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Yang XH, Tu QM, Li L, Guo YP, Wang NS, Jin HM. Triglyceride-lowering therapy for the prevention of cardiovascular events, stroke, and mortality in patients with diabetes: A meta-analysis of randomized controlled trials. Atherosclerosis 2023:117187. [PMID: 37527961 DOI: 10.1016/j.atherosclerosis.2023.117187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND AIMS Triglyceride (TG)-lowering therapy is efficient for the prevention of cardiovascular disease (CVD) in the general population; however, for diabetic individuals, it is more controversial. The purpose of this study was to pool the results from randomized controlled trials (RCTs) to clarify whether the lowering of TG is beneficial for the prevention of CVD events, stroke, and mortality in subjects with diabetes. METHODS MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials were searched to identify the relevant literature. We included randomized controlled trials (RCTs) to assess the association of triglyceride-lowering therapy with the prevention of CVD events, stroke, and mortality in diabetic patients. RESULTS Overall, 19 studies were included in this meta-analysis. Compared with the control groups, TG lowering was associated with a decreased risk of CVD events (RR = 0.91, 95% CI 0.87-0.95, p = 0.000) and CVD mortality (RR = 0.93, 95% CI 0.86-1.00, p = 0.047). There was no significant correlation between TG-lowering therapy and the incidence of stroke and all-cause mortality (RR = 0.93, 95% CI 0.86-1.02, p = 0.129 and RR = 0.97, 95% CI 0.93-1.01, p = 0.107, respectively). Subgroup analysis showed that the decreased CVD risk resulting from TG-lowering therapy was independent of age, sex, region, duration of follow-up, degree of TG reduction and glycemic control. CONCLUSIONS TG-lowering therapy is associated with a reduction in CVD events and cardiovascular-specific mortality, but not in stroke and all-cause mortality. Future large, multicenter RCTs will further confirm these conclusions.
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Affiliation(s)
- Xiu Hong Yang
- Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China; Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Ming Tu
- Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China
| | - Li Li
- Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China
| | - Yong Ping Guo
- Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Nian Song Wang
- Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Hui Min Jin
- Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China; Department of Nephrology, The People's Hospital of Wenshan Prefecture, Yunnan Province, China.
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Newman CB, Blaha MJ, Boord JB, Cariou B, Chait A, Fein HG, Ginsberg HN, Goldberg IJ, Murad MH, Subramanian S, Tannock LR. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2020; 105:5909161. [PMID: 32951056 DOI: 10.1210/clinem/dgaa674] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride-induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces ASCVD risk. CONCLUSION This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases.
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Affiliation(s)
- Connie B Newman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Jeffrey B Boord
- Department of Administration and Parkview Physicians Group Endocrinology Section, Parkview Health System, Fort Wayne, Indiana
| | - Bertrand Cariou
- Department of Endocrinology, L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Alan Chait
- Department of Medicine, University of Washington, Seattle, Washington
| | - Henry G Fein
- Department of Medicine, Division of Endocrinology, Sinai Hospital, Baltimore, Maryland
| | - Henry N Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ira J Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
| | | | - Lisa R Tannock
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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Arnold SV, Bhatt DL, Barsness GW, Beatty AL, Deedwania PC, Inzucchi SE, Kosiborod M, Leiter LA, Lipska KJ, Newman JD, Welty FK. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e779-e806. [PMID: 32279539 DOI: 10.1161/cir.0000000000000766] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes.
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4
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Alzeidan R, Shata Z, Hassounah MM, Baghdadi LR, Hersi A, Fayed A, Kashour T, Elmorshedy H. Effectiveness of digital health using the transtheoretical model to prevent or delay type 2 diabetes in impaired glucose tolerance patients: protocol for a randomized control trial. BMC Public Health 2019; 19:1550. [PMID: 31752774 PMCID: PMC6873582 DOI: 10.1186/s12889-019-7921-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/08/2019] [Indexed: 01/22/2023] Open
Abstract
Background There is high prevalence of prediabetes and type 2 diabetes mellitus (T2DM) in Saudi Arabia that is still increasing. Early diagnosis of prediabetes, and immediate, effective intervention is yet unestablished. Conventional health promotion approaches are used to educate prediabetic patients. Behavior modification is very effective in prediabetics to delay T2DM. Thus, the main objective of this study is to examine the effect of the new behavioral model, the Transtheoretical Model short messages (text 4 change) to modify lifestyle to prevent or delay the onset of T2DM, through promotion of a healthy diet and increased physical activity, in impaired glucose tolerance patients. Another objective is to estimate the impact of this model on markers of cardiovascular and metabolic risks as T2DM is one of the modifiable risk factors to prevent cardiovascular diseases. Methods This is a randomized controlled trial. One thousand and sixteen, eligible Saudi adults will be recruited from the Heart Health Promotion study (HHP), which was conducted at the King Saud University from July 2013 to April 2014. These adults were at a higher risk of developing T2DM within 2–3 years. The research team’s database has a contact list and they will recruit individuals over 6–8 weeks. All participants will be randomized at a 1:1 ratio into two groups, receive group education about lifestyle modifications and written information about diet and physical activity. Text 4 change SMS texts will be sent only to the intervention group. All participants will be assessed at baseline, 6, 12, 18, 24, 30, and 36 months for behavioral change using a World Health Organization (WHO) STEPS questionnaire and for glycated hemoglobin, biochemical and anthropometric measurements using standard methods. Discussion This new approach for promoting the importance of behavior modification in prediabetics is expected to delay and/or prevent the development of T2DM in Saudi Arabia, subsequently reducing the risk of cardiovascular morbidity and mortality too. Results from this study will promote an innovative and high-tech way to decrease the burden of cardiovascular diseases in Saudi Arabia. Trial registration International Standard Randomized Control Trial, registration number ISRCTN10857643. Registered 4 June, 2018.
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Affiliation(s)
- Rasmieh Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zeinab Shata
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Marwah Mazen Hassounah
- Community Medicine Unit, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leena Rashad Baghdadi
- Department of Family and Community Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Ahmad Hersi
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amel Fayed
- High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Princess Nourah Bint Abdulrahman University, College of Medicine, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Princess Nourah Bint Abdulrahman University, College of Medicine, Riyadh, Saudi Arabia
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Alexopoulos AS, Qamar A, Hutchins K, Crowley MJ, Batch BC, Guyton JR. Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes. Curr Diab Rep 2019; 19:13. [PMID: 30806837 PMCID: PMC6664805 DOI: 10.1007/s11892-019-1136-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Moderate hypertriglyceridemia is exceedingly common in diabetes, and there is growing evidence that it contributes to residual cardiovascular risk in statin-optimized patients. Major fibrate trials yielded inconclusive results regarding the cardiovascular benefit of lowering triglycerides, although there was a signal for improvement among patients with high triglycerides and low high-density lipoprotein (HDL)-the "diabetic dyslipidemia" phenotype. Until recently, no trials have examined a priori the impact of triglyceride lowering in patients with diabetic dyslipidemia, who are likely among the highest cardiovascular-risk patients. RECENT FINDINGS In the recent REDUCE IT trial, omega-3 fatty acid icosapent ethyl demonstrated efficacy in lowering cardiovascular events in patients with high triglycerides, low HDL, and statin-optimized low-density lipoprotein (LDL). The ongoing PROMINENT trial is examining the impact of pemafibrate in a similar patient population. Emerging evidence suggests that lowering triglycerides may reduce residual cardiovascular risk, especially in high-risk patients with diabetic dyslipidemia.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA.
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, NC, USA.
| | - Ali Qamar
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, NC, USA
| | - Kathryn Hutchins
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, NC, USA
| | - Matthew J Crowley
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, NC, USA
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, NC, USA
| | - John R Guyton
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
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Järvinen O, Hokkanen M, Huhtala H. Diabetics have Inferior Long-Term Survival and Quality of Life after CABG. Int J Angiol 2019; 28:50-56. [PMID: 30880894 DOI: 10.1055/s-0038-1676791] [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] [Indexed: 10/27/2022] Open
Abstract
A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG. Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later. Thirty-day mortality was 2.7 versus 1.6 ( p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% ( p = 0.287) and 63.5% versus 81.6% ( p < 0.001), respectively. After 1 year, diabetics improved significantly ( p < 0.005) in seven, and nondiabetics ( p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly ( p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time. Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.
