiliation(s)
- Cy Pan
- Chinese PLA General Hospital, Beijing, People's Republic of China
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Daniels LB, Grady D, Mosca L, Collins P, Mitlak BH, Amewou-Atisso MG, Wenger NK, Barrett-Connor E. Is diabetes mellitus a heart disease equivalent in women? Results from an international study of postmenopausal women in the Raloxifene Use for the Heart (RUTH) Trial. Circ Cardiovasc Qual Outcomes 2013; 6:164-70. [PMID: 23481531 DOI: 10.1161/circoutcomes.112.966986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have concluded that diabetes mellitus and heart disease carry similar risk for future cardiovascular disease (CVD). Most of these studies were too small to quantify independent risks specific to women. The purpose of this study was to determine whether diabetes mellitus is a coronary heart disease (CHD) risk equivalent for prediction of future CHD and CVD events in women. METHODS AND RESULTS The Raloxifene Use for the Heart (RUTH) trial was an international, multicenter, double-blind, randomized, placebo-controlled trial of raloxifene and CVD outcomes in 10 101 postmenopausal women selected for high CHD risk. Of these, 3672 had a history of diabetes mellitus without known CHD, and 3265 had a history of CHD without known diabetes mellitus. Cox proportional hazard models were used to compare cardiovascular outcomes in these 2 groups. Mean age at baseline was 67.5 years; median follow-up was 5.6 years. There were 725 deaths, including 450 cardiovascular deaths. In age-adjusted analyses, diabetic women had an increased risk of all-cause mortality compared with women with CHD. Although the overall risk of CHD and CVD was lower in diabetic women compared with women with CHD, the risk of fatal CHD, fatal CVD, and all-cause mortality was similar (hazard ratio [95% confidence interval]: 0.85 [0.65-1.12], 0.99 [0.78-1.25], and 1.18 [0.98-1.42], respectively, after adjusting for age, lifestyle factors, CHD risk factors, statin use, and treatment assignment). CONCLUSIONS In the RUTH trial, diabetes mellitus was a CHD risk equivalent in women for fatal, but not nonfatal, CHD and CVD.
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Affiliation(s)
- Lori B Daniels
- Division of Cardiology, University of California-San Diego, 9444 Medical Center Dr, La Jolla, CA 92037–7411, USA.
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Chinda K, Chattipakorn S, Chattipakorn N. Cardioprotective effects of incretin during ischaemia-reperfusion. Diab Vasc Dis Res 2012; 9:256-69. [PMID: 22496404 DOI: 10.1177/1479164112440816] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Incretin is a gut derived peptide hormone secreted in the intestine after food ingestion, and is degraded rapidly after secretion by dipeptidyl peptidase (DPP)-4. Incretin-based therapy, such as glucagon-like peptide (GLP)-1 and the DPP-4 inhibitor, has been proposed as a new therapeutic approach for the treatment of type 2 diabetic patients. In the past few years, growing evidence also demonstrated the cardioprotective effects of incretin-based therapy, especially during ischaemia-reperfusion (I/R) injury in both the animal models and in clinical studies. However, inconsistent reports exist regarding the use of these pharmacological interventions. In this article, a comprehensive review regarding both basic and clinical studies reporting the effects of GLP-1 and DPP-4 inhibitors on I/R hearts is presented and discussed. The consistent findings as well as controversial results are summarised, focusing on the effects of incretin on the infarct size, left ventricular function and haemodynamic improvement during an I/R injury.
