Cardiometabolic Risk Factors Associated With Type 2 Diabetes Mellitus: A Mechanistic Insight

Construction of a risk prediction model for hypertension in type 2 diabetes: Independent risk factors and nomogram

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder increasingly linked with hypertension, posing significant health risks. The need for a predictive model tailored for T2DM patients is evident, as current tools may not fully capture the unique risks in this population. This study hypothesizes that a nomogram incorporating specific risk factors will improve hypertension risk prediction in T2DM patients.

AIM

To develop and validate a nomogram prediction model for hypertension in T2DM patients.

METHODS

A retrospective observational study was conducted using data from 26850 T2DM patients from the Anhui Provincial Primary Medical and Health Information Management System (2022 to 2024). The study included patients aged 18 and above with available data on key variables. Exclusion criteria were type 1 diabetes, gestational diabetes, insufficient data, secondary hypertension, and abnormal liver and kidney function. The Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression were used to construct the nomogram, which was validated on separate datasets.

RESULTS

The developed nomogram for T2DM patients incorporated age, low-density lipoprotein, body mass index, diabetes duration, and urine protein levels as key predictive factors. In the training dataset, the model demonstrated a high discriminative power with an area under the receiver operating characteristic curve (AUC) of 0.823, indicating strong predictive accuracy. The validation dataset confirmed these findings with an AUC of 0.812. The calibration curve analysis showed excellent agreement between predicted and observed outcomes, with absolute errors of 0.017 for the training set and 0.031 for the validation set. The Hosmer-Lemeshow test yielded non-significant results for both sets (χ² = 7.066, P = 0.562 for training; χ² = 6.122, P = 0.709 for validation), suggesting good model fit.

CONCLUSION

The nomogram effectively predicts hypertension risk in T2DM patients, offering a valuable tool for personalized risk assessment and guiding targeted interventions. This model provides a significant advancement in the management of T2DM and hypertension comorbidity.

Hypertension and associated factors among patients with diabetes mellitus attending a follow-up clinic in central Ethiopia

Hypertension and diabetes mellitus are highly prevalent chronic diseases worldwide, and their coexistence presents a growing public health challenge, particularly in low-resource settings like Ethiopia. Thus, this study aimed to assess hypertension and its associated factors in patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. A health facility-based cross-sectional study was conducted. Study participants were selected using a systematic random sampling method. Data were collected through a structured, interviewer-administered questionnaire and patient record reviews. A binary logistic regression model was employed to examine the association between hypertension and the explanatory variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, and statistical significance was determined at a p-value of < 0.05. A total of 379 patients with diabetes mellitus participated in the study. The prevalence of hypertension was 34.6% (95% CI: 29.8-39.4). Being aged 41-60 years (AOR = 2.26, 95% CI: 1.23-4.15), having type 2 diabetes (AOR = 3.83, 95% CI: 1.07-13.65), the presence of comorbidities (AOR = 2.72, 95% CI: 1.59-4.67), and poor medication adherence (AOR = 2.06, 95% CI: 1.12-3.77) were statistically significant factors associated with hypertension among diabetes mellitus patients. More than one-third of patients with diabetes mellitus had hypertension. Older age, type 2 diabetes, the presence of comorbidities, and poor medication adherence were factors associated with hypertension. Regular blood pressure checks, especially for older patients, managing comorbidities, and improving medication adherence through education and simpler regimens are recommended.

Association between lipoprotein(a) and coronary heart disease risk in type 2 diabetes mellitus and evaluation of statin treatment effects

OBJECTIVE

The aim of this study was to investigate the association between lipoprotein(a) and coronary heart disease risk in type 2 diabetes mellitus patients and evaluate the effectiveness of statin therapy.

METHODS

This retrospective analysis included 120 patients diagnosed with type 2 diabetes mellitus. Of these, 90 patients diagnosed with coronary heart disease via coronary angiography received rosuvastatin treatment for over 6 months. The remaining 30 patients exhibited no coronary heart disease or other diabetic macrovascular complications and had not received any lipid-lowering treatment. Patients with type 2 diabetes mellitus and coronary heart disease were categorized into two groups based on the severity of coronary lesions. Baseline characteristics and blood lipid data were compared among groups. Logistic regression analysis was employed to investigate the association between lipoprotein(a) and coronary heart disease risk in type 2 diabetes mellitus patients. Receiver operating characteristic curves were utilized to evaluate the diagnostic value of lipoprotein(a) for coronary heart disease.