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Affiliation(s)
- Otso Järvinen
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
| | - Matti Hokkanen
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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7
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Yang GR, Yuan MX, Fu HJ, Wan G, Li D, Dye TD, Zhu LX, Xie RR, Lv YJ, Zhang JD, Du XP, Li YL, Ji Y, Li Y, Cui XL, Wang ZM, Cheng SY, Liu DY, Wang Q, Zhou L, Gao Y, Yuan SY. The Association between Metabolic Syndrome and Morbid Events in Type 2 Diabetes after a 7-Year Community Management: Beijing Community Diabetes Study 17. J Diabetes Res 2019; 2019:5237371. [PMID: 31281851 PMCID: PMC6594276 DOI: 10.1155/2019/5237371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/27/2018] [Accepted: 01/13/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To examine the association between morbid events and metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM). METHODS A prospective, longitudinal, multicenter study was conducted at 13 community health centers associated with Beijing Tongren Hospital. From 2008 to 2015, there have been 3,525 T2DM patients being managed based on the Chinese guideline for T2DM. The morbid events included macrovascular events, diabetic kidney disease, ophthalmologic events, cancer, and all-cause death. RESULTS At baseline, there were 2,708 people with MS and 817 without MS. After a seven-year management, there were 351 (12.96%) events in MS people and 74 (9.06%) events in people without MS (p = 0.003). The prevalence of macrovascular events (6.06%) was much higher in MS people than in people without MS (3.79%, p = 0.013). Cox regression analysis showed an association between MS and morbid events even after adjusting for confounding variables (adjusted hazard ratio = 1.44). MS was also associated with macrovascular events (adjusted hazard ratio = 1.96). The occurrence of morbid events and macrovascular events was increased when the numbers of metabolic abnormalities were 1, 2, 3, and 4 (p < 0.001). There was no continuously statistically significant difference in the cumulative prevalence of morbid events between patients with MS and patients without MS during the first five years. However, after six or seven years, the cumulative prevalence of morbid events in patients with MS was continuously significantly higher than that in patients without MS (11.00% vs. 8.20%, 12.96% vs. 9.06%, p < 0.05). CONCLUSIONS T2DM with MS had higher incidence of morbid events, especially cardiovascular events, even after integrated management. The occurrence of morbid and macrovascular events increased as the number of metabolic abnormalities increased. MS was associated with increased risk of morbid events by 44% and macrovascular events by 96%. It would take at least six years to observe the association between MS and morbid events in T2DM.
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Affiliation(s)
- Guang-Ran Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming-Xia Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Han-Jing Fu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Department of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Dongmei Li
- Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Timothy D. Dye
- Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Liang-Xiang Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong-Rong Xie
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Jie Lv
- Cuigezhuang Community Health Service Center, Beijing, China
| | | | - Xue-Ping Du
- Yuetan Community Health Service Center of Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yu-Ling Li
- Xinjiekou Community Health Service Center, Beijing, China
| | - Yu Ji
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, China
| | - Yue Li
- Aerospace Central Hospital, Beijing, China
| | - Xue-Li Cui
- Sanlitun Community Health Service Center, Beijing, China
| | - Zi-Ming Wang
- Jiangtai Community Health Service Center, Beijing, China
| | - Shu-Yan Cheng
- Balizhuang Community Health Service Center, Beijing, China
| | - De-Yuan Liu
- Zuojiazhuang Community Health Service Center, Beijing, China
| | - Qian Wang
- Majiapu Community Health Service Center, Beijing, China
| | - Li Zhou
- School Hospital of Central University for Nationalities, Beijing, China
| | - Ying Gao
- The First People's Hospital of Dongcheng District, Beijing, China
| | - Shen-Yuan Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Gupta KK, Ali S, Sanghera RS. Pharmacological Options in Atherosclerosis: A Review of the Existing Evidence. Cardiol Ther 2018; 8:5-20. [PMID: 30543029 PMCID: PMC6525235 DOI: 10.1007/s40119-018-0123-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 12/11/2022] Open
Abstract
Coronary heart disease (CHD) is the leading cause of mortality worldwide and high low-density lipoprotein (LDL) cholesterol levels have been shown to be key in the pathogenesis of this condition. Lipid control has therefore been the subject of decades of research and has led to many large and robust randomized controlled trials, as well as the highest grossing drug of all time—Lipitor (atorvastatin). Statin therapy has long been indicated for secondary and more recently primary prevention. However, despite the large-scale use of statins, CHD prevalence remains high, and some patients do not respond to statin therapy. There has been a large push to find and test alternative lipid-lowering agents, these include fibrates, cholesterol absorption inhibitors, and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors. It is the aim of this review to assess the literature surrounding each of these groups of drugs.
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Affiliation(s)
| | - Shair Ali
- St George's Hospital NHS Trust, London, UK
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Cavallari I, Delli Veneri A, Maddaloni E, Melfi R, Patti G, Napoli N, Pozzilli P, Di Sciascio G. Comparison of Lipid-Lowering Medications and Risk for Cardiovascular Disease in Diabetes. Curr Diab Rep 2018; 18:138. [PMID: 30370486 DOI: 10.1007/s11892-018-1117-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF THE REVIEW To summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes. RECENT FINDINGS Statins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol. In subjects with diabetes, with or without established cardiovascular disease, each 39 mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins remain the first-line lipid-lowering agents for the management of dyslipidemia in individuals with diabetes; however, the addition of non-statin therapies to lower LDL cholesterol, such as ezetimibe and PCSK-9 inhibitors, to maximally tolerated statin therapy is recommended in patients with atherosclerotic cardiovascular disease and baseline LDL cholesterol over 70 mg/dl. Recent data support even lower LDL cholesterol targets (< 55 mg/dl) to further reduce the risk of cardiovascular events especially in subjects with diabetes and documented cardiovascular disease.
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Affiliation(s)
- Ilaria Cavallari
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Alessia Delli Veneri
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Rosetta Melfi
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Giuseppe Patti
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Germano Di Sciascio
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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10
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Jang JH, Park JE, Han JS. Scopoletin inhibits α-glucosidase in vitro and alleviates postprandial hyperglycemia in mice with diabetes. Eur J Pharmacol 2018; 834:152-156. [PMID: 30031794 DOI: 10.1016/j.ejphar.2018.07.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/30/2022]
Abstract
The aim of this study was to investigate whether scopoletin could inhibit the activities of the carbohydrate digestive enzymes, α-glucosidase and α-amylase, and reduce postprandial hyperglycemia in streptozotocin (STZ)-induced diabetes in mice. Scopoletin showed a distinct inhibitory effect on α-glucosidase and α-amylase. The half maximal inhibitory concentration (IC50) of scopoletin was 85.12 and 37.36 μM for α-glucosidase and α-amylase, respectively, which were lower values than those for acarbose. The increase in postprandial blood glucose levels was significantly suppressed in the scopoletin group compared to the control group of STZ-induced diabetes in mice. Moreover, the area under the curve significantly decreased with the administration of scopoletin in STZ-induced diabetes in mice. These results showed that scopoletin might help to lower postprandial hyperglycemia through inhibition of carbohydrate digestive enzymes.
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Affiliation(s)
- June Hyuk Jang
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Republic of Korea
| | - Jae Eun Park
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Republic of Korea
| | - Ji Sook Han
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Republic of Korea.
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11
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12
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Park JE, Lee JH, Han JS. Sargassum yezoense Extract Inhibits Carbohydrate Digestive Enzymes In Vitro and Alleviates Postprandial Hyperglycemia in Diabetic Mice. Prev Nutr Food Sci 2017; 22:166-171. [PMID: 29043213 PMCID: PMC5642797 DOI: 10.3746/pnf.2017.22.3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/21/2017] [Indexed: 11/28/2022] Open
Abstract
In this study, we investigated whether Sargassum yezoense extract (SYE) could inhibit α-glucosidase and α-amylase activities, and alleviate postprandial hyperglycemia in streptozotocin (STZ)-induced diabetic mice. Freeze-dried S. yezoense was extracted with 80% ethanol and concentrated for use in this study. The hypoglycemic effect was determined by evaluating the inhibitory activities of SYE against α-glucosidase and α-amylase as well as its ability to decrease postprandial blood glucose levels. The half-maximal inhibitory concentrations of SYE against α-glucosidase and α-amylase were 0.078±0.004 and 0.212±0.064 mg/mL, respectively. SYE was a more effective inhibitor of α-glucosidase and α-amylase activities than the positive control, acarbose. The increase in postprandial blood glucose levels was significantly alleviated in the SYE group compared with that in the control group of STZ-induced diabetic mice. Furthermore, the area under the curves significantly decreased with SYE administration in STZ-induced diabetic mice. These results suggest that SYE is a potent inhibitor of α-glucosidase and α-amylase activities and alleviates postprandial hyperglycemia caused by dietary carbohydrates.
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Affiliation(s)
- Jae-Eun Park
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Ji-Hee Lee
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Ji-Sook Han
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
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Abstract
PURPOSE OF REVIEW This article reviews current knowledge concerning diabetic dyslipidemia and cardiovascular disease (CVD). It reviews strategies to reduce diabetes-associated CVD, including reducing low-density lipoprotein levels, lowering triglycerides, and increasing high-density lipoproteins (HDL). Special considerations, such as the multifactorial chylomicronemia syndrome and partial lipodystrophy, and the role of glucose-lowering strategies in the management of diabetic dyslipidemia are discussed. RECENT FINDINGS The strongest evidence to date for reducing CVD in diabetes comes from the use of statins. While triglyceride lowering remains inconclusive, an ongoing trial might provide some finality to this question. The role of increasing HDL remains elusive, and HDL cholesterol appears to be an unsatisfactory metric for monitoring therapy. The use of statins offers the best current way to reduce diabetes-associated CVD. However, several novel and promising approaches for the management of diabetic dyslipidemia aimed at reducing CVD are in the pipeline.