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Affiliation(s)
- Kroekkiat Chinda
- Cardiac Electrophysiology Research and Training Centre, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Kaur J, Bhardwaj A, Huang Z, Narang D, Chen TY, Plane F, Knaus EE. Synthesis and Biological Investigations of Nitric Oxide Releasing Nateglinide and Meglitinide Type II Antidiabetic Prodrugs: In-Vivo Antihyperglycemic Activities and Blood Pressure Lowering Studies. J Med Chem 2012; 55:7883-91. [DOI: 10.1021/jm300997w] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jatinder Kaur
- Faculty of Pharmacy and Pharmaceutical
Sciences, University of Alberta, Edmonton,
Alberta T6G 2E1, Canada
| | - Atul Bhardwaj
- Faculty of Pharmacy and Pharmaceutical
Sciences, University of Alberta, Edmonton,
Alberta T6G 2E1, Canada
| | - Zhangjian Huang
- Faculty of Pharmacy and Pharmaceutical
Sciences, University of Alberta, Edmonton,
Alberta T6G 2E1, Canada
| | - Deepak Narang
- Department of Pharmacology,
Faculty of Medicine, University of Alberta, Edmonton, Alberta T6G 2H7, Canada
| | - Ting-Yueh Chen
- Department of Pharmacology,
Faculty of Medicine, University of Alberta, Edmonton, Alberta T6G 2H7, Canada
| | - Frances Plane
- Department of Pharmacology,
Faculty of Medicine, University of Alberta, Edmonton, Alberta T6G 2H7, Canada
| | - Edward E. Knaus
- Faculty of Pharmacy and Pharmaceutical
Sciences, University of Alberta, Edmonton,
Alberta T6G 2E1, Canada
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Lee C, Joseph L, Colosimo A, Dasgupta K. Mortality in diabetes compared with previous cardiovascular disease: a gender-specific meta-analysis. DIABETES & METABOLISM 2012; 38:420-7. [PMID: 22682738 DOI: 10.1016/j.diabet.2012.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 04/05/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
AIMS Diabetes has been described as a cardiovascular disease (CVD) risk equivalent. There is evidence, however, that its impact may differ between women and men. For this reason, our study aimed to obtain gender-specific hazard ratios (HRs) comparing diabetes and CVD patients in terms of all-cause, CVD and coronary heart disease (CHD) mortality. METHODS Individuals with diabetes (without CVD) and those with CVD (without diabetes) were examined through a systematic review of articles that provided gender-specific HRs for mortality. Searches included Medline, Embase and the Cochrane Library database (from January 1998 to December 2009) and exploded MeSH headings [cardiovascular diseases, risk, epidemiologic studies, case-control studies, cohort studies, mortality, outcome assessment (health care), sex factors, survival analysis and diabetes mellitus, type 2]. Two observers selected and reviewed the studies and hierarchical Bayesian random-effects models were used to combine HRs, thereby accommodating any between-study differences through inclusion of a between-study variance in HRs. RESULTS Out of 5425 studies, nine were relevant (0.17%). CVD and CHD mortality in men was lower for diabetes alone (CVD mortality HR: 0.82, 95% CrI: 0.69-0.98; CHD mortality HR: 0.73, 95% CrI: 0.65-0.83). In contrast, rates appeared to be higher in women with diabetes alone (CVD mortality HR: 1.29, 95% CrI: 0.79-2.26; CHD mortality HR: 1.28, 95% CrI: 0.75-2.22), although wide credible intervals precluded any definitive conclusions. All-cause mortality in men was similar for diabetes and previous CVD (HR: 1.02, 95% CrI: 0.93-1.12) whereas, among women, it was at least as high and possibly higher for diabetes alone (HR: 1.25, 95% CrI: 0.89-1.76). CONCLUSION Compared with previous CVD, diabetes alone leads to lower CVD and CHD mortality risk in men, and similar all-cause mortality. In contrast, although further studies are needed, it is possible that diabetes leads to higher CVD, CHD and all-cause mortality in women.