RESULTS

Compared with the control group, lipoprotein(a) levers were higher in both the mild and severe groups. Logistic regression analysis demonstrated that lipoprotein(a) is independently associated with the risk of coronary heart disease in type 2 diabetes mellitus patients. The area under the receiver operating characteristic curve for lipoprotein(a) was 0.729. When lipoprotein(a) was 97.5 mg/L, the diagnosis of coronary heart disease had high sensitivity and specificity. After statin therapy, high-density lipoprotein cholesterol and apolipoprotein A levels increased, while other lipid parameters decreased. However, the lipoprotein(a) level decrease was not statistically significant.

CONCLUSION

Lipoprotein(a) is an independent risk factor for coronary heart disease in type 2 diabetes mellitus patients. Lipid-lowering therapy with statins alone cannot reduce lipoprotein(a) levels.

Association of family history of cardiovascular disease with the prevalence of cardiometabolic risk factors in young adults in the United Arab Emirates: The UAE healthy future study

INTRODUCTION

Family history of cardiovascular disease (CVD) is an independent risk factor for coronary heart disease, and the risk increases with number of family members affected. It offers insights into shared genetic, environmental and lifestyle factors that influence heart disease risk. In this study, we aimed to estimate the association of family history of CVD and its risk factors, as well as the number of affected parents or siblings, with the prevalence of major cardiometabolic risk factors (CRFs) such as hypertension, dysglycemia, dyslipidemia and obesity in a sample of young adults.

METHODS

The study utilized a cross-sectional analysis of baseline data from the UAE Healthy Future Study (UAEHFS), involving 5,058 respondents below the age of 40 years. Information on parental and sibling health regarding heart disease and stroke, hypertension, type 2 diabetes (T2D), high cholesterol and obesity, was gathered through a self-completed questionnaire. CRFs were estimated based on body measurements, biochemical markers and self-reported conditions. Multivariate regression analyses were used to examine the associations between categories of family history and the estimated CRFs.

RESULTS

More than half (58%) of the sample reported having a positive family history of CVD or its risk factors. The most common family history reported was T2D and hypertension, which accounted for 39.8% and 35% of the sample, respectively. The prevalence of all CRFs was significantly higher among those with a positive family history compared to those without family-history (P < 0.001). The prevalence and likelihood of having a CRF increased as the number of parents and/or siblings affected increased, indicating a potential dose-response trend. The odds were highest among individuals with both parental-and-sibling family history of disease, where they increased to 2.36 (95% CI 1.68-3.32) for hypertension, 2.59 (95% CI 1.86-3.60) for dysglycemia, 1.9 (95% CI 1.29-2.91) for dyslipidemia and 3.79 (95% CI 2.83-5.06) for obesity.

CONCLUSION

In this study, we addressed the effect of family history as an independent risk factor on the major CRFs for the first time in the region. We observed that the majority of young Emirati adults had a positive family history of CVD-related diseases. Family history showed a strong association with the increased prevalence of CRFs. Additionally, having more relatives with specific diseases was associated with a higher risk of developing CRFs. Identifying people with a history of these conditions can help in early intervention and personalized risk assessments.

Effects of Coenzyme Q10 Supplementation on Metabolic Indicators in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant that has been suggested to have beneficial effects on lipid profiles and blood pressure. This systematic review and meta-analysis aim to evaluate the effects of CoQ10 supplementation on these parameters in patients with Type 2 Diabetes (T2D).

OBJECTIVE

To assess the impact of CoQ10 supplementation on lipid profiles and blood pressure in individuals diagnosed with Type 2 Diabetes.

METHODS

A systematic literature search was conducted in databases such as PubMed, Cochrane Library, and Scopus for randomized controlled trials (RCTs) published up to July 2024. Studies included were those that examined the effects of CoQ10 supplementation on lipid profiles (total cholesterol, LDL, HDL, triglycerides) and blood pressure (systolic and diastolic) in T2D patients.

RESULTS

16 studies were included. CoQ10supplementation reduced SBP (WMD: -3.86 mmHg, 95% CI: -6.01 to -1.71, P = 0.014, I2 = 83.7%; P < 0.001) and DBP (WMD: -2.70 mmHg, 95% CI: -4.50 to -0.91, P = 0.024, I2 = 92.1%; P < 0.001), but did not change lipid profile. Additionally, subgroup analysis indicated that the effects of CoQ10 on lipid profiles levels were more pronounced in studies where the daily dosage of CoQ10 was 100 mg or less, and the duration of the study was under 12 weeks.

