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Rydén L, Norhammar A. SGLT2 inhibitors in clinical practice. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00133-5. [PMID: 38768619 DOI: 10.1016/s2213-8587(24)00133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Lars Rydén
- Department for Medicine Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Anna Norhammar
- Department for Medicine Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden
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Sebring D, Buhlin K, Lund H, Norhammar A, Rydén L, Kvist T. Endodontic inflammatory disease and future cardiovascular events and mortality. A report from the PAROKRANK study. J Endod 2024:S0099-2399(24)00283-8. [PMID: 38763484 DOI: 10.1016/j.joen.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Prospective studies assessing the relation between endodontic inflammatory disease and subsequent cardiovascular events are few. The present aim was to explore associations between endodontic variables and future cardiovascular events in patients with myocardial infarction and matched controls participating in the PAROKRANK study. METHODS Eight-hundred and five patients hospitalized for a first myocardial infarction and 805 controls were recruited between 2010 to 2014. Signs of endodontic inflammatory disease were assessed in panoramic radiographs taken at baseline. Mortality and morbidity data during the approximately eight years of follow up were obtained from national registries. The risk for future cardiovascular events (first of mortality and non-fatal myocardial infarction, stroke, or hospitalization for heart failure) was analyzed with the Log-rank test and Cox proportional hazards regression, adjusted for the following confounders: sex, age, smoking, myocardial infarction, diabetes, education, marital status, family history of cardiovascular disease, and marginal periodontitis. RESULTS In total, 285 future events were observed during the follow-up period. Unadjusted analyses revealed that ≥1 root filled tooth increased the risk of a future event. Following adjustment, the number of remaining teeth and non-root filled teeth decreased the risk of future events while higher DMFT-score increased the risk and ≥1 primary apical periodontitis decreased the risk of suffering cardiovascular events. Higher DMFT-score and decayed teeth increased the risk of all-cause mortality. CONCLUSIONS Tooth loss is a strong indicator of an increased risk for future cardiovascular events. Root filled teeth seem of limited value as a risk indicator when accounting for other risk factors. The potential effect of dental interventions on future events should be assessed in future research.
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Affiliation(s)
- Dan Sebring
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kåre Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Henrik Lund
- Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Norhammar
- Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden; Capio S:t Görans hospital, Stockholm, Sweden
| | - Lars Rydén
- Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kvist
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gavin JR, Rodbard HW, Battelino T, Brosius F, Ceriello A, Cosentino F, Giorgino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Prashant Nedungadi T, Parkin CG, Topsever P, Rydén L, Huey-Herng Sheu W, Standl E, Olav Vandvik P, Schnell O. Disparities in prevalence and treatment of diabetes, cardiovascular and chronic kidney diseases - Recommendations from the taskforce of the guideline workshop. Diabetes Res Clin Pract 2024; 211:111666. [PMID: 38616041 DOI: 10.1016/j.diabres.2024.111666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
There is a mounting clinical, psychosocial, and socioeconomic burden worldwide as the prevalence of diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD) continues to rise. Despite the introduction of therapeutic interventions with demonstrated efficacy to prevent the development or progression of these common chronic diseases, many individuals have limited access to these innovations due to their race/ethnicity, and/or socioeconomic status (SES). However, practical guidance to providers and healthcare systems for addressing these disparities is often lacking. In this article, we review the prevalence and impact of healthcare disparities derived from the above-mentioned chronic conditions and present broad-based recommendations for improving access to quality care and health outcomes within the most vulnerable populations.
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Affiliation(s)
- James R Gavin
- Emory University School of Medicine, Atlanta, GA, USA
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD 20852, USA.
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724-5022, USA.
| | - Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni MI 20099, Italy.
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 641 Durham Centre, Box 17969, Durham, NC 27715, USA.
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China.
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, Stuttgart 70199, Germany.
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI 53703, USA.
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, Beograd 11000, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University Pauwelsstraße 30, 52074 Aachen, Germany.
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV 89074, USA
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İçerenköy, Kayışdağı Cd. No: 32, Ataşehir/İstanbul 34752, Türkiye.
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden.
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli 350, Taiwan.