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Affiliation(s)
- C Lee
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Lang S, Mary-Krause M, Simon A, Partisani M, Gilquin J, Cotte L, Boccara F, Costagliola D. HIV replication and immune status are independent predictors of the risk of myocardial infarction in HIV-infected individuals. Clin Infect Dis 2012; 55:600-7. [PMID: 22610928 DOI: 10.1093/cid/cis489] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals infected by human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease than the general population. The specific effects of virological and immunological parameters on the risk of myocardial infarction (MI) in HIV-infected individuals are debated. METHODS We conducted a nested case-control study within the French Hospital Database on HIV. Case patients (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded and validated first MI. Up to 5 HIV-infected controls (n = 884) matched for age, sex, and clinical center were selected, at random with replacement, among patients with no history of MI. Conditional logistic regression models were used to identify predictors of the risk of MI. RESULTS Plasma HIV-1 RNA levels >50 copies/mL, a low CD4 T-cell nadir, and a high CD8 T-cell count were independently associated with an increased risk of MI, with respective odds ratios of 1.51 (95% confidence interval, 1.09-2.10), 0.90 (.83-.97) per log(2) unit, and 1.48 (1.01-2.18) for the highest tertile of CD8 T-cell counts (>1150 cells/mm(3)) compared with the lowest (≤760 cells/mm(3)). CONCLUSIONS Independently of cardiovascular risk factors and antiretroviral therapy, HIV replication, a low CD4 T-cell nadir and a high current CD8 T-cell count are associated with an increased risk of MI in HIV-infected individuals. This suggests new paths for interventions to diminish the risk of MI in HIV-infected patients.
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Wannamethee SG, Papacosta O, Lawlor DA, Whincup PH, Lowe GD, Ebrahim S, Sattar N. Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women's Heart Health Study. Diabetologia 2012; 55:80-7. [PMID: 21861177 DOI: 10.1007/s00125-011-2284-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/25/2011] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is associated with greater relative risk of CHD in women than in men, which is not fully explained by conventional cardiovascular risk factors. We assessed whether cardiovascular risk factors including more novel factors such as markers of insulin resistance, inflammation, activated coagulation and endothelial dysfunction differ more between diabetic and non-diabetic women than between diabetic and non-diabetic men, and the role of insulin resistance. METHODS A cross-sectional study of non-diabetic and diabetic men and women (n = 7,529) aged 60-79 years with no previous myocardial infarction who underwent an examination was conducted. Measurements of anthropometry, blood pressure and fasting measurements of lipids, insulin, glucose and haemostatic and inflammatory markers were taken. RESULTS Non-diabetic women tended to have more favourable risk factors and were less insulin resistant than non-diabetic men, but this was diminished in the diabetic state. Levels of waist circumference, BMI, von Willebrand factor (VWF), WBC count, insulin resistance (HOMA-IR), diastolic blood pressure, HDL-cholesterol, tissue plasminogen activator (t-PA) and factor VIII differed more between diabetic and non-diabetic women than between diabetic and non-diabetic men (test for diabetes × sex interaction p < 0.05). The more adverse effect of diabetes on these risk markers in women was associated with, and thereby largely attenuated by, insulin resistance. CONCLUSIONS/INTERPRETATION The greater adverse influence of diabetes per se on adiposity and HOMA-IR and downstream blood pressure, lipids, endothelial dysfunction and systemic inflammation in women compared with men may contribute to their greater relative risk of coronary heart disease.
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Affiliation(s)
- S G Wannamethee
- Department of Primary Care and Population Health, UCL Medical School, Hampstead Campus, Rowland Hill St, London, NW3 2PF, UK.