CONCLUSIONS

Coenzyme Q10 supplementation appears to have a beneficial effect on lipid profiles and may contribute to lowering blood pressure in patients with Type 2 Diabetes. These findings suggest that CoQ10 could be a valuable adjunctive therapy for managing cardiovascular risk in this population. Additional in-depth research is needed to validate these findings and understand the underlying mechanisms in more detail.

PCSK9 Expression in Vascular Smooth Muscle Cells: Role of Insulin Resistance and High Glucose

Beyond the regulation of cholesterol metabolism, a number of extrahepatic functions of proprotein convertase subtilisin/kexin type 9 (PCSK9) have been increasingly identified. The main purpose of this study was to verify whether PCSK9 expression in vascular smooth muscle cells (VSMC) is influenced by insulin resistance and high glucose (HG). In cultured rat aortic VSMC from lean insulin-sensitive Zucker rats (LZRs) and obese insulin-resistant Zucker rats (OZRs), a classical animal model of insulin resistance, we evaluated PCSK9 expression with or without the monoclonal antibodies against PCSK9 Alirocumab and Evolocumab or the synthetic PCSK9-binding peptide PEP 2-8. Effects and molecular mechanisms underlying altered PCSK9 expression were evaluated by proliferation and migration assay, reactive oxygen species (ROS) production, and involvement of PKC, NADPH-oxidase, MAPK/ERK-1/2 pathway activation. As a result, we found that, in comparison with LZR, VSMC from OZR showed basal PCSK9 overexpression mitigated by Alirocumab, Evolocumab, PEP 2-8, and the inhibitors of PKC, NADPH-oxidase, and MAPK. The finding of PCSK9 upregulation in VSMC from OZR paralleled with increased ROS production, proliferation, and migration. HG increased PCSK9 expression in VSMC from LZR, but not in OZR, via oxidative stress and with effects reduced by PCSK9 inhibitors. These findings suggest that a dysregulation of PCSK9 in VSMC could be involved in vascular damage in metabolic disorders, such as obesity and diabetes.

Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

As an emerging concept, Cardiovascular-kidney-metabolic syndrome (CKM) elucidates the intricate interconnection between metabolic disorders(Mets), cardiovascular disease(CVD), and chronic kidney disease(CKD). Within this context, while numerous studies have demonstrated a correlation between the Atherogenic Index of Plasma (AIP) and CVD, the precise relationship between long-term fluctuations in the AIP and the incidence of CVD in patients with CKM syndrome remains unclear.

METHOD

The CKM stages 0-3 population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The outcome CVD was defined as self-reported heart disease and/or stroke. AIP control level was classified using k-mean cluster analysis. Logistic regression was used to analyse the effect of cumulative AIP (cumAIP) on the incidence of CVD. Restricted cubic spline models (RCS) were used to explore the potential non-linear relationship between cumulative AIP and CVD risk at different CKM syndrome stages.

RESULTS

Of the 3429 CKM stages 0-3 participants, 620 patients developed CVD during the 3-year follow-up period. After adjusting for various confounders, the odds ratio (OR) for the well-controlled class 2 compared with the best AIP control class 1 were 1.37 (1.04, 1.81), the OR for the moderately-controlled class 3 were 1.54 (95% CI, 1.04-2.26), the poorly-controlled class 4 were 1.65 (95% CI, 1.13-2.41), and the worst-controlled class 5 were 2.14 (95% CI, 1.15-3.97). In restricted cubic spline regression analyses, changes in AIP were linearly associated with the occurrence of CVD events. Further weighted quartiles and regression analyses indicated that triglyceride(TG) was a key variable for AIP in predicting CVD events in the CKM stages 0-3 population.

CONCLUSIONS

Poor control level of AIP are associated with an increased risk of CVD events in the population of CKM stages 0-3. Long-term dynamic monitoring of changes in AIP may help in the early identification of patients at high risk of developing CVD in the individuals with CKM stages 0-3.

Targeting AMPK with Irisin: Implications for metabolic disorders, cardiovascular health, and inflammatory conditions - A systematic review

