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Campos Muñiz C, León-García PE, Serrato Diaz A, Hernández-Pérez E. [Diabetes mellitus prediction based on the triglyceride and glucose index]. Med Clin (Barc) 2023; 160:231-236. [PMID: 35933191 DOI: 10.1016/j.medcli.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION In Mexico, type 2 Diabetes mellitus (DM2) presents epidemiological levels with a prevalence rate of 9.12% and with the highest overweight and obesity rates worldwide. To overcome this situation, strategies must be created focused on the identification of subjects at risk. The Triglyceride and Glucose (TyG) index, was created for the detection of insulin resistance, has recently been used in the prediction of DM. The objective of the present study was to determine the predictive power of the TyG index in a cohort from Mexico City. METHODS 3195 patients were selected from a cohort of patients from the chronic degenerative area of the Health Centers of the Public Health Services of Mexico City. The ability of the TyG index in predicting diabetes was evaluated as: ln [Fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. after a follow-up of at least 4.5 years. A CHAID test was determined that was corroborated by a ROC test. RESULTS the value of the TyG index was significantly higher for patients who develop DM2. Values of AUC=0.934, 95% CI: 0.924-0.924. Obtaining a cut-off point of 9.45 in women; in men: DM2 AUC=0.824, 95% CI: 0.824-0.873, and cut-off point 9.12. CONCLUSIONS The TyG index is a good marker in the prediction of DM2. The CHAID determination is a useful tool in the prediction of DM2.
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Affiliation(s)
- Carolina Campos Muñiz
- Departamento de Ciencias de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana Iztapalapa, Ciudad de México, México
| | - Plácido Enrique León-García
- Secretaría de Salud Pública del Distrito Federal, Servicios de Salud Pública del Distrito Federal, Ciudad de México, México
| | - Alejandra Serrato Diaz
- Departamento de Hidrobiología, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana Iztapalapa, Ciudad de México, México
| | - Elizabeth Hernández-Pérez
- Departamento de Ciencias de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana Iztapalapa, Ciudad de México, México.
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Blais JE, Ye X, Wan EYF, Wong WCW, Wong ICK, Tomlinson B, Chan EW. Effectiveness of Simvastatin Versus Gemfibrozil for Primary Prevention of Cardiovascular Events: A Retrospective Cohort Study of 223,699 Primary Care Patients. Clin Drug Investig 2022; 42:987-997. [PMID: 36239913 DOI: 10.1007/s40261-022-01208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Evidence of the effectiveness of statins compared with fibrates for primary prevention of cardiovascular events is limited. Therefore, we assessed the comparative effectiveness of simvastatin versus gemfibrozil for primary prevention of major adverse cardiovascular events (MACE) and mortality. METHODS This territory-wide cohort study used electronic health records of simvastatin and gemfibrozil prescriptions from the Hong Kong Hospital Authority and compared simvastatin or gemfibrozil initiation. The primary outcome was MACE, defined as the composite of the first diagnosis of cardiovascular mortality, coronary heart disease, or stroke. Secondary outcomes were the individual components of MACE, all-cause mortality, and non-cardiovascular mortality. Inverse probability of treatment weighting on the propensity score was used to estimate hazard ratios (HRs). RESULTS A total of 223,699 individuals (120,207 [53.7%] women; median follow-up 7.0 years [interquartile range 5.7-9.1]) who were prescribed simvastatin (n = 168,630) or gemfibrozil (n = 55,069) were included. Simvastatin was associated with a reduced risk of MACE (HR 0.90, 95% confidence interval [CI] 0.88-0.93), all-cause mortality (HR 0.88, 95% CI 0.86-0.90), cardiovascular mortality (HR 0.71, 95% CI 0.67-0.76), and non-cardiovascular mortality (HR 0.92, 95% CI 0.89-0.95). Associations for MACE varied according to baseline characteristics with gemfibrozil being associated with a reduced risk of MACE in men and patients with low baseline high-density lipoprotein (HDL) cholesterol (< 1.0 mmol/L). CONCLUSION The results of this study showed better population-level effectiveness of simvastatin compared with gemfibrozil for the primary prevention of MACE; however, a definitive randomized controlled trial is required to compare simvastatin with gemfibrozil among patients with low HDL cholesterol, as they appear to obtain benefit with gemfibrozil.
