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Mokhtarpour K, Yadegar A, Mohammadi F, Aghayan S, Seyedi S, Rabizadeh S, Esteghamati A, Nakhjavani M. Impact of Gender on Chronic Complications in Participants With Type 2 Diabetes: Evidence From a Cross-Sectional Study. Endocrinol Diabetes Metab 2024; 7:e488. [PMID: 38718275 PMCID: PMC11078530 DOI: 10.1002/edm2.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION This study aimed to assess and compare the prevalence of diabetes complications between men and women with Type 2 diabetes (T2D), as well as how gender relates to these complications. METHODS In this cross-sectional study, complications of diabetes, including coronary artery disease (CAD), retinopathy, neuropathy and diabetic kidney disease (DKD), were evaluated in 1867 participants with T2D. Additionally, baseline characteristics of the individuals, including anthropometric measurements, metabolic parameters and the use of dyslipidaemia drugs and antihyperglycaemic agents, were assessed. Gender differences in complications were examined using the chi-squared test. Multivariate logistic regression was employed to investigate the relationship between gender and T2D complications, with and without adjusting for the characteristics of the studied population. RESULTS In the studied population, 62.1% had at least one complication, and complications were 33.5% for DKD, 29.6% for CAD, 22.9% for neuropathy and 19.1% for retinopathy. The prevalence of CAD and neuropathy was higher in men. However, DKD and retinopathy were more prevalent among women. Odds ratios of experiencing any complication, CAD and retinopathy in men compared with women were 1.57 (95% CI: 1.27-2.03), 2.27 (95% CI: 1.72-2.99) and 0.72 (95% CI: 0.52-0.98), respectively, after adjusting for demographic factors, anthropometric measures, metabolic parameters and the consumption of dyslipidaemia drugs and antihyperglycaemic agents. CONCLUSION The prevalence of diabetes complications was significantly higher in men with diabetes, highlighting the need for better treatment adherence. CAD was associated with the male gender, whereas retinopathy was associated with the female gender. Men and women with diabetes should be monitored closely for CAD and retinopathy, respectively, regardless of their age, diabetes duration, anthropometric measures, laboratory findings and medications.
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Affiliation(s)
- Kiavash Mokhtarpour
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Fatemeh Mohammadi
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Seyedeh Nazanin Aghayan
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Seyed Arsalan Seyedi
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
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2
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Niu Y, Wang G, Feng X, Niu H, Shi W, Shen Y. Sex-specific association between monocyte to high-density lipoprotein cholesterol and extensive abdominal aortic calcification in humans. Lipids 2024; 59:29-40. [PMID: 38282428 DOI: 10.1002/lipd.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024]
Abstract
Recent studies have identified monocyte-to-high-density lipoprotein cholesterol ratio (MHR) as a simple marker of atherosclerosis. Abdominal aortic calcification (AAC) is a direct result of vascular atherosclerosis. Our study aims to investigate the association between MHR and the prevalent extensive AAC and assess the value of MHR for identifying prevalent extensive AAC. 2857 subjects (28.07%) from the cross-sectional National Health and Nutrition Examination Survey 2013-2014 were included in our study. AAC was detected through dual-energy x-ray absorptiometry and quantified by Kauppila score. Extensive AAC was identified in 153 (10.44% of 1465) females and 146 (10.49% of 1392) males. With the full adjustment, each SD increase of MHR resulted in an 87.3% additional risk for extensive AAC in females. When dividing into quartiles, the top quartile had a 3.472 times risk of prevalent extensive AAC than the bottom quartile. However, no significant association was observed in males. Furthermore, smooth curve fitting implicated that the significant association was linear in the whole range of MHR among females. Additionally, ROC demonstrated an improvement in the identification of extensive AAC only among females when introducing MHR into established risk factors of atherosclerosis (0.808 vs. 0.864, p < 0.001). Finally, category-free net reclassification index and integrated discrimination index also supported the improvement by MHR in females. Our study revealed a linear association between MHR and prevalent extensive AAC in females. Moreover, our results implicated the potential value of MHR to refine the identification of prevalent extensive AAC in females.
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Affiliation(s)
- Yuyu Niu
- Department of Cardiovascular Medicine, First People's Hospital of Xinxiang and The Fifth Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, China
| | - Guifang Wang
- Department of Cardiovascular Medicine, First People's Hospital of Xinxiang and The Fifth Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, China
| | - Xianjun Feng
- Department of Cardiovascular Medicine, First People's Hospital of Xinxiang and The Fifth Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, China
| | - Hongyi Niu
- Sanquan College, Xinxiang Medical University, Xinxiang, Henan, China
| | - Wenrui Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingxue Shen
- Department of Cardiology, Yuhuan Second People's Hospital, Zhejiang, China
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3
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Diabetes and cardiovascular risk according to sex: An overview of epidemiological data from the early Framingham reports to the cardiovascular outcomes trials. ANNALES D'ENDOCRINOLOGIE 2023; 84:57-68. [PMID: 36183805 DOI: 10.1016/j.ando.2022.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
Male sex is a major cardiovascular risk factor in the general population, with men showing higher age-adjusted prevalence of cardiovascular disease than women. Diabetes, another major cardiovascular risk factor, affects cardiovascular risk differentially between men and women. Data from prospective observational studies showed that women with diabetes had greater relative risk of cardiovascular events than men with diabetes, leading to a smaller difference between diabetic men and women than between non-diabetic men and women in terms of cardiovascular disease. This excess relative risk concerns cardiovascular death, coronary heart disease, stroke and heart failure. It is greatest in the youngest age group and decreases gradually with age. Although many mechanisms have been proposed to explain the greater cardiovascular burden in women with diabetes, little is known about the impact of diverse anti-hyperglycemic drugs on cardiovascular events according to sex. Hence, cardiovascular outcomes trials provide a unique opportunity to study the impact of novel anti-hyperglycemic drugs on cardiovascular outcomes in men and women with type-2 diabetes. Here, we present an overview of the epidemiological data concerning sex-related differences in cardiovascular disease in people with diabetes, with a focus on the effects of novel anti-hyperglycemic drugs on cardiovascular outcomes in men and women. In addition, we summarize proposed mechanisms to explain these differences, with relevant references for the interested reader.
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4
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Domingo-Relloso A, Gribble MO, Riffo-Campos AL, Haack K, Cole SA, Tellez-Plaza M, Umans JG, Fretts AM, Zhang Y, Fallin MD, Navas-Acien A, Everson TM. Epigenetics of type 2 diabetes and diabetes-related outcomes in the Strong Heart Study. Clin Epigenetics 2022; 14:177. [PMID: 36529747 PMCID: PMC9759920 DOI: 10.1186/s13148-022-01392-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes has dramatically increased in the past years. Increasing evidence supports that blood DNA methylation, the best studied epigenetic mark, is related to diabetes risk. Few prospective studies, however, are available. We studied the association of blood DNA methylation with diabetes in the Strong Heart Study. We used limma, Iterative Sure Independence Screening and Cox regression to study the association of blood DNA methylation with fasting glucose, HOMA-IR and incident type 2 diabetes among 1312 American Indians from the Strong Heart Study. DNA methylation was measured using Illumina's MethylationEPIC beadchip. We also assessed the biological relevance of our findings using bioinformatics analyses. RESULTS Among the 358 differentially methylated positions (DMPs) that were cross-sectionally associated either with fasting glucose or HOMA-IR, 49 were prospectively associated with incident type 2 diabetes, although no DMPs remained significant after multiple comparisons correction. Multiple of the top DMPs were annotated to genes with relevant functions for diabetes including SREBF1, associated with obesity, type 2 diabetes and insulin sensitivity; ABCG1, involved in cholesterol and phospholipids transport; and HDAC1, of the HDAC family. (HDAC inhibitors have been proposed as an emerging treatment for diabetes and its complications.) CONCLUSIONS: Our results suggest that differences in peripheral blood DNA methylation are related to cross-sectional markers of glucose metabolism and insulin activity. While some of these DMPs were modestly associated with prospective incident type 2 diabetes, they did not survive multiple testing. Common DMPs with diabetes epigenome-wide association studies from other populations suggest a partially common epigenomic signature of glucose and insulin activity.
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Affiliation(s)
- Arce Domingo-Relloso
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain. .,Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. .,Department of Statistics and Operations Research, University of Valencia, Valencia, Spain.
| | - Matthew O. Gribble
- grid.265892.20000000106344187Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL USA
| | - Angela L. Riffo-Campos
- grid.412163.30000 0001 2287 9552Millennium Nucleus On Sociomedicine (SocioMed) and Vicerrectoría Académica, Universidad de La Frontera, Temuco, Chile ,grid.5338.d0000 0001 2173 938XDepartment of Computer Science, ETSE, University of Valencia, Valencia, Spain
| | - Karin Haack
- grid.250889.e0000 0001 2215 0219Population Health Program, Texas Biomedical Research Institute, San Antonio, TX USA
| | - Shelley A. Cole
- grid.250889.e0000 0001 2215 0219Population Health Program, Texas Biomedical Research Institute, San Antonio, TX USA
| | - Maria Tellez-Plaza
- grid.413448.e0000 0000 9314 1427Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Jason G. Umans
- grid.415232.30000 0004 0391 7375MedStar Health Research Institute, Hyattsville, MD USA ,grid.440590.cGeorgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC USA
| | - Amanda M. Fretts
- grid.34477.330000000122986657Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA USA
| | - Ying Zhang
- grid.266902.90000 0001 2179 3618Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - M. Daniele Fallin
- grid.189967.80000 0001 0941 6502Emory University Rollins School of Public Health, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Ana Navas-Acien
- grid.21729.3f0000000419368729Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY USA
| | - Todd M. Everson
- grid.189967.80000 0001 0941 6502Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
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5
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Kumar S, Kumari B, Kaushik A, Banerjee A, Mahto M, Bansal A. Relation Between HbA1c and Lipid Profile Among Prediabetics, Diabetics, and Non-diabetics: A Hospital-Based Cross-Sectional Analysis. Cureus 2022; 14:e32909. [PMID: 36699757 PMCID: PMC9870815 DOI: 10.7759/cureus.32909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION An unusually high blood glucose level is a hallmark of diabetes mellitus, with an imbalance between insulin levels and insulin sensitivity leading to an insulin functional deficit. Since it serves as both a risk indicator and a gauge of long-term glycemic control, the HbA1c concentration is a crucial component of standard diabetes treatment. The use of the HbA1c concentration in the diagnosis of diabetes is expanding as the test's accuracy increases. Dyslipidemic profiles can appear before type 2 diabetes manifests itself and are independent risk factors for the disease. Additionally, dyslipidemia, especially in diabetics, might affect pancreatic beta-cell survival and activity. This study was undertaken with the aim to find out any correlation between HbA1c and lipid profile among diabetics, prediabetics, and non-diabetics. METHODS A total of 1,000 individuals with age 18-60 years were included in the study (non-diabetics = 186, prediabetics = 238, diabetics = 576). HbA1c was estimated by capillary electrophoresis and a lipid profile was done using a fully automatic chemistry analyzer. RESULT Diabetes was found to be significantly associated with dyslipidemia. In diabetics, a statistically significant increase in the level of triglyceride and very low-density lipoprotein (VLDL) was seen as compared to prediabetics. Diabetic women were found to be significantly more dyslipidemic as compared to diabetic males. The mean HbA1c among diabetics was found to be 8.3. CONCLUSION In hyperglycemia-induced dyslipidemia, raised triglyceride and VLDL were the most common findings, and combined lipid abnormalities were more commonly seen as compared to a single abnormality in the lipid profile. Patients with poor glycemic control more commonly develop dyslipidemia, which may be a reason for an increased incidence of cardiovascular catastrophes in such patients.