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Affiliation(s)
- Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
| | - Ira Goldberg
- Division of Endocrinology, New York University, New York, NY, USA
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Gonzales TK, Yonker JA, Chang V, Roan CL, Herd P, Atwood CS. Myocardial infarction in the Wisconsin Longitudinal Study: the interaction among environmental, health, social, behavioural and genetic factors. BMJ Open 2017; 7:e011529. [PMID: 28115328 PMCID: PMC5278299 DOI: 10.1136/bmjopen-2016-011529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study examined how environmental, health, social, behavioural and genetic factors interact to contribute to myocardial infarction (MI) risk. DESIGN Survey data collected by Wisconsin Longitudinal Study (WLS), USA, from 1957 to 2011, including 235 environmental, health, social and behavioural factors, and 77 single- nucleotide polymorphisms were analysed for association with MI. To identify associations with MI we utilized recursive partitioning and random forest prior to logistic regression and chi-squared analyses. PARTICIPANTS 6198 WLS participants (2938 men; 3260 women) who (1) had a MI before 72 years and (2) had a MI between 65 and 72 years. RESULTS In men, stroke (LR OR: 5.01, 95% CI 3.36 to 7.48), high cholesterol (3.29, 2.59 to 4.18), diabetes (3.24, 2.53 to 4.15) and high blood pressure (2.39, 1.92 to 2.96) were significantly associated with MI up to 72 years of age. For those with high cholesterol, the interaction of smoking and lower alcohol consumption increased prevalence from 23% to 41%, with exposure to dangerous working conditions, a factor not previously linked with MI, further increasing prevalence to 50%. Conversely, MI was reported in <2.5% of men with normal cholesterol and no history of diabetes or depression. Only stroke (4.08, 2.17 to 7.65) and diabetes (2.71, 1.81 to 4.04) by 65 remained significantly associated with MI for men after age 65. For women, diabetes (5.62, 4.08 to 7.75), high blood pressure (3.21, 2.34 to 4.39), high cholesterol (2.03, 1.38 to 3.00) and dissatisfaction with their financial situation (4.00, 1.94 to 8.27) were significantly associated with MI up to 72 years of age. Conversely, often engaging in physical activity alone (0.53, 0.32 to 0.89) or with others (0.34, 0.21 to 0.57) was associated with the largest reduction in odds of MI. Being non-diabetic with normal blood pressure and engaging in physical activity often lowered prevalence of MI to 0.2%. Only diabetes by 65 (4.25, 2.50 to 7.24) and being exposed to dangerous work conditions at 54 (2.24, 1.36 to 3.69) remained significantly associated with MI for women after age 65, while still menstruating at 54 (0.46, 0.23 to 0.91) was associated with reduced odds of MI. CONCLUSIONS Together these results indicate important differences in factors associated with MI between the sexes, that combinations of factors greatly influence the likelihood of MI, that MI-associated factors change and associations weaken after 65 years of age in both sexes, and that the limited genotypes assessed were secondary to environmental, health, social and behavioral factors.
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Affiliation(s)
- Tina K Gonzales
- Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
| | - James A Yonker
- Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
| | - Vicky Chang
- Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
| | - Carol L Roan
- Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
| | - Pamela Herd
- Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
- La Follete School of Public Affairs, University of Wisconsin, Madison, Wisconsin, USA
| | - Craig S Atwood
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- Geriatric Research, Education and Clinical Center, Veterans Administration Hospital, Madison, Wisconsin, USA
- School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Choi SI, Park MH, Han JS. Gynura procumbens Extract Alleviates Postprandial Hyperglycemia in Diabetic Mice. Prev Nutr Food Sci 2016; 21:181-186. [PMID: 27752493 PMCID: PMC5063202 DOI: 10.3746/pnf.2016.21.3.181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/16/2016] [Indexed: 11/06/2022] Open
Abstract
This study was designed to investigate the inhibitory effect of Gynura procumbens extract against carbohydrate digesting enzymes and its ability to ameliorate postprandial hyperglycemia in streptozotocin (STZ)-induced diabetic mice. G. procumbens extract showed prominent α-glucosidase and α-amylase inhibitory effects. The half-maximal inhibitory concentration (IC50) of G. procumbens extract against α-glucosidase and α-amylase was 0.092±0.018 and 0.084±0.027 mg/mL, respectively, suggesting that the α-amylase inhibition activity of the G. procumbens extract was more effective than that of the positive control, acarbose (IC50=0.164 mg/mL). The increase in postprandial blood glucose levels was more significantly alleviated in the G. procumbens extract group than in the control group of STZ-induced diabetic mice. Moreover, the area under the curve significantly decreased with G. procumbens extract administration in STZ-induced diabetic mice. These results suggest that G. procumbens extract may help alleviate postprandial hyperglycemia by inhibiting carbohydrate digesting enzymes.
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Affiliation(s)
- Sung-In Choi
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Mi Hwa Park
- Department of Food and Nutrition, College of Medical and Life Science, Silla University, Busan 46958, Korea
| | - Ji-Sook Han
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
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Holwerda SW, Vianna LC, Restaino RM, Chaudhary K, Young CN, Fadel PJ. Arterial baroreflex control of sympathetic nerve activity and heart rate in patients with type 2 diabetes. Am J Physiol Heart Circ Physiol 2016; 311:H1170-H1179. [PMID: 27591221 DOI: 10.1152/ajpheart.00384.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/24/2016] [Indexed: 02/08/2023]
Abstract
Despite greater blood pressure reactivity to acute cardiovascular stressors and a higher prevalence of hypertension in type 2 diabetes (T2D) patients, limited information is available regarding arterial baroreflex (ABR) control in T2D. We hypothesized that ABR control of muscle sympathetic nerve activity (MSNA) and heart rate (HR) are attenuated in T2D patients. Seventeen T2D patients (50 ± 2 yr; 31 ± 1 kg/m2), 9 weight-matched controls (WM-CON, 46 ± 2 yr; 32 ± 2 kg/m2) and 10 lean controls (Lean-CON, 49 ± 3 yr; 23 ± 1 kg/m2), underwent bolus infusions of sodium nitroprusside (100 μg) followed 60 s later by phenylephrine (150 μg) and weighted linear regression performed. No group differences in overall sympathetic baroreflex gain were observed (T2D: -2.5 ± 0.3 vs. WM-CON: -2.6 ± 0.2 vs. Lean-CON: -2.7 ± 0.4 arbitrary units·beat·mmHg-1, P > 0.05) or in sympathetic baroreflex gain when derived separately during blood pressure (BP) falls (nitroprusside) and BP rises (phenylephrine). In contrast, overall cardiac baroreflex gain was reduced in T2D patients compared with Lean-CON (T2D: 8.2 ± 1.5 vs. Lean-CON: 15.6 ± 2.9 ms·mmHg-1, P < 0.05) and also tended to be reduced in WM-CON (9.3 ± 1.9 ms·mmHg-1) compared with Lean-CON (P = 0.059). Likewise, during BP rises, cardiac baroreflex gain was reduced in T2D patients and weight-matched controls compared with lean controls (P < 0.05), whereas no group differences were found during BP falls (P > 0.05). Sympathetic and cardiac ABR gains were comparable between normotensive and hypertensive T2D patients (P > 0.05). These findings suggest preserved ABR control of MSNA in T2D patients compared with both obese and lean age-matched counterparts, with a selective impairment in ABR HR control in T2D that may be related to obesity.
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Affiliation(s)
- Seth W Holwerda
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - Lauro C Vianna
- Faculty of Physical Education, University of Brasilia, Distrito Federal, Brazil
| | - Robert M Restaino
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Kunal Chaudhary
- Department of Internal Medicine, University of Missouri, Columbia, Missouri
| | - Colin N Young
- Department of Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
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17
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Elkeles RS, Flather M, Feher MD, Godsland I, Richmond W, Humphries SE, Rubens MB, Underwood SR. Prospective evaluation of diabetic ischaemic heart disease by computed tomography: the PREDICT study. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514020020011001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coronary heart disease (CHD) is the main cause of morbidity and mortality in type 2 diabetic subjects. Electron beam computed tomography (EBCT) of the coronary arteries provides a non-invasive method of detecting and quantifying coronary calcification (coronary calcium score), which is known to be an early marker of coronary atheroma in non-diabetic subjects. 600 type 2 diabetic subjects aged between 50 and 70 years of either sex will undergo EBCT. They will be followed-up for a mean period of four years. Recruitment started in September 2000 and preliminary results are expected in 2004. The primary aim is to assess the predictive power of the coronary calcium score for coronary events specifically in type 2 diabetic subjects. Secondary aims are to assess the relationship between coronary calcium score in type 2 diabetes and conventional risk factors, with novel risk markers, plasma homocysteine and C-reactive protein, and with key genetic markers of CHD.
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Affiliation(s)
- Robert S Elkeles
- Unit for Metabolic Medicine, Faculty of Medicine, Imperial College,
| | | | - Michael D Feher
- Beta Cell Unit, Chelsea and Westminster Hospital, 269 Fulham Road, London SW10 9NH
| | - Ian Godsland
- Unit for Metabolic Medicine, Faculty of Medicine, Imperial College
| | - William Richmond
- Department of Chemical Pathology, St Mary's Hospital, Praed Street, London, W2 1NY
| | - Stephen E Humphries
- Division of Cardiovascular Genetics, Rayne Institute, University College London, 5 University Street, London, WC1E 6JJ
| | | | - S Richard Underwood
- Department of Cardiac Imaging, Royal Brompton Hospital, Sydney Street, London SW3 6NP
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18
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Van Gaal LF, Peiffer F, Ballaux D. Reducing cardiovascular risk in patients with type 2 diabetes: the potential contribution of nicotinic acid. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514050050060901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current treatment guidelines highlight the increased cardiovascular risk associated with type 2 diabetes and identify the need for intensive risk factor management. Dyslipidaemia characterised by elevated serum triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C) and an increase in small, dense low-density lipoprotein cholesterol (LDL-C) particles (the lipid triad), is one of the most important modifiable cardiovascular risk factors in patients with type 2 diabetes. Statins, which are effective in reducing LDL-C, are currently considered the foundation of lipid-lowering treatment in type 2 diabetes, in addition to lifestyle modification. Increasingly, guidelines also identify low HDL-C as an important secondary priority for treatment. Of the available treatment options, both fibrates and nicotinic acid are effective in treating dyslipidaemia associated with type 2 diabetes, although the latter has greater potency in raising HDL-C. Based on its profile of activity, addition of nicotinic acid to primary statin therapy would be a logical strategy in the treatment of diabetic dyslipidaemia. Outcome data from large prospective studies are awaited to confirm the potential morbidity and mortality benefits of this approach.