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Affiliation(s)
- Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xuxiao Ye
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Eric Y F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Sha Tin, Hong Kong SAR, China
| | - William C W Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of General Practice, HKU-Shenzhen Hospital, Shenzhen, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Sha Tin, Hong Kong SAR, China
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Brian Tomlinson
- Faculty of Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Sha Tin, Hong Kong SAR, China.
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, Hong Kong SAR, China.
- Department of Pharmacy, HKU-Shenzhen Hospital, Shenzhen, China.
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Barrios V, Soronen J, Carter AM, Anastassopoulou A. Lipid management across Europe in the real-world setting: a rapid evidence review. Curr Med Res Opin 2021; 37:2049-2059. [PMID: 34517739 DOI: 10.1080/03007995.2021.1973396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide a contemporary overview of recent real-world lipid-lowering therapy (LLT) practices and outcomes in patients with hypercholesterolemia/dyslipidemia at high/very high risk of atherosclerotic cardiovascular disease in Europe. METHODS A structured literature review of recent (July 2015-July 2020) real-world studies reporting lipid management and outcomes was conducted using a rapid evidence synthesis. Outcomes included patient characteristics, LLT treatment practices, adherence and low-density lipoprotein cholesterol (LDL-C) goal attainment. RESULTS Fifty-three real-world observational studies in high/very high risk patients were selected after screening 5664 records (n = 50 national [sample size range 38-237,279] and n = 3 multinational studies [sample size range 6648-8456]). Mean age ranged from 33 to 77 years; hypertension, diabetes and obesity were commonly reported comorbidities. Statins were the most common LLT; patients without familial hypercholesterolemia (FH) mostly received high or moderate intensity statins/LLT, while patients with FH mostly received high intensity statins/LLT. The proportion of patients receiving ezetimibe was low overall (ezetimibe + statin use in those with and without familial hypercholesterolemia [FH] range 5%-59% and 1%-22%, respectively). Overall, the use of proprotein convertase subtilisin/kexin 9 inhibitor (PCSK9i) therapy was limited. Adherence to LLT therapies was defined variably and ranged from 46%-92%. LDL-C goal attainment was suboptimal, irrespective of LLT (overall range in goal attainment with oral LLT was 2%-73% [FH: 2%-23%] and with PCSK9i was 20%-65%). CONCLUSIONS LDL-C control is suboptimal and the available LLT armamentarium, most importantly combination therapy, is being underutilized in high/very high risk patients leading to inadequate management of cardiovascular risk.