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Affiliation(s)
- Sushil Kumar
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Bandana Kumari
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Amit Kaushik
- Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Ayan Banerjee
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Mala Mahto
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Akash Bansal
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
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6
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Braffett BH, Bebu I, El ghormli L, Cowie CC, Sivitz WI, Pop-Busui R, Larkin ME, Gubitosi-Klug RA, Nathan DM, Lachin JM, Dagogo-Jack S. Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men With Type 1 Diabetes. JAMA Netw Open 2022; 5:e2230710. [PMID: 36074461 PMCID: PMC9459657 DOI: 10.1001/jamanetworkopen.2022.30710] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE The lower risk of cardiovascular disease (CVD) among women compared with men in the general population may be diminished among those with diabetes. OBJECTIVE To evaluate cardiometabolic risk factors and their management in association with CVD events in women vs men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data obtained during the combined DCCT (randomized clinical trial, conducted 1983-1993) and EDIC (observational study, conducted 1994 to present) studies through April 30, 2018 (mean [SD] follow-up, 28.8 [5.8] years), at 27 clinical centers in the US and Canada. Data analyses were performed between July 2021 and April 2022. EXPOSURE During the DCCT phase, patients were randomized to intensive vs conventional diabetes therapy. MAIN OUTCOMES AND MEASURES Cardiometabolic risk factors and CVD events were assessed via detailed medical history and focused physical examinations. Blood and urine samples were assayed centrally. CVD events were adjudicated by a review committee. Linear mixed models and Cox proportional hazards models evaluated sex differences in cardiometabolic risk factors and CVD risk over follow-up. RESULTS A total of 1441 participants with type 1 diabetes (mean [SD] age at DCCT baseline, 26.8 [7.1] years; 761 [52.8%] men; 1390 [96.5%] non-Hispanic White) were included. Over the duration of the study, compared with men, women had significantly lower body mass index (BMI, calculated as weight in kilograms divided by height in meters squared; β = -0.43 [SE, 0.16]; P = .006), waist circumference (β = -10.56 cm [SE, 0.52 cm]; P < .001), blood pressure (systolic: β = -5.77 mm Hg [SE, 0.35 mm Hg]; P < .001; diastolic: β = -3.23 mm Hg [SE, 0.26 mm Hg]; P < .001), and triglyceride levels (β = -10.10 mg/dL [SE, 1.98 mg/dL]; P < .001); higher HDL cholesterol levels (β = 9.36 mg/dL [SE, 0.57 mg/dL]; P < .001); and similar LDL cholesterol levels (β = -0.76 mg/dL [SE, 1.22 mg/dL]; P = .53). Women, compared with men, achieved recommended targets more frequently for blood pressure (ie, <130/80 mm Hg: 90.0% vs 77.4%; P < .001) and triglycerides (ie, <150 mg/dL: 97.3% vs 90.5%; P < .001). However, sex-specific HDL cholesterol targets (ie, ≥50 mg/dL for women, ≥40 mg/dL for men) were achieved less often (74.3% vs 86.6%; P < .001) and cardioprotective medications were used less frequently in women than men (ie, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker: 29.6% [95% CI, 25.7%-33.9%] vs 40.0% [95% CI, 36.1%-44.0%]; P = .001; lipid-lowering medication: 25.3% [95% CI, 22.1%-28.7%] vs 39.6% [95% CI, 36.1%-43.2%]; P < .001). Women also had significantly higher pulse rates (mean [SD], 75.2 [6.8] beats per minute vs 71.8 [6.9] beats per minute; P < .001) and hemoglobin A1c levels (mean [SD], 8.3% [1.0%] vs 8.1% [1.0%]; P = .01) and achieved targets for tighter glycemic control less often than men (ie, hemoglobin A1c <7%: 11.2% [95% CI, 9.3%-13.3%] vs 14.0% [95% CI, 12.0%-16.3%]; P = .03). CONCLUSIONS AND RELEVANCE These findings suggest that despite a more favorable cardiometabolic risk factor profile, women with type 1 diabetes did not have a significantly lower CVD event burden than men, suggesting a greater clinical impact of cardiometabolic risk factors in women vs men with diabetes. These findings call for conscientious optimization of the control of CVD risk factors in women with type 1 diabetes.
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Affiliation(s)
| | - Ionut Bebu
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Laure El ghormli
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Catherine C. Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - William I. Sivitz
- Division of Endocrinology and Metabolism, University of Iowa, Iowa City
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor
| | - Mary E. Larkin
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston
| | - Rose A. Gubitosi-Klug
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Case-Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis
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7
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Domingo-Relloso A, Makhani K, Riffo-Campos AL, Tellez-Plaza M, Klein KO, Subedi P, Zhao J, Moon KA, Bozack AK, Haack K, Goessler W, Umans JG, Best LG, Zhang Y, Herreros-Martinez M, Glabonjat RA, Schilling K, Galvez-Fernandez M, Kent JW, Sanchez TR, Taylor KD, Johnson WC, Durda P, Tracy RP, Rotter JI, Rich SS, Van Den Berg D, Kasela S, Lappalainen T, Vasan RS, Joehanes R, Howard BV, Levy D, Lohman K, Liu Y, Fallin MD, Cole SA, Mann KK, Navas-Acien A. Arsenic Exposure, Blood DNA Methylation, and Cardiovascular Disease. Circ Res 2022; 131:e51-e69. [PMID: 35658476 DOI: 10.1161/circresaha.122.320991] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Epigenetic dysregulation has been proposed as a key mechanism for arsenic-related cardiovascular disease (CVD). We evaluated differentially methylated positions (DMPs) as potential mediators on the association between arsenic and CVD. METHODS Blood DNA methylation was measured in 2321 participants (mean age 56.2, 58.6% women) of the Strong Heart Study, a prospective cohort of American Indians. Urinary arsenic species were measured using high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry. We identified DMPs that are potential mediators between arsenic and CVD. In a cross-species analysis, we compared those DMPs with differential liver DNA methylation following early-life arsenic exposure in the apoE knockout (apoE-/-) mouse model of atherosclerosis. RESULTS A total of 20 and 13 DMPs were potential mediators for CVD incidence and mortality, respectively, several of them annotated to genes related to diabetes. Eleven of these DMPs were similarly associated with incident CVD in 3 diverse prospective cohorts (Framingham Heart Study, Women's Health Initiative, and Multi-Ethnic Study of Atherosclerosis). In the mouse model, differentially methylated regions in 20 of those genes and DMPs in 10 genes were associated with arsenic. CONCLUSIONS Differential DNA methylation might be part of the biological link between arsenic and CVD. The gene functions suggest that diabetes might represent a relevant mechanism for arsenic-related cardiovascular risk in populations with a high burden of diabetes.
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Affiliation(s)
- Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.).,Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.).,Department of Statistics and Operations Research (A.D.-R.), University of Valencia, Spain
| | - Kiran Makhani
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.)
| | - Angela L Riffo-Campos
- Department of Computer Science, ETSE (A.L.R.-C.), University of Valencia, Spain.,Millennium Nucleus on Sociomedicine (SocioMed) and Vicerrectoría Académica, Universidad de La Frontera, Temuco, Chile (A.L.R.-C.)
| | - Maria Tellez-Plaza
- Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.)
| | - Kathleen Oros Klein
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.)
| | - Pooja Subedi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville (P.S., J.Z.)
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville (P.S., J.Z.)
| | - Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.A.M.)
| | - Anne K Bozack
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.K.B.)
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry for Health and Environment, University of Graz, Austria (W.G.)
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD. Now with Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.W.H.).,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.V.H.)
| | - Lyle G Best
- Missouri Breaks Industries and Research, Inc, Eagle Butte, SD (L.G.B.)
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center (Y.Z.)
| | | | - Ronald A Glabonjat
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Kathrin Schilling
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Marta Galvez-Fernandez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.).,Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.)
| | - Jack W Kent
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (K.D.T., J.I.R.)
| | - W Craig Johnson
- Department of Biostatistics, University of Washington, Seattle (W.C.J.)
| | - Peter Durda
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT (P.D., R.P.T.)
| | - Russell P Tracy
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT (P.D., R.P.T.)
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (K.D.T., J.I.R.)
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA (S.S.R.)
| | - David Van Den Berg
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles' CA (D.V.D.B.)
| | - Silva Kasela
- New York Genome Center (S.K., T.L.).,Department of Systems Biology, Columbia University' NY (S.K., T.L.)
| | - Tuuli Lappalainen
- New York Genome Center (S.K., T.L.).,Department of Systems Biology, Columbia University' NY (S.K., T.L.)
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V.).,Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Department of Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.)
| | - Roby Joehanes
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J., D.L.).,Framingham Heart Study, MA (R.J., D.L.)
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD. Now with Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.W.H.).,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.V.H.)
| | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J., D.L.).,Framingham Heart Study, MA (R.J., D.L.)
| | - Kurt Lohman
- Department of Medicine, Duke University Medical Center, Durham, NC (K.L., Y.L.)
| | - Yongmei Liu
- Department of Medicine, Duke University Medical Center, Durham, NC (K.L., Y.L.)
| | - M Daniele Fallin
- Departments of Mental Health and Epidemiology, Johns Hopkins University, Baltimore, MD (M.D.F.)
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Koren K Mann
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.).,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada (K.K.M.)
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
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8
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Female Heart Disease. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Thomas EG, Rhodius-Meester H, Exalto L, Peters SAE, van Bloemendaal L, Ponds R, Muller M. Sex-Specific Associations of Diabetes With Brain Structure and Function in a Geriatric Population. Front Aging Neurosci 2022; 14:885787. [PMID: 35837485 PMCID: PMC9273850 DOI: 10.3389/fnagi.2022.885787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Globally, women with dementia have a higher disease burden than men with dementia. In addition, women with diabetes especially are at higher risk for cognitive impairment and dementia compared to men with diabetes. Differences in the influence of diabetes on the cerebral vasculature and brain structure may contribute to these sex-specific differences. We examined sex-specific patterns in the relationship between diabetes and brain structure, as well as diabetes and cognitive function. Methods In total, 893 patients [age 79 ± 6.6 years, 446 (50%) women] from the Amsterdam Ageing Cohort with available data on brain structures (assessed by an MRI or CT scan) and cognitive function were included. All patients underwent a thorough standardized clinical and neuropsychological assessment (including tests on memory, executive functioning, processing speed, language). Brain structure abnormalities were quantified using visual scales. Results Cross-sectional multivariable regression analyses showed that diabetes was associated with increased incidence of cerebral lacunes and brain atrophy in women (OR 2.18 (1.00–4.72) but not in men. Furthermore, diabetes was associated with decreased executive function, processing speed and language in women [B −0.07 (0.00–0.13), −0.06 (0.02–0.10) and −0.07 (0.01–0.12) resp.] but not in men. Conclusions Diabetes is related to increased risk of having lacunes, brain atrophy and impaired cognitive function in women but not in men. Further research is required to understand the time trajectory leading up to these changes and to understand the mechanisms behind them in order to improve preventive health care for both sexes.
