American Diabetes Association Annual Meeting, 1999: more on cardiovascular disease

Effects of Melissa officinalis (lemon balm) consumption on serum lipid profile: a meta-analysis of randomized controlled trials

BACKGROUND

According to traditional medicine, Melissa officinalis L., (lemon balm) has been known to remove harmful substances from the blood and is considered a cardiac tonic. Therefore, its use as a cardiovascular remedy may explain the lipid-lowering effects of lemon balm. Dyslipidemia can be considered as a significant preventable risk factor for atherosclerosis, coronary heart disease and type 2 diabetes. The present study is the first meta-analysis to investigate the effects of M. officinalis administration on serum levels of high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride (TG) and total cholesterol (TC).

METHODS

From inception to October 2023, a thorough search through literature was conducted using PubMed, Scopus, and Web of Science. The inclusion criteria of this study were randomized controlled trials, with or without blinding which provided adequate data for each group at the beginning and end of the follow-up period. Meta-analysis was performed on randomized controlled trials using Comprehensive Meta-Analysis (CMA) V4 software. Risk of bias in the selected studies was examined according to the revised Cochrane risk-of-bias tool for randomized trials. Begg's funnel plot symmetry status, Begg's rank correlation, and Egger's weighted regression tests were employed to evaluate potential publication bias.

RESULTS

The meta-analysis comprised of 5 randomized controlled trials with a total of 302 patients. The findings of the meta-analysis indicated that the consumption of lemon balm had a significant decrease in TG (SMD (95% CI): -0.396(-0.620, -0.173), p-value = 0.001), TC (SMD (95% CI): -0.416 (-0.641, -0.192), p-value < 0.001) and LDL (SMD (95% CI): -0.23(-0.45, -0.008), p < 0.05) levels compared to the placebo group. While it had no statistically significant effect on HDL level (SMD (95% CI): 0.336(-0.091, 0.767), p-value = 0.123). No significant and detectable publication bias was found in the meta-analysis. Additionally, all included clinical studies demonstrated a low risk of bias for missing outcome data and selection of the reported results. The robustness of the results was demonstrated by a sensitivity analysis using the one-study remove method.

CONCLUSIONS

The findings of this meta-analysis provide evidence that lemon balm may be administered as a safe and beneficial herbal medicine for reducing TC, TG and LDL levels. According to the pooled results of 5 studies with a total of 302 patients, lemon balm intake had no significant effect on HDL level. This study reinforces the notion that lemon balm may have a substantial impact on serum lipid profile as a potential remedy in cases of dyslipidemia. The main concern of our research is the limited number of eligible studies and the relatively small population size of each individual study. The patients of these studies had different types of diseases and metabolic syndromes. However, the meta-analysis was sufficiently powered to detect the considerable effects of lemon balm in the combined population regardless of type of diseases.

Effects of Astaxanthin supplementation on selected metabolic parameters, anthropometric indices, Sirtuin1 and TNF-α levels in patients with coronary artery disease: A randomized, double-blind, placebo-controlled clinical trial

Background

Atherosclerosis can develop as a result of an increase in oxidative stress and concurrently rising levels of inflammation. Astaxanthin (AX), a red fat-soluble pigment classified as a xanthophyll, may be able to prevent the vascular damage induced by free radicals and the activation of inflammatory signaling pathways. The objective of the current study is to assess the effects of AX supplementation on cardiometabolic risk factors in individuals with coronary artery disease (CAD).

Methods

This randomized double-blind placebo-controlled clinical trial was conducted among 50 CAD patients. Participants were randomly allocated into two groups to intake either AX supplements (12 mg/day) or placebo for 8 weeks. Lipid profile, glycemic parameters, anthropometric indices, body composition, Siruin1 and TNF-α levels were measured at baseline and after 8 weeks.

Results

Body composition, glycemic indices, serum levels of TNF-α, Sirtuin1 did not differ substantially between the AX and placebo groups (p &gt; 0.05). The data of AX group showed significant reduction in total cholesterol (−14.95 ± 33.57 mg/dl, p &lt; 0.05) and LDL-C (−14.64 ± 28.27 mg/dl, p &lt; 0.05). However, TG and HDL-C levels could not be affected through AX supplementation.

