Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes

Impact of Population-Based Screening for Diabetes and Prediabetes Among 67-Year-Olds Using Point-of-Care HbA1c on Healthcare Ultilisation, Results from the VISP Cohort

Purpose

The present study aims to evaluate the changes in healthcare utilization following population-based screening for diabetes mellitus (DM) using point-of-care HbA1c measurement in the Viborg Screening Program (VISP) cohort, which invites all 67-year-olds in Viborg, Denmark, for cardiovascular disease (CVD) and DM screening.

Patients and Methods

We conducted a cohort study using data from VISP and Danish national health registers. The study included 2386 individuals invited to VISP from August 1, 2014, to May 31, 2017. Exclusion criteria were non-attenders, those with prior DM, and those with missing HbA1c measurements. Pre- and post-screening healthcare utilization was analyzed, stratified by HbA1c levels: <42 mmol/mol (normal), 42-48 mmol/mol (pre-DM), and ≥48 mmol/mol (DM). Statistical analyses were performed using Poisson and logistic regression models to compare ratios of healthcare utilization before and after screening.

Results

Of the participants, 16.5% had pre-DM, and 3.4% had DM. Screening resulted in increased general physician contacts across all HbA1c groups, the highest increase was seen in the DM group with a pre- vs post-screening odds ratio [OR] of 3.25 (95% CI: 1.06-9.95) and a relative odds ratio [ROR] of 2.70 (0.87-8.39). Also, in this group, the OR for having ≥1 HbA1c measurement one year pre- vs post-screening was 5.56 (2.77 -11.14) and 26.8% (17.6-37.9) started glucose-lowering treatment within two years post-screening. Despite expectations, healthcare utilization did not decrease among those with normal HbA1c levels.

Conclusion

Population-based screening for DM and CVD among 67-year-olds resulted in increased healthcare utilization, particularly among those with screen-detected DM and pre-DM. The anticipated reduction in healthcare utilization among individuals with normal HbA1c levels was not observed. These findings highlight the potential for screening to enhance disease management and underscore the need for strategies to optimize healthcare resource use following screening, especially for individuals without DM.

Trial Registration

NCT03395509.

Factors predicting the occurrence of aortic valve calcification in patients with coronary artery calcification in China

OBJECTIVES

In patients with coronary artery calcification (CAC), a predictor of adverse cardiovascular events, coronary computed tomography angiography (CCTA) also shows valvular calcification. In this study, we evaluated common clinical indicators in CAC patients with aortic (AoVC) and mitral valve (MVC) calcification.

METHODS

CAC and valvular calcification were quantified using the Agatston score in 636 hospitalised patients with CAC who underwent CCTA.

RESULTS

Valvular calcification was found in 30.5% of patients, with 25.2% (160 patients) showing AoVC. Age was an independent predictor of AoVC in both men (odds ratio (OR), 1.086; 95% confidence interval (CI), [1.054-1.119]; p < 0.001) and women (OR, 1.109; CI, [1.066-1.154]; p < 0.001). In men, we also found that a history of cerebral infarction was an independent predictor of AoVC (OR, 2.402; CI, [1.177-4.902]; p < 0.05). The independent predictors of AoVC in the 60- to 69-years age group were BMI (OR, 1.181; CI, [1.061-1.316]; p < 0.01) and history of cerebral infarction (OR, 3.187; CI, [1.283-7.919]; p < 0.05).

CONCLUSIONS

Age is a key independent predictor of AoVC in CAC patients. History of cerebrovascular disease was also an independent predictor of AoVC, but only in men and patients aged 60-69 years. Our results indicate that a history of cerebral infarction may be used as a risk factor when identifying AoVC in patients with CAC.

Identification of potential biomarkers of vascular calcification using bioinformatics analysis and validation in vivo

Background

Vascular calcification (VC) is the most widespread pathological change in diseases of the vascular system. However, we know poorly about the molecular mechanisms and effective therapeutic approaches of VC.

Methods

The VC dataset, GSE146638, was downloaded from the Gene Expression Omnibus (GEO) database. Using the edgeR package to screen Differentially expressed genes (DEGs). Gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA) were used to find pathways affecting VC. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed on the DEGs. Meanwhile, using the String database and Cytoscape software to construct protein-protein interaction (PPI) networks and identify hub genes with the highest module scores. Correlation analysis was performed for hub genes. Receiver operating characteristic (ROC) curves, expression level analysis, GSEA, and subcellular localization were performed for each hub gene. Expression of hub genes in normal and calcified vascular tissues was verified by quantitative reverse transcription PCR (RT-qPCR) and immunohistochemistry (IHC) experiments. The hub gene-related miRNA-mRNA and TF-mRNA networks were constructed and functionally enriched for analysis. Finally, the DGIdb database was utilized to search for alternative drugs targeting VC hub genes.