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Affiliation(s)
- Elias G. Thomas
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, Netherlands
- *Correspondence: Elias G. Thomas
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Lieza Exalto
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Liselotte van Bloemendaal
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
| | - Rudolf Ponds
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
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10
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R Charlier SH, Meier C, Jick SS, Meier CR, Becker C. Association between glycemic control and risk of venous thromboembolism in diabetic patients: a nested case-control study. Cardiovasc Diabetol 2022; 21:2. [PMID: 34983504 PMCID: PMC8729078 DOI: 10.1186/s12933-021-01432-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM. METHODS We conducted a nested case-control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders. RESULTS We identified 2'653 VTE cases and 10'612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36-55% increased relative risk of VTE when compared to women with HbA1c > 6.5-7.0%. CONCLUSIONS Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5-7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.
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Affiliation(s)
- Sarah H R Charlier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christian Meier
- Division of Endocrinology, Diabetes & Metabolism, University Hospital Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, USA.,School of Public Health, Boston University, Boston University School of Medicine, Lexington, USA
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Lexington, USA.
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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11
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Ding Q, Funk M, Spatz ES, Lin H, Batten J, Wu E, Whittemore R. Sex-specific impact of diabetes on all-cause mortality among adults with acute myocardial infarction: An updated systematic review and meta-analysis, 1988-2021. Front Endocrinol (Lausanne) 2022; 13:918095. [PMID: 36060979 PMCID: PMC9428712 DOI: 10.3389/fendo.2022.918095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of diabetes and its impact on mortality after acute myocardial infarction (AMI) are well-established. Sex-specific analyses of the impact of diabetes on all-cause mortality after AMI have not been updated and comprehensively investigated. OBJECTIVE To conduct a systematic review and meta-analysis that examined sex-specific short-term, mid-term and long-term all-cause mortality associated with diabetes among AMI survivors (diabetes versus non-diabetes patients in men and women separately), using up-to-date data. METHODS We systematically searched Embase and MEDLINE for studies that were published from inception to November 14, 2021. Studies were included if (1) they studied post-AMI all-cause-mortality in patients with and without diabetes, (2) sex-specific all-cause mortality at short-term (in-hospital or within 90 days after discharge), mid-term (>90 days and within 5 years), and/or long-term (>5 years) were reported. From eligible studies, we used random effects meta-analyses models to estimate pooled unadjusted and adjusted sex-specific risk ratio (RR) of all-cause mortality at short-, mid-, and long-term follow-up for adults with diabetes compared with those without diabetes. RESULTS Of the 3647 unique studies identified, 20 studies met inclusion criteria. In the unadjusted analysis (Total N=673,985; women=34.2%; diabetes patients=19.6%), patients with diabetes were at a higher risk for all-cause mortality at short-term (men: RR, 2.06; women: RR, 1.83); and mid-term follow-up (men: RR, 1.69; women: RR, 1.52) compared with those without diabetes in both men and women. However, when adjusted RRs were used (Total N=7,144,921; women=40.0%; diabetes patients=28.4%), the associations between diabetes and all-cause mortality in both men and women were attenuated, but still significantly elevated for short-term (men: RR, 1.16; 95% CI, 1.12-1.20; women: RR, 1.29; 95% CI, 1.15-1.46), mid-term (men: RR, 1.39; 95% CI, 1.31-1.46; women: RR, 1.38; 95% CI, 1.20-1.58), and long-term mortality (men: RR, 1.58; 95% CI, 1.22-2.05; women: RR, 1.76; 95% CI, 1.25-2.47). In men, all-cause mortality risk associated with diabetes tended to increase with the duration of follow-up (p<0.0001). CONCLUSIONS Diabetes has substantial and sustained effects on post-AMI all-cause mortality at short-term, mid-term and long-term follow-up, regardless of sex. Tailoring AMI treatment based on patients' diabetes status, duration of follow-up and sex may help narrow the gap in all-cause mortality between patients with diabetes and those without diabetes.
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Affiliation(s)
- Qinglan Ding
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
- School of Nursing, Yale University, West Haven, CT, United States
- *Correspondence: Qinglan Ding,
| | - Marjorie Funk
- School of Nursing, Yale University, West Haven, CT, United States
| | - Erica S. Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Haiqun Lin
- Rutgers University School of Nursing, Newark, NJ, United States
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States
| | - Emily Wu
- Krannert School of Management, Purdue University, West Lafayette, IN, United States
| | - Robin Whittemore
- School of Nursing, Yale University, West Haven, CT, United States
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12
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Saltzman LY. Sex Differences in the Relationship Between Child Maltreatment, Recent Bereavement, and Average Heart Rate. OMEGA-JOURNAL OF DEATH AND DYING 2021; 84:459-473. [PMID: 31865859 PMCID: PMC7306425 DOI: 10.1177/0030222819894139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study explores the sex differences in cardiovascular outcomes among bereaved individuals. In addition, the study differentiates the impact of child maltreatment and recent loss on the physical health of adult men and women. This study conducted a secondary analysis of data drawn from the Biomarker Subproject of the National Survey of Midlife Development in the United States (n = 1,255). Analysis included a series of regression models estimated in Stata version 15.1. A main effect for both sex and loss was observed. Both male and female respondents with loss had higher average heart rates as compared to male respondents without loss. Interestingly, being a female without loss was also associated with a higher average heart rate as compared to males without loss. The findings suggest that sex differences in cardiovascular functioning do occur and that these differences may be exacerbated by experiences of trauma and loss, and this relationship has implications for assessment and intervention.
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Affiliation(s)
- Leia Y Saltzman
- School of Social Work, Tulane University, New Orleans, LA, USA
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13
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Anthropometric Measurements, Metabolic Profile and Physical Fitness in a Sample of Spanish Women with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211955. [PMID: 34831711 PMCID: PMC8623435 DOI: 10.3390/ijerph182211955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023]
Abstract
Background: Exercise training has proven to be effective for treatment of metabolic diseases, such as type 2 diabetes mellitus. The aims of this study were to compare anthropometric measurements, metabolic profile and physical fitness between active and sedentary women with type 2 diabetes, and to analyse relationships between anthropometry and metabolic profile and components of physical fitness (balance, flexibility, strength and endurance). Methods: Cross-sectional research on 28 women with type 2 diabetes. Amount of daily physical activity, BMI, waist circumference, HbA1c, fibrinogen, hs-CRP, tiptoe dynamic balance, static balance, finger floor distance, abdominal, upper and lower limb strength and walking cardiovascular endurance were recorded. Results: Age: 58.5 ± 7.8. Overall, 16 subjects were physically active and 12 were sedentary. Active subjects had lower BMI (p = 0.033) and better cardiovascular endurance (p = 0.025). BMI and waist circumference were not influenced by any physical fitness component. HbA1c, fibrinogen and hs-CRP were related with worse dynamic balance (p = 0.036, 0.006 and 0.031, respectively). Conclusions: Active women had lower BMI and showed a better performance in cardiovascular endurance. Tiptoe dynamic balance impairments were related to worse glycaemic control, hypercoagulation and inflammatory state.
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14
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Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, Jiménez-Trujillo I, de Miguel-Yanes JM, Carabantes-Alarcon D, de Miguel-Diez J, Lopez-Herranz M. Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016-18. Cardiovasc Diabetol 2021; 20:138. [PMID: 34243780 PMCID: PMC8272346 DOI: 10.1186/s12933-021-01334-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01334-2.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department. Hospital General, Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
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15
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Wysocka-Mincewicz M, Gołębiewska J, Baszyńska-Wilk M, Olechowski A. Gender-Specific Risk Factors for the Development of Retinal Changes in Children with Type 1 Diabetes. J Pers Med 2021; 11:588. [PMID: 34205725 PMCID: PMC8235352 DOI: 10.3390/jpm11060588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/29/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to determine gender-specific risk factor sets which could influence optical coherence tomography (OCT) results in children with type 1 diabetes (T1D). MATERIAL AND METHODS 175 children with T1D without symptoms of diabetic retinopathy were enrolled, but 330 eyes were used for the final analysis (168 children, mean age 12.81 ± 3.63 years, diabetes duration 4.59 ± 3.71 years). The multivariate regression models for retinal thickness (foveal FT, and parafoveal PFT) and vascular densities (superficial and deep) were carried out separately for both genders using all metabolic and demographic parameters. RESULTS In the statistically significant multiple regression models for all analyzed OCT parameters for both genders, pH at the onset of diabetes were in existence, as well as for retinal thickness current HbA1c. Duration of continuous insulin infusion (CSII) was an important factor in all parameters, except PFT. For the girls, the most significant factors were daily insulin dose, uric acid, and triglycerides, but for the boys, it was serum creatinine, systolic pressure, and free thyroxine level. CONCLUSIONS We detected significant risk factors set for development of OCT parameters changes, and they were not identical for both genders. Current metabolic control, diabetic ketoacidosis at the disease onset, serum creatinine and longer use of CSII are the most important factors for retinal thickness and vessel densities in both genders in children with type 1 diabetes. For the girls, elements of metabolic syndrome (uric acid and triglycerides) and parameters of insulin amount were more pronounced.