Conclusion

Our results suggest that AX supplementation play a beneficial role in reducing some components of lipid profile levels. However, further clinical investigations in CAD patients are required to obtain more conclusive findings.

Clinical trial registration

www.Irct.ir., identifier IRCT20201227049857N1.

Prevalence and Pattern of Dyslipidemia and Its Associated Factors Among Patients with Type 2 Diabetes Mellitus in Jordan: A Cross-Sectional Study

BACKGROUND

Dyslipidemia and type 2 diabetes mellitus (T2DM) are growing health problems, particularly in developing countries. This study aimed to determine the prevalence and pattern of dyslipidemia and its associated factors among patients with T2DM.

METHODS

A cross-sectional study was conducted among patients with T2DM attending Family Medicine Clinics in Jordan between August 2017 and March 2019. The socio-demographics, clinical features, medications, and laboratory findings were collected. These laboratory findings included high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TGs).

RESULTS

A total of 870 patients with T2DM were included. The prevalence of dyslipidemia among patients with T2DM was 91.4%. The most common patterns of dyslipidemia were low HDL-C (66.2%), high LDL-C (62.1%), and hypertriglyceridemia (58.2%). Female gender, obesity, and hypertension were associated with diabetic dyslipidemia patterns. T2DM duration and poor glycemic control were associated with high LDL-C and hypercholesterolemia. Hypertriglyceridemia was associated with poor glycemic control and smoking.

CONCLUSION

Dyslipidemia is highly prevalent among patients with T2DM. Evidence -based interventions are needed to prevent and control dyslipidemia among patients with T2DM in Jordan.

Prevalence of dyslipidemia and factors affecting lipid profile in patients with type 2 diabetes

AIM

Dyslipidemia is an established marker for endothelial dysfunction and cardiovascular risk in diabetes. So we aimed to explore the prevalence of dyslipidemia in patients with type2 diabetes mellitus (DM) and to determine the association between dyslipidemia and other health care and biochemical indicators.

MATERIALS AND METHODS

A cross-sectional study was carried out at private health care center. A total of 291 diabetic patients aged 18 years and above attended the clinic from August 2017 through April 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23).

RESULTS

out of the 291 diabetes patients recruited 22.3% had hypercholesterolemia (TC ≥ 200) and 61.9% had hypertriglyceridemia. Abnormal LDL-C levels (≥130) were found in 8.9% of patients and HDL-C was less than 40 mg/dl in 54.3%. There was a statistically significant difference (P = 0.048) in abnormal HDL levels (˂ 40 mg/dl) among females (59.3%) and males (47.6). Patients with HbA1c values ≥ 7.0%had significantly higher values of total cholesterol (TC) and abnormal LDL-C compared with the patients who had HbA1c ˂ 7.0%.

CONCLUSION

dyslipidemia is highly prevalent among diabetic population particularly in those with poorly controlled diabetes. This calls for early and universal screening of lipid profile. There is also an urgent demand for measures that target tight glycemic, optimal lipid profile control and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.

Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice

BACKGROUND

Evidence on the influence of comorbidity and comedication on clinical outcomes in patients with type 2 diabetes mellitus is scarce.

AIM

To ascertain the effect of five chronic diseases (joint disorder, respiratory disease, anaemia, malignancy, depression) and three chronically used drugs (non-steroid anti-inflammatory drugs [NSAIDs], corticosteroids, antidepressants) on treatment for hypoglycaemia in patients with type 2 diabetes.

DESIGN AND SETTING

Retrospective cohort study in a variety of practices across Flanders, Belgium.

METHOD

A retrospective cohort study was conducted, based on data from Intego, a general practice-based continuous morbidity registry. Multiple logistic regression analysis was used to predict the change in glycosylated haemoglobin (HbA1c) levels related to comorbidity, comedication, and a combination of both in 3416 patients with type 2 diabetes. Adjustments were made for age, sex, and diabetes-treatment group (diet, oral antidiabetic drugs, combination treatment, insulin).