Irisin-based interventions have gained attention for their potential to modulate the adenosine monophosphate (AMP)-activated protein kinase (AMPK) pathway in various diseases. Physiologically, irisin is a myokine released during physical exercise that exerts anti-inflammatory effects and is a metabolic and cardiometabolic enhancer. On the other hand, AMPK is crucial for maintaining energy balance and metabolic homeostasis. Therefore, individuals presenting low blood levels of irisin and AMPK dysregulation are more predisposed to metabolic disorders and cardiovascular health inflammatory conditions since regulating energy balance and metabolic homeostasis are crucial for preventing or treating these disorders. In light of those mentioned above and considering that no review has addressed the intricate relationships between irisin and AMPK regulation in the realm of metabolic disorders, cardiovascular health, and inflammatory conditions, we comprehensively reviewed studies involving irisin's effects on AMPK signaling in different models and interventions. Our systematic analysis involved in vitro studies, animal models, and their relevant clinical implications of irisin targeting AMPK due to the absence of relevant clinical trials. The outcomes and limitations of the included studies were extensively highlighted. Objectively, irisin improved metabolic disorders by enhancing β-cell function and insulin secretion in diabetes, mitigating myocardial injury in cardiovascular conditions, and reducing inflammation and oxidative stress in various injury models by targeting AMPK. However, the lack of clinical trials limits the generalizability of these findings to human subjects. Future research should focus on translating these findings into clinical applications and exploring the broader implications of irisin-based interventions in human health.

Drug-Induced Myocardial Infarction: A Review of Pharmacological Triggers and Pathophysiological Mechanisms

Myocardial infarction (MI) is a significant cardiovascular event caused by the decrease in or complete cessation of blood flow to a portion of the myocardium. It can arise from a variety of etiological factors, including pharmacological triggers. This review aims to explore the diverse drugs and substances that might lead to drug-induced myocardial infarction, focusing on their mechanisms of action and the pathophysiological processes involved. Various established and emerging pharmacological agents that could elevate the risk of myocardial infarction, such as nonsteroidal anti-inflammatory drugs, hormonal therapies, anticoagulants, and antipsychotic medications, are discussed. The role of drug-induced endothelial dysfunction, coronary artery spasm, and thrombosis are presented in order to highlight the underlying mechanisms. This review emphasizes the need for increased awareness among healthcare professionals to mitigate the risks associated with different pharmacological therapies to improve patient outcomes.

Residual Syntax score and percutaneous coronary intervention in diabetic patients with renal insufficiency

OBJECTIVE

To investigate the correlation between residual Syntax score (rSS) and long-term prognosis in diabetic patients with renal insufficiency undergoing percutaneous coronary intervention (PCI).

METHODS

In this retrospective study, we included 510 patients with coronary heart disease, diabetes, and renal insufficiency who received PCI at the Third People's Hospital of Chengdu from July 2018 to December 2020. Patients were divided into three groups based on their eGFR levels: 113 patients with eGFR ≥ 60 mL/min/1.73 m2, 256 patients with eGFR between 30 and 60 mL/min/1.73 m2, and 141 patients with eGFR < 30 mL/min/1.73 m2. Revascularization was quantified using the residual SYNTAX score (rSS), with an rSS > 8 indicating incomplete revascularization. We collected baseline data on cardiovascular adverse events and followed up with patients for 12 months, analyzing the correlations between rSS and biochemical markers such as blood glucose, uric acid, urea, serum creatinine, and eGFR, as well as the relationship between major adverse cardiovascular events (MACE) and rSS.

RESULTS

Univariate analysis identified myocardial infarction (MI), β-blocker use, and follow-up duration as factors significantly associated with the long-term prognosis of diabetic patients with renal insufficiency after PCI (P < 0.05). MI (OR=3.053, P=0.009), β-blocker use (OR=3.134, P=0.009), and follow-up duration (OR=0.998, P=0.05) were independent risk factors for long-term prognosis in these patients. rSS was positively correlated with blood glucose (r=0.973, P=0.000), uric acid (r=0.933, P=0.000), urea (r=0.907, P=0.000), serum creatinine (r=0.588, P=0.000), and eGFR (r=0.623, P=0.000). Syntax score was also positively correlated with long-term prognosis (OR=0.138, P=0.001).

CONCLUSION

The rSS is a valuable tool for evaluating independent risk factors such as incomplete revascularization, MI, β-blocker use, and follow-up duration, all of which are positively correlated with the long-term prognosis of diabetic patients with renal insufficiency after PCI.

Effect of boswellia (Boswellia serrata L.) supplementation on glycemic markers and lipid profile in type 2 diabetic patients: a systematic review and meta-analysis

Background

Type 2 diabetes mellitus (T2DM) is a significant global health challenge whose prevalence is projected to increase alarmingly. Recently, due to better safety and fewer adverse effects, herbal medicines have been used to manage T2DM. This study aimed to evaluate the efficacy of boswellia in improving glycemic markers and lipid profiles in T2DM patients.

Methods

A comprehensive search was conducted on the PubMed, Web of Science, and Scopus databases for all relevant studies published up to April 30, 2024. The effects of boswellia supplementation were evaluated using glycemic markers and lipid profiles. The data were extracted and meta-analyzed using Stata software.