Results

By comparing the genes with normal vessels, there were 64 DEGs in mildly calcified vessels and 650 DEGs in severely calcified vessels. Spp1, Sost, Col1a1, Fn1, and Ibsp were central in the progression of the entire VC by the MCODE plug-in. These hub genes are primarily enriched in ossification, extracellular matrix, and ECM-receptor interactions. Expression level results showed that Spp1, Sost, Ibsp, and Fn1 were significantly highly expressed in VC, and Col1a1 was incredibly low. RT-qPCR and IHC validation results were consistent with bioinformatic analysis. We found multiple pathways of hub genes acting in VC and identified 16 targeting drugs.

Conclusions

This study perfected the molecular regulatory mechanism of VC. Our results indicated that Spp1, Sost, Col1a1, Fn1, and Ibsp could be potential novel biomarkers for VC and promising therapeutic targets.

Nonlinear relationship between HbA1c and coronary artery calcium score progression: a secondary analysis based on a retrospective cohort study

OBJECTIVE

Coronary artery calcium score and glycated hemoglobin(HbA1c) are both considered risk factors for coronary heart disease. However, the relationship between coronary artery calcium score and HbA1c is still unclear. Consequently, the present study was undertaken to explore HbA1c association with coronary artery calcium score progression in South Korea.

METHODS

This study is a secondary analysis based on a retrospective cohort study in which 8151 participants received Health examination kits at the Health Promotion Center, Samsung Medical Center in Seoul, South Korea, from March 1, 2003-December 31, 2013. Cox proportional-hazards regression model was then used to evaluate the independent relationship between HbA1c and coronary artery calcium score progression.

RESULTS

After adjusting potential confounding factors (age, sex, BMI, height, weight, SBP, DBP, TC, LDL-C, HDL-C, triglycerides, smoking status, alcohol consumption, reflux esophagitis status, hypertension, diabetes, dyslipidemia, ischemic heart disease and cerebrovascular disease), it was revealed that there was a nonlinear relationship between HbA1c and coronary artery calcium score progression, while the scoring point was 5.8%. The effect size was 2.06 to the left of the inflection point, while the 95% CI was 1.85 to 2.29. Whereas, the effect size was 1.04, on the right side of the inflection point while 95% CI was 0.99 to1.10.

CONCLUSION

The relationship between HbA1c and coronary artery calcium score progression is nonlinear. HbA1c is positively related to coronary artery calcium score progression when HbA1c level was less than 5.8%.

Involving people with type 2 diabetes in facilitating participation in a cardiovascular screening programme

BACKGROUND

Knowledge is lacking about how to increase uptake among people with type 2 diabetes (T2D) invited to preventive initiatives like cardiovascular screening.

AIM

To explore how to improve participation of people with T2D in cardiovascular screening using patient and public involvement (PPI).

METHODS

Patient and public involvement was included in a qualitative research design. From April to October 2019, we invited 40- to 60-year-old people with T2D (n = 17) to individual consultative meetings, using an interviewing approach. Before the interviews, participants were asked to read a proposed invitation letter to be used in a cardiovascular screening programme. Inductive content analysis was undertaken.

RESULTS

Participants considered cardiovascular screening important and beneficial from both a personal and social perspective. We found that the relational interaction between the person with T2D and the health-care professional was key to participation and that nudging captured through the design of the screening programme and the wording of the invitation letter was requested.

CONCLUSION

In preventive initiatives perceived as meaningful by the invitee, a focus on recruitment is crucial to facilitate participation. This study contributed with knowledge about how to promote participation by involving health-care professionals in recruitment initiatives and through nudging. This knowledge may assist researchers, policymakers and ethicists' understanding and assessment of the ethical appropriateness and public acceptability of nudging in cardiovascular screening.

PATIENT OR PUBLIC CONTRIBUTION

By consulting 17 people with T2D, we are now in a position to suggest how a screening initiative should be altered because tools to improve uptake have been identified.

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

Background

Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD.

Methods

We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis.

Results

The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives.

Conclusion

Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10172-6.