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Affiliation(s)
- Marta Wysocka-Mincewicz
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | | | - Marta Baszyńska-Wilk
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | - Andrzej Olechowski
- Ophthalmology Department, South TEES Hospitals NHS Foundation Trust the James Cook University Hospital, Marton Road, Middlesbrough S4 3BW, UK;
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16
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Chadalavada S, Jensen MT, Aung N, Cooper J, Lekadir K, Munroe PB, Petersen SE. Women With Diabetes Are at Increased Relative Risk of Heart Failure Compared to Men: Insights From UK Biobank. Front Cardiovasc Med 2021; 8:658726. [PMID: 33889602 PMCID: PMC8057521 DOI: 10.3389/fcvm.2021.658726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
Aims: To investigate the effect of diabetes on mortality and incident heart failure (HF) according to sex, in the low risk population of UK Biobank. To evaluate potential contributing factors for any differences seen in HF end-point. Methods: The entire UK Biobank study population were included. Participants that withdrew consent or were diagnosed with diabetes after enrolment were excluded from the study. Univariate and multivariate cox regression models were used to assess endpoints of mortality and incident HF, with median follow-up periods of 9 years and 8 years respectively. Results: A total of 493,167 participants were included, hereof 22,685 with diabetes (4.6%). Two thousand four hundred fifty four died and 1,223 were diagnosed or admitted with HF during the follow up periods of 9 and 8 years respectively. Overall, the mortality and HF risk were almost doubled in those with diabetes compared to those without diabetes (hazard ratio (HR) of 1.9 for both mortality and heart failure) in the UK Biobank population. Women with diabetes (both types) experience a 22% increased risk of HF compared to men (HR of 2.2 (95% CI: 1.9-2.5) vs. 1.8 (1.7-2.0) respectively). Women with type 1 diabetes (T1DM) were associated with 88% increased risk of HF compared to men (HR 4.7 (3.6-6.2) vs. 2.5 (2.0-3.0) respectively), while the risk of HF for type 2 diabetes (T2DM) was 17% higher in women compared to men (2.0 (1.7-2.3) vs. 1.7 (1.6-1.9) respectively). The increased risk of HF in women was independent of confounding factors. The findings were similar in a model with all-cause mortality as a competing risk. This interaction between sex, diabetes and outcome of HF is much more prominent for T1DM (p = 0.0001) than T2DM (p = 0.1). Conclusion: Women with diabetes, particularly those with T1DM, experience a greater increase in risk of heart failure compared to men with diabetes, which cannot be explained by the increased prevalence of cardiac risk factors in this cohort.
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Affiliation(s)
- Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Magnus T Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.,Department of Cardiology, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques and Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
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Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073659. [PMID: 33915785 PMCID: PMC8037293 DOI: 10.3390/ijerph18073659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the existence of sex differences. Methods: Matched-pair analysis using the Spanish National Hospital discharge. Results: IS was coded in 92,524 men and 79,731 women (29.53% with T2DM). The adjusted incidence of IS (IRR 2.02; 95% CI 1.99–2.04) was higher in T2DM than non-T2DM subjects, with higher IRRs in both sexes. Men with T2DM had a higher incidence of IS than T2DM women (IRR 1.54; 95% CI 1.51–1.57). After matching patients with T2DM, those with other comorbid conditions, however, significantly less frequently received endovascular thrombectomy and thrombolytic therapy. In-hospital mortality (IHM) was lower among T2DM men than matched non-T2DM men (8.23% vs. 8.71%; p < 0.001). Women with T2DM had a higher IHM rate than T2DM men (11.5% vs. 10.20%; p = 0.004). After adjusting for confounders, women with T2DM had a 12% higher mortality risk than T2DM men (OR 1.12; 95% CI 1.04–1.21). Conclusions: T2DM is associated with higher incidence of IS in both sexes. Men with T2DM have a higher incidence rates of IS than T2DM women. Women with T2DM have a higher risk of dying in the hospital.
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Zhou G, Liu L, Li X, Hou X, Wang L, Sun R, Huang H, Li Z, Li W, Wang C, Ba Y. ESRα Promoter Methylation May Modify the Association Between Lipid Metabolism and Type 2 Diabetes in Chinese Farmers. Front Public Health 2021; 9:578134. [PMID: 33748055 PMCID: PMC7969800 DOI: 10.3389/fpubh.2021.578134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study is aimed to explore the potential association among the estrogen receptor alpha (ESRα) promoter methylation, lipid metabolism and the risk of type 2 diabetes mellitus (T2DM). Methods: A total of 1143 rural residents were recruited randomly from Henan Province, China. The circulating methylation levels in ESRα promoter region were determined by quantitative methylation-specific polymerase chain reaction. Serum high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol (TC) and fasting plasma-glucose (FPG) were measured. Results: The ESRα promoter methylation levels were negatively associated with HDL-C levels whether gender stratification was performed (P < 0.05) and positively correlated with LDL-C in men (P < 0.05). Each unit standard deviation (SD) increment in TG was associated with a 43% increase (95% CI: 1.25, 1.64) in the risks of T2DM in all participants, a 36% increase (95% CI: 1.13, 1.64) in the risks of T2DM in men and a 49% increase (95% CI: 1.21, 1.83) in the risks of T2DM in women. Furthermore, each SD increment in HDL-C was associated with a reduction of 25% (OR = 0.75, 95% CI: 0.58, 0.97) in the risks of T2DM in men, and the risk of T2DM in men may be more susceptible to HDL-C than that in women (P for interaction < 0.05). Additionally, we found that the risk of T2DM in participants with lower methylation levels (≤4.07%) were more susceptible to HDL-C (P for interaction < 0.05). Conclusions: These findings suggested that lipid metabolism was associated with ESRα promoter methylation levels and the risk of T2DM. Besides, the levels of ESRα promoter methylation and gender can modify the association of HDL-C and T2DM.
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Affiliation(s)
- Guoyu Zhou
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China.,Yellow River Institute for Ecological Protection & Regional Coordinated Development, Zhengzhou University, Zhengzhou, China
| | - Lihua Liu
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xing Li
- Department of Nutrition and Food Health, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiangbo Hou
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ling Wang
- Department of Nutrition and Food Health, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Renjie Sun
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hui Huang
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhiyuan Li
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wenjie Li
- Department of Nutrition and Food Health, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yue Ba
- Department of Environment Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, China.,Yellow River Institute for Ecological Protection & Regional Coordinated Development, Zhengzhou University, Zhengzhou, China
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Jin Q, Zhu Q, Wang K, Chen M, Li X. Allisartan isoproxil attenuates oxidative stress and inflammation through the SIRT1/Nrf2/NF‑κB signalling pathway in diabetic cardiomyopathy rats. Mol Med Rep 2021; 23:215. [PMID: 33495841 PMCID: PMC7845586 DOI: 10.3892/mmr.2021.11854] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Allisartan isoproxil is a new nonpeptide angiotensin II receptor blocker (ARB) precursor drug that is used to treat hypertension and reduce the risk of heart disease. The present study explored the effects of allisartan isoproxil on diabetic cardiomyopathy (DCM) and revealed the roles of hyperglycaemia-induced oxidative stress and inflammation. A rat DCM model was established by high-fat diet feeding in combination with intraperitoneal injection of streptozocin. Echocardiographs showed that diabetic rats exhibited significantly decreased cardiac function. Troponin T (cTnT) and B-type natriuretic peptide (BNP) were significantly increased in DCM rats as obtained by ELISA. Allisartan isoproxil significantly improved the EF% and E™/A™ ratio. Histopathologic staining showed that allisartan isoproxil prevented histological alterations, attenuated the accumulation of collagen, and ameliorated cTnT and BNP levels. Western blot and immunohistochemical results indicated that the expression levels of silent information regulator 2 homologue 1 (SIRT1) and nuclear factor erythroid 2-related factor 2 (Nrf2) were decreased in the hearts of diabetic rats, and antioxidant defences were also decreased. In addition, allisartan isoproxil decreased the expression of NF-κB p65 and the inflammatory cytokines TNF-α and IL-1β which were determined by reverse transcription-quantitative PCR in the diabetic heart. Western blotting and TUNEL staining results also showed that cardiac Bax and cleaved caspase-3 and the number of apoptotic myocardial cells were increased in the diabetic heart and decreased following treatment with allisartan isoproxil. In conclusion, the present results indicated that allisartan isoproxil alleviated DCM by attenuating diabetes-induced oxidative stress and inflammation through the SIRT1/Nrf2/NF-κB signalling pathway.
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Affiliation(s)
- Qinyang Jin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Qin Zhu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang 310007, P.R. China
| | - Kai Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mengli Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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20
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McKinley CE, Roh S, Lee YS. American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2021; 18:32-48. [PMID: 32780658 PMCID: PMC7790549 DOI: 10.1080/26408066.2020.1799648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The top causes of death for American Indians (AIs), including heart and liver disease, are associated with alcohol use. Using the culturally based Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this article was to examine AI alcohol use from a sex-specific wellness approach, exploring its associated physical, behavioral, and mental risk and protective factors. METHOD Data were drawn from a cross-sectional survey with 479 AI adults in South Dakota. We employed a series of multiple hierarchical regression analyses to assess the associations of demographic (sex, age, marital status, income, and educational attainment), physical (Body Mass Index and cardiovascular risk), behavioral (smoking and health self-efficacy) and mental (depressive symptoms) factors with alcohol use. RESULTS Results indicated that surveyed males tended to drink three times that of females, and depressive symptoms were associated with higher levels of alcohol use. DISCUSSION This study highlights the need to examine AI alcohol use with sex in mind.
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Affiliation(s)
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, 365 Health Science Center, Sioux Falls, SD, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, USA
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21
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Seghieri G, De Bellis A, Seghieri M, Gualdani E, Policardo L, Franconi F, Francesconi P. Gender Difference in the Risk of Adverse Outcomes After Diabetic Foot Disease: A Mini-Review. Curr Diabetes Rev 2021; 17:207-213. [PMID: 32674734 DOI: 10.2174/1573399816666200716195600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022]
Abstract
Diabetic foot disease (DFD) is a complication of diabetes mellitus, characterized by multiple pathogenetic factors, bearing a very high burden of disability as well as of direct and indirect costs for individuals or healthcare systems. A further characteristic of DFD is that it is associated with a marked risk of subsequent hospitalizations for incident cardiovascular events, chronic renal failure or of allcause mortality. Additionally, DFD is strongly linked to the male sex, being much more prevalent among men. However, even if DFD mainly affects males, several past reports suggest that females are disadvantaged as regards the risk of subsequent adverse outcomes. This review aims to clarify this point, attempting to provide an explanation for this apparent oddity: being DFD a typically male complication of diabetes but, seemingly, with a greater load of subsequent consequences for females.
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Affiliation(s)
| | - Alessandra De Bellis
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Marta Seghieri
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | | | | | - Flavia Franconi
- National Laboratory of Gender Medicine and Gender Pharmacology of National Institute of Biostructures and Biosystems, University of Sassari, Italy
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22
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Sex and gender aspects in vascular pathophysiology. Clin Sci (Lond) 2020; 134:2203-2207. [PMID: 32844996 DOI: 10.1042/cs20200876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease (CVD) is a leading cause of global mortality in men and women. The prevalence, pathophysiology, clinical manifestations and outcomes of CVD observed in these two populations is being increasingly recognized as distinct. In this editorial, we provide an overview of mechanisms related to differences in vascular pathophysiology between men and women and explore the contributions of both sex and gender.