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Institute of Health and Society, University of Oslo, Lovisenberggata 17, Oslo 0456, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
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Schnell O, Barnard-Kelly K, Battelino T, Ceriello A, Larsson HE, Fernández-Fernández B, Forst T, Frias JP, Gavin JR, Giorgino F, Groop PH, Heerspink HJL, Herzig S, Hummel M, Huntley G, Ibrahim M, Itzhak B, Jacob S, Ji L, Kosiborod M, Lalic N, Macieira S, Malik RA, Mankovsky B, Marx N, Mathieu C, Müller TD, Ray K, Rodbard HW, Rossing P, Rydén L, Schumm-Draeger PM, Schwarz P, Škrha J, Snoek F, Tacke F, Taylor B, Jeppesen BT, Tesfaye S, Topsever P, Vilsbøll T, Yu X, Standl E. CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes. Cardiovasc Diabetol 2024; 23:104. [PMID: 38504284 PMCID: PMC10953147 DOI: 10.1186/s12933-024-02180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5-6, 2024 ( http://www.cvot.org ).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany.
| | | | - Tadej Battelino
- University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Helena Elding Larsson
- Department of Pediatrics, Skåne University Hospital, Malmö/Lund, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Thomas Forst
- CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | | | - James R Gavin
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Diabetes, Central Medical School, Monash University, Melbourne, Australia
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Herzig
- Division Diabetic Complications, Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg, Germany
| | - Michael Hummel
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany
| | - George Huntley
- Diabetes Leadership Council, Indianapolis, IN, United States of America
| | - Mahmoud Ibrahim
- Center for Diabetes Education, EDC, Charlotte, NC, United States of America
| | - Baruch Itzhak
- Clalit Health Services, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Stephan Jacob
- Practice for Prevention and Therapy and Cardio-Metabolic Institute, Villingen-Schwenningen, Germany
| | - Linong Ji
- Peking University People's Hospital, Xicheng District, Beijing, China
| | - Mikhail Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Nebosja Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Ar-Rayyan, Doha, Qatar
| | - Boris Mankovsky
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Nikolaus Marx
- Clinic for Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine (Medical Clinic I), RWTH Aachen University Hospital, Aachen, Germany
| | - Chantal Mathieu
- Department of Endocrinology, Catholic University Leuven, Leuven, Belgium
| | - Timo D Müller
- Institute for Diabetes and Obesity, Helmholtz Munich, Munich, Germany
- Walther-Straub Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Kausik Ray
- School of Public Health, Imperial College London, London, United Kingdom
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, United States of America
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Peter Schwarz
- Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Škrha
- Third Medical Department and Laboratory for Endocrinology and Metabolism, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frank Snoek
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Bruce Taylor
- Diabetes Patient Advocacy Coalition, Tampa, FL, United States of America
| | | | - Solomon Tesfaye
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
- University of Sheffield, Sheffield, United Kingdom
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Eberhard Standl
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany
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Gustafsson A, Norhammar A, Klinge B, Rydén L. [Periodontitis - an often neglected risk factor for several other diseases]. Lakartidningen 2024; 121:23137. [PMID: 38477900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Periodontitis is a chronic inflammatory disease that degrades dental supporting tissues, including the alveolar bone. The global prevalence is 19%, in Sweden it is 11%. Left untreated, periodontitis can cause loss of teeth. The initial clinical manifestations of periodontitis usually start between 35 and 45 years of age. The underlying pathological mechanism is an aberrant inflammatory response to the bacteria colonizing the gingival crevice. Periodontitis has been associated with several other diseases, most prominently diabetes. The relation between periodontitis and diabetes is bidirectional in the sense that diabetes increases the risk for periodontitis and vice versa. Periodontitis also increases the risk for cardiovascular disease and cancer.
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Affiliation(s)
- Anders Gustafsson
- professor, övertandläkare, Karolinska institutet, Stockholm, Karolinska institutet, Stockholm
| | - Anna Norhammar
- adjungerad professor, specialist i kardiologi, internmedicin och klinisk fysiologi, fysiologkliniken, Capio S:t Görans sjukhus; Karolinska institutet, Stockholm
| | - Björn Klinge
- professor emeritus, specialisttandläkare,, Karolins-ka institutet, Stockholm; Malmö universitet
| | - Lars Rydén
- professor, Karolinska institutet, Stockholm
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Norhammar A, Gustafsson A, Rydén L, Brismar K. [Diabetes and periodontitis - common, important but often neglected]. Lakartidningen 2024; 121:23130. [PMID: 38477901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Diabetes and periodontitis are two global epidemics. There is a two-way relationship between diabetes and periodontitis. Diabetes increases the risk of periodontitis and periodontitis increases the risk for deteriorating glucose levels, having undetected diabetes, and for future diabetes. A recent Cochrane report summarized that there is moderate-certainty evidence that periodontal treatment improves glycaemic control in people with both periodontitis and diabetes. The recent PAROKRANK study found that undetected dysglycaemia was independently associated to both myocardial infarction and to periodontitis. To increase awareness of oral health in people with diabetes this article summarizes recent evidence.