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Affiliation(s)
- Luc F Van Gaal
- Department of Diabetology, Metabolism and Nutrition, Antwerp University Hospital, University of Antwerp, Belgium,
| | - Frida Peiffer
- Department of Diabetology, Metabolism and Nutrition, Antwerp University Hospital, University of Antwerp, Belgium
| | - Dominique Ballaux
- Department of Diabetology, Metabolism and Nutrition, Antwerp University Hospital, University of Antwerp, Belgium
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Abstract
As agonists of the peroxisome proliferator-activated receptor α (PPARα), fibrates are established, effective and well-tolerated agents in the management of atherogenic dyslipidaemia. Key actions of fibrates include a reduction in elevated triglyceride levels (by up to 50%) and a rise in high-density lipoprotein cholesterol (HDL-C) concentrations (typically by 5—15%). Fibrates promote a shift from small, dense low-density lipoprotein (LDL) to larger more buoyant particles, which are less susceptible to oxidation and possess higher binding affinity for removal by the non-atherogenic LDL receptor pathway. Thus, fibrates can correct lipid abnormalities commonly observed in patients with type 2 diabetes and metabolic syndrome. Clinical evidence has demonstrated the value of fibrate therapy in secondary and primary prevention settings, as well as in patients with type 2 diabetes. However, FIELD, the largest fibrate study to date in diabetic patients, predominantly in a primary prevention setting, showed a non-significant 11% reduction in the primary end point of coronary heart disease death and non-fatal myocardial infarction with fenofibrate, although total cardiovascular events, corresponding to the secondary end point, were significantly reduced by 11% (p=0.035). It is possible that risk reduction with fenofibrate may have been attenuated by the two-fold greater drop-in use of statin therapy in the placebo group. However, the interesting results of fenofibrate on attenuation of microangiographic symptomatology potentially suggest a new recommendation for fibrate therapy, although further studies are required to validate these findings.
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Affiliation(s)
- M John Chapman
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 551, Dyslipoprotéinemies et Athérosclérose: Génétique, Métabolisme et Thérapeutique, Hôpital de la Pitié, 83, Bd de l'Hôpital — Pavilion B. Delessert, 75651 Paris, Cedex 13, France,
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20
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Abstract
Therapy with both statins and fibrates reduces the risk of coronary events. In the fibrate studies the extent of reduction is disproportionately large in people with features of the metabolic syndrome such as overweight, elevated baseline levels of plasma triglyceride and low baseline high density lipoprotein-cholesterol (HDL-c). In such people, treatment with fibrates results in a 40—50% reduction in coronary heart disease events, much greater than predicted (from the human population studies) by the joint changes in concentrations of HDL-c or low density lipoprotein-cholesterol.
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Affiliation(s)
- Philip Barter
- HRI (The Heart Research Institute), 145 Missenden Road, Camperdown, Sydney, NSW 2050, Australia,
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21
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Abstract
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose regulation. However, physicians continue to rely on fasting plasma glucose and glycated hemoglobin to guide management. There is a linear relationship between the risk of cardiovascular death and the 2-h oral glucose tolerance test, while a study confirms postprandial hyperglycemia as independent risk factor for cardiovascular disease in type 2 diabetes. At the same time, several studies show that postprandial hypertriglyceridemia may also be a cardiovascular risk factor. Interestingly, the simultaneous presence of postprandial hyperglycemia and postprandial hypertriglyceridemia has an additive effect in worsening endothelial function and inflammation. Evidence supports the hypothesis glucose postprandial hyperglycemia and hypertriglyceridemia may favor the appearance of the cardiovascular disease through the generation of an oxidative stress. Furthermore, clinical data suggest that postprandial hyperglycemia is a common phenomenon even in patients who may be considered in "good metabolic control". Therefore, physicians should consider monitoring and targeting postprandial plasma glucose, as well as glycated hemoglobin and fasting plasma glucose, in patients with type 2 diabetes.
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Affiliation(s)
- Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.
- Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain.
| | - Stefano Genovese
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
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22
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Holwerda SW, Restaino RM, Manrique C, Lastra G, Fisher JP, Fadel PJ. Augmented pressor and sympathetic responses to skeletal muscle metaboreflex activation in type 2 diabetes patients. Am J Physiol Heart Circ Physiol 2015; 310:H300-9. [PMID: 26566729 DOI: 10.1152/ajpheart.00636.2015] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/06/2015] [Indexed: 11/22/2022]
Abstract
Previous studies have reported exaggerated increases in arterial blood pressure during exercise in type 2 diabetes (T2D) patients. However, little is known regarding the underlying neural mechanism(s) involved. We hypothesized that T2D patients would exhibit an augmented muscle metaboreflex activation and this contributes to greater pressor and sympathetic responses during exercise. Mean arterial pressure (MAP), heart rate (HR), and muscle sympathetic nerve activity (MSNA) were measured in 16 patients with T2D (8 normotensive and 8 hypertensive) and 10 healthy controls. Graded isolation of the muscle metaboreflex was achieved by postexercise ischemia (PEI) following static handgrip performed at 30% and 40% maximal voluntary contraction (MVC). A cold pressor test (CPT) was also performed as a generalized sympathoexcitatory stimulus. Increases in MAP and MSNA during 30 and 40% MVC handgrip were augmented in T2D patients compared with controls (P < 0.05), and these differences were maintained during PEI (MAP: 30% MVC PEI: T2D, Δ16 ± 2 mmHg vs. controls, Δ8 ± 1 mmHg; 40% MVC PEI: T2D, Δ26 ± 3 mmHg vs. controls, Δ16 ± 2 mmHg, both P < 0.05). MAP and MSNA responses to handgrip and PEI were not different between normotensive and hypertensive T2D patients (P > 0.05). Interestingly, MSNA responses were also greater in T2D patients compared with controls during the CPT (P < 0.05). Collectively, these findings indicate that muscle metaboreflex activation is augmented in T2D patients and this contributes, in part, to augmented pressor and sympathetic responses to exercise in this patient group. Greater CPT responses suggest that a heightened central sympathetic reactivity may be involved.
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Affiliation(s)
- Seth W Holwerda
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Robert M Restaino
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Camila Manrique
- Department of Medicine, University of Missouri, Columbia, Missouri
| | - Guido Lastra
- Department of Medicine, University of Missouri, Columbia, Missouri
| | - James P Fisher
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paul J Fadel
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; and
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Hermans MP, Bouenizabila E, Amoussou-Guenou DK, Ahn SA, Rousseau MF. Baseline diabetes as a way to predict CV outcomes in a lipid-modifying trial: a meta-analysis of 330,376 patients from 47 landmark studies. Cardiovasc Diabetol 2015; 14:60. [PMID: 25990410 PMCID: PMC4489105 DOI: 10.1186/s12933-015-0226-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a major cardiovascular risk factor. However, its influence on the rate of occurrence of cardiovascular (CV) events during a clinical trial that included a diabetes subgroup has not yet been quantified. AIMS To establish equations relating baseline diabetes prevalence and incident CV events, based on comparator arms data of major lipid-modifying trials. METHODS Meta-analysis of primary outcomes (PO) rates of key prospective trials, for which the baseline proportion of diabetics was reported, including studies having specifically reported CV outcomes within their diabetic subgroups. RESULTS 47 studies, representing 330,376 patients (among whom 124,115 diabetics), were analyzed as regards the relationship between CV outcomes rates (including CHD) and the number of diabetics enrolled. Altogether, a total of 18,445 and 16,156 events occurred in the comparator and treatment arms, respectively. There were significant linear relationships between diabetes prevalence and both PO and CHD rates (%/year): y = 0.0299*x + 3.12 [PO] (p = 0.0128); and y = 0.0531*x + 1.54 [CHD] (p = 0.0094), baseline diabetes predicting PO rates between 3.12 %/year (no diabetic included) and 6.11 %/year (all patients diabetic); and CHD rates between 1.54 %/year (no diabetic) and 6.85 %/year (all patients diabetic). The slopes of the equations did not differ according to whether they were derived from primary or secondary prevention trials. CONCLUSIONS Absolute and relative CV risk associated with diabetes at inclusion can be readily predicted using linear equations relating diabetes prevalence to primary outcomes or CHD rates.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Evariste Bouenizabila
- Service de Maladies Métaboliques et Endocriniennes, Centre Hospitalier et Universitaire de Brazzaville, Brazzaville, Congo.