Results

This meta-analysis included five studies with a total of 287 patients with T2DM. It was found that boswellia in patients with T2DM compared to the placebo or control group significantly reduced hemoglobin A1C (HbA1C) (SMD: -1.01; 95%CI: -1.55 to -0.46; P=0.00), total cholesterol (TC) (SMD: -0.44; 95%CI: -0.68 to -0.21; P=0.00), Triglycerides (TG) (SMD: -0.42; 95%CI: -0.66 to -0.19); P=0.00) and low-density lipoprotein (LDL) (SMD: -0.43; 95%CI: -0.73 to -0.12); P=0.006) levels, while reduced fasting blood glucose (FBG) but it was not significant (SMD: -1.34, 95%CI: -2.68 to 0.00; P=0.05). Notably, it did not affect high-density lipoprotein (HDL) (SMD: 0.56, 95%CI: -0.14 to -1.26; P=0.118).

Conclusion

In summary, boswellia supplementation has the potential to improve glycemic markers and lipid profiles in patients with T2DM. It may help diabetic patients in addition to a controlled diet and other treatments.

Systematic review registration

crd.york.ac.uk/PROSPERO/display_record.php?RecordID=538347, identifier CRD42024538347.

A Comprehensive Review of Metabolic Syndrome and Its Role in Cardiovascular Disease and Type 2 Diabetes Mellitus: Mechanisms, Risk Factors, and Management

Metabolic syndrome is a multifaceted metabolic disorder characterized by a constellation of interconnected risk factors, including insulin resistance, abdominal obesity, dyslipidemia, and hypertension. These components collectively predispose individuals to an elevated risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The prevalence of metabolic syndrome has escalated globally, paralleling the rise in obesity rates and sedentary lifestyles. This review explores the pathophysiology underlying metabolic syndrome, emphasizing its role in the development and progression of CVD and T2DM. Epidemiological data underscore the substantial public health burden metabolic syndrome poses, necessitating effective preventive strategies and management approaches. The current diagnostic criteria and screening tools are discussed, highlighting their utility in clinical practice. Management strategies encompass lifestyle modifications, pharmacotherapy, and surgical interventions, each targeting specific components of metabolic syndrome to mitigate cardiovascular and metabolic risks. The challenges in diagnosing and managing metabolic syndrome are addressed alongside emerging research directions to enhance prevention and treatment outcomes. By elucidating the intricate relationship between metabolic syndrome, CVD, and T2DM, this review aims to guide healthcare practitioners in optimizing patient care and advancing public health initiatives to combat this pervasive syndrome.

Evaluation of Lipid Profile Modulation by Berberis asiatica, Withania somnifera, and Their Synergy in Type 2 Diabetic Wistar Rats

Introduction Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and hyperglycemia, leading to complications such as dyslipidemia, which increases cardiovascular risks. Current treatments for dyslipidemia often have undesirable side effects. This study aims to evaluate the effects of Berberis asiatica (BA), Withania somnifera (WS), and their combination in the ratio of 1:1 on the lipid profile in T2DM-induced Wistar rats. Additionally, the study investigates the potential synergistic effects of these two herbs. Materials and methods Mature albino Wistar rats of both sexes were employed, weighing 150-250 g. Rats were obtained from the Central Animal House of Krishna Institute of Medical Sciences and kept under standard laboratory conditions. The study was conducted per the guidelines set by the Committee for Control and Supervision of Experiments on Animals (CCSEA). T2DM was induced using streptozotocin (STZ) and nicotinamide (NIC). Thirteen groups of rats were formed, including normal control (NC), diabetic control (DC), and various treatment groups received varying dosages of BA, WS, their polyherbal combination (PHC), and the conventional medications metformin (MET) and glimepiride (GLI). Lipid profiles were measured, and the data were analyzed using one-way ANOVA, followed by the Tukey-Kramer post-hoc test. Results The study revealed that both BA and WS showed statistically significant lipid-lowering effects in diabetic rats. The BA-treated groups displayed a statistically significant and considerable decrease in total cholesterol (TC) and low-density lipoprotein (LDL) levels compared to the DC group. Similarly, WS-treated groups also showed statistically significant reduced levels of TC and LDL, along with an increase in high-density lipoprotein (HDL). The PHC of BA and WS exhibited enhanced lipid-lowering effects compared to individual treatments. No significant differences in triglyceride (TG) levels were observed among the treatment groups. Conclusion BA and WS, individually and in combination, effectively modulate lipid profiles in T2DM rats. Their synergistic effects provide a promising alternative for managing dyslipidemia in diabetic patients. Further research is needed to determine the clinical consequences of these findings.

