1
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Kerola AM, Juonala M, Palomäki A, Semb AG, Rautava P, Kytö V. Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction. Diabetes Care 2022; 45:1657-1665. [PMID: 35679070 PMCID: PMC9274223 DOI: 10.2337/dc22-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score-matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32-1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.
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Affiliation(s)
- Anne M Kerola
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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2
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Kogan A, Wieder-Finesod A, Frogel J, Peled-Potashnik Y, Ram E, Raanani E, Sternik L. Surgical treatment on infective endocarditis: impact of diabetes on mortality. Cardiovasc Diabetol 2022; 21:120. [PMID: 35773698 PMCID: PMC9248198 DOI: 10.1186/s12933-022-01557-x] [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: 02/20/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is a frequent co-morbidity among patients suffering from infective endocarditis (IE). The aim of the study was to evaluate the impact of type 2 DM on the early-, intermediate- and long-term mortality of patients who underwent surgical treatment of endocarditis. METHODS We performed an observational cohort study in the large tertiary center in Israel during 14 years. All data of patients who underwent surgical treatment of endocarditis, performed between 2006 and 2020 were extracted from the departmental database. Patients were divided into two groups: Group I (non-diabetic patients), and Group II (diabetic patients). RESULTS The study population includes 420 patients. Group I (non-diabetic patients), comprise 326 patients, and Group II (diabetic patients), comprise 94 patients. Mean follow-up duration was 39.3 ± 28.1 months. Short-term, 30-day and in-hospital mortality, also intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 11.7% vs. 7.7%. (p = 0.215); 12.8% vs. 8.3% (p = 0.285); 20.2% vs. 13.2% (p = 0.1) and 23.4% vs. 15.6% (p = 0.09) respectively. Long-term, 5-year mortality was significantly higher in the DM group, compared to the non-DM group: 30.9% vs. 16.6% (p = 0.003). Furthermore, predictors for long-term mortality included diabetes (CI 1.056-2.785, p = 0.029), as demonstrated by regression analysis. CONCLUSIONS Diabetic patients have trend to increasing mortality at the short- and intermediate period post-surgery for IE, but this is not statistically significant. Survival of diabetic patients deteriorates after more than three years follow surgery. Diabetes is an independent predictor for long-term, 5-year mortality after surgical treatment of endocarditis, regardless of the patients age and comorbidities. Trial registration Ethical Committee of Sheba Medical Centre, Israel on 02.12. 2014, Protocol 4257.
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Affiliation(s)
- Alexander Kogan
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Anat Wieder-Finesod
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled-Potashnik
- Division of Cardiology, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Dinh NTT, Cox IA, de Graaff B, Campbell JA, Stokes B, Palmer AJ. A Comprehensive Systematic Review of Data Linkage Publications on Diabetes in Australia. Front Public Health 2022; 10:757987. [PMID: 35692316 PMCID: PMC9174992 DOI: 10.3389/fpubh.2022.757987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Our study aimed to identify the common themes, knowledge gaps and to evaluate the quality of data linkage research on diabetes in Australia. Methods This systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement). Six biomedical databases and the Australian Population Health Research Network (PHRN) website were searched. A narrative synthesis was conducted to comprehensively identify the common themes and knowledge gaps. The guidelines for studies involving data linkage were used to appraise methodological quality of included studies. Results After screening and hand-searching, 118 studies were included in the final analysis. Data linkage publications confirmed negative health outcomes in people with diabetes, reported risk factors for diabetes and its complications, and found an inverse association between primary care use and hospitalization. Linked data were used to validate data sources and diabetes instruments. There were limited publications investigating healthcare expenditure and adverse drug reactions (ADRs) in people with diabetes. Regarding methodological assessment, important information about the linkage performed was under-reported in included studies. Conclusions In the future, more up to date data linkage research addressing costs of diabetes and its complications in a contemporary Australian setting, as well as research assessing ADRs of recently approved antidiabetic medications, are required.