| | - Daniel K Amoussou-Guenou
- Service d'Endocrinologie et Métabolisme, CNHU HKM Cotonou, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
| | - Sylvie A Ahn
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Michel F Rousseau
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
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You HN, Lee HA, Park MH, Lee JH, Han JS. Phlorofucofuroeckol A isolated from Ecklonia cava alleviates postprandial hyperglycemia in diabetic mice. Eur J Pharmacol 2015; 752:92-6. [PMID: 25680946 DOI: 10.1016/j.ejphar.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
Abstract
This study was designed to investigate whether phlorofucofuroeckol A inhibited α-glucosidase and α-amylase activities and alleviated postprandial hyperglycemia in diabetic mice. Phlorofucofuroeckol A that was isolated from Ecklonia cava (brown algae) demonstrated prominent inhibitory effects against α-glucosidase and α-amylase activities. The IC50 values of phlorofucofuroeckol A against α-glucosidase and α-amylase were 19.52 and 6.34μM, respectively. These inhibitory activities of phlorofucofuroeckol A were higher than those of acarbose, which was used as a positive control. Increases in postprandial blood glucose levels were significantly more suppressed in the group administered phlorofucofuroeckol A compared to the control group in both diabetic and normal mice. Moreover, the area under the curve was significantly lower after phlorofucofuroeckol A administration (2296 versus 2690mmolmin/l) in the diabetic mice. These results suggested that phlorofucofuroeckol A is a potent α-glucosidase inhibitor and can alleviate the postprandial hyperglycemia that is caused by starch.
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Affiliation(s)
- Han-Nui You
- Department of Food Science and Nutrition, Pusan National University, Busan 609-735, Republic of Korea.
| | - Hyun-Ah Lee
- Department of Food Science and Nutrition, Pusan National University, Busan 609-735, Republic of Korea.
| | - Mi-Hwa Park
- Department of Food and Nutrition, College of Medical and Life Science, Silla University, Busan 617-736, Republic of Korea
| | - Ji-Hyeok Lee
- Department of Marine Life Science, Jeju National University, Jeju 690-756, Republic of Korea
| | - Ji-Sook Han
- Department of Food Science and Nutrition, Pusan National University, Busan 609-735, Republic of Korea.
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25
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Baghdadi LR, Woodman RJ, Shanahan EM, Mangoni AA. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS One 2015; 10:e0117952. [PMID: 25689371 PMCID: PMC4331556 DOI: 10.1371/journal.pone.0117952] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/03/2015] [Indexed: 12/20/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is known to increase the risk of cardiovascular (CV) disease. However, the individual impact of traditional CV risk factors in RA is unknown. Objective To assess the strength of the association between individual CV risk factors and rate of either myocardial infarction (MI), combined CV morbidity (MI, angina pectoris, heart failure, stroke, and peripheral arterial disease (PAD)) or CV mortality in RA patients. Methods RA studies reporting traditional CV risk factors [hypertension, type 2 diabetes (T2D), smoking, hypercholesterolaemia, obesity, and physical inactivity] as exposures and MI, CV morbidity (MI, angina, heart failure, stroke, and PAD combined) or CV mortality alone as outcomes were searched until March 2013 using MEDLINE, Scopus and Cochrane. Meta-analyses combined relative risk (RR) estimates from each study where either the RR and 95% confidence intervals or where raw counts were available. Results Ten studies reporting sufficient data for inclusion into meta-analyses were identified. Relevant data was available for each risk factor and MI and CV morbidity but no studies reported on CV mortality. Risk of MI increased in RA patients with hypertension (RR 1.84, 95% CI 1.38, 2.46) and T2D (RR 1.89, 95% CI 1.36, 2.63). CV morbidity increased with hypertension (RR 2.24, 95% CI 1.42, 3.06), T2D (RR 1.94, 95% CI 1.58, 2.30), smoking (RR 1.50, 95% CI 1.15, 1.84), hypercholesterolaemia (RR 1.73, 95% CI 1.03, 2.44) and obesity (RR 1.16, 95% CI 1.03, 1.29) but not with physical inactivity (RR 1.00, 95% CI 0.71, 1.29). Conclusion Hypertension, T2D, smoking, hypercholesterolaemia and obesity increased CV risk in patients with RA. These results highlight the importance of managing CV risk factors in RA, similarly to non-RA patients.
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Affiliation(s)
- Leena R. Baghdadi
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia, Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, Australia
- Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, Australia
| | - E. Michael Shanahan
- Department of Rheumatology, School of Medicine, Flinders University, Adelaide, Australia
| | - Arduino A. Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
- * E-mail:
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Pisaniello AD, Scherer DJ, Kataoka Y, Nicholls SJ. Ongoing challenges for pharmacotherapy for dyslipidemia. Expert Opin Pharmacother 2014; 16:347-56. [PMID: 25476544 DOI: 10.1517/14656566.2014.986094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While increasing evidence has led to lipid-modifying therapy achieving an important role in the treatment guidelines for the prevention of cardiovascular disease, these agents are suboptimally used and there remains a considerable risk of clinical events. Accordingly, there is a need to develop more effective lipid-modifying approaches in many patients. AREAS COVERED A literature search was performed of topical manuscripts focusing on factors influencing use of established therapies and new agents in development that target a range of lipid factors. EXPERT OPINION More intensive efforts are required to ensure that statin use is maximized in higher risk patients. A range of novel therapies, including proprotein convertase subtilisin kexin-type 9 and cholesteryl ester transfer protein inhibitors, may provide additional protection, although this remains to be established by clinical trials.
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Affiliation(s)
- Anthony D Pisaniello
- University of Adelaide, South Australian Health and Medical Research Institute , PO Box 11060, Adelaide, SA, 5001 , Australia +61 8 8128 4510 ;
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Piniés JA, González-Carril F, Arteagoitia JM, Irigoien I, Altzibar JM, Rodriguez-Murua JL, Echevarriarteun L. Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: the Basque Country Prospective Complications and Mortality Study risk engine (BASCORE). Diabetologia 2014; 57:2324-33. [PMID: 25212259 DOI: 10.1007/s00125-014-3370-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/14/2014] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed. METHODS We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed. RESULTS The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno's C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk. CONCLUSIONS/INTERPRETATION This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.
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Affiliation(s)
- José A Piniés
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza-Basque Country Health Service, Baracaldo, Bizkaia, Spain
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Huh JH, Seok H, Lee BW, Kang ES, Lee HC, Cha BS. Effect of cilostazol on carotid intima-media thickness in type 2 diabetic patients without cardiovascular event. Endocrine 2014; 47:138-45. [PMID: 24381128 DOI: 10.1007/s12020-013-0120-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
Abstract
We investigated the efficacy of cilostazol treatment for 2 years on the attenuation of carotid intima-media thickness (IMT) progression in type 2 diabetic patients without cardiovascular disease history, as compared with other antiplatelet agents. We recruited a total of 230 type 2 diabetic patients who had undergone IMT measurement twice within 1.5-2.5 years (mean 2.06 ± 0.32 years) interval. Among these participants, we classified them into three groups according to antiplatelet agent administration at baseline: Group I (n = 66), antiplatelet naïve; Group II (n = 75), other antiplatelet agent administration; and Group III (n = 50), cilostazol administration. We then analyzed the changes in clinical characteristics from baseline to 2 years. The changes in annual mean IMT at 2 years were 0.019 ± 0.045 mm/year, -0.001 ± 0.058 mm/year, and -0.019 ± 0.043 mm/year for Group I, II, and III, respectively (P < 0.001). Mean change in total cholesterol, low-density lipoprotein-cholesterol, and triglyceride compared with baseline decreased the most in Group III even after adjustment for statin use. We also observed that the odds ratio of carotid IMT progression at 2 years was the lowest in patients who were treated with cilostazol even after adjustment for change of metabolic parameters. When we categorized patients according to baseline carotid IMT tertile, the efficacy of cilostazol against carotid IMT progression was significant only when baseline IMT was over 0.662 mm (mean 0.801). Two-year treatment with cilostazol strongly inhibited carotid IMT progression compared to other antiplatelet agents in type 2 diabetic patients. This beneficial effect of cilostazol was significant when baseline IMT was thicker than 0.662 mm (mean 0.801 mm).
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Affiliation(s)
- Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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Jiao FF, Lam CLK, Fung C, McGhee SM. Comparison of four cardiovascular risk prediction functions among Chinese patients with diabetes mellitus in the primary care setting. J Diabetes Investig 2014; 5:606-14. [PMID: 25411630 PMCID: PMC4188120 DOI: 10.1111/jdi.12188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 11/26/2022] Open
Abstract
AIMS/INTRODUCTION To assess the feasibility, convergent validity and sensitivity of four cardiovascular risk prediction functions in Chinese diabetic patients in the primary care setting. MATERIALS AND METHODS A cross-sectional study of 1,140 diabetic patients was carried out to compare four cardiovascular risk functions, which were respectively developed from the Framingham heart study, the USA-People's Republic of China Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology cohort (PRC), the United Kingdom Prospective Diabetes Study (UKPDS) and the Joint Asia Diabetes Evaluation program (JADE). Feasibility was assessed by the percentage of patients with complete data for risk prediction. Convergent validity was measured by Spearman's rank correlation, paired Wilcoxon signed-rank sum test and Bland-Altman plots. Effect size differences between clinical risk groups were used to assess the sensitivity. RESULTS Risk prediction was feasible by the Framingham, UKPDS and PRC risk functions in more than 98% patients, whereas just 74% of patients had complete data for the JADE function. The annual total coronary heart disease (CHD) risk predicted by the JADE and the UKPDS functions showed excellent agreement with no significant difference, and a correlation of 0.8048. The Framingham and the PRC functions predicted significantly lower CHD risk than those by the UKPDS and the JADE functions. The UKPDS and the Framingham functions were more sensitive in differentiating clinical risk groups. CONCLUSIONS The UKPDS risk engine showed good feasibility, convergent validity and sensitivity in predicting CHD risk in Chinese diabetic patients. The JADE function showed excellent agreement with the UKPDS risk engine, but it was less feasible in the primary care setting.