PFAS and their association with the increased risk of cardiovascular disease in postmenopausal women

Cardiovascular diseases (CVDs) are one of the major causes of death globally. In addition to traditional risk factors such as unhealthy lifestyles (smoking, obesity, sedentary) and genetics, common environmental exposures, including persistent environmental contaminants, may also influence CVD risk. Per- and polyfluoroalkyl substances (PFASs) are a class of highly fluorinated chemicals used in household consumer and industrial products known to persist in our environment for years, causing health concerns that are now linked to endocrine disruptions and related outcomes in women, including interference of the cardiovascular and reproductive systems. In postmenopausal women, higher levels of PFAS are observed than in premenopausal women due to the cessation of menstruation, which is crucial for PFAS excretion. Because of these findings, we explored the association between perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorobutanesulfonic acid in postmenopausal women from our previously established CVD study. We used liquid chromatography with tandem mass spectrometry, supported by machine learning approaches, and the detection and quantification of serum metabolites and proteins. Here, we show that PFOS can be a good predictor of coronary artery disease, whereas PFOA can be an intermediate predictor of coronary microvascular disease. We also found that the PFAS levels in our study are significantly associated with inflammation-related proteins. Our findings may provide new insight into the potential mechanisms underlying the PFAS-induced risk of CVDs in this population. This study shows that exposure to PFOA and PFOS is associated with an increased risk of cardiovascular disease in postmenopausal women. PFOS and PFOA levels correlate with amino acids and proteins related to inflammation. These circulating biomarkers contribute to the etiology of CVD and potentially implicate a mechanistic relationship between PFAS exposure and increased risk of cardiovascular events in this population.

Examining the Impact of Ertugliflozin on Cardiovascular Outcomes in Patients with Diabetes and Metabolic Syndrome: A Systematic Review of Clinical Trials

Cardiovascular diseases (CVDs) constitute a significant cause of morbidity and mortality globally, particularly among individuals with type 2 diabetes mellitus (T2DM). Ertugliflozin, a Sodium-Glucose Co-transporter-2 (SGLT2) inhibitor, is hypothesized to confer cardiovascular protection; however, long-term follow-up studies are necessary to support the hypothesis. This systematic review was conducted to evaluate the cardiovascular effects of ertugliflozin in diabetic versus non-diabetic cohorts, focusing on major adverse cardiovascular events (MACEs), hospitalizations for heart failure, and cardiovascular mortality. Adhering to PRISMA guidelines, the review encompassed studies indexed in PubMed, Scopus, and Web of Science up to March 2024. Eligibility was restricted to studies involving T2DM patients undergoing ertugliflozin treatment with reported outcomes relevant to cardiovascular health. Out of 767 initially identified articles, 6 met the inclusion criteria. Data concerning hazard ratios (HR) and confidence intervals (CI) were extracted to compare the effects of ertugliflozin with those of a placebo or other standard therapies. The collective sample size across these studies was 8246 participants. Ertugliflozin was associated with a significant reduction in hospitalizations for heart failure relative to a placebo (HR 0.70, 95% CI 0.54-0.90, p < 0.05). Furthermore, when combined with metformin, ertugliflozin potentially reduced MACEs (HR 0.92, 95% CI 0.79-1.07), although this finding did not reach statistical significance. Importantly, for patients with pre-existing heart failure, ertugliflozin significantly decreased the exacerbations of heart failure (HR 0.53, 95% CI 0.33-0.84, p < 0.01). Overall, ertugliflozin markedly reduces hospitalizations due to heart failure in T2DM patients and may improve additional cardiovascular outcomes. These results endorse the integration of ertugliflozin into therapeutic protocols for T2DM patients at elevated cardiovascular risk and substantiate its efficacy among SGLT2 inhibitors. Continued investigations are recommended to delineate its long-term cardiovascular benefits in diverse patient populations, including the potential impact on arrhythmias.

Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review

BACKGOUND

Inflammatory hematological ratios (IHRs), such as neutrophil to lymphocyte, monocyte to lymphocyte, and platelet to lymphocyte ratios, are associated with mental disorders, symptoms severity, and the disease phase. Evidence from the studies in adult patients has been summarized in systematic reviews and meta-analyses. The results of the studies in adolescents remain poorly systematized.

AIM

To summarize the findings from the studies that investigated the relationship of IHRs with mental disorders in adolescent patients.