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Jacob L, Greiner RA, Luedde M, Kostev K. Prevalence of and Factors Associated With the Prescription of Fibrates Among Patients Receiving Lipid-Lowering Drugs in Germany. J Cardiovasc Pharmacol 2021; 78:885-890. [PMID: 34654787 DOI: 10.1097/fjc.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Little recent data are available about the patterns of prescription for fibrates in patients followed in primary care practices. Therefore, the goal of this study was to analyze the prevalence of and the factors associated with the use of fibrates among patients receiving lipid-lowering drugs in Germany. The study included patients aged ≥18 years with at least 1 visit to 1 of 1070 general practices in Germany between January and December 2019. Lipid-lowering drugs included statins (without and with ezetimibe) and fibrates. The prevalence of the prescription of fibrates corresponded to the number of patients with at least 1 prescription for fibrates divided by the total number of patients receiving lipid-lowering drugs. A logistic regression model was used to assess the relationship between several demographic, clinical, and biological factors and the prescription of fibrates. A total of 111,329 patients were included in this study (mean [SD] age 68.8 [11.5] years; 56.0% of patients were men). The prevalence of the prescription of fibrates was 1.5%. Male sex, hypertension, diabetes mellitus, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, and high triglyceride were positively associated with the use of fibrates. By contrast, there was a negative relationship between the odds of receiving fibrates and coronary heart disease, myocardial infarction, peripheral arterial disease, and stroke including transient ischemic attack. Overall, we found that fibrates were infrequently prescribed in general practices in Germany.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr Antoni Pujadas, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
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Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol 2021; 21:241. [PMID: 34742250 PMCID: PMC8571870 DOI: 10.1186/s12874-021-01440-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background Major adverse cardiovascular events (MACE) are increasingly used as composite outcomes in randomized controlled trials (RCTs) and observational studies. However, it is unclear how observational studies most commonly define MACE in the literature when using administrative data. Methods We identified peer-reviewed articles published in MEDLINE and EMBASE between January 1, 2010 to October 9, 2020. Studies utilizing administrative data to assess the MACE composite outcome using International Classification of Diseases 9th or 10th Revision diagnosis codes were included. Reviews, abstracts, and studies not providing outcome code definitions were excluded. Data extracted included data source, timeframe, MACE components, code definitions, code positions, and outcome validation. Results A total of 920 articles were screened, 412 were retained for full-text review, and 58 were included. Only 8.6% (n = 5/58) matched the traditional three-point MACE RCT definition of acute myocardial infarction (AMI), stroke, or cardiovascular death. None matched four-point (+unstable angina) or five-point MACE (+unstable angina and heart failure). The most common MACE components were: AMI and stroke, 15.5% (n = 9/58); AMI, stroke, and all-cause death, 13.8% (n = 8/58); and AMI, stroke and cardiovascular death 8.6% (n = 5/58). Further, 67% (n = 39/58) did not validate outcomes or cite validation studies. Additionally, 70.7% (n = 41/58) did not report code positions of endpoints, 20.7% (n = 12/58) used the primary position, and 8.6% (n = 5/58) used any position. Conclusions Components of MACE endpoints and diagnostic codes used varied widely across observational studies. Variability in the MACE definitions used and information reported across observational studies prohibit the comparison, replication, and aggregation of findings. Studies should transparently report the administrative codes used and code positions, as well as utilize validated outcome definitions when possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01440-5.
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Affiliation(s)
- Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA. .,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.
| | - Leon Hsueh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Elie Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Wang C, Wang F, Cao Q, Li Z, Huang L, Chen S. Effect and safety of combination lipid-lowering therapies based on statin treatment versus statin monotherapies on patients with high risk of cardiovascular events. Aging Med (Milton) 2018; 1:176-184. [PMID: 31942495 PMCID: PMC6880669 DOI: 10.1002/agm2.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022] Open
Abstract
This study aimed to compare the effect and safety of statin monotherapies and combination therapies on lipid-lowing therapies. We searched for published randomized controlled trial (RCT) reports of statin monotherapies and combination therapies in patients with high risk of cardiovascular events, and extracted lipid levels to perform meta-analysis. A total of 12 RCT reports were included in this study. According to the new guidelines (low-density lipoprotein cholesterol [LDL-C] < 100 mg/dL, high-density lipoprotein cholesterol [HDL-C] > 130 mg/dL), the percent of LDL-C attaining goals in combination therapy is more than that of monotherapy (risk ratio [RR] = 1.43, 95% confidence interval [CI]: 1.13 to 1.82, P = 0.003), and the percent of LDL-C and HDL-C attaining goals in combination therapy is greater than that of monotherapy (RR = 1.43, 95% CI: 1.24 to 1.65, P = 0.000). The changing level of blood lipid had significant statistical difference between the two groups. The degree of blood lipid lowered by combination therapy was larger than in monotherapy (standard mean difference [SMD] = -0.45, 95% CI: -0.75 to -0.14, P = 0.004; SMD = -0.72, 95% CI: 0.04 to 1.39, P = 0.039; and SMD = -0.71, 95% CI: -1.12 to -0.3, P = 0.001 in LDL-C, HDL-C, and triglyceride, respectively). The incidence of adverse events was not significantly different between the two groups (RR = 1.15, 95% CI: 0.91 to 1.37, P = 0.096; RR = 1.5, 95% CI: 0.55 to 4.1, P = 0.427; RR = 0.63, 95% CI: 0.33 to 1.24, P = 0.181 in incidence of total adverse events, drug-related treatment, and myalgia, respectively). Combination therapy can bring better effect in reducing lipid. It does not increase the incidence of adverse events, so it can be used widely and safely.