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Affiliation(s)
- Fang Fang Jiao
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Colman Fung
- Department of Family Medicine and Primary CareLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
| | - Sarah Morag McGhee
- School of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongPokfulamHong Kong
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Lipidtherapie bei koronarer Herzkrankheit und Diabetes. Herz 2014; 39:299-305. [DOI: 10.1007/s00059-014-4083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The role of hypertriglyceridemia in the development of atherosclerosis and endothelial dysfunction. Nutrients 2014; 6:1236-50. [PMID: 24667131 PMCID: PMC3967190 DOI: 10.3390/nu6031236] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022] Open
Abstract
A hereditary postprandial hypertriglyceridemic rabbit (PHT rabbit) is a new dyslipidemic model showing remarkably high plasma triglycerides with only limited elevation of plasma total cholesterol. In PHT rabbits, plasma triglyceride was markedly elevated postprandially compared with healthy Japanese white (JW) rabbits. In physiological experiments, the ring preparation of the thoracic aorta was suspended in an organ bath filled with modified Krebs-Henseleit solution, and the developed tension was recorded. Endothelial function was evaluated by acetylcholine-induced vasorelaxation in each preparation with intact endothelium. The acetylcholine-induced endothelium-dependent relaxation was diminished in PHT compared with JW rabbits, suggesting endothelial dysfunction in PHT rabbits. Histological examination was carried out in adipose tissue, liver and aorta. They were fixed in formaldehyde and embedded in paraffin. The tissues were sliced (4 μm) and stained using hematoxylin-eosin solution. In the adipose tissue, the visceral fat accumulated, and the size of adipose cells was enlarged in PHT rabbits. The liver of the PHT rabbit was fatty and degenerated. In aorta, increased intimal thickness was observed, suggesting the progression of atherosclerosis in the PHT rabbit. This study suggests the important role of postprandial hypertriglyceridemia in atherosclerosis. By using PHT rabbits, the effects of hypertriglyceridemia on health and diseases could be evaluated precisely.
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Lachaine J, Beauchemin C, Mathurin K, Gilbert D, Beillat M. Cost-effectiveness of asenapine in the treatment of bipolar disorder in Canada. BMC Psychiatry 2014; 14:16. [PMID: 24450548 PMCID: PMC3905654 DOI: 10.1186/1471-244x-14-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bipolar disorder (BPD) is prevalent and is associated with a significant economic burden. Asenapine, the first tetracyclic antipsychotic approved in Canada for the treatment of BPD, has shown a comparable efficacy profile to other atypical antipsychotics. In addition, it is associated with a favourable metabolic profile and minimal weight gain potential. This study aimed to assess the economic impact of asenapine compared to olanzapine in the treatment of BPD in Canada. METHODS A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with olanzapine. The decision tree takes into account the occurrence of extrapyramidal symptoms (EPS), the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases (CHDs), and stroke. Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a five-year time horizon with yearly cycles. RESULTS In the treatment of BPD, asenapine is a dominant strategy over olanzapine from both a MoH and a societal perspective. In fact, asenapine is associated with lower costs and more quality-adjusted life years (QALYs). Results of the probabilistic sensitivity analysis indicated that asenapine remains a dominant strategy in 99.2% of the simulations, in both a MoH and a societal perspective, and this result is robust to the many deterministic sensitivity analyses performed. CONCLUSIONS This economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine in the treatment of BPD in Canada.
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Affiliation(s)
- Jean Lachaine
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada.
| | - Catherine Beauchemin
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada
| | - Karine Mathurin
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada
| | - Dominique Gilbert
- Market Access and Health Outcomes, Lundbeck Canada Inc., Montreal, Quebec, Canada
| | - Maud Beillat
- Health Economics and HTA, Lundbeck S.A.S., Issy-Les-Moulineaux, France
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Abstract
Elevated blood levels of low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk for atherosclerotic coronary heart disease (CHD). Atorvastatin is a statin drug that inhibits 3-hydroxy-3-methyl-glutaryl coenzyme A reductase (the rate-limiting step of cholesterol production) and primarily lowers LDL-C levels. Atorvastatin has also been shown to significantly reduce CHD events. However, as with all statins (and all other monotherapy lipid-altering drugs), atorvastatin alone reduces the risk of CHD in only a minority of patients relative to placebo. Conversely, it is low levels of high-density lipoprotein cholesterol that are associated with increased CHD risk. Torcetrapib is a cholesteryl ester transfer protein inhibitor that primarily raises high-density lipoprotein cholesterol levels, and cholesteryl ester transfer protein inhibition has generally been shown to reduce atherosclerosis in rabbits. Taken together, atorvastatin and torcetrapib provide striking improvements in lipid levels, and complementary actions upon important lipid parameters. This review examines the chemistry, mechanism of action, pharmacokinetics, metabolism, safety/tolerability and efficacy of the combination torcetrapib/atorvastatin agent that is currently in development and that provides complementary lipid benefits towards the goal of reducing CHD risk beyond that of atorvastatin alone.
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Affiliation(s)
- Harold Bays
- L-MARC Research Center, 3288 Illinois Avenue, Louisville, KY 40213, USA.
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Hamilton SJ, Watts GF. Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials. Rev Diabet Stud 2013; 10:191-203. [PMID: 24380092 PMCID: PMC4063096 DOI: 10.1900/rds.2013.10.191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 01/29/2023] Open
Abstract
Patients with type 2 diabetes (T2D) are at a markedly increased risk of cardiovascular disease (CVD). Dyslipidemia is a common risk factor and a strong predictor of CVD in T2D patients. Although statins decrease the incidence of CVD in T2D, residual cardiovascular risk remains high despite the achievement of optimal or near-optimal plasma low-density lipoprotein (LDL) cholesterol concentrations. This may, in part, be due to uncorrected atherogenic dyslipidemia. Hypertriglyceridemia, the driving force behind diabetic dyslipidemia, results from hepatic overproduction and/or delayed clearance of triglyceride-rich lipoproteins. In patients treated with a statin to LDL-cholesterol goals, the addition of ezetimibe, fenofibrate, niacin, or n-3 fatty acid ethyl esters may be required to correct the persistent atherogenic dyslipidemia. Clinical trial evidence describing best practice is limited, but recent data supports the strategy of adding fenofibrate to a statin, and suggests specific benefits in dyslipidemic patients and in the improvement of diabetic retinopathy. However, based on results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled LDL-cholesterol. Further evidence is required to support the role of ezetimibe and n-3 fatty acids in treating residual CVD risk in statin-treated T2D patients.
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Affiliation(s)
- Sandra J. Hamilton
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Gerald F. Watts
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
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Hamilton SJ, Watts GF. Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials. Rev Diabet Stud 2013. [PMID: 24380092 DOI: 10.1002/pdi.1610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with type 2 diabetes (T2D) are at a markedly increased risk of cardiovascular disease (CVD). Dyslipidemia is a common risk factor and a strong predictor of CVD in T2D patients. Although statins decrease the incidence of CVD in T2D, residual cardiovascular risk remains high despite the achievement of optimal or near-optimal plasma low-density lipoprotein (LDL) cholesterol concentrations. This may, in part, be due to uncorrected atherogenic dyslipidemia. Hypertriglyceridemia, the driving force behind diabetic dyslipidemia, results from hepatic overproduction and/or delayed clearance of triglyceride-rich lipoproteins. In patients treated with a statin to LDL-cholesterol goals, the addition of ezetimibe, fenofibrate, niacin, or n-3 fatty acid ethyl esters may be required to correct the persistent atherogenic dyslipidemia. Clinical trial evidence describing best practice is limited, but recent data supports the strategy of adding fenofibrate to a statin, and suggests specific benefits in dyslipidemic patients and in the improvement of diabetic retinopathy. However, based on results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled LDL-cholesterol. Further evidence is required to support the role of ezetimibe and n-3 fatty acids in treating residual CVD risk in statin-treated T2D patients.
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Affiliation(s)
- Sandra J Hamilton
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Gerald F Watts
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
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Zou C, Hu H. Use of pioglitazone in the treatment of diabetes: effect on cardiovascular risk. Vasc Health Risk Manag 2013; 9:429-33. [PMID: 24023518 PMCID: PMC3764952 DOI: 10.2147/vhrm.s34421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pioglitazone and other thiazolidinediones (TZDs) initially showed great promise as unique receptor-mediated oral therapy for type 2 diabetes, but a host of serious side effects, primarily cardiovascular, have limited their utility. It is crucial at this point to perform a risk- benefit analysis to determine what role pioglitazone should play in our current treatment of type 2 diabetes and where the future of this class of drugs is headed. This review provides a comprehensive overview of the present literature. Clinical data currently available indicate that pioglitazone is an effective and generally well-tolerated treatment option for use in patients with type 2 diabetes. Pioglitazone can still reduce adverse cardiovascular risk.