METHODS

This scoping review included studies of IHRs in patients aged 10-19 years with mental disorders (other than anorexia nervosa), published in English by December 31, 2023. The search for relevant papers was performed in MEDLINE. The studies were categorized into two groups: studies with external controls (healthy adolescents) and studies with internal controls (patients in different phases of mental disorder, with or without self-harm/suicidal behaviors).

RESULTS

A total of 11 studies were included in the review (all cross-sectional ones). The results of these studies demonstrate that 1) adolescents with mental disorders (major depressive disorder, psychotic disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, substance use disorders) have higher IHR values than individuals of the same age without corresponding disorders (5 studies); 2) IHR values are positively correlated with the severity of psychopathological symptoms (1 study); 3) higher IHR values are associated with the phase of the mental disorder - manic episode in bipolar disorder (1 study) and exacerbation of psychosis in psychotic disorders (1 study); and 4) higher IHR values are associated with self-harm/suicidal behaviors - suicide attempts (1 study) and non-suicidal self-injury (1 study).

CONCLUSION

IHRs are associated with mental disorders in adolescents, and higher IHR values are associated with a more severe/acute clinical presentation (severity of symptoms, mania, acute psychosis, self-harm/suicidal behaviors). Further studies of higher methodological quality are needed to evaluate the diagnostic and prognostic value of IHRs as biomarkers of mental disorders in adolescence.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

A Review of Fetal Development in Pregnancies with Maternal Type 2 Diabetes Mellitus (T2DM)-Associated Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation: Possible Links to Pregestational Prediabetes

Research has identified fetal risk factors for adult diseases, forming the basis for the Developmental Origins of Health and Disease (DOHaD) hypothesis. DOHaD suggests that maternal insults during pregnancy cause structural and functional changes in fetal organs, increasing the risk of chronic diseases like type 2 diabetes mellitus (T2DM) in adulthood. It is proposed that altered maternal physiology, such as increased glucocorticoid (GC) levels associated with a dysregulated hypothalamic-pituitary-adrenal (HPA) axis in maternal stress and T2DM during pregnancy, exposes the fetus to excess GC. Prenatal glucocorticoid exposure reduces fetal growth and programs the fetal HPA axis, permanently altering its activity into adulthood. This programmed HPA axis is linked to increased risks of hypertension, cardiovascular diseases, and mental disorders in adulthood. With the global rise in T2DM, particularly among young adults of reproductive age, it is crucial to prevent its onset. T2DM is often preceded by a prediabetic state, a condition that does not show any symptoms, causing many to unknowingly progress to T2DM. Studying prediabetes is essential, as it is a reversible stage that may help prevent T2DM-related pregnancy complications. The existing literature focuses on HPA axis dysregulation in T2DM pregnancies and its link to fetal programming. However, the effects of prediabetes on HPA axis function, specifically glucocorticoid in pregnancy and fetal outcomes, are not well understood. This review consolidates research on T2DM during pregnancy, its impact on fetal programming via the HPA axis, and possible links with pregestational prediabetes.

Cardiometabolic risk factors in MASLD patients with HCC: the other side of the coin

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) constitutes the commonest cause of chronic liver disorder worldwide, whereby affecting around one third of the global population. This clinical condition may evolve into Metabolic Dysfunction-Associated Steatohepatitis (MASH), fibrosis, cirrhosis and hepatocellular carcinoma (HCC), in a predisposed subgroup of patients. The complex pathogenesis of MASLD is severely entangled with obesity, dyslipidemia and type 2 diabetes (T2D), so far so nutritional and lifestyle recommendations may be crucial in influencing the risk of HCC and modifying its prognosis. However, the causative association between HCC onset and the presence of metabolic comorbidities is not completely clarified. Therefore, the present review aimed to summarize the main literature findings that correlate the presence of inherited or acquired hyperlipidemia and metabolic risk factors with the increased predisposition towards liver cancer in MASLD patients. Here, we gathered the evidence underlining the relationship between circulating/hepatic lipids, cardiovascular events, metabolic comorbidities and hepatocarcinogenesis. In addition, we reported previous studies supporting the impact of triglyceride and/or cholesterol accumulation in generating aberrancies in the intracellular membranes of organelles, oxidative stress, ATP depletion and hepatocyte degeneration, influencing the risk of HCC and its response to therapeutic approaches. Finally, our pursuit was to emphasize the link between HCC and the presence of cardiometabolic abnormalities in our large cohort of histologically-characterized patients affected by MASLD (n=1538), of whom 86 had MASLD-HCC by including unpublished data.