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Affiliation(s)
- Ngan T T Dinh
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Department of Pharmacology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Vietnam
| | - Ingrid A Cox
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Barbara de Graaff
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Brian Stokes
- Tasmanian Data Linkage Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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4
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Markousis-Mavrogenis G, Bacopoulou F, Mavragani C, Voulgari P, Kolovou G, Kitas GD, Chrousos GP, Mavrogeni SI. Coronary microvascular disease: The "Meeting Point" of Cardiology, Rheumatology and Endocrinology. Eur J Clin Invest 2022; 52:e13737. [PMID: 34939183 DOI: 10.1111/eci.13737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exertional chest pain/dyspnea or chest pain at rest are the main symptoms of coronary artery disease (CAD), which are traditionally attributed to insufficiency of the epicardial coronary arteries. However, 2/3 of women and 1/3 of men with angina and 10% of patients with acute myocardial infarction have no evidence of epicardial coronary artery stenosis in X-ray coronary angiography. In these cases, coronary microvascular disease (CMD) is the main causative factor. AIMS To present the pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology. MATERIALS-METHODS The pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology was evaluated. It includes impaired microvascular vasodilatation, which leads to inability of the organism to deal with myocardial oxygen needs and, hence, development of ischemic pain. CMD, observed in inflammatory autoimmune rheumatic and endocrine/metabolic disorders, brings together Cardiology, Rheumatology and Endocrinology. Causative factors include persistent systemic inflammation and endocrine/metabolic abnormalities influencing directly the coronary microvasculature. In the past, the evaluation of microcirculation was feasible only with the use of invasive techniques, such as coronary flow reserve assessment. Currently, the application of advanced imaging modalities, such as cardiovascular magnetic resonance (CMR), can evaluate CMD non-invasively and without ionizing radiation. RESULTS CMD may present with a variety of symptoms with 1/3 to 2/3 of them expressed as typical chest pain in effort, more commonly found in women during menopause than in men. Atypical presentation includes chest pain at rest or exertional dyspnea,but post exercise symptoms are not uncommon. The treatment with nitrates is less effective in CMD, because their vasodilator action in coronary micro-circulation is less pronounced than in the epicardial coronary arteries. DISCUSSION Although both classic and new medications have been used in the treatment of CMD, there are still many questions regarding both the pathophysiology and the treatment of this disorder. The potential effects of anti-rheumatic and endocrine medications on the evolution of CMD need further evaluation. CONCLUSION CMD is a multifactorial disease leading to myocardial ischemia/fibrosis alone or in combination with epicardial coronary artery disease. Endothelial dysfunction/vasospasm, systemic inflammation, and/or neuroendocrine activation may act as causative factors and bring Cardiology, Rheumatology and Endocrinology together. Currently, the application of advanced imaging modalities, and specifically CMR, allows reliable assessment of the extent and severity of CMD. These measurements should not be limited to "pure cardiac patients", as it is known that CMD affects the majority of patients with autoimmune rheumatic and endocrine/metabolic disorders.
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Affiliation(s)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Clio Mavragani
- Pathophysiology Department, University of Athens, Athens, Greece
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Hospital, Athens, Greece.,Epidemiology Department, University of Manchester, Manchester, UK
| | - George D Kitas
- Epidemiology Department, University of Manchester, Manchester, UK
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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5
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Two-Year Clinical Outcomes Between Prediabetic and Diabetic Patients With STEMI and Multivessel Disease Who Underwent Successful PCI Using Drug-Eluting Stents. Angiology 2020; 72:50-61. [PMID: 32806925 DOI: 10.1177/0003319720949311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To evaluate clinical implication of prediabetes, we compared a 2-year major clinical outcome including patient-oriented composite outcomes (POCOs), stent thrombosis (ST), and stroke between prediabetes and diabetes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). A total of 4097 patients with STEMI and MVD (normoglycemia [group A: 1001], prediabetes [group B: 1518], and diabetes [group C: 1578]) who received drug-eluting stents were evaluated. Patient-oriented composite outcomes were defined as all-cause death, recurrent myocardial infarction (MI), or any repeat revascularization. The cumulative incidences of POCOs, ST, and stroke were similar between groups B and C. The cumulative incidences of all-cause death (adjusted hazard ratio [aHR]: 1.483; 95% CI: 1.027-2.143; P = .036) and all-cause death or MI (aHR: 1.429, 95% CI: 1.034-1.974; P = .031) were higher in group B than in group A. The cumulative incidences of all-cause death (aHR: 1.563; 95% CI: 1.089-2.243; P = .015), cardiac death (aHR: 1.661; 95% CI: 1.123-2.457; P = .011), and all-cause death or MI were higher in group C than in group A. In conclusion, prediabetes could potentially have a similar impact as diabetes on major clinical outcomes in patients with STEMI and MVD.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, 85082Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, 85082Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, 65416Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, 222187Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