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Affiliation(s)
- Cong Zou
- Department of Endocrinology, Fourth Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Park MH, Ju JW, Park M, Han J. Daidzein inhibits carbohydrate digestive enzymes in vitro and alleviates postprandial hyperglycemia in diabetic mice. Eur J Pharmacol 2013; 712:48-52. [DOI: 10.1016/j.ejphar.2013.04.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 01/04/2023]
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Sharifi F, Hojeghani N, Mazloomzadeh S, Shajari Z. The efficacy of Ezetimibe added to ongoing Fibrate-Statin therapy on postprandial lipid profile in the patients with type 2 Diabetes mellitus. J Diabetes Metab Disord 2013; 12:24. [PMID: 23734746 PMCID: PMC3729534 DOI: 10.1186/2251-6581-12-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 05/27/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postprandial hypertriglyceridemia in diabetes mellitus can be followed by endothelial dysfunction, impaired vascular compliance and increased cardiovascular complications. So focus on better control of postprandial hypertriglyceridemia is as important as controlling fasting triglyceride level in type 2 DM. OBJECTIVE We evaluated the effect of ezetimibe adding to fibrate or statin on postprandial hypertriglyceridemia. METHODS In a randomized controlled clinical trial, 47 subjects with type 2 diabetes and hypertiglyceridemia were enrolled and divided in three treatment groups including Gemfibrozil 1200mg/d + placebo(group A), Ezetimibe10mg/d + Gemfibrozile 1200mg/d(group B) or Ezetimibe10mg/d + Atorvastatin10mg/d (group C) for a 6- week period. Oral fat loading test were performed in the initiation and also at the end of the study and lipid profile and APOB were measured. RESULTS Fasting and postprandial serum triglyceride (TG) decreased significantly with all the three treatment groups with no difference between them in the percent of TG reduction. Although serum total cholesterol decreased significantly in all the three groups of treatment its reduction was more prominent in group C(-38.1% ± 11.2%in group C vs. -16.5% ± 19.6% and -7.2% ± 10.7% in groups B & A respectively, p < 0.0001 ). Fasting serum HDL increased significantly only by Gemfibrozil (23.4% ± 28.4% vs. 6.4% ± 18.9% and 1.8% ± 17.7%, p < 0.05 ). Fasting serum APOB was reduced only in ezetimibe containing groups (B &C). CONCLUSION Adding ezetimibe to gemfibrozil has no additional effect on reducing postprandial TG but ezetimibe can potentiate the effect of low-dose atorvastatin on lowering TG and LDL-c.
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Affiliation(s)
- Faranak Sharifi
- Metabolic Diseases Research Centre, Zanjan University of Medical Sciences, Zanjan, Iran.
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Abstract
The management of dyslipidemia in adults with diabetes is receiving more attention. However, there is a paucity of large, prospective, randomized outcome trials designed for diabetic patients. Diabetic dyslipidemia is characterized by an increase in triglyceride levels, low high-density lipoprotein (HDL) cholesterol concentrations, and small, dense low-density lipoprotein (LDL) particles. The treatment goals include an LDL cholesterol less than 100 mg/dL, triglyceride level less than 150 mg/dL, and an HDL greater than 40 mg/dL for men and more than 50 mg/dL for women. In the Diabetic Atherosclerosis Intervention Study, fenofibrate resulted in a 42% less increase in the percent stenosis, as assessed by quantitative coronary arteriography. The Heart Protection Study documented the unambiguous benefit of simvastatin in reducing all-cause mortality among 5963 diabetic patients. The Lescol Intervention Prevention Study observed a reduction in major adverse cardiac events in diabetics undergoing percutaneous intervention who received fluvastatin. The Veterans Affairs HDL Cholesterol Intervention Trial reported a reduction in major coronary events among 627 diabetic patients with low HDL cholesterol who sustained a myocardial infarction. The Fenofibrate Intervention and Event Lowering in Diabetics (FIELD) Trial (n = 9795), the Action to Control Cardiovascular Risk in Diabetes (ACCORD, n = 10,000), the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non Insulin Dependent Diabetes Mellitus (ASPEN, n = 2421), and the Collaborative Atorvastatin Diabetes Study (CARDS, n = 2140) will provide the prospective outcome data that are needed for the management of patients. Combination drug therapy will be necessary to achieve treatment goals. Careful monitoring will be required to avoid myositis and hepatotoxicity.
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Affiliation(s)
- L Michael Prisant
- Medical College of Georgia, 1120 Fifteenth Street, BI-5084, Augusta, GA 30912, USA
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Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diagnosed, Untreated Type 2 Diabetes. Echocardiography 2013; 30:644-8. [DOI: 10.1111/echo.12125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hakki Simsek
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Musa Sahin
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Yilmaz Gunes
- Cardiology Department; Hisar Intercontinental Hospital; Istanbul; Turkey
| | - Adnan Dogan
- Cardiology Department; Dumlupinar University; Faculty of Medicine; Kutahya; Turkey
| | | | - Mustafa Tuncer
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
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Søndergaard E, Sørensen LP, Rahbek I, Gormsen LC, Christiansen JS, Nielsen S. Postprandial VLDL-triacylglycerol secretion is not suppressed in obese type 2 diabetic men. Diabetologia 2012; 55:2733-2740. [PMID: 22752024 DOI: 10.1007/s00125-012-2624-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is characterised by insulin resistance and increased post-absorptive secretion of VLDL-triacylglycerol (VLDL-TAG). Whether postprandial suppression of endogenous VLDL-TAG secretion is abnormal--a finding that would link hyperlipidaemia and type 2 diabetes--remains unclear. METHODS Eight type 2 diabetic men and eight healthy men were studied before and after a fat-free test meal (40% of resting energy expenditure). VLDL-TAG kinetics were assessed using a primed-constant infusion of ex vivo labelled [1-(14)C]triolein VLDL-TAG using non-steady-state calculations. RESULTS Type 2 diabetic men had a higher basal VLDL-TAG secretion rate and concentration than healthy men (mean ± SD secretion rate 137 ± 61 vs 78 ± 30 μmol/min, respectively [p = 0.03]; median concentration 1.03 [range 0.58-1.75] vs 0.33 [0.13-1.14] mmol/l, respectively [p < 0.01]). Postprandially, the VLDL-TAG secretion rate decreased in healthy men (p < 0.01), but remained unchanged in diabetic men (p = 0.47). The VLDL-TAG concentration increased in diabetic men and decreased in healthy men postprandially (p < 0.05). The difference in VLDL-TAG secretion rate between the two groups approached significance (p = 0.06) and the relative change in VLDL-TAG secretion rate was significantly different (p = 0.01) between the two groups. Basal VLDL-TAG clearance was significantly lower in diabetic men (diabetic men 133 [49-390] ml/min; healthy controls 215 [137-933] ml/min [p < 0.05]). After meal ingestion, clearance decreased in healthy men (p = 0.03), but was unchanged in diabetic men (p = 0.58). CONCLUSIONS/INTERPRETATION Obese type 2 diabetic men have impaired postprandial suppression of VLDL-TAG secretion compared with lean healthy men, contributing to their postprandial lipaemia and hypertriacylglycerolaemia.
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Affiliation(s)
- E Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - L P Sørensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - I Rahbek
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - L C Gormsen
- Department of Clinical Physiology and Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J S Christiansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - S Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
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Alipour N, Wong ND, Malik S. The metabolic syndrome and dyslipidemia in primary and secondary prevention: examining the implications of recent trials. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/clp.12.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abdel-Rahman EM, Saadulla L, Reeves WB, Awad AS. Therapeutic modalities in diabetic nephropathy: standard and emerging approaches. J Gen Intern Med 2012; 27:458-68. [PMID: 22005942 PMCID: PMC3304033 DOI: 10.1007/s11606-011-1912-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 08/09/2011] [Accepted: 09/21/2011] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.
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Affiliation(s)
- Emaad M. Abdel-Rahman
- Department of Medicine, Division of Nephrology, University of Virginia, Charlottesville, VA USA
| | - Lawand Saadulla
- Department of Medicine, Division of Nephrology, Penn State Hershey Medical Center, College of Medicine, Hershey, PA USA
| | - W. Brian Reeves
- Department of Medicine, Division of Nephrology, Penn State Hershey Medical Center, College of Medicine, Hershey, PA USA
| | - Alaa S. Awad
- Department of Medicine, Division of Nephrology, Penn State Hershey Medical Center, College of Medicine, Hershey, PA USA
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Tonkin A, Hunt D, Voysey M, Kesäniemi A, Hamer A, Waites J, Mahar L, Mann S, Glasziou P, Forder P, Simes J, Keech AC. Effects of fenofibrate on cardiovascular events in patients with diabetes, with and without prior cardiovascular disease: The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Am Heart J 2012; 163:508-14. [PMID: 22424024 DOI: 10.1016/j.ahj.2011.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/14/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND In the FIELD study, comparison of the effect of fenofibrate on cardiovascular disease (CVD) between those with prior CVD and without was a prespecified subgroup analysis. METHODS The effects of fenofibrate on total CVD events and its components in patients who did (n = 2,131) and did not (n = 7,664) have a history of CVD were computed by Cox proportional hazards modeling and compared by testing for treatment-by-subgroup interaction. The analyses were adjusted for commencement of statins, use of other CVD medications, and baseline covariates. Effects on other CVD end points were explored. RESULTS Patients with prior CVD were more likely than those without to be male, to be older (by 3.3 years), to have had a history of diabetes for 2 years longer at baseline, and to have diabetic complications, hypertension, and higher rates of use of insulin and CVD medications. Discontinuation of fenofibrate was similar between the subgroups, but more patients with prior CVD than without, and also more placebo than fenofibrate-assigned patients, commenced statin therapy. The borderline difference in the effects of fenofibrate between those who did (hazard ratio [HR] 1.02, 95% CI 0.86-1.20) and did not have prior CVD (HR 0.81, 95% CI 0.70-0.94; heterogeneity P = .045) became nonsignificant after adjustment for baseline covariates and other CVD medications (HR 0.96, 95% CI 0.81-1.14 vs HR 0.78, 95% CI 0.67-0.90) (heterogeneity P = .06). CONCLUSIONS Our findings do not support treating patients with fenofibrate differently based on any history of CVD, in line with evidence from other trials.
