1
|
Fortin E, Lundin M, Mellbin L, Norhammar A, Näsman P, Smetana S, Sörensson P, Ferrannini E, Rydén L, Ferrannini G. Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia : Experiences from the randomized, controlled SOCOGAMI trial. Cardiovasc Diabetol 2023; 22:208. [PMID: 37568149 PMCID: PMC10422806 DOI: 10.1186/s12933-023-01950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM. METHODS Forty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit. RESULTS After 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline. CONCLUSIONS Empagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia. TRIAL REGISTRATION NUMBER EudraCT number 2015-004571-73.
Collapse
Affiliation(s)
- Elena Fortin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lundin
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Stina Smetana
- Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Ele Ferrannini
- Department of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- Internal Medicine Unit, Södertälje Hospital, Södertälje, Stockholm Region, Sweden.
| |
Collapse
|
2
|
Haider MM, Kamal N, Bashar MI, Rahman MM, Khan SH, Alam N. Religious disparities in health in Bangladesh-the case of hypertension and diabetes: evidence from two nationally representative cross-sectional surveys. BMJ Open 2023; 13:e067960. [PMID: 36725091 PMCID: PMC9896189 DOI: 10.1136/bmjopen-2022-067960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Religious affiliation, beliefs, and practices shape lifestyles and disease risks. This study examined Hindu-Muslim differences in the prevalence and management of hypertension and diabetes in Bangladesh, a religiously plural country with 91% Muslims and 8% Hindus. DESIGN, SETTINGS AND PARTICIPANTS We used the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS) and 2017-2018 BDHS data. The 2011 BDHS collected blood pressure (BP) data with an 89% response rate (RR) and fasting blood glucose (FBG) data (RR 85%) from household members aged 35 years and above. The 2017-2018 BDHS collected BP and FBG data from household members aged 18 years and above with 89% and 84% RRs, respectively. We analysed 6628 participants for hypertension and 6370 participants for diabetes from the 2011 BDHS, 11 449 for hypertension and 10 744 for diabetes from the 2017-2018 BDHS. METHODS We followed the WHO guidelines to define hypertension and diabetes. We used descriptive statistics and multiple logistic regression to examine the Hindu-Muslim differences in hypertension and diabetes, and estimated predicted probabilities to examine the changes in hypertension and diabetes risk over time. RESULTS Nine in 10 of the sample were Muslims. About 31% of Hindus and 24% of Muslims were hypertensive; 10% of both Hindus and Muslims were diabetic in 2017-2018. The odds of being hypertensive were 45% higher among Hindus than Muslims (adjusted OR: 1.45; 95% CI: 1.23 to 1.71; p<0.001). The levels of awareness, medication and control of hypertension were similar between the religious groups. Between the 2011 and 2017-2018 BDHS, the Hindu-Muslim difference in the prevalence of hypertension increased non-significantly, by 3 percentage points. CONCLUSIONS Further studies on religious-based lifestyles, Hindu-Muslim differences in diet, physical activity, stress, and other risk factors of hypertension and diabetes are needed to understand Hindus' higher likelihood of being hypertensive, in contrast, not diabetic compared with Muslims.