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Affiliation(s)
- Chunli Wang
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fei Wang
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qing Cao
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhen Li
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liya Huang
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuyan Chen
- Department of GeriatricsXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Béliard S, Rabès JP, Cariou B, Farnier M, Krempf M, Ferrières J, Danchin N, Bruckert E. [Familial hypercholesterolemia: An under-diagnosed and under-treated disease. Survey of 495 physicians]. Presse Med 2018; 47:e159-e167. [PMID: 30060905 DOI: 10.1016/j.lpm.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 09/01/2017] [Accepted: 01/15/2018] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Heterozygous familial hypercholesterolemia (FH) is one of the most frequent genetic diseases with a prevalence of 1/250. It is characterized by a very high cholesterol level since birth and is often complicated by cardiovascular diseases (CV) in young patients. While early diagnosis and appropriate therapeutic management can avoid CV complications, HF is largely under-diagnosed and therefore under-treated. METHODS To investigate the management of HF in France, we conducted a survey with 495 general practitioners (n=200) and specialists (n=295). RESULTS The results revealed: a large underestimation of the CV risk and a high therapeutic inertia in the management of the affected patients. The practitioners reported a real need for more information about the disease. CONCLUSION Given the high frequency of HF and the associated cardiovascular morbidity and mortality, general practitioners have a decisive role to play for the identification and the management of these patients. The recent publication of HAS recommendations on family screening procedures and care of HF patients should improve the management of this disease.
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Affiliation(s)
- Sophie Béliard
- Aix-Marseille université, Inserm, Inra, C2VN, 13005 Marseille, France; AP-HM, La Conception Hospital, Department of Nutrition, Metabolic diseases, Endocrinology, 13005 Marseille, France.
| | - Jean-Pierre Rabès
- Hôpitaux universitaires Paris-Île-de-France-Ouest, hôpital Ambroise-Paré, laboratoire de biochimie et génétique moléculaire, 92100 Boulogne-Billancourt, France
| | - Bertrand Cariou
- Hôpital Nord-Guillaume-et-René-Laënnec, service d'endocrinologie, maladies métaboliques et nutrition, 44000 Nantes, France
| | - Michel Farnier
- Rond-Point de la Nation, Point Médical, endocrinologie et métabolisme, 21000 Dijon, France
| | - Michel Krempf
- Hôpital Nord-Guillaume-et-René-Laënnec, service d'endocrinologie, maladies métaboliques et nutrition, 44000 Nantes, France
| | - Jean Ferrières
- CHU Rangueil, Fédération de cardiologie, 31000 Toulouse, France
| | | | - Eric Bruckert
- Hôpital Pitié-Salpêtrière, endocrinologie, métabolisme et prévention des maladies cardiovasculaires, 75013 Paris, France
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Hartz JC, de Ferranti S, Gidding S. Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care. J Endocr Soc 2018; 2:497-512. [PMID: 29850649 PMCID: PMC5961027 DOI: 10.1210/js.2018-00079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population. Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component. Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM. However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear, as data are scarce. In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.