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23
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Succurro E, Fiorentino TV, Miceli S, Perticone M, Sciacqua A, Andreozzi F, Sesti G. Relative Risk of Cardiovascular Disease Is Higher in Women With Type 2 Diabetes, but Not in Those With Prediabetes, as Compared With Men. Diabetes Care 2020; 43:3070-3078. [PMID: 32998991 DOI: 10.2337/dc20-1401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Most but not all studies suggest that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in women with prediabetes compared with men with prediabetes. RESEARCH DESIGN AND METHODS In a cross-sectional study, in 3,540 adults with normal glucose tolerance (NGT), prediabetes, and diabetes, we compared the RR for prevalent nonfatal CVD between men and women. In a longitudinal study including 1,658 adults with NGT, prediabetes, and diabetes, we compared the RR for incidences of major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events, after 5.6 years of follow-up. RESULTS Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, hs-CRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in women with diabetes (RR 9.29; 95% CI 4.73-18.25; P < 0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P < 0.0001), but no difference in RR for CVD was observed comparing women and men with prediabetes. In the longitudinal study, we found that women with diabetes, but not those with prediabetes, have higher RR (RR 5.25; 95% CI 3.22-8.56; P < 0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P < 0.0001). CONCLUSIONS This study suggests that women with diabetes, but not those with prediabetes, have higher RR for prevalent and incident major adverse outcomes than men.
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Affiliation(s)
- Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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24
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Ohkuma T, Peters SAE, Jun M, Harrap S, Cooper M, Hamet P, Poulter N, Chalmers J, Woodward M. Sex-specific associations between cardiovascular risk factors and myocardial infarction in patients with type 2 diabetes: The ADVANCE-ON study. Diabetes Obes Metab 2020; 22:1818-1826. [PMID: 32476250 DOI: 10.1111/dom.14103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
AIM To examine possible sex differences in the excess risk of myocardial infarction (MI) consequent to a range of conventional risk factors in a large-scale international cohort of patients with diabetes, and to quantify these potential differences both on the relative and absolute scales. MATERIALS AND METHODS Eleven thousand and sixty-five participants (42% women) with type 2 diabetes in the ADVANCE trial and its post-trial follow-up study, ADVANCE-ON, were included. Cox regression models were used to estimate hazard ratios (HRs) for associations between risk factors and MI (fatal and non-fatal) by sex, and the women-to-men ratio of HRs (RHR). RESULTS Over a median of 9.6 years of follow-up, 719 patients experienced MI. Smoking status, smoking intensity, higher systolic blood pressure (SBP), HbA1c, total and LDL cholesterol, duration of diabetes, triglycerides, body mass index (BMI) and lower HDL cholesterol were associated with an increased risk of MI in both sexes. Furthermore, some variables were associated with a greater relative risk of MI in women than men: RHRs were 1.75 (95% CI: 1.05-2.91) for current smoking, 1.53 (1.00-2.32) for former smoking, 1.18 (1.02-1.37) for SBP, and 1.13 (95% CI, 1.003-1.26) for duration of diabetes. Although incidence rates of MI were higher in men (9.3 per 1000 person-years) compared with women (5.8 per 1000 person-years), rate differences associated with risk factors were greater in women than men, except for HDL cholesterol and BMI. CONCLUSIONS In patients with type 2 diabetes, smoking, higher SBP and longer duration of diabetes had a greater relative and absolute effect in women than men, highlighting the importance of routine sex-specific approaches and early interventions in women with diabetes.
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Affiliation(s)
- Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Harrap
- Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Cooper
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Pavel Hamet
- Center de Recherche, Center Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Neil Poulter
- International Center for Circulatory Health, Imperial College, London, UK
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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25
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Perrino C, Ferdinandy P, Bøtker HE, Brundel BJJM, Collins P, Davidson SM, den Ruijter HM, Engel FB, Gerdts E, Girao H, Gyöngyösi M, Hausenloy DJ, Lecour S, Madonna R, Marber M, Murphy E, Pesce M, Regitz-Zagrosek V, Sluijter JPG, Steffens S, Gollmann-Tepeköylü C, Van Laake LW, Van Linthout S, Schulz R, Ytrehus K. Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart. Cardiovasc Res 2020; 117:367-385. [PMID: 32484892 DOI: 10.1093/cvr/cvaa155] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/29/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.
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Affiliation(s)
- Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary.,Pharmahungary Group, Hajnoczy str. 6., H-6722 Szeged, Hungary
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam, 1108 HV, the Netherlands
| | - Peter Collins
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, South Kensington Campus, London SW7 2AZ, UK.,Royal Brompton Hospital, Sydney St, Chelsea, London SW3 6NP, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, WC1E 6HX London, UK
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Muscle Research Center Erlangen (MURCE), Schwabachanlage 12, 91054 Erlangen, Germany
| | - Eva Gerdts
- Department for Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Henrique Girao
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548 Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, and Clinical Academic Centre of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228, Singapore.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Chris Barnard Building, University of Cape Town, Private Bag X3 7935 Observatory, Cape Town, South Africa
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Lungarno Antonio Pacinotti 43, 56126 Pisa, Italy.,Department of Internal Medicine, University of Texas Medical School in Houston, 6410 Fannin St #1014, Houston, TX 77030, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Elizabeth Murphy
- Laboratory of Cardiac Physiology, Cardiovascular Branch, NHLBI, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS Via Parea, 4, I-20138 Milan, Italy
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender in Medicine, Center for Cardiovascular Research, DZHK, partner site Berlin, Geschäftsstelle Potsdamer Str. 58, 10785 Berlin, Germany.,University of Zürich, Rämistrasse 71, 8006 Zürich, Germany
| | - Joost P G Sluijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands.,Circulatory Health Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Pettenkoferstr. 9, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Can Gollmann-Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstr.35, A - 6020 Innsbruck, Austria
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Ludwigstraße 23, 35390 Giessen, Germany
| | - Kirsti Ytrehus
- Department of Medical Biology, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9037 Tromsø, Norway
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Burnette CE, Ka'apu K, Scarnato JM, Liddell J. Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:24-48. [PMID: 32133411 PMCID: PMC7055486 DOI: 10.1080/26408066.2019.1617817] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
PURPOSE The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples. METHODS A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n= 15; Sociocultural, n =17; Behavioral/Physical, n =19). RESULTS This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment-including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors. DISCUSSION Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.
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Affiliation(s)
| | | | | | - Jessica Liddell
- City, Culture, & Community Doctoral Program, Tulane University
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27
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Huyser KR, Rockell J, Jernigan VBB, Taniguchi T, Wilson C, Manson SM, O'Connell J. Sex Differences in Diabetes Prevalence, Comorbidities, and Health Care Utilization among American Indians Living in the Northern Plains. Curr Dev Nutr 2020; 4:42-48. [PMID: 32258998 PMCID: PMC7101481 DOI: 10.1093/cdn/nzz089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/21/2019] [Accepted: 07/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease (CVD). Owing to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the NHANES. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions. OBJECTIVE We examined the sex differences in diabetes prevalence, comorbidity experience, health care utilization, and treatment costs among AIs within a Northern Plains Indian Health Service (IHS) service unit. METHODS We assessed data from a sample of 11,144 persons using an IHS service unit in the Northern Plains region of the United States. Detailed analyses were conducted for adults (n = 7299) on prevalence of diabetes by age and sex. We described sex differences in comorbidities, health care utilization, and treatment costs among the adults with diabetes. RESULTS In our sample, adult men and women had a similar prevalence of diabetes (10.0% and 11.0%, respectively). The prevalence of CVD among men and women with diabetes was 45.7% and 34.0%, respectively. Among adults with diabetes, men had a statistically higher prevalence of hypertension and substance use disorders than women. The men were statistically less likely to have a non-substance use mental health disorder. Although men had higher utilization and costs for hospital inpatient services than women, the differences were not statistically significant. CONCLUSIONS In this AI population, there were differences in comorbidity profiles between adult men and women with diabetes, which have differential mortality and cost consequences. Appropriate diabetes management addressing gender-specific comorbidities, such as substance use disorders for men and non-substance use mental health disorders for women, may help reduce additional comorbidities or complications to diabetes.
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Affiliation(s)
- Kimberly R Huyser
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | | | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Al-Shamsi S, Govender RD, Soteriades ES. Mortality and potential years of life lost attributable to non-optimal glycaemic control in men and women with diabetes in the United Arab Emirates: a population-based retrospective cohort study. BMJ Open 2019; 9:e032654. [PMID: 31501134 PMCID: PMC6738721 DOI: 10.1136/bmjopen-2019-032654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Numerous studies reported that achieving near-normal glycated haemoglobin (HbA1c) levels in patients with diabetes may delay or even prevent vascular complications. However, information regarding the impact of non-optimal HbA1c control on adverse health outcomes in an Arab population is unknown. The aim of this study was to estimate the fraction of deaths and potential years of life lost (PYLL) attributable to non-optimal HbA1c control among Emirati men and women with diabetes in the United Arab Emirates (UAE). DESIGN A retrospective cohort study. SETTING This study was conducted in outpatient clinics at a tertiary care centre in Al Ain, UAE, between April 2008 and September 2018. PARTICIPANTS The sample comprised of 583 adult UAE nationals, aged≥18 years, with diabetes. Overall, 57% (n=332) of the study participants were men and 43% (n=251) were women. EXPOSURE Non-optimal HbA1c control, defined as HbA1c≥6.5%. PRIMARY OUTCOME MEASURE All-cause mortality, defined as death from any cause. RESULTS At the end of the 9-year follow-up period, 86 (14.8%) participants died. Overall, up to 33% (95% CI 2% to 63%) of deaths were attributable to non-optimal HbA1c control among patients with diabetes mellitus (DM). Stratified by sex, the adjusted fraction of avoidable mortality was 17% (95% CI -23% to 57%) for men and 50% (95% CI 3% to 98%) for women. Both deaths and PYLL attributable to non-optimal HbA1c control were higher in women compared with men. CONCLUSIONS Up to one-third of all deaths in adult UAE nationals with DM could be attributed to non-optimal HbA1c control. Effective sex-specific interventions and healthcare quality-improvement programmes should urgently be implemented.
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Affiliation(s)
- Saif Al-Shamsi
- Internal Medicine, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Romona Devi Govender
- Family Medicine, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Elpidoforos S Soteriades
- Institute of Public Health, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, United Arab Emirates
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Affiliation(s)
- O. D. Ostroumova
- I.M. Sechenov First Moscow State Medical University; Russian Clinical and Research Center of Gerontology
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Ohkuma T, Komorita Y, Peters SAE, Woodward M. Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals. Diabetologia 2019; 62:1550-1560. [PMID: 31317230 PMCID: PMC6677875 DOI: 10.1007/s00125-019-4926-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference. METHODS A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes. RESULTS Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13). CONCLUSIONS/INTERPRETATION The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes. PROSPERO registration: CRD42019135246.
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Affiliation(s)
- Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.
| | - Yuji Komorita
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK.
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
- The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Natsis M, Antza C, Doundoulakis I, Stabouli S, Kotsis V. Hypertension in Obesity: Novel Insights. Curr Hypertens Rev 2019; 16:30-36. [PMID: 30987571 DOI: 10.2174/1573402115666190415154603] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND The relationship between obesity and hypertension has been established in both adults and children. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the likelihood of adverse cardiovascular effects and raises concerns about aggressive treatment strategies. OBJECTIVE Despite the impressive elements which indicate an important role for excessive weight gain in increasing blood pressure, not all obese patients are hypertensive. A subgroup of obese people may not develop hypertension. Furthermore, masked hypertension occurs more common among obese patients, and body fat distribution has a major role in the development of hypertension. METHOD We conducted a research of the relevant literature regarding obesity-induced hypertension and possible treatment strategies. RESULTS Successful weight loss is correlated with blood pressure reduction and requires a multidisciplinary approach that includes personalized dietary interventions combined with regular exercise and cognitive behavioral therapy. CONCLUSION Pharmacological therapy may be considered as part of a comprehensive obesity management strategy. More research and new treatment therapies are required in this field.