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Affiliation(s)
- Anna Norhammar
- adjungerad professor, specialist i kardiologi, internmedicin och klinisk fysiologi, fysiologkliniken, Capio S:t Görans sjukhus; Karolinska institutet, Stockholm
| | - Anders Gustafsson
- professor, övertandläkare, Karolinska institutet, Stockholm, Karolinska institutet, Stockholm
| | - Lars Rydén
- professor, Karolinska institutet, Stockholm
| | - Kerstin Brismar
- specialist i endokrinologi och diabetologi; professor, institutionen för molekylär medicin och kirurgi, Karolinska institutet
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Morrow LM, Becker F, Coleman RL, Gerstein HC, Rydén L, Schöder S, Gray AM, Leal J, Holman RR. Comparison of medical resources and costs among patients with coronary heart disease and impaired glucose tolerance in the Acarbose Cardiovascular Evaluation trial. J Diabetes 2024; 16:e13473. [PMID: 37915263 PMCID: PMC10859317 DOI: 10.1111/1753-0407.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The Acarbose Cardiovascular Evaluation (ACE) trial (ISRCTN91899513) evaluated the alpha-glucosidase inhibitor acarbose, compared with placebo, in 6522 patients with coronary heart disease and impaired glucose tolerance in China and showed a reduced incidence of diabetes. We assessed the within-trial medical resource use and costs, and quality-adjusted life years (QALYs). METHODS Resource use data were collected prospectively within the ACE trial. Hospitalizations, medications, and outpatient visits were valued using Chinese unit costs. Medication use was measured in drug days, with cardiovascular and diabetes drugs summed across the trial by participant. Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level questionnaire. Regression analyses were used to compare resource use, costs, and QALYs, accounting for regional variation. Costs and QALYs were discounted at 3% yearly. RESULTS Hospitalizations were 6% higher in the acarbose arm during the trial (rate ratio 1.06, p = .009), but there were no significant differences in total inpatient days (rate ratio 1.04, p = .30). Total costs per participant, including study drug, were significantly higher for acarbose (¥ [Yuan] 56 480, £6213), compared with placebo (¥48 079, £5289; mean ratio 1.18, p < 0.001). QALYs reported by participants in the acarbose arm (3.96 QALYs) were marginally higher than in the placebo arm (3.95 QALYs), but the difference was not statistically significant (0.01 QALYs; p = .58). CONCLUSIONS Acarbose, compared with placebo, participants cost more due to study drug costs and reported no statistically significant difference in QALYs. These higher within-trial costs could potentially be offset in future by savings from the acarbose-related lower incidence of diabetes.
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Affiliation(s)
- Liam Mc Morrow
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Frauke Becker
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Ruth L. Coleman
- Diabetes Trials Unit, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Hertzel C. Gerstein
- Department of Medicine and Population Health Research InstituteMcMaster University and Hamilton Health SciencesHamiltonCanada
| | - Lars Rydén
- Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | | | | | - Jose Leal
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
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Fortin E, Campi B, Ferrannini E, Mari A, Mellbin LG, Norhammar A, Näsman P, Rydén L, Saba A, Ferrannini G. High Mannose Correlates With Surrogate Indexes of Insulin Resistance and Is Associated With an Increased Risk of Cardiovascular Events Independently of Glycemic Status and Traditional Risk Factors. Diabetes Care 2024; 47:246-251. [PMID: 38055929 DOI: 10.2337/dc23-0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To explore the associations among mannose, indexes of insulin resistance (IR) and secretion, and long-term cardiovascular outcomes. RESEARCH DESIGN AND METHODS Fasting mannose was assayed in 1,403 participants, one-half of which had a first myocardial infarction (MI) with either normal glucose tolerance (n = 1,045) or newly detected dysglycemia (i.e., impaired glucose tolerance or type 2 diabetes; n = 358). Regression models were used to explore mannose associations with surrogate indexes of IR/insulin secretion. Multivariate Cox models were used to investigate the independent association between high (higher quartile) versus low (lower three quartiles) mannose and major adverse cardiac events (MACE) (n = 163) during the 10-year follow-up. RESULTS Mannose was independently associated with IR indexes (all P ≤ 0.001). High versus low mannose was independently associated with MACE (hazard ratio 1.54, 95% CI 1.07-2.20) in the overall population. CONCLUSIONS Mannose might represent a new biomarker able to track early, potentially detrimental glucometabolic alterations independently of glycemic state.