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Affiliation(s)
- Jacob C Hartz
- Boston Children’s Hospital, Department of Cardiology, Boston, Massachusetts
| | - Sarah de Ferranti
- Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, Delaware
| | - Samuel Gidding
- Boston Children’s Hospital, Department of Cardiology, Boston, Massachusetts
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Beloeil H, Ruchard D, Drewniak N, Molliex S. Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study. Br J Anaesth 2017; 119:1186-1193. [DOI: 10.1093/bja/aex268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 11/13/2022] Open
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Abstract
Abnormal lipids, sometimes referred to as diabetes dyslipidemia, is a common condition in patients with diabetes. With the increasing number of patients with abnormal lipids, especially those with type 2 diabetes, health care practitioners, including nurses, have to properly manage patients with diabetes as well as abnormal lipids. This article examines the pathophysiology of abnormal lipids, the management of abnormal lipids, and the lipid goals for patients with diabetes. Lastly, this article discusses pharmacologic and nonpharmacologic therapies and the role of primary care providers and nurses in the management of abnormal lipids.
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Affiliation(s)
- Ngozi D Mbue
- Health Sciences Research and Development Center for Innovations in Quality, Effectiveness and Safety, 152, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Michael E. DeBakey Veterans Affairs Medical Center, 152, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA.
| | - John E Mbue
- Michael E. DeBakey Veterans Affairs Medical Center, 152, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Jane A Anderson
- Health Sciences Research and Development Center for Innovations in Quality, Effectiveness and Safety, 152, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Michael E. DeBakey Veterans Affairs Medical Center, 152, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA
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11
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Miranda S, Chaignot C, Collin C, Dray-Spira R, Weill A, Zureik M. Human papillomavirus vaccination and risk of autoimmune diseases: A large cohort study of over 2million young girls in France. Vaccine 2017; 35:4761-4768. [PMID: 28750853 DOI: 10.1016/j.vaccine.2017.06.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/01/2017] [Accepted: 06/09/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Whether human papillomavirus (HPV) vaccination could induce or trigger autoimmune diseases (AID) has been questioned, and potentially contributes to low immunization coverage in France. This study evaluated the association between HPV vaccination and the risk of AID using routinely collected data sources. METHODS All girls aged 13-16years between 2008 and 2012, covered by the general health insurance scheme and without history of HPV vaccination or AID, were included and followed using French nationwide databases. Fourteen neurological, rheumatological, haematological, gastrointestinal or endocrine AID, were identified from ICD-10 codes allocated to hospital stays and long-term illnesses or by marker drugs. Their incidence was compared between girls exposed and non-exposed to HPV vaccination, using a Cox model adjusted for inclusion year, geographic area, socio-economic indicators, healthcare use level and other immunizations. RESULTS Among 2,252,716 girls, 37% received HPV vaccine and 4,096 AID occurred during a mean follow-up time of 33months. The incidence of AID was not increased after exposure to HPV vaccination, except for Guillain-Barré syndrome (GBS) (incidence rate of 1.4 among exposed [20 cases] versus 0.4 per 100,000 PY among unexposed [23 cases]; adjusted HR: 3.78 [1.79-7.98]). This association persisted across numerous sensitivity analyses and was particularly marked in the first months following vaccination. Under the hypothesis of a causal relationship, this would result in 1-2 GBS cases attributable to HPV vaccine per 100,000 girls vaccinated. CONCLUSIONS Our study provides reassuring results regarding the risk of AID after HPV vaccination, but an apparently increased risk of GBS was detected. Further studies are warranted to confirm this finding.
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Affiliation(s)
- Sara Miranda
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Christophe Chaignot
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS) [French National Health Insurance Fund for Salaried Workers], Paris, France
| | - Cédric Collin
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Rosemary Dray-Spira
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS) [French National Health Insurance Fund for Salaried Workers], Paris, France
| | - Mahmoud Zureik
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France.
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