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Affiliation(s)
- Michail Natsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Doundoulakis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Stabouli
- 1st Department of Pediatrics, Hippokration Hospital, Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Boulet MM, Cheillan D, Di Filippo M, Buisson C, Michalski MC, Moulin P, Calzada C. Large triglyceride-rich lipoproteins from fasting patients with type 2 diabetes activate platelets. DIABETES & METABOLISM 2019; 46:54-60. [PMID: 30981822 DOI: 10.1016/j.diabet.2019.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 01/06/2023]
Abstract
AIMS Type 2 diabetes (T2D) patients present with risk factors for atherothrombosis such as fasting hypertriglyceridaemia and platelet hyperactivity. Our study objective was to determine the effect of large triglyceride-rich lipoproteins (TGRL) from fasting T2D patients on platelet aggregation and, if any, to identify the signaling pathway involved. METHODS Large TGRL were isolated from the plasma of 25 T2D patients by ultracentrifugation (density < 1.000 g/mL). Platelets were isolated from healthy blood donors (HBD) and suspended in buffer, then preincubated in the presence or absence of TGRL and stimulated with either collagen or thrombin. Platelet aggregation and the arachidonic acid (AA) signaling pathway were studied. RESULTS Fasting T2D large TGRL were mostly of hepatic origin (apoB100/apoB48 ratio: 42 ± 7) and rich in triglycerides (TG/total apoB ratio: 4.2 ± 0.5), and able to potentiate agonist-stimulated platelet aggregation (collagen: +68%, P < 0.05; thrombin: +771%, P < 0.05). It should also be mentioned that TGRL from the plasma of HBD (n = 7) had no effect on platelet aggregation. In addition, T2D large TGRL increased thromboxane B2 (TxB2) concentration in platelets stimulated with either collagen (+34%, P < 0.05) or thrombin (+37%, P < 0.05) compared with platelets stimulated with either of these agonists without TGRL. Phosphorylation of p38 MAPK and cytosolic phospholipase A2 (cPLA2) was enhanced after incubation of platelets with T2D TGRL and thrombin (+87% and +32%, respectively, P < 0.05) compared with platelets incubated with thrombin only. CONCLUSION Large TGRL from fasting T2D patients may play a role in the development of atherothrombosis by increasing platelet aggregation and activating the platelet AA signaling pathway.
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Affiliation(s)
- M M Boulet
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France
| | - D Cheillan
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France; Laboratoire de biochimie et de biologie moléculaire Grand Est, centre de biologie et de pathologie Est, hospices civils de Lyon, 69677 Bron, France
| | - M Di Filippo
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France; Laboratoire de biochimie et de biologie moléculaire Grand Est, centre de biologie et de pathologie Est, hospices civils de Lyon, 69677 Bron, France
| | - C Buisson
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France
| | - M-C Michalski
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France
| | - P Moulin
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France; Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, hôpital Louis-Pradel, hospices civils de Lyon, 69677 Bron, France
| | - C Calzada
- Université-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, université Claude-Bernard Lyon 1, IMBL, 69621 Villeurbanne, France.
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Al-Salameh A, Chanson P, Bucher S, Ringa V, Becquemont L. Cardiovascular Disease in Type 2 Diabetes: A Review of Sex-Related Differences in Predisposition and Prevention. Mayo Clin Proc 2019; 94:287-308. [PMID: 30711127 DOI: 10.1016/j.mayocp.2018.08.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes mellitus is a major risk factor for cardiovascular disease. However, compiled data suggest that type 2 diabetes affects the risk of cardiovascular disease differentially according to sex. In recent years, large meta-analyses have confirmed that women with type 2 diabetes have a higher relative risk of incident coronary heart disease, fatal coronary heart disease, and stroke compared with their male counterparts. The reasons for these disparities are not completely elucidated. A greater burden of cardiometabolic risk in women was proposed as a partial explanation. Indeed, several studies suggest that women experience a larger deterioration in major cardiovascular risk factors and put on more weight than do men during their transition from normoglycemia to overt type 2 diabetes. This excess weight is associated with higher levels of biomarkers of endothelial dysfunction, inflammation, and procoagulant state. Moreover, sex differences in the prescription and use of some cardiovascular drugs may compound an "existing" disparity. We searched PubMed for articles published in English and French, by using the following terms: ("cardiovascular diseases") AND ("diabetes mellitus") AND ("sex disparity" OR "sex differences" OR "sex related differences" OR "sex-related differences" OR "sex disparities"). In this article, we review the available literature on the sex aspects of primary and secondary prevention of cardiovascular disease in people with type 2 diabetes, in the predisposition to cardiovascular disease in those people, and in the control of diabetes and associated cardiovascular risk factors.
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Affiliation(s)
- Abdallah Al-Salameh
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Centre de Recherche Clinique Paris-Sud, Le Kremlin-Bicêtre, France.
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France; Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM U1185, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Bucher
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; General Practice Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Virginie Ringa
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France
| | - Laurent Becquemont
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Centre de Recherche Clinique Paris-Sud, Le Kremlin-Bicêtre, France; Pharmacology Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
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Madonna R, Balistreri CR, De Rosa S, Muscoli S, Selvaggio S, Selvaggio G, Ferdinandy P, De Caterina R. Impact of Sex Differences and Diabetes on Coronary Atherosclerosis and Ischemic Heart Disease. J Clin Med 2019; 8:jcm8010098. [PMID: 30654523 PMCID: PMC6351940 DOI: 10.3390/jcm8010098] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVD) including coronary artery disease (CAD) and ischemic heart disease (IHD) are the main cause of mortality in industrialized countries. Although it is well known that there is a difference in the risk of these diseases in women and men, current therapy does not consider the sexual dimorphism; i.e., differences in anatomical structures and metabolism of tissues. Here, we discuss how genetic, epigenetic, hormonal, cellular or molecular factors may explain the different CVD risk, especially in high-risk groups such as women with diabetes. We analyze whether sex may modify the effects of diabetes at risk of CAD. Finally, we discuss current diagnostic techniques in the evaluation of CAD and IHD in diabetic women.
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Affiliation(s)
- Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine-CESI-MeT, Institute of Cardiology, "G. d'Annunzio" University, Via dei Vestini 31, 66100 Chieti, Italy.
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, 77065 TX, USA.
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy.
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, 00133 Rome, Italy.
| | - Stefano Selvaggio
- Geriatric Division, A.R.N.A.S. Ospedale "Garibaldi" Nesima, 95122 Catania, Italy.
| | | | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
- Pharmahungary Group, 6722 Szeged, Hungary.
| | - Raffaele De Caterina
- Institute of Cardiology, University of Pisa, C/o Ospedale di Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
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Aderibigbe MA, Obafemi TO, Olaleye MT, Akinmoladun AC. Effects of gender, age and treatment duration on lipid profile and renal function indices in diabetic patients attending a teaching hospital in South-Western Nigeria. Afr Health Sci 2018; 18:900-908. [PMID: 30766553 PMCID: PMC6354870 DOI: 10.4314/ahs.v18i4.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 Diabetes Mellitus (T2DM) is associated with diabetic nephropathy and hyperlipidemia. Gender, age, medication adherence, lifestyle, culture and socioeconomic status could be sources of diversity in T2DM leading to differences in predisposition, development and clinical presentation. Objectives Therefore, this study aimed to investigate the influence of gender, age and treatment duration on kidney and lipid-related biochemical indices of T2DM patients attending Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria (EKSUTH). Methods Blood from diabetic patients and healthy subjects was analysed for fasting blood glucose (FBG), renal function parameters and lipid profile. Influence of age, gender and treatment duration on indices was assessed using standard baseline values. Results Dyslipidemia was pronounced among female diabetics while the incidence of diabetes was found to be higher in middle-age. The percentage of diabetics with high levels of FPG, urea, creatinine, cholesterol, triglyceride and low density lipoprotein-cholesterol after 9–10 years of treatment were lower compared with the percentage after 5–6 years of treatment. Conclusion Gender, age and treatment duration influenced clinical course of T2DM among patients presenting at EKSUTH but long term treatment appeared to improve T2DM among patients.
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Bajwa EI, Malik S. Debunking the Myth of Diabetes Mellitus as Cardiovascular Disease Equivalent: What Took So Long? CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Strand LB, Tsai MK, Wen CP, Chang SS, Brumpton BM. Is having asthma associated with an increased risk of dying from cardiovascular disease? A prospective cohort study of 446 346 Taiwanese adults. BMJ Open 2018; 8:e019992. [PMID: 29858410 PMCID: PMC5988076 DOI: 10.1136/bmjopen-2017-019992] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES A significant proportion of cardiovascular disease (CVD) cannot be explained by well-known risk factors such as high cholesterol, hypertension and diabetes. One potential novel risk factor for CVD is asthma. We aimed to investigate the association between asthma and mortality due to CVD. DESIGN Prospective cohort study. SETTING A large health check-up programme from 1994 to 2011 in Taipei, Taiwan. PARTICIPANTS 446 346 Taiwanese adults. Each participant answered questions regarding asthma history (yes/no) and current daily use of asthma medications (yes/no). Active asthma was defined as those using current daily medications for asthma. OUTCOMES The participants were followed for mortality from CVD, coronary heart disease (CHD) and stroke obtained through linkage to the cause-of-death register until 31 December 2011. RESULTS We found an increased risk of dying from CVD in individuals with active asthma (adjusted HR (aHR) 1.32, 95% CI 1.08 to 1.62). The risk of death from CHD or stroke was increased in a similar manner (aHR 1.16, 95% CI 0.78 to 1.73 and aHR 1.23, 95% CI 0.86 to 1.74, respectively) although the HR estimates were less precise than that of CVD. For deaths from CVD, CHD and stroke, we found stronger associations with active asthma than non-active asthma, and for CVD and stroke stronger associations in men than women. CONCLUSION Our study suggests that asthma, particularly active asthma, may be associated with adverse cardiovascular consequences.