Collapse
Affiliation(s)
- M Moinuddin Haider
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nahid Kamal
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mamun Ibn Bashar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Mahabubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
3
|
Lundin M, Ferrannini G, Mellbin L, Johansson I, Norhammar A, Näsman P, Shahim B, Smetana S, Venkateshvaran A, Wang A, Sörensson P, Rydén L. SOdium-glucose CO-transporter inhibition in patients with newly detected Glucose Abnormalities and a recent Myocardial Infarction (SOCOGAMI). Diabetes Res Clin Pract 2022; 193:110141. [PMID: 36336088 DOI: 10.1016/j.diabres.2022.110141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/10/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Established dysglycaemia (impaired glucose tolerance [IGT] or type 2 diabetes [T2DM]) is a risk factor for further cardiovascular events in patients with coronary artery disease. Sodium-glucose cotransporter 2 inhibitors reduce this risk. The aim of the present investigation was to test the hypothesis that empagliflozin exerts beneficial effects on myocardial function in patients with a recent acute coronary syndrome and newly detected dysglycaemia. METHODS Forty-two patients (mean age 67.5 years, 81 % male) with recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected IGT (n = 27) or T2DM (n = 15) were randomised to 25 mg of empagliflozin daily (n = 20) or placebo (n = 22) on top of ongoing therapy. They were investigated with oral glucose tolerance tests, stress-perfusion cardiac magnetic resonance imaging (CMR) and echocardiography at three occasions: before randomisation, after seven months on study drug and three months following cessation of such drug. Primary outcome was a change in left ventricular (LV) end-diastolic volume (LVEDV) and secondary outcomes were a change in a) systolic and diastolic LV function; b) coronary flow reserve; c) myocardial extracellular volume (ECV) in non-infarcted myocardium; d) aortic pulse wave velocity. RESULTS Empagliflozin induced a significant decrease in fasting and post load glucose (p < 0.05) and body weight (p < 0.01). Empagliflozin did not influence LVEDV, LV systolic or mass indexes, coronary flow reserve, ECV or aortic pulse wave velocity. Echocardiographic indices of LV diastolic function (E/e' and mitral E/A ratio) were not influenced. No safety concerns were identified. CONCLUSIONS/INTERPRETATION Empagliflozin had predicted effects on the dysglycaemia but did not influence variables expressing LV function, coronary flow reserve and ECV. An explanation may be that the LV function of the patients was within the normal range.
Collapse
Affiliation(s)
- Magnus Lundin
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Capio S:t Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Bahira Shahim
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Smetana
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anne Wang
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
4
|
Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population. Diabetes Care 2022; 45:2111-2117. [PMID: 35771773 DOI: 10.2337/dc22-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
Collapse
Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Göran's Hospital, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Terhi Vihervaara
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
De Bacquer D, Jennings CS, Mirrakhimov E, Lovic D, Bruthans J, De Smedt D, Gotcheva N, Dolzhenko M, Fras Z, Pogosova N, Lehto S, Hasan-Ali H, Jankowski P, Kotseva K, De Backer G, Wood D, Rydén L. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:568-576. [PMID: 34315174 DOI: 10.1093/ehjqcco/qcab043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
AIMS Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. METHODS AND RESULTS Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month. CONCLUSIONS The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.
Collapse
Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Erkin Mirrakhimov
- Department of Cardiology and Internal Diseases, Kyrgyz State Medical Academy, Akhunbaev str. 92, 720020, Bishkek, Kyrgyzstan.,National Centre of Cardiology and Internal Medicine Named After Academician Mirrakhimov MM, Togolok Moldo str. 3, 720040, Bishkek, Kyrgyzstan
| | - Dragan Lovic
- Cardiology Department, Singidunum University, School of Medicine, Clinic for Internal Disease Intermedica, Jovana Ristica str. 20/2, 18000 Nis, Serbia
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Nina Gotcheva
- National Heart Hospital, Department of Cardiology, Konjovitza str. 65, 1309 Sofia, Bulgaria
| | - Maria Dolzhenko
- Shupyk National Medical Academy of Postgraduate Education, Dorohozhytska 9, 04112, Kyiv, Ukraine
| | - Zlatko Fras
- Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Zaloška 7, SI-1525 Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nana Pogosova
- National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, 3-rd Cherepkovskaya str. 15A, 121552 Moscow, Russia
| | - Seppo Lehto
- Department of Internal Medicine, Lapland Central Hospital, Ounasrinteentie 22, 96400 Rovaniemi, Finland
| | - Hasan Hasan-Ali
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut University Campus, 71515 Assiut, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, 2 Jakubowski Str., 30-688 Kraków, Poland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, FoU - Tema Hjärta och Kärl, S1:02, Karolinska Universitetssjukhuset/Solna, SE-171 76, Stockholm, Sweden
| |
Collapse
|
6
|