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Affiliation(s)
- Andrew Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Laraia BA, Karter AJ, Warton EM, Schillinger D, Moffet HH, Adler N. Place matters: neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE). Soc Sci Med 2012; 74:1082-90. [PMID: 22373821 DOI: 10.1016/j.socscimed.2011.11.036] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 09/01/2011] [Accepted: 11/25/2011] [Indexed: 11/26/2022]
Abstract
While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n = 19,804) from the Diabetes Study of Northern California (DISTANCE) cohort study, an ethnically-stratified, random sample of members of Kaiser Permanente Northern California (KPNC), an integrated managed care consortium, with type 2 diabetes who completed a survey between 2005 and 2007 and who lived in a 19 county study area were included in the analyses. We estimated the association between a validated neighborhood deprivation index (NDI) and four cardiometabolic risk factors: body mass index (BMI = kg/m2), glycosylated hemoglobin (A1c), low density lipoproteins (LDL) and systolic blood pressure (SBP) using multi-level models. Outcomes were modeled in their continuous form and as binary indicators of poor control (severe obesity: BMI ≥35, poor glycemic control: A1c ≥9%, hypercholesterolemia: LDL ≥130 mg/dL, and hypertension: SBP ≥140 mmHg). BMI, A1c and SBP increased monotonically across quartiles of NDI (p < 0.001 in each case); however, LDL was significantly associated with NDI only when comparing the most to the least deprived quartile. NDI remained significantly associated with BMI and A1c after adjusting for individual level factors including income and education. A linear trend (p < 0.001) was observed in the relative risk ratios for dichotomous indicators of severe obesity, poor glycemic control, and 2 or more poorly controlled cardiometabolic risk factors across NDI quartile. In adjusted models, higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes. However, longitudinal data are needed to test the causal direction of these relationships.
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Affiliation(s)
- Barbara A Laraia
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA.
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Seon CS, Min KW, Lee SY, Nho KW, Park SH, Koo BK, Han KA. Cardiovascular Risk Assessment with Vascular Function, Carotid Atherosclerosis and the UKPDS Risk Engine in Korean Patients with Newly Diagnosed Type 2 Diabetes. Diabetes Metab J 2011; 35:619-27. [PMID: 22247905 PMCID: PMC3253973 DOI: 10.4093/dmj.2011.35.6.619] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 07/26/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes have an increased risk of cardiovascular disease. Few studies have evaluated the cardiovascular disease (CVD) risk simultaneously using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine and non-invasive vascular tests in patients with newly diagnosed type 2 diabetes. METHODS Participants (n=380; aged 20 to 81 years) with newly diagnosed type 2 diabetes were free of clinical evidence of CVD. The 10-year coronary heart disease (CHD) and stroke risks were calculated for each patient using the UKPDS risk engine. Carotid intima media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AI) were measured. The correlations between the UKPDS risk engine and the non-invasive vascular tests were assessed using partial correlation analysis, after adjusting for age, and multiple regression analysis. RESULTS The mean 10-year CHD and 10-year stroke risks were 14.92±11.53% and 4.03±3.95%, respectively. The 10-year CHD risk correlated with CIMT (P<0.001), FMD (P=0.017), and PWV (P=0.35) after adjusting for age. The 10-year stroke risk correlated only with the mean CIMT (P<0.001) after adjusting for age. FMD correlated with age (P<0.01) and systolic blood pressure (P=0.09). CIMT correlated with age (P<0.01), HbA1c (P=0.05), and gender (P<0.01). CONCLUSION The CVD risk is increased at the onset of type 2 diabetes. CIMT, FMD, and PWV along with the UKPDS risk engine should be considered to evaluate cardiovascular disease risk in patients with newly diagnosed type 2 diabetes.
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Affiliation(s)
- Choon Sik Seon
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Kyung Wan Min
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
- Diabetes Clinic, Eulji Medical Center, Seoul, Korea
| | - Seung Yup Lee
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Kyoung Woo Nho
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Se Hwan Park
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Boramae Hospital, Seoul, Korea
| | - Kyung Ah Han
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
- Diabetes Clinic, Eulji Medical Center, Seoul, Korea
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Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BGA, Wong JLA, Norman RJ, Costello MF. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust 2011; 195:S65-112. [PMID: 21929505 DOI: 10.5694/mja11.10915] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 08/26/2011] [Indexed: 12/19/2022]
Affiliation(s)
- Helena J Teede
- Research Unit, Jean Hailes Foundation for Women's Health, Melbourne, VIC, Australia.
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Abstract
PURPOSE OF REVIEW Fibrates continue to be a viable treatment option for mixed atherogenic dyslipidemia, and recent reports from clinical studies have shed new light on the therapeutic utility of fibrates for the prevention of microvascular and macrovascular disease, especially in combination with statins. RECENT FINDINGS Data from randomized placebo-controlled trials have shown that fibrates reduce nonfatal coronary events but do not confer any benefit on mortality or other adverse cardiovascular outcomes. The ACCORD Lipid trial studied the additive effect of fenofibrate therapy along with low-dose simvastatin therapy in 5,518 patients with type 2 diabetes mellitus, and found that fenofibrate did not affect any of the adverse cardiovascular outcomes, either individually or as part of a composite outcome, after 4.7 years of follow-up. An a priori subgroup analysis showed a significant benefit from fenofibrate-simvastatin combination therapy over simvastatin alone in participants with moderate hypertriglyceridemia and low HDL-cholesterol on major cardiovascular events, consistent with post-hoc analyses of previous fibrate trials. The ACCORD-Eye study adds to the sparse clinical data on the effect of fenofibrate on diabetic retinopathy, and showed that fenofibrate may be used to reduce the risk of progression of diabetic retinopathy even in patients with established disease. The combination of statin and fibrate was well tolerated. SUMMARY Fibrate therapy does not reduce mortality but may reduce nonfatal coronary events in patients at risk for cardiovascular disease, including those with type 2 diabetes. The ACCORD Lipid study shows that the combination of low-dose simvastatin and fenofibrate is well tolerated, and is potentially cardioprotective in patients with atherogenic 'mixed' dyslipidemia.
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Affiliation(s)
- Sandeep A Saha
- Providence Sacred Heart Medical Center, Spokane, WA 99220-2555, USA.
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The Use of Fibric Acid Derivatives in Cardiovascular Prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:335-42. [DOI: 10.1007/s11936-011-0128-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sondergaard E, Rahbek I, Sørensen LP, Christiansen JS, Gormsen LC, Jensen MD, Nielsen S. Effects of exercise on VLDL-triglyceride oxidation and turnover. Am J Physiol Endocrinol Metab 2011; 300:E939-44. [PMID: 21386064 PMCID: PMC3279302 DOI: 10.1152/ajpendo.00031.2011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lipids are important substrates for oxidation at rest and during exercise. Aerobic exercise mediates a delayed onset decrease in total and VLDL-triglyceride (TG) plasma concentration. However, the acute effects of exercise on VLDL-TG oxidation and turnover remain unclear. Here, we studied the acute effects of 90 min of moderate-intensity exercise in healthy women and men. VLDL-TG kinetics were assessed using a primed constant infusion of ex vivo labeled [1-(14)C]triolein VLDL-TG. Fractional VLDL-TG-derived fatty acid oxidation was measured from (14)CO(2) specific activity in expired air. VLDL-TG concentration was unaltered during exercise and early recovery, whereas non-VLDL-TG concentration decreased significantly.VLDL-TG secretion rate decreased significantly during exercise and remained suppressed during recovery. Total VLDL-TG oxidation rate was unaffected by exercise. However, the contribution of VLDL-TG oxidation to total energy expenditure fell from 14 ± 9% at rest to 3 ± 4% during exercise. We conclude that VLDL-TG fatty acids are quantitatively important oxidative substrates under basal postabsorptive conditions but remain unaffected during 90-min moderate-intensity exercise and, thus, become relatively less important during exercise. Lower VLDL secretion rate during exercise may contribute to the decrease in TG concentrations during and after exercise.
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Affiliation(s)
- Esben Sondergaard
- Dept. of Endocrinology and Internal Medicine, Aarhus Univ. Hospital, Norrebrogade 44, DK-8000 Aarhus C, Denmark
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