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6
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Everett CC, Reynolds C, Fernandez C, Stocken DD, Sharples LD, Sathyapalan T, Heller S, Storey RF, Ajjan RA. Rationale and design of the LIBERATES trial: Protocol for a randomised controlled trial of flash glucose monitoring for optimisation of glycaemia in individuals with type 2 diabetes and recent myocardial infarction. Diab Vasc Dis Res 2020; 17:1479164120957934. [PMID: 33081502 PMCID: PMC7919208 DOI: 10.1177/1479164120957934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyperglycaemia in individuals with type 2 diabetes (T2D) and myocardial infarction (MI) is associated with guarded clinical prognosis. Studies improving glucose levels in T2D following MI relied on HbA1c as the main glycaemic marker, failing to address potential adverse effects of hypoglycaemia and glucose variability. We describe the design of the LIBERATES trial that investigates the role of flash glucose monitoring in optimising glycaemic markers in high vascular risk individuals with T2D. This multicentre trial is designed to recruit up to 150 insulin and/or sulphonylurea-treated T2D patients, within 5 days of a proven MI. Individuals will be randomised 1:1 into intervention and control groups using flash glucose monitoring sensors and traditional self-monitoring of blood glucose, respectively. The control group will also wear a blinded continuous glucose monitoring sensor. The primary outcome is the difference in time spent in euglycaemia (defined as glucose levels between 3.9-10.0 mmol/l), comparing study groups 3 months following recruitment, assessed daily for 14 days and as an average. Secondary and exploratory end points include time spent in hypoglycaemia and hyperglycaemia, HbA1c, quality of life measures, major adverse cardiac events and cost-effectiveness of the intervention. This study will establish the role of flash glucose monitoring in glycaemic management of individuals with T2D sustaining a cardiac event.(Trial Registration: ISRCTN14974233, registered 12th June 2017).
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Affiliation(s)
- Colin C Everett
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | - Catherine Reynolds
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | - Catherine Fernandez
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | - Deborah D Stocken
- Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
| | - Linda D Sharples
- London School of Hygiene and Tropical Medicine, University of London, Bloomsbury, London, UK
| | | | - Simon Heller
- Department of Oncology and Metabolism, Sheffield Teaching Hospitals Trust, Sheffield, South Yorkshire, UK
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Ramzi A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, UK
- Department of Diabetes and Endocirnology, Leeds Teaching Hospitals Trust, Leeds, West Yorkshire, UK
- Ramzi A Ajjan, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, The LIGHT Laboratories, Clarendon Way, Leeds, West Yorkshire LS2 9JT, UK.
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7
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Patel H, Aggarwal NT, Rao A, Bryant E, Sanghani RM, Byrnes M, Kalra D, Dairaghi L, Braun L, Gabriel S, Volgman AS. Microvascular Disease and Small-Vessel Disease: The Nexus of Multiple Diseases of Women. J Womens Health (Larchmt) 2020; 29:770-779. [PMID: 32074468 PMCID: PMC7307673 DOI: 10.1089/jwh.2019.7826] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophysiological basis that differentially affects various organs in some patients. The prevalence of small-vessel disease in the heart has been found to be higher in women compared with men. Additionally, other diseases prominently affecting women, including heart failure with preserved ejection fraction, Takotsubo cardiomyopathy, cerebral small-vessel disease, preeclampsia, pulmonary arterial hypertension (PAH), endothelial dysfunction in diabetes, diabetic cardiomyopathy, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, may have a common etiologic linkage related to microvascular disease. To the best of our knowledge this is the first article to investigate this potential linkage. We sought to identify various diseases with a shared pathophysiology involving microvascular/endothelial dysfunction that primarily affect women, and their potential implications for disease management. Advanced imaging technologies, such as magnetic resonance imaging and positron-emission tomography, enable the detection and increased understanding of microvascular dysfunction in various diseases. Therapies that improve endothelial function, such as those used in PAH, may also be associated with benefits across the full spectrum of microvascular dysfunction. A shared pathology across multiple organ systems highlights the need for a collaborative, multidisciplinary approach among medical subspecialty practitioners who care for women with small-vessel disease. Such an approach may lead to accelerated research in diseases that affect women and their quality of life.