Meziani S, Ferrannini G, Bjerre M, Hansen TK, Ritsinger V, Norhammar A, Gyberg V, Näsman P, Rydén L, Mellbin LG. Mannose-binding lectin does not explain the dismal prognosis after an acute coronary event in dysglycaemic patients. A report from the GAMI cohort. Cardiovasc Diabetol 2022; 21:129. [PMID: 35804351 PMCID: PMC9270763 DOI: 10.1186/s12933-022-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Mannose binding lectin (MBL) has been suggested to be associated with an impaired cardiovascular prognosis in dysglycaemic conditions, but results are still contrasting. Our aims are (i) to examine whether MBL levels differ between patients with an acute myocardial infarction (MI) and healthy controls and between subgroups with different glucose tolerance status, and (ii) to investigate the relation between MBL and future cardiovascular events. Methods MBL levels were assessed at discharge and after 3 months in 161 AMI patients without any previously known glucose perturbations and in 183 age- and gender-matched controls from the Glucose metabolism in patients with Acute Myocardial Infarction (GAMI) study. Participants were classified as having dysglycaemia, i.e. type 2 diabetes or impaired glucose tolerance, or not by an oral glucose tolerance test. The primary outcome was a composite of cardiovascular events comprising cardiovascular death, AMI, stroke or severe heart failure during 11 years of follow-up. Total and cardiovascular mortality served as secondary outcomes. Results At hospital discharge patients had higher MBL levels (median 1246 μg/L) than three months later (median 575 μg/L; p < 0.01), the latter did not significantly differ from those in the controls (801 μg/L; p = 0.47). MBL levels were not affected by dysglycaemia either in patients or controls. Independent of glycaemic state, increasing MBL levels did not predict any of the studied outcomes in patients. In unadjusted analyses increasing MBL levels predicted cardiovascular events (hazard ratio HR: 1.67, 95% confidence interval CI 1.06–2.64) and total mortality (HR 1.53, 95% CI 1.12–2.10) in the control group. However, this did not remain in adjusted analyses. Conclusions Patients had higher MBL levels than controls during the hospital phase of AMI, supporting the assumption that elevated MBL reflects acute stress. MBL was not found to be independently associated with cardiovascular prognosis in patients with AMI regardless of glucose state. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01562-0.
Collapse
Affiliation(s)
- Sara Meziani
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.
| | - Mette Bjerre
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Troels K Hansen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Viveca Ritsinger
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Capio St. Görans Hospital, Stockholm, Sweden
| | - Viveca Gyberg
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
7
|
Baker T, Ngwalangwa F, Masanjala H, Dube Q, Langton J, Marrone G, Hildenwall H. Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial. LANCET GLOBAL HEALTH 2020; 8:e1546-e1554. [PMID: 33038950 DOI: 10.1016/s2214-109x(20)30388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/03/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low blood glucose concentrations are common in sick children who present to hospital in low-resource settings and are associated with increased mortality. The cutoff blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/L) is not evidence-based. We aimed to assess whether increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely ill children at presentation to hospital improves mortality outcomes. METHODS We did a pragmatic, randomised controlled trial at two referral hospitals in Malawi. Severely ill children aged 1 month to 5 years presenting to the emergency department with a capillary blood glucose concentration of between 2·5 mmol/L (3·0 mmol/L in severely malnourished children) and 5·0 mmol/L were randomly assigned (1:1) by a computer-generated randomisation sequence, stratified by study site and severe malnutrition, to receive either an immediate intravenous bolus of 10% dextrose at 5 mL/kg followed by a 24-h maintenance infusion of 10% dextrose at 100 mL/kg for the first 10 kg of bodyweight, 50 mL/kg for the next 10 kg, and 20 mL/kg for each subsequent kg of bodyweight (intervention group) or observation for a minimum of 60 min and standard care (control group). Participants and study personnel were not masked to treatment allocation. The primary outcome was all-cause in-hospital mortality, assessed on an intention-to-treat basis. Safety was also assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT02989675. FINDINGS Between Dec 5, 2016, and Jan 22, 2019, 10 947 children were screened, of whom 332 were randomly assigned, and 322 were included in the final analysis (n=162 in the control group and n=160 in the intervention group). The study was terminated after an interim analysis at 24% enrolment indicated futility. The median age of participants was 2·3 years (IQR 1·4-3·2), 65 (45%) were female, and the baseline characteristics of participants were similar between the two groups. The number of in-hospital deaths from any cause was 26 (16%) in the control group and 24 (15%) in the intervention group, with an absolute mortality difference of 1·0% (95% CI -6·9 to 9·0). Serious adverse events, including hypoglycaemia, hyperglycaemia, convulsions, reduced consciousness, and death, were reported in 47 (29%) children in the control group and 39 (24%) children in the intervention group. INTERPRETATION Increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely sick children in Malawi from 2·5 mmol/L to 5·0 mmol/L did not reduce all-cause in-hospital mortality. Our findings do not support changing the cutoff for dextrose administration, and further research on the optimal management of severely ill children who present to the emergency department with low blood glucose concentrations is warranted. FUNDING Swedish Research Council and Stockholm Country Council.