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Affiliation(s)
- Linn Beate Strand
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Min Kuang Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
- China Medical University Hospital, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chi Pang Wen
- China Medical University Hospital, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Ben M Brumpton
- Department of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Marumo M, Ebara S, Nishibe I, Soneda JI, Wakabayashi I. Relationships of Age and Gender with Ankle-brachial Systolic Pressure Index and Cardio-ankle Vascular Index in Patients with Diabetes Mellitus. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wan EYF, Fong DYT, Fung CSC, Yu EYT, Chin WY, Chan AKC, Lam CLK. Development of a cardiovascular diseases risk prediction model and tools for Chinese patients with type 2 diabetes mellitus: A population-based retrospective cohort study. Diabetes Obes Metab 2018; 20:309-318. [PMID: 28722290 DOI: 10.1111/dom.13066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023]
Abstract
AIMS Evidence-based cardiovascular diseases (CVD) risk prediction models and tools specific for Chinese patients with type 2 diabetes mellitus (T2DM) are currently unavailable. This study aimed to develop and validate a CVD risk prediction model for Chinese T2DM patients. METHODS A retrospective cohort study was conducted with 137 935 Chinese patients aged 18 to 79 years with T2DM and without prior history of CVD, who had received public primary care services between January 1, 2010 and December 31, 2010. Using the derivation cohort over a median follow-up of 5 years, the interaction effect between predictors and age were derived using Cox proportional hazards regression with a forward stepwise approach. Harrell's C statistic and calibration plot were used on the validation cohort to assess the discrimination and calibration of the models. The web calculator and chart were developed based on the developed models. RESULTS For both genders, predictors for higher risk of CVD were older age, smoking, longer diabetes duration, usage of anti-hypertensive drug and insulin, higher body mass index, haemoglobin A1c (HbA1c), systolic and diastolic blood pressure, a total cholesterol to high-density lipoprotein-cholesterol (TC/HDL-C) ratio and urine albumin to creatinine ratio, and lower estimated glomerular filtration rate. Interaction factors with age demonstrated a greater weighting of TC/HDL-C ratio in both younger females and males, and smoking status and HbA1c in younger males. CONCLUSION The developed models, translated into a web calculator and color-coded chart, served as evidence-based visual aids that facilitate clinicians to estimate quickly the 5-year CVD risk for Chinese T2DM patients and to guide intervention.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
- Department of Surgery, School of Nursing, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Daniel Yee Tak Fong
- Department of Surgery, School of Nursing, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
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Read SH, McAllister DA, Colhoun HM, Farran B, Fischbacher C, Kerssens JJ, Leese GP, Lindsay RS, McCrimmon RJ, McGurnaghan S, Philip S, Sattar N, Wild SH. Incident ischaemic stroke and Type 2 diabetes: trends in incidence and case fatality in Scotland 2004-2013. Diabet Med 2018; 35:99-106. [PMID: 29044687 DOI: 10.1111/dme.13528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
AIM To describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013. METHODS Using population-wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year-specific incidence and case-fatality rates for people with Type 2 diabetes and for people without diabetes. RESULTS During 41.0 million person-years of follow-up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case-fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)]. CONCLUSIONS Ischaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future.
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Affiliation(s)
- S H Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - D A McAllister
- Institutes of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - B Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Fischbacher
- Information Services Division, NHS National Services, Edinburgh, UK
| | - J J Kerssens
- Information Services Division, NHS National Services, Edinburgh, UK
| | - G P Leese
- Department of Diabetes and Endocrinology, University of Dundee, Dundee, UK
| | - R S Lindsay
- Institutes of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - S McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S Philip
- Department of Diabetes and Endocrinology, NHS Grampian, Aberdeen, UK
| | - N Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Wan EYF, Fong DYT, Fung CSC, Yu EYT, Chin WY, Chan AKC, Lam CLK. Classification Rule for 5-year Cardiovascular Diseases Risk using decision tree in Primary Care Chinese Patients with Type 2 Diabetes Mellitus. Sci Rep 2017; 7:15238. [PMID: 29127341 PMCID: PMC5681694 DOI: 10.1038/s41598-017-15579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease(CVD) is the leading cause of mortality among patients with type 2 diabetes mellitus(T2DM), and a risk classification model for CVD among primary care diabetic patients is pivotal for risk-based interventions and patient information. This study developed a simple tool for a 5-year CVD risk prediction for primary care Chinese patients with T2DM. A retrospective cohort study was conducted on 137,935 primary care Chinese T2DM patients aged 18-79 years without history of CVD between 1 January 2010 and 31 December 2010. New events of CVD of the cohort over a median follow up of 5 years were extracted from the medical records. A classification rule of 5-year CVD risk was obtained from the derivation cohort and validated in the validation cohort. Significant risk factors included in decision tree were age, gender, smoking status, diagnosis duration, obesity, unsatisfactory control on haemoglobin A1c and cholesterol, albuminuria and stage of chronic kidney disease, which categorized patients into five 5-year CVD risk groups(<5%; 5-9%; 10-14%; 15-19% and ≥20%). Taking the group with the lowest CVD risk, the hazard ratios varied from 1.92(1.77,2.08) to 8.46(7.75,9.24). The present prediction model performed comparable discrimination and better calibration from the plot compared to other current existing models.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | | | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
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42
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Dong X, Cai R, Sun J, Huang R, Wang P, Sun H, Tian S, Wang S. Diabetes as a risk factor for acute coronary syndrome in women compared with men: a meta-analysis, including 10 856 279 individuals and 106 703 acute coronary syndrome events. Diabetes Metab Res Rev 2017; 33. [PMID: 28103417 DOI: 10.1002/dmrr.2887] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 09/17/2016] [Accepted: 01/16/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diabetes mellitus is a significant cause of death and disability worldwide and is a strong risk factor for acute coronary syndrome (ACS). Whether diabetes confers the same excess risk of ACS in both sexes is unknown. Therefore, we undertook a meta-analysis to estimate the relative risk (RR) for ACS associated with diabetes in men and women. METHODS We systematically searched PubMed, Embase, and Cochrane Library databases for both case-control and cohort studies published between January 1, 1966, and January 1, 2015. Studies were included if they reported sex-specific estimates of the RR, hazard ratio, or odds ratio for the association between diabetes and ACS. We pooled the sex-specific RR and the ratio between women and men using a random-effect model with inverse-variance weighting. RESULTS We included 9 case-control and 10 cohort studies with data for 10 856 279 individuals and at least 106 703 fatal and nonfatal ACS events. The pooled maximum-adjusted RR of ACS associated with diabetes was 2.46 (95% CI, 1.92-3.17) in women and 1.68 (95% CI, 1.39-2.04) in men. In patients with diabetes compared with those without diabetes, women had a significantly greater risk of ACS-the pooled women-to-men RR and the ratio of relative risks was 1.38 (95% CI, 1.25-1.52; P < .001), with no evidence of publication bias. CONCLUSIONS The excess risk of ACS associated with diabetes is significantly higher in women than in men. This finding may be explained by more adverse cardiovascular risk profiles and suggests that further work is needed to clarify the relevant biological, behavioural, and social mechanisms.
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Affiliation(s)
- Xue Dong
- Department of Endocrinology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Rongrong Cai
- Medical School of Southeast University, Nanjing, China
| | - Jie Sun
- Medical School of Southeast University, Nanjing, China
| | - Rong Huang
- Medical School of Southeast University, Nanjing, China
| | - Pin Wang
- Medical School of Southeast University, Nanjing, China
| | - Haixia Sun
- Medical School of Southeast University, Nanjing, China
| | - Sai Tian
- Medical School of Southeast University, Nanjing, China
| | - Shaohua Wang
- Department of Endocrinology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
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43
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Wakabayashi I. Gender differences in cardiovascular risk factors in patients with coronary artery disease and those with type 2 diabetes. J Thorac Dis 2017; 9:E503-E506. [PMID: 28616322 DOI: 10.21037/jtd.2017.04.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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44
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Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol 2017; 6:8-16. [PMID: 31646113 PMCID: PMC6768526 DOI: 10.1097/xce.0000000000000116] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
As one of the leading causes of death in the USA, diabetes mellitus (DM) has become an epidemic over the past few decades. Despite the high prevalence of diagnosed DM, close to half of all people with DM are unaware of their disease. The risk of type 2 DM is determined by interplay of genetic and metabolic factors. Patients with type 2 DM have a higher risk of death from cardiovascular causes compared with their nondiabetic counterparts, and the mortality rate of DM associated cardiovascular disease is different among ethnicity groups and sex groups. Because of its adverse effect on people's health, DM also imposes an economic burden on individuals and households affected, as well as on the healthcare system. Current guidelines for cardiovascular disease prevention have focused on lifestyle management, blood pressure control, lipid control, blood glucose control, antiplatelet agent use, and tobacco use cessation.
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Affiliation(s)
- Wenjun Fan
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California, USA
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45
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Habibi J, Aroor AR, Sowers JR, Jia G, Hayden MR, Garro M, Barron B, Mayoux E, Rector RS, Whaley-Connell A, DeMarco VG. Sodium glucose transporter 2 (SGLT2) inhibition with empagliflozin improves cardiac diastolic function in a female rodent model of diabetes. Cardiovasc Diabetol 2017; 16:9. [PMID: 28086951 PMCID: PMC5237274 DOI: 10.1186/s12933-016-0489-z] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/25/2016] [Indexed: 01/08/2023] Open
Abstract
Obese and diabetic individuals are at increased risk for impairments in diastolic relaxation and heart failure with preserved ejection fraction. The impairments in diastolic relaxation are especially pronounced in obese and diabetic women and predict future cardiovascular disease (CVD) events in this population. Recent clinical data suggest sodium glucose transporter-2 (SGLT2) inhibition reduces CVD events in diabetic individuals, but the mechanisms of this CVD protection are unknown. To determine whether targeting SGLT2 improves diastolic relaxation, we utilized empagliflozin (EMPA) in female db/db mice. Eleven week old female db/db mice were fed normal mouse chow, with or without EMPA, for 5 weeks. Blood pressure (BP), HbA1c and fasting glucose were significantly increased in untreated db/db mice (DbC) (P < 0.01). EMPA treatment (DbE) improved glycemic indices (P < 0.05), but not BP (P > 0.05). At baseline, DbC and DbE had already established impaired diastolic relaxation as indicated by impaired septal wall motion (>tissue Doppler derived E'/A' ratio) and increased left ventricular (LV) filling pressure (<E/E' ratio). Although these abnormalities persisted throughout the study period in DbC, diastolic function improved with EMPA treatment. In DbC, myocardial fibrosis was accompanied by increased expression of profibrotic/prohypertrophic proteins, serum/glucocorticoid regulated kinase 1 (SGK1) and the epithelial sodium channel (ENaC), and the development of these abnormalities were reduced with EMPA. DbC exhibited eccentric LV hypertrophy that was slightly improved by EMPA, indicated by a reduction in cardiomyocyte cross sectional area. In summary, EMPA improved glycemic indices along with diastolic relaxation, as well as SGK1/ENaC profibrosis signaling and associated interstitial fibrosis, all of which occurred in the absence of any changes in BP.