RESULTS

Concomitant joint and respiratory disorders, as well as the chronic use of NSAIDs and corticosteroids, either separately or in combination, were significantly associated with the worsening of HbA1c levels. Anaemia, depression, malignancy, and antidepressants had no statistically significant influence on the efficacy of treatment for hypoglycaemia.

CONCLUSION

The presence of some comorbid diseases or drug use can impede the efficacy of treatment for type 2 diabetes. This finding supports the need to develop treatment recommendations, taking into account the presence of both chronic comorbidity and comedication. Further research must be undertaken to ascertain the effect other combinations of chronic diseases have on the efficacy of treatment of this and other diseases.

Additive antiproteinuric effect of pentoxifylline in patients with type 2 diabetes under angiotensin II receptor blockade: a short-term, randomized, controlled trial

Despite the beneficial effects of blockade of the renin-angiotensin system in diabetic nephropathy (DN), albuminuria and progression of renal disease are not completely halted by these agents. Therefore, it is necessary to explore potential antiproteinuric and renoprotective effects of innovative therapeutic approaches. This study tested the hypothesis that the combination of pentoxifylline (PTF) with angiotensin II receptor blockers in normotensive patients with type 2 diabetes produces an additive antiproteinuric effect. Sixty-one patients with DN and residual albuminuria despite treatment with the recommended doses of ARB for >1 yr were randomly assigned to receive the addition of 1200 mg of PTF daily (n = 30) or to a control group (n = 31). Baseline characteristics were similar between groups, and correlation analysis showed a significant association between urinary albumin excretion (UAE) and urinary TNF-alpha (R = 0.53, P < 0.001). After 4 mo, albuminuria showed a significant decrease in patients who received PTF, from 900 mg/24 h (466 to 1542 mg/d) to 791 mg/24 h (309 to 1400 mg/d; P < 0.001), whereas no significant changes were observed in the control group: 920 mg/24 h (450 to 1489 mg/d) at baseline, and 900 mg/24 h (428 to 1800 mg/d) at the end of the study. The mean percentage variation of UAE in the treatment and control groups was -16.7 and 5.5%, respectively (between-group comparison, P < 0.001). This additive antiproteinuric effect was not dependent on changes in BP or metabolic control. However, both serum and urinary levels of TNF-alpha also decreased in patients who received PTF, from 6.4 pg/ml (2.1 to 9.7) and 16 pg/mg (8 to 29) at baseline to 4.6 pg/ml (0.4 to 9) and 14.2 pg/mg (3 to 26) at the end of the study, respectively (P < 0.01), without significant variations in control patients. Moreover, regression analysis at the end of the study showed a correlation between the change in UAE and the change in urinary TNF-alpha in patients who were treated with PTF (R = 0.49, P < 0.001). In conclusion, administration of PTF to patients who have type 2 diabetes and are under long-term treatment with an ARB produces a significant additive antiproteinuric effect associated with a reduction of urinary TNF-alpha excretion.

Expression levels and functional aspects of the hyaluronan receptor CD44. Effects of insulin, glucose, IGF-I, or growth hormone on human arterial smooth muscle cells

An increased amount of hyaluronan (HA) in the arterial wall is a feature of the diabetic macroangiopathy. The functional consequences of accumulated HA are mediated through binding to CD44. The regulation of this receptor by diabetic metabolic and hormonal factors is, however unknown. The objective of this study was to examine the influence of glucose, insulin, insulin-like growth factor I (IGF-I), and human growth hormone (hGH) on the formation and function of the HA receptor CD44 in cultures of human aortic smooth muscle cells (SMCs). Migration of nonproliferating SMCs were determined by estimating the area covered by cells 6 days after removal of a barrier. Cellular content of standard CD44 and its isoforms, CD44v3 and CD44v6, and HA-binding capacity were measured using a modified enzyme-linked immunosorbent assay procedure. The analysis is made either with antibodies against CD44 or with HA as a ligand. The migration assay showed that glucose, insulin, and IGF-I were able to stimulate SMC migration (2 P < .01). Anti-CD44 antibody inhibited the stimulated migration at most concentrations. Insulin increased HA binding at 100 to 1000 micro U/mL insulin (2 P < .03). CD44 expression was only elevated at 1000 micro U/mL insulin (2 P < .03), whereas CD44 content decreased at 2 ng/mL hGH and increased at 16 ng/mL hGH (2 P < .01). Glucose and IGF-I reduced the amount of the variant isoform CD44v3 (2 P < .01) but did not change the amount of total CD44. CD44v6 was not present on human arterial SMCs. In conclusion, the present data obtained with human arterial SMCs in vitro support a role of CD44 and its isoform, CD44v3, in the SMC response to the metabolic and hormonal disorders of diabetes.

Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus

BACKGROUND

Data about the relationship of inflammation to nephropathy in type 2 diabetes mellitus are scarce. In the present study, we test the hypothesis that inflammatory parameters are independently related to urinary albumin excretion (UAE) at early stages of nephropathy.

METHODS

Sixty-five patients with type 2 diabetes with microalbuminuria (MAB) or mild proteinuria (protein < 1 g/d) were included. We analyzed serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-alpha), as well as urinary level of this cytokine.

RESULTS

Inflammatory parameters were significantly greater in patients with diabetes than controls; furthermore, urinary TNF-alpha levels increased significantly as nephropathy progressed. Median urinary TNF-alpha level was 7 pg/mg in normoalbuminurics, 13 pg/mg in microalbuminurics (P < 0.001), and 18 pg/mg in proteinurics (P < 0.001 versus normoalbuminuria and P < 0.01 versus MAB). Albuminuria was related to hs-CRP (r= 0.68; P < 0.001) and serum (r = 0.45; P < 0.01) and urinary TNF-alpha levels (r = 0.71; P < 0.001), but there was no association between serum and urinary TNF-alpha levels. Partial correlation analysis showed that hs-CRP level, urinary TNF-alpha level, duration of diabetes, and glycated hemoglobin level remained significantly associated with UAE. A stepwise multiple regression analysis showed that UAE was significantly associated with hs-CRP level (P < 0.001), duration of diabetes (P < 0.001), urinary TNF-alpha level (P < 0.01), and glycated hemoglobin level (P < 0.05; adjusted R2 = 0.73; P < 0.001).

CONCLUSION

Inflammatory parameters in patients with type 2 diabetes at an early stage of nephropathy are independently associated with UAE. In addition to traditional metabolic and hemodynamic factors, it is possible to hypothesize on the participation of inflammation in the pathogenesis of diabetic nephropathy.

[The role of diabetes mellitus in cardiac disease in Spain. The CARDIOTENS Study 1999]

BACKGROUND

We analyse the characteristics of the patients with diabetes and cardiac disease included in the CARDIOTENS 1999 study.

PATIENTS AND METHOD

32,051 outpatients who were seen the same day by 1,159 primary healthcare physicians (79%) and cardiologists (21%) were prospectively registered in a database including demographic and clinical data and therapeutic profile.

RESULTS

History of cardiac disease was present in 19% (6,194 patients) of the whole population, and 1,275 of them (20.6%) were diabetics. Hypertension was present in 74% of diabetic patients with cardiac disease. Coronary heart disease (angina pectoris or previous myocardial infarction) was present in 45% of diabetic patients with heart failure. Less than 30% of these patients had blood pressure levels under 130/85 mmHg, as recommended by international guidelines. An LDL-cholesterol level lower than 100 mgrs/dl was observed in only 12% of diabetic patients with coronary heart disease; the mean values of total cholesterol and LDL-cholesterol of these patients were significantly (p < 0.01) higher in those seen by primary healthcare physicians. Less than 40% of diabetic patients with cardiac disease were treated with an angiotensin converting enzyme inhibitor, a therapy which was otherwise used in 50% of diabetic patients with heart failure. A beta-blocker therapy was used in 26% of diabetic patients with coronary heart disease and 39% of them were being treated with statins.

CONCLUSIONS

More than 20% of patients with cardiac disease in this study were diabetics. Blood pressure and cholesterol levels recommended by current guidelines were attained in a limited proportion of these patients. The use of drugs with demonstrated prognostic benefit in diabetic patients with heart disease is scarce.