Collapse
Affiliation(s)
- Tim Baker
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Fatsani Ngwalangwa
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Henderson Masanjala
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gaetano Marrone
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hildenwall
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Gradidge P, Phaswana M, Wijndaele K, Crowther N, Draper C. Standing up against office sitting: A study protocol. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1415. [PMID: 32935066 PMCID: PMC7479433 DOI: 10.4102/sajp.v76i1.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/01/2020] [Indexed: 11/01/2022] Open
Abstract
Background Sedentary behaviour is associated with cardiometabolic diseases amongst office-bound workers, mostly through extended sitting and engaging in low-energy-demanding activities during work hours. The aim of this study is to assess the effectiveness of standing desks and healthy messages on cardiovascular parameters in a cohort of office-based workers and to explore the perceptions of these workers about the suitability of this intervention to lower occupation-related sedentariness. Methods/design The protocol will use a mixed-methods study design. Phase 1 of this study is a 12-month, single blinded, randomised controlled trial, which will include baseline, 3-month, 6-month and 12-month post-intervention assessments of plausible cardiometabolic risk biomarkers in office-bound workers at a South African credit and information management company. These biomarkers include anthropometry, sedentary behaviour and physical activity, sleep duration, blood pressure, glucose, glycated haemoglobin (HbA1c), lipid profile and cardiorespiratory fitness. Participants will be randomised into an intervention or control group. The intervention group will be provided with an adjustable sit-stand desk and receive weekly health-promoting messages for the intervention period. Phase 2 will use focus group discussions conducted post-intervention to explore the study participants' perceptions of the effectiveness of the intervention. Cardiometabolic risk biomarkers and changes in these variables will be compared between the intervention group and the control group at the four time points using descriptive and inferential statistics. Discussion Regression analysis will be undertaken to determine the association of cardiometabolic risk biomarkers with cardiometabolic diseases. A thematic content analysis approach will be used to explore emerging themes from focus group discussions. Protocol identification Pan African Clinical Trial Registry, PACTR201911656014962.
Collapse
Affiliation(s)
- Philippe Gradidge
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Merling Phaswana
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Nigel Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine Draper
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
9
|
Ferrannini G, De Bacquer D, De Backer G, Kotseva K, Mellbin L, Wood D, Rydén L. Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease-A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V. Diabetes Care 2020; 43:726-733. [PMID: 32079627 DOI: 10.2337/dc19-2165] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/24/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.
Collapse
Affiliation(s)
- Giulia Ferrannini
- Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.,Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,European Society of Cardiology, Sophia Antipolis, France
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
| | | | | |
Collapse
|
10
|
Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Cifkova R, Davletov K, Dilic M, Dolzhenko M, Gaita D, Gotcheva N, Hasan-Ali H, Jankowski P, Lionis C, Mancas S, Milićić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Vulić D, Wood D. Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries. Eur J Prev Cardiol 2020; 28:370-379. [PMID: 33966079 DOI: 10.1177/2047487320908698] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. METHODS The method used was a cross-stional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. RESULTS A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. CONCLUSION The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.