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Scott R, Donoghoe M, Watts GF, O'Brien R, Pardy C, Taskinen MR, Davis TME, Colman PG, Manning P, Fulcher G, Keech AC. Impact of metabolic syndrome and its components on cardiovascular disease event rates in 4900 patients with type 2 diabetes assigned to placebo in the FIELD randomised trial. Cardiovasc Diabetol 2011; 10:102. [PMID: 22104275 PMCID: PMC3286386 DOI: 10.1186/1475-2840-10-102] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/21/2011] [Indexed: 01/14/2023] Open
Abstract
Background Patients with the metabolic syndrome are more likely to develop type 2 diabetes and may have an increased risk of cardiovascular disease (CVD) events.We aimed to establish whether CVD event rates were influenced by the metabolic syndrome as defined by the World Health Organisation (WHO), the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) and to determine which component(s) of the metabolic syndrome (MS) conferred the highest cardiovascular risk in in 4900 patients with type 2 diabetes allocated to placebo in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. Research design and methods We determined the influence of MS variables, as defined by NCEP ATPIII, IDF and WHO, on CVD risk over 5 years, after adjustment for CVD, sex, HbA1c, creatinine, and age, and interactions between the MS variables in a Cox proportional-hazards model. Results About 80% had hypertension, and about half had other features of the metabolic syndrome (IDF, ATPIII). There was no difference in the prevalence of metabolic syndrome variables between those with and without CVD at study entry. The WHO definition identified those at higher CVD risk across both sexes, all ages, and in those without prior CVD, while the ATPIII definition predicted risk only in those aged over 65 years and in men but not in women. Patients meeting the IDF definition did not have higher risk than those without IDF MS. CVD risk was strongly influenced by prior CVD, sex, age (particularly in women), baseline HbA1c, renal dysfunction, hypertension, and dyslipidemia (low HDL-c, triglycerides > 1.7 mmol/L). The combination of low HDL-c and marked hypertriglyceridemia (> 2.3 mmol/L) increased CVD risk by 41%. Baseline systolic blood pressure increased risk by 16% per 10 mmHg in those with no prior CVD, but had no effect in those with CVD. In those without prior CVD, increasing numbers of metabolic syndrome variables (excluding waist) escalated risk. Conclusion Absence of the metabolic syndrome (by the WHO definition) identifies diabetes patients without prior CVD, who have a lower risk of future CVD events. Hypertension and dyslipidemia increase risk.
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Affiliation(s)
- Russell Scott
- Lipid & Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand.
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Abstract
OBJECTIVE To investigate the management of hypertension in patients with diabetes mellitus, living in a rural setting. METHOD A community health screening clinic was conducted at Charles Sturt University, Albury-Wodonga, in rural southeastern Australia. Patients with either diagnosed hypertension or high blood pressure who attended the clinic were eligible for inclusion in the present study. The awareness and control of hypertension was compared between patients with and without diabetes mellitus. RESULTS A total of 449 patients with hypertension were analyzed. One hundred twenty-one (26.9%) had hypertension and diabetes mellitus, and 328 (73.1%) had hypertension without diabetes mellitus. Hypertension awareness (61.2% versus 36.9%, P=0.014) and control (17.4% versus 7.0%, P=0.040) were significantly better in the hypertensive patients with diabetes mellitus than in the hypertensive patients without diabetes mellitus. Antihypertensive medication use was also significantly higher in patients with diabetes mellitus than in patients without diabetes mellitus (one antihypertensive medication, 41.3% versus 25.0%, P=0.045). CONCLUSION Awareness and control of hypertension were suboptimal in the patients in the present study. Diabetes mellitus, however, was associated with both higher awareness and better control of hypertension than having hypertension alone. This may be partially due to a higher use of antihypertensive medications by patients with diabetes mellitus.
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Affiliation(s)
- Fiona White
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga
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Tryniszewski W, Kuśmierczyk J, Maziarz Z, Goś R, Mikhailidis DP, Banach M, Rysz J, Pesudovs K. Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes. J Diabetes Complications 2011; 25:253-7. [PMID: 21439854 DOI: 10.1016/j.jdiacomp.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. MATERIALS AND METHODS A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. RESULTS In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. CONCLUSIONS Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.
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Affiliation(s)
- Wiesław Tryniszewski
- Department of Radiological and Isotopic Diagnostics and Therapy, Medical University of Lodz, Poland.
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