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Affiliation(s)
- Hena Patel
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush Medical College, Rush University, Chicago, Illinois
| | - Anupama Rao
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | | | - Rupa M Sanghani
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Mary Byrnes
- Clinical Nursing, Rush Medical College, Rush University, Chicago, Illinois
| | - Dinesh Kalra
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Leigh Dairaghi
- Rush Medical College, Rush University, Chicago, Illinois
| | - Lynne Braun
- Rush College of Nursing and Medicine, Rush University, Chicago, Illinois
| | - Sherine Gabriel
- Department of Rheumatology, Rush Medical College, Rush University, Chicago, Illinois
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8
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Geraci G, Buccheri D, Zanoli L, Fatuzzo P, Di Natale K, Zammuto MM, Nardi E, Geraci C, Mancia E, Zambelli G, Piraino D, Signorelli SS, Granata A, Cottone S, Mule G. Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease. Exp Ther Med 2019; 17:3255-3263. [PMID: 30906482 DOI: 10.3892/etm.2019.7279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
Abstract
Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, coronary atherosclerotic burden and carotid atherosclerotic disease. A total of 130 patients with hypertension aged between 30-80 years who had been referred for an elective coronary angiography were enrolled in the present study. A duplex ultrasound of the intrarenal vasculature was performed to evaluate the resistive index (RI), pulsatility index (PI) and acceleration time (AT). The carotid intima-media thickness was additionally assessed. A coronary angiography was performed to detect the atherosclerotic burden using the Gensini Score (GS). Based on the GS values, subjects were divided into quintiles (I: ≤9; II: 9-17; III: 17-30; IV: 30-44; and V: GS >44) as well as in subjects with mild (GS ≤30) or severe coronary disease (GS >30). A weak significant difference in PI was identified among quintiles (P=0.041), whereas, RI and AT did not differ significantly. PI was associated with GS in the group with low coronary atherosclerotic burden (GS ≤30; P=0.047), whereas, no association was detected in subjects with GS >30. This association remained following adjustment for age and left ventricular ejection fraction (P=0.025). In conclusion, renal vascular alterations were associated with coronary atherosclerotic burden in patients with hypertension with mild coronary disease.
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Affiliation(s)
- Giulio Geraci
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Dario Buccheri
- Unit of Interventional Cardiology, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Pasquale Fatuzzo
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Katia Di Natale
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Marta M Zammuto
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Emilio Nardi
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Calogero Geraci
- Unit of Cardiology, S. Elia Hospital, I-93100 Caltanissetta, Italy
| | - Ettore Mancia
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giulia Zambelli
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Davide Piraino
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Salvatore S Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Santina Cottone
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giuseppe Mule
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
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9
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Sara JD, Taher R, Kolluri N, Vella A, Lerman LO, Lerman A. Coronary microvascular dysfunction is associated with poor glycemic control amongst female diabetics with chest pain and non-obstructive coronary artery disease. Cardiovasc Diabetol 2019; 18:22. [PMID: 30819191 PMCID: PMC6393964 DOI: 10.1186/s12933-019-0833-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus are at an increased risk of adverse cardiovascular events compared to those without diabetes. The timing, relative to disease onset, and degree of glycemic control that reduces the risk of adverse cardiovascular events remains uncertain. Coronary microvascular dysfunction is prevalent in patients with type 2 diabetes mellitus and is linked to adverse cardiovascular events. We assessed the association between endothelial-dependent and endothelial-independent coronary microvascular dysfunction and glycemic control in patients presenting with chest pain and nonobstructive coronary disease at angiography. Methods Patients presenting with chest pain and found to have non-obstructive CAD (stenosis < 40%) at angiography underwent an invasive assessment of endothelial-independent and endothelial –dependent microvascular function. Endothelial-independent microvascular function was assessed by comparing the coronary flow velocity, measured using a Doppler guidewire, in response to intracoronary infusion of adenosine to calculate the coronary flow reserve ratio in response to adenosine (CFRAdn Ratio). A CFRAdn Ratio ≤ 2.5 was considered abnormal. Endothelial-dependent microvascular function was assessed by measuring the percent change in coronary blood flow in response to intracoronary infusions of acetylcholine (%ΔCBFAch), and microvascular endothelial dysfunction defined as a %ΔCBFAch of ≤ 50%. Patients were classified by normal versus abnormal CFRAdn Ratio and %ΔCBFAch. Measurements of HbA1c and fasting serum glucose were obtained prior to catheterization and compared between groups. Results Between 1993 and 2012, 1469 patients (mean age 50.4 years, 35% male) underwent coronary angiography and invasive testing for coronary microvascular dysfunction, of which 129 (8.8%) had type 2 diabetes. Fifty-one (39.5%) had an abnormal %ΔCBFAch and 49 (38.0%) had an abnormal CFRAdn Ratio. Conventional cardiovascular risk factors and cardiovascular or diabetic medication use did not vary significantly between groups. Females with an abnormal CFRAdn Ratio or abnormal %ΔCBFAch had a significantly higher HbA1c compared to patients with a normal CFRAdn Ratio or %ΔCBFAch respectively: HbA1c % (standard deviation) 7.4 (2.1) vs. 6.5 (1.1), p = 0.035 and 7.3 (1.9) vs. 6.4 (1.2), p = 0.022, respectively. Female patients with an abnormal CFRAdn Ratio had significantly higher fasting serum glucose concentrations compared to those with a normal CFRAdn Ratio: fasting serum glucose mg/dL (standard deviation) 144.4 (55.6) vs. 121.9 (28.1), p = 0.035. This was not observed in men. Amongst female diabetics, a higher HbA1c was significantly associated with any coronary microvascular dysfunction both in a univariate and multivariate analysis: odds ratio (95% confidence interval) 1.69 (1.01–2.86) p = 0.049; and a fasting serum glucose > 140 mg/dL was significantly associated with an abnormal CFRAdn Ratio, 4.28 (1.43–12.81). Conclusion Poor glycemic control is associated with coronary microvascular dysfunction amongst female diabetics presenting with chest pain and non-obstructive CAD. These findings highlight the importance of sex specific risk stratification models and treatment strategies when managing cardiovascular risk amongst diabetics. Further studies are required to identify additional risk prevention tools and therapies targeting microvascular dysfunction as an integrated index of cardiovascular risk. Electronic supplementary material The online version of this article (10.1186/s12933-019-0833-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaskanwal D Sara
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Riad Taher
- Internal Medicine Department and Department of Endocrinology, Rambam HealthCare Campus, Haifa, Israel
| | - Nikhil Kolluri
- Division of Internal Medicine, Mayo College of Medicine, Rochester, MN, USA
| | - Adrian Vella
- Division of Diabetes and Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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Reges O, Leibowitz M, Hoshen M, Leventer-Roberts M, Greenland P, Balicer R. Diabetes control: Incidence of acute myocardial infarction and all-cause mortality among patients with 3-6 years' disease duration. Eur J Prev Cardiol 2017; 24:1083-1092. [PMID: 28387143 DOI: 10.1177/2047487317702041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Optimal glycated haemoglobin (HbA1c) concentrations to minimize large vessel complications and prolong life in diabetes patients are not well established. Design A retrospective cohort study from 2010 to 2012 using data from the Clalit Health Service (Clalit) integrated healthcare system's electronic data warehouse. Patients included had newly incident diabetes, had at least two HbA1c measurements during the 3 years prior to 1 January 2010 without any disruption(s) in Clalit membership between 2010 and 2014. Methods Time-dependent variables were utilized for HbA1c concentration exposure at three time periods. Diabetes control was evaluated taking average HbA1c measures per time period. Unadjusted and adjusted extended Cox regression analyses assessed the association between time-dependent average HbA1c level and acute myocardial infarction and all-cause mortality. Results Among our 61,971 participants, 2.0% experienced acute myocardial infarction and 6.9% died. Compared to patients with HbA1c 7.0 to < 7.5%, a higher risk of myocardial infarction was found with 8.5 to < 9.0% (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.05-1.91) and ≥9.0% (HR 1.87, 95% CI 1.50-2.33) groups; a lower risk was found among <6.0% (HR 0.74, 95% CI 0.59-0.93), 6.0 to < 6.5% (HR 0.77, 95% CI 0.64-0.94) and 6.5 to < 7.0% (HR 0.73, 95% CI 0.60-0.88) groups. The association with all-cause mortality was J-shaped, demonstrating a higher risk in those <6.0% (HR 1.20, 95% CI 1.06-1.34), 7.5 to < 8.0% (HR 1.17, 95% CI 1.02-1.35), 8.0 to < 8.5% (HR 1.38, 95% CI 1.16-1.64), 8.5 to < 9.0% (HR 1.36, 95% CI 1.10-1.67) and ≥9.0% (HR 1.74, 95% CI 1.49-2.04) groups. Conclusions HbA1c concentration below 6.0% may be associated with an excess risk for all-cause mortality. Clinicians must be aware of this association when treating individual patients.
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Affiliation(s)
- Orna Reges
- 1 Clalit Research Institute, Clalit Health Services, Israel
| | - Morton Leibowitz
- 1 Clalit Research Institute, Clalit Health Services, Israel.,2 Department of Medicine, New York University School of Medicine, USA
| | - Moshe Hoshen
- 1 Clalit Research Institute, Clalit Health Services, Israel
| | - Maya Leventer-Roberts
- 1 Clalit Research Institute, Clalit Health Services, Israel.,3 Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, USA
| | - Philip Greenland
- 4 Departments of Preventive Medicine and of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Ran Balicer
- 1 Clalit Research Institute, Clalit Health Services, Israel.,5 Department of Epidemiology, Ben-Gurion University of the Negev, Israel
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