Collapse
Affiliation(s)
- Kornelia Kotseva
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Guy De Backer
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Arno Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Diederick Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Aldo Maggioni
- Maria Cecilia Hospital, GVMCare & Research Cotignola, Italy.,EURObservational Research Programme, European Society of Cardiology, France
| | | | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Portugal
| | - Carlos Aguiar
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, Czech Republic
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, Czech Republic
| | - Kairat Davletov
- Health Research Institute, Al-Farabi Kazakh National University, Kazakhstan
| | - Mirza Dilic
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Maryna Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Ukraine
| | - Dan Gaita
- Clinica de Recuperare Cardiovasculara, Universitatea de Medicina si Farmacie Victor Babes, Romania
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, Bulgaria
| | - Hosam Hasan-Ali
- Cardiovascular Medicine Department, Assiut University, Egypt
| | - Piotr Jankowski
- I Department of Cardiology, Interventional Electro-cardiology and Hypertension, Jagiellonian University Medical College, Poland
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete, Greece
| | - Silvia Mancas
- Clinica de Recuperare Cardiovasculara, Universitatea de Medicina si Farmacie Victor Babes, Romania
| | | | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Kyrgyzstan.,National Center of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Kyrgyzstan
| | - Rafael Oganov
- National Research Center for Preventive Medicine, Russia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Ministry of Healthcare of the Russian Federation, Russia
| | - Željko Reiner
- University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - Duško Vulić
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | | |
Collapse
|
11
|
Baumstark A, Jendrike N, Kamecke U, Liebing C, Pleus S, Freckmann G. Measurement accuracy of two professional-use systems for point-of-care testing of blood glucose. Clin Chem Lab Med 2020; 58:445-455. [PMID: 31693491 DOI: 10.1515/cclm-2019-0549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
Background The professional-use systems HemoCue® Glucose 201+ (HC201+) and HemoCue® Glucose 201 RT (HC201RT) are widely used for point-of-care testing (POCT) of blood glucose (BG). HC201RT utilizes unit-use microcuvettes which can be stored at room temperature, whereas HC201+ microcuvettes have to be stored at <8 °C. In this study, system accuracy of HC201+ and HC201RT was evaluated using capillary and venous blood samples. Methods For each system, two reagent system lots were evaluated within a period of 2 years based on testing procedures of ISO 15197:2013, a standard applicable for self-monitoring of blood glucose (SMBG) systems. For each reagent system lot, the investigation was performed by using 100 capillary and 95 to 99 venous blood samples. Comparison measurements were performed with a hexokinase laboratory method. Accuracy criteria of ISO 15197:2013 and POCT12-A3 were applied. In addition, bias was analyzed according to Bland and Altman, and error grid analysis was performed. Results When measuring capillary samples, both systems fulfilled accuracy requirements of ISO 15197:2013 and POCT12-A3 with the investigated reagent system lots. When measuring venous samples, only HC201+ fulfilled these requirements. Bias between HC201+ and reference measurements was more consistent over venous and capillary samples and microcuvette lots than for HC201RT. Error grid analysis showed that clinical actions might have been different depending on which system was used. Conclusions In this study, HC201+ showed a high level of accuracy irrespective of the sample type (capillary or venous). In contrast, HC201RT measurement results were markedly affected by the type of sample.
Collapse
Affiliation(s)
- Annette Baumstark
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Nina Jendrike
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Ulrike Kamecke
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Christina Liebing
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| |
Collapse
|
12
|
Kristensen K, Wangel AM, Katsarou A, Shaat N, Simmons D, Fadl H, Berntorp K. Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference. J Diabetes Res 2020; 2020:7937403. [PMID: 32280717 PMCID: PMC7115054 DOI: 10.1155/2020/7937403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. METHODS A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n = 135), 1 h (n = 135), 1 h (n = 135), 1 h (. RESULTS Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P < 0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. CONCLUSIONS A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.
Collapse
Affiliation(s)
- Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anne-Marie Wangel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Current status of secondary prevention in Czech coronary patients in the EUROASPIRE V Study. COR ET VASA 2019. [DOI: 10.33678/cor.2019.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan-Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stöerk S, Tokgözoğlu L, Tsioufis C, Vulic D, Wood D. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019; 26:824-835. [DOI: 10.1177/2047487318825350] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.