Pregestational Prediabetes Induces Maternal Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation and Results in Adverse Foetal Outcomes

Maternal type 2 diabetes mellitus (T2DM) has been shown to result in foetal programming of the hypothalamic-pituitary-adrenal (HPA) axis, leading to adverse foetal outcomes. T2DM is preceded by prediabetes and shares similar pathophysiological complications. However, no studies have investigated the effects of maternal prediabetes on foetal HPA axis function and postnatal offspring development. Hence, this study investigated the effects of pregestational prediabetes on maternal HPA axis function and postnatal offspring development. Pre-diabetic (PD) and non-pre-diabetic (NPD) female Sprague Dawley rats were mated with non-prediabetic males. After gestation, male pups born from the PD and NPD groups were collected. Markers of HPA axis function, adrenocorticotropin hormone (ACTH) and corticosterone, were measured in all dams and pups. Glucose tolerance, insulin and gene expressions of mineralocorticoid (MR) and glucocorticoid (GR) receptors were further measured in all pups at birth and their developmental milestones. The results demonstrated increased basal concentrations of ACTH and corticosterone in the dams from the PD group by comparison to NPD. Furthermore, the results show an increase basal ACTH and corticosterone concentrations, disturbed MR and GR gene expression, glucose intolerance and insulin resistance assessed via the Homeostasis Model Assessment (HOMA) indices in the pups born from the PD group compared to NPD group at all developmental milestones. These observations reveal that pregestational prediabetes is associated with maternal dysregulation of the HPA axis, impacting offspring HPA axis development along with impaired glucose handling.

Liver fat as a dietary target by Chinese Medical Nutrition Therapy (CMNT) diet for treating type 2 diabetes with non-alcoholic fatty liver disease: study protocol for a randomised controlled trial

INTRODUCTION

Type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) often coexist and increase risk for developing liver fibrosis and diabetes complications if no effective measures are taken. Dietary intervention is known to be able to achieve diabetes remission, while evidence regarding the long-term effect on liver fat is limited for comorbidity management of type 2 diabetes and NAFLD. This study aims to investigate the long-term effect of a Chinese Medical Nutrition Therapy (CMNT) diet accompanied by intermittent energy restriction on reducing liver fat and glycated haemoglobin (HbA1c) in patients with type 2 diabetes and NAFLD.

METHODS AND ANALYSIS

This is a multicentre two-armed parallel randomised controlled trial study. 120 participants with type 2 diabetes and NAFLD will be recruited from the physical examination centres of multiple hospitals in China. Participants will be randomly allocated 1:1 to either the CMNT group or the usual care group. The CMNT group will be instructed to consume the provided specific meal replacement Chinese medicinal foods consisting of 6 cycles of 5 consecutive days followed by 10 days of regular food intake. The usual care group will be given standard dietary advice. Primary outcomes are changes in the controlled attenuation parameter value by transient elastography and HbA1c level. Secondary outcomes include differences in anthropometrics, clinical blood markers, questionnaires, gut microbiota and metabolomics. Further follow-up will be performed at 6 months, 1 year and 2 years.

ETHICS AND DISSEMINATION

The study protocol was approved by the Biomedical Research Ethics Committee of Hunan Agricultural University (BRECHAU20200235).The results will be disseminated via relevant peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05439226.

Mitochondrial Melatonin: Beneficial Effects in Protecting against Heart Failure

Cardiovascular disease is the cause of physical infirmity and thousands of deaths annually. Typically, during heart failure, cardiomyocyte mitochondria falter in terms of energy production and metabolic processing. Additionally, inflammation and the accumulation of non-contractile fibrous tissue contribute to cardiac malfunction. Melatonin, an endogenously produced molecule, experimentally reduces the initiation and progression of atherosclerotic lesions, which are often the basis of coronary artery disease. The current review critically analyzes published data related to the experimental use of melatonin to forestall coronary artery pathologies. Collectively, these studies document melatonin's anti-atherosclerotic actions in reducing LDL oxidation and triglyceride levels, lowering endothelial malfunction, limiting adhesion molecule formation, preventing macrophage polarization to the M1 pro-inflammatory phenotype, changing cellular metabolism, scavenging destructive reactive oxygen species, preventing the proliferation and invasion of arterial smooth muscle cells into the lesioned area, restricting the ingrowth of blood vessels from the vasa vasorum, and solidifying the plaque cap to reduce the chance of its rupture. Diabetic hyperglycemia, which aggravates atherosclerotic plaque formation, is also inhibited by melatonin supplementation in experimental animals. The potential value of non-toxic melatonin as a possible inhibitor of cardiac pathology in humans should be seriously considered by performing clinical trials using this multifunctional molecule.