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Affiliation(s)
- Javad Habibi
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Annayya R Aroor
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - James R Sowers
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Department of Medical Pharmacology and Physiology, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA.,The Dalton Cardiovascular Research Center, Columbia, MO, USA
| | - Guanghong Jia
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Melvin R Hayden
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA
| | - Mona Garro
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Brady Barron
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Eric Mayoux
- Department of Cardiometabolic Diseases Research, Boehringer-Ingelheim, Biberach, Germany
| | - R Scott Rector
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA.,Departments of Medicine-Gastroenterology and Hepatology and Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Adam Whaley-Connell
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA.,Division of Nephrology, University of Missouri, School of Medicine, Columbia, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Vincent G DeMarco
- Department of Medicine, Division of Endocrinology, Diabetes and Cardiovascular Center, University of Missouri, School of Medicine, Columbia, USA. .,Department of Medical Pharmacology and Physiology, University of Missouri, School of Medicine, Columbia, USA. .,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA.
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46
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Policardo L, Seghieri G, Francesconi P, Anichini R, Franconi F, Del Prato S. Gender difference in diabetes related excess risk of cardiovascular events: When does the 'risk window' open? J Diabetes Complications 2017; 31:74-79. [PMID: 27746087 DOI: 10.1016/j.jdiacomp.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Women with diabetes have a greater excess risk for cardiovascular diseases (CVD) than men. This study was aimed at clarifying whether this effect is lifelong or more evident in some life-periods. METHODS The effect of diabetes and gender on the risk of first ever hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of these major cardiovascular events (MACE) have been evaluated by a Cox-hazard model, over years 2008-2012 querying administrative databases of a cohort living in Tuscany, Italy. RESULTS Comparing subjects with diabetes to those without it the overall age-adjusted excess risk was higher in women than in men for AMI and MACE and higher in men for LEA, with no difference for IS or CHF. In women the excess risk for AMI and MACE started earlier (46yr) and lasted until age of more than 85yr, while 'risk-windows' opened later and had a shorter duration for CHF (56-65yr) and IS (66-75yr). CONCLUSION Diabetic women have a significant diabetes-associated excess of CVD risk, except for LEA, with a 'risk window' opening earlier and lasting longer for AMI and MACE, later and with a shorter duration for IS and CHF.
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Affiliation(s)
| | - Giuseppe Seghieri
- Agenzia Regionale Sanità Toscana, Florence, Italy; Centre of Study for Gender Health, Pistoia, Italy.
| | | | | | - Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy and Laboratory of Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
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47
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Khavandi M, Duarte F, Ginsberg HN, Reyes-Soffer G. Treatment of Dyslipidemias to Prevent Cardiovascular Disease in Patients with Type 2 Diabetes. Curr Cardiol Rep 2017; 19:7. [PMID: 28132397 PMCID: PMC5503120 DOI: 10.1007/s11886-017-0818-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Current preventive and treatment guidelines for type 2 diabetes have failed to decrease the incidence of comorbidities, such as dyslipidemia and ultimately heart disease. The goal of this review is to describe the physiological and metabolic lipid alterations that develop in patients with type 2 diabetes mellitus. Questions addressed include the differences in lipid and lipoprotein metabolism that characterize the dyslipidemia of insulin resistance and type 2 diabetes mellitus. We also examine the relevance of the new AHA/ADA treatment guidelines to dyslipidemic individuals. RECENT FINDINGS In this review, we provide an update on the pathophysiology of diabetic dyslipidemia, including the role of several apolipoproteins such as apoC-III. We also point to new studies and new agents for the treatment of individuals with type 2 diabetes mellitus who need lipid therapies. Type 2 diabetes mellitus causes cardiovascular disease via several pathways, including dyslipidemia characterized by increased plasma levels of apoB-lipoproteins and triglycerides, and low plasma concentrations of HDL cholesterol. Treatments to normalize the dyslipidemia and reduce the risk for cardiovascular events include the following: lifestyle and medication, particularly statins, and if necessary, ezetimibe, to significantly lower LDL cholesterol. Other treatments, more focused on triglycerides and HDL cholesterol, are less well supported by randomized clinical trials and should be used on an individual basis. Newer agents, particularly the PCSK9 inhibitors, show a great promise for even greater lowering of LDL cholesterol, but we await the results of ongoing clinical trials.
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Affiliation(s)
- Maryam Khavandi
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Francisco Duarte
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Henry N Ginsberg
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Gissette Reyes-Soffer
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA.
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48
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Whittemore R, Melkus GD, Sullivan A, Grey M. A Nurse-Coaching Intervention for Women With Type 2 Diabetes. DIABETES EDUCATOR 2016; 30:795-804. [PMID: 15510531 DOI: 10.1177/014572170403000515] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this pilot study was to determine the efficacy of a 6-month nurse-coaching intervention that was provided after diabetes education for women with type 2 diabetes. METHODS In this pilot study, 53 women were randomized to the nurse-coaching intervention or a standard care control condition. The nurse-coaching intervention consisted of 5 individualized sessions and 2 follow-up phone calls over 6 months. The nurse-coaching sessions included educational, behavioral, and affective strategies. Data were collected on physiologic adaptation (hemoglobin A1c [A1C] and body mass index [BMI]), self-management (dietary and exercise), psychosocial adaptation (diabetes-related distress and integration), and treatment satisfaction at baseline, 3 months, and 6 months. RESULTS Women in the treatment group demonstrated better diet self-management, less diabetes-related distress, better integration, and more satisfaction with care, and had trends of better exercise self-management and BMI. The A1C levels improved in both groups at 3 months, yet the difference between the groups was not significant. Attendance at nurse-coaching sessions was 96%. CONCLUSIONS This nurse-coaching intervention demonstrates promise as a means of improving self-management and psychosocial outcomes in women with type 2 diabetes.
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49
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Padilla J, Ramirez-Perez FI, Habibi J, Bostick B, Aroor AR, Hayden MR, Jia G, Garro M, DeMarco VG, Manrique C, Booth FW, Martinez-Lemus LA, Sowers JR. Regular Exercise Reduces Endothelial Cortical Stiffness in Western Diet-Fed Female Mice. Hypertension 2016; 68:1236-1244. [PMID: 27572153 DOI: 10.1161/hypertensionaha.116.07954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
We recently showed that Western diet-induced obesity and insulin resistance promotes endothelial cortical stiffness in young female mice. Herein, we tested the hypothesis that regular aerobic exercise would attenuate the development of endothelial and whole artery stiffness in female Western diet-fed mice. Four-week-old C57BL/6 mice were randomized into sedentary (ie, caged confined, n=6) or regular exercise (ie, access to running wheels, n=7) conditions for 16 weeks. Exercise training improved glucose tolerance in the absence of changes in body weight and body composition. Compared with sedentary mice, exercise-trained mice exhibited reduced endothelial cortical stiffness in aortic explants (sedentary 11.9±1.7 kPa versus exercise 5.5±1.0 kPa; P<0.05), as assessed by atomic force microscopy. This effect of exercise was not accompanied by changes in aortic pulse wave velocity (P>0.05), an in vivo measure of aortic stiffness. In comparison, exercise reduced femoral artery stiffness in isolated pressurized arteries and led to an increase in femoral internal artery diameter and wall cross-sectional area (P<0.05), indicative of outward hypertrophic remodeling. These effects of exercise were associated with an increase in femoral artery elastin content and increased number of fenestrae in the internal elastic lamina (P<0.05). Collectively, these data demonstrate for the first time that the aortic endothelium is highly plastic and, thus, amenable to reductions in stiffness with regular aerobic exercise in the absence of changes in in vivo whole aortic stiffness. Comparatively, the same level of exercise caused destiffening effects in peripheral muscular arteries, such as the femoral artery, that perfuse the working limbs.
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Affiliation(s)
- Jaume Padilla
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Francisco I Ramirez-Perez
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Javad Habibi
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Brian Bostick
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Annayya R Aroor
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Melvin R Hayden
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Guanghong Jia
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Mona Garro
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Vincent G DeMarco
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Camila Manrique
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Frank W Booth
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - Luis A Martinez-Lemus
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.)
| | - James R Sowers
- From the Department of Nutrition and Exercise Physiology (J.P., F.W.B.), Dalton Cardiovascular Research Center (J.P., F.I.R.-P., L.A.M.-L., J.R.S.), Department of Child Health (J.P.), Department of Biological Engineering (F.I.R.-P., L.A.M.-L.); Division of Cardiovascular Medicine, Department of Medicine (B.B.), Diabetes and Cardiovascular Research Center (J.H., A.R.A., M.R.H., G.J., M.G., V.G.D., C.M., J.R.S.), Department of Medical Pharmacology and Physiology (L.A.M.-L., J.R.S.), and Biomedical Sciences (F.W.B.), University of Missouri; and Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (J.R.S.).
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Lim HH, Kim OY. Association of Serum Apolipoprotein B with the Increased Risk of Diabetes in Korean Men. Clin Nutr Res 2016; 5:204-12. [PMID: 27482524 PMCID: PMC4967723 DOI: 10.7762/cnr.2016.5.3.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/19/2022] Open
Abstract
This study aimed to investigate the association of Apolipoprotein B (ApoB) with the risk of diabetes in Koreans. Korean men (n = 790, 40-79 years) who had been never diagnosed for diabetes before participating were enrolled. Subjects were categorized into normal fasting glucose (NFG, n = 519), impaired fasting glucose (IFG, n = 188) and newly-onset diabetes (n = 83) according to fasting glucose levels. Age was not significantly different among the subgroups. Mean values of BMI, waist circumference, Blood pressure(BP), triglyceride, non-HDL cholesterol were significantly higher in IFG or newly-onset diabetic subjects compared to NFG subjects. The levels of glucose, insulin, free fatty acid, insulin resistance and ApoB were highest in diabetic patients and lowest in NFG subjects. According to ApoB level, subjects were divided into two groups (high-ApoB group: ≥ 87.0 mg/dL vs. low-ApoB group: < 87.0 mg/dL). The risk of diabetes was higher in the high-ApoB group than the low-ApoB group [OR0: 2.392, (95% CI: 1.470-3.893), P0 < 0.001]. This association was maintained after adjusted for age and BMI [OR1: 2.228, (95% CI: 1.362-3.646), P1 = 0.001] and further adjustment for blood pressure, triglyceride, HDL-cholesterol, LDL-cholesterol, non-HDL-cholesterol, ApoA1 and adiponectin [OR2: 1.984, (95% CI: 1.001-4.064), P2 = 0.049]. The association was much greater in subjects with metabolic syndrome (MetS) [OR1: 2.805 (95% CI: 1.137-5.737), P1 = 0.005] than in those without [OR1: 1.917 (95% CI: 0.989-3.718), P1 = 0.054]. After 3-month, further investigation was randomly performed in subjects with NFG or IFG who agreed to reinvestigation. Multiple stepwise regression analysis revealed that net change of ApoB levels was a main contributor to the net change of glucose levels (standardized b-coefficient: 0.315, p = 0.002). In conclusion, ApoB levels are closely associated with the increased risk of diabetes in Korean men.
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Affiliation(s)
- Hyo Hee Lim
- Korea Centers for Disease Control and Prevention, Korea National Institute of Health, Cheongju 28159, Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition, Brain Busan 21 project, Dong-A University, Busan 49201, Korea
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