Collapse
Affiliation(s)
- Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arno Hoes
- European Society of Cardiology, Sophia Antipolis, France
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Diederick Grobbee
- European Society of Cardiology, Sophia Antipolis, France
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Aldo Maggioni
- European Society of Cardiology, Sophia Antipolis, France
- ANMCO Research Centre, Florence, Italy
| | - Pedro Marques-Vidal
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Catriona Jennings
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Aguiar
- European Society of Cardiology, Sophia Antipolis, France
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular diseases, Medical Faculty, Vilnius University, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Almudena Castro Conde
- Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Renata Cifkova
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Jim Crowley
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Galway University Hospital and Croí, the West of Ireland Cardiac and Stroke Foundation, Croí Heart and Stroke Centre, Galway, Ireland
| | - Kairat Davletov
- School of Public Health, Public Health Research Centre, Kazakh National Medical University, Almaty, Kazakhstan
| | - Jaap Deckers
- European Society of Cardiology, Sophia Antipolis, France
- Erasmus MC, Rotterdam, The Netherlands
| | - Delphine De Smedt
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Johan De Sutter
- European Society of Cardiology, Sophia Antipolis, France
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium
- AZ Maria Middelares Ghent, Belgium
| | - Mirza Dilic
- European Society of Cardiology, Sophia Antipolis, France
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Marina Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Vilnis Dzerve
- European Society of Cardiology, Sophia Antipolis, France
- Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- European Society of Cardiology, Sophia Antipolis, France
- Pauls Stradins Clinical University Hospita, University of Latvia, Riga, Latvia
| | - Zlatko Fras
- European Society of Cardiology, Sophia Antipolis, France
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
| | - Dan Gaita
- European Society of Cardiology, Sophia Antipolis, France
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Nina Gotcheva
- National Heart Hospital, Dept Cardiology, Sofia, Bulgaria
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Centre, University Hospital Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
| | - Hosam Hasan-Ali
- Assiut University Heart Hospital, Cardiovascular Medicine Department, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Nebojsa Lalic
- Department for Metabolic Disorder, Intensive Treatment and Cell Therapy in Diabetes, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Seppo Lehto
- European Society of Cardiology, Sophia Antipolis, France
- Varkaus Hospital, Finland
| | - Dragan Lovic
- European Society of Cardiology, Sophia Antipolis, France
- Clinic for Internal Disease Intermedic, Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Silvia Mancas
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Linda Mellbin
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Davor Milicic
- European Society of Cardiology, Sophia Antipolis, France
- University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia
| | - Erkin Mirrakhimov
- European Society of Cardiology, Sophia Antipolis, France
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | - Rafael Oganov
- National Research Centre for Preventive Medicine, Directorate, Moscow, Russia
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Zeljko Reiner
- European Society of Cardiology, Sophia Antipolis, France
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Stefan Stöerk
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Lâle Tokgözoğlu
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Costas Tsioufis
- European Society of Cardiology, Sophia Antipolis, France
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dusko Vulic
- Centre for Medical Research, School of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
- National University of Ireland, Galway, Ireland *Listed in Supplemental Appendix
| | | |
Collapse
|
15
|
Shahim B, Kjellström B, Gyberg V, Jennings C, Smetana S, Rydén L. The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease. Diabetes Technol Ther 2018; 20:596-602. [PMID: 30074818 DOI: 10.1089/dia.2018.0157] [Citation(s) in RCA: 8] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Point-of-care equipment for measuring glucose saves time and costs for both patients and professionals and minimizes preanalytic errors when screening for or managing dysglycemia, that is, impaired glucose tolerance and type 2 diabetes. The accuracy of such devices has, however, been questioned compared with analyses at an accredited hospital laboratory. OBJECTIVE To investigate the agreement between glucose measurements made by the point-of-care HemoCue® Glucose 201 RT System (HemoCue, Ängelholm, Sweden) and local hospital laboratories. MATERIAL Patients with established coronary artery disease (CAD) recruited in Sweden and the United Kingdom within the auspices of the European Action on Secondary and primary Prevention by Intervention to Reduce Events (EUROASPIRE) V survey (n = 87; 18-80 years) with or without previously known dysglycemia were investigated. Plasma glucose values collected in the fasting state (n = 85) and 60 (n = 57) and 120 (n = 72) min after a glucose load were analyzed both using HemoCue monitors and local hospital laboratories. The two measurement techniques were compared using a bias plot according to Bland-Altman, the surveillance error grid, and Spearman correlation test. RESULTS The bias plot method showed small differences between the HemoCue and local hospital laboratory methods, the HemoCue and central hospital laboratory, and the local hospital laboratories and the central hospital laboratory. In the surveillance error grid, 98.6% of the values were in the deep green zone, indicating no risk and the remaining values (1.4%) were within the light green zone, indicating "slight lower risk." CONCLUSION The HemoCue point-of-care system is accurate for dysglycemia screening in patients with CAD.
Collapse
Affiliation(s)
- Bahira Shahim
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Barbro Kjellström
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Viveca Gyberg
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
- 2 Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet , Huddinge, Sweden
| | - Catriona Jennings
- 3 Faculty of Medicine, NHLI Imperial College London , Hammersmith Campus, London, United Kingdom
| | - Stina Smetana
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Lars Rydén
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| |
Collapse
|