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Affiliation(s)
- Elena Fortin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Beatrice Campi
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Andrea Mari
- National Research Council Institute of Neuroscience, Padova, Italy
| | - Linda G Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Capio St. Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Saba
- Mass Spectrometry Laboratory, Department of Pathology, University of Pisa, Pisa, Italy
- Clinical Pathology Laboratory, Santa Chiara University Hospital, Pisa, Italy
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Riccio A, Fortin E, Mellbin L, Norhammar A, Näsman P, Rydén L, Sesti G, Ferrannini G. Sex differences in the association between insulin resistance and non-fatal myocardial infarction across glycaemic states. Cardiovasc Diabetol 2024; 23:25. [PMID: 38218814 PMCID: PMC10787422 DOI: 10.1186/s12933-023-02093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Females are generally less prone to cardiovascular (CV) events than males, but this protection is trumped by diabetes. The mechanism behind the increased relative risk in females with diabetes is not fully understood. Insulin resistance (IR) is suggested to be a more important contributor to CV morbidity in females than in males. We aim to investigate differences in the association between IR indexes (Homeostatic Model Assessment of IR - HOMA-IR, visceral adiposity index - VAI, and triglycerides/high-density lipoprotein-cholesterol - TG/HDL-C index), and a first non-fatal myocardial infarction (MI) across different glycaemic states. METHODS IR indexes were calculated in a population with (n = 696) and without (n = 707) a first non-fatal MI, free from known diabetes. MI cases were investigated at least six weeks after the event. All participants were categorized by an oral glucose tolerance test as having normal glucose tolerance, impaired fasting glucose, impaired glucose tolerance, or newly diagnosed diabetes. Comparison of proportion of glycaemic states by sex was tested by chi-square test. The associations between sex, a first non-fatal MI, IR indexes, and traditional CV risk factors were analysed by multivariate logistic regression models. Continuous variables were logarithmically transformed. RESULTS Of the total population 19% were females and 81% males, out of whom 47% and 50% had a first non-fatal MI, respectively. Compared with males, females were older, less often smokers, with lower body mass index and higher total cholesterol and high-density lipoprotein cholesterol levels. The proportion of glycaemic states did not differ between the sexes (p = 0.06). Females were less insulin resistant than males, especially among cases and with normal glucose tolerance. In logistic regression models adjusted for major CV risk factors including sex, the associations between VAI and TG/HDL-C index and a first non-fatal MI remained significant only in females (odds ratios and 95% confidence intervals: 1.7, 1.0-2.9, and 1.9, 1.1-3.4 respectively). CONCLUSIONS These results support the assumption that IR indexes based on anthropometrics and lipid panel, i.e., VAI and TG/HDL-C, could be a better measure of IR and CV-predictor for non-fatal MI in females, even without glycaemic perturbations.
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Affiliation(s)
- Alessia Riccio
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden.
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
| | - Elena Fortin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
- Capio St Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
- Center for safety research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institute Stockholm, Stockholm, Sweden
- Internal Medicine Unit, Södertälje hospital, Södertälje, Sweden
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10
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Rautio E, Gadler F, Gudbjörnsdottir S, Franzén S, Rydén L, Savarese G, Svensson AM, Mellbin LG. Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population. Cardiovasc Diabetol 2024; 23:18. [PMID: 38184588 PMCID: PMC10771698 DOI: 10.1186/s12933-023-02084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Increased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment. METHOD 416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk. RESULTS Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21-1.45] for ICD, 1.74 [1.55-1.95] for CRT-P and 1.69 [1.43-1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective. CONCLUSIONS Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
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Affiliation(s)
- Elina Rautio
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Fredrik Gadler
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Franzén
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Health Metrics Unit, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Rydén
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Linda G Mellbin
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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11
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Sebring D, Kvist T, Lund H, Jonasson P, Lira-Junior R, Norhammar A, Rydén L, Buhlin K. Primary apical periodontitis correlates to elevated levels of interleukin-8 in a Swedish population: A report from the PAROKRANK study. Int Endod J 2024; 57:12-22. [PMID: 38290211 DOI: 10.1111/iej.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 02/01/2024]
Abstract
AIM To explore associations between root filled teeth, primary and secondary apical periodontitis, and levels of inflammatory markers in blood from patients with a first myocardial infarction and matched controls. METHODOLOGY Between May 2010 and February 2014, 805 patients with a first myocardial infarction and 805 controls, matched for sex, age, and postal code area, were recruited to the multicentre case-control study PAROKRANK (periodontitis and its relation to coronary artery disease). All participants underwent a physical and oral examination, as well as blood sampling. Using panoramic radiography, root filled teeth, primary apical periodontitis, and secondary apical periodontitis were assessed by three independent observers. Blood samples were analysed with enzyme-linked immunosorbent assay method for the following inflammatory markers: interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12p70, tumour necrosis factor-α, and high-sensitivity C-reactive protein (hsCRP). Additionally, white blood cell count and plasma-fibrinogen were analysed. Associations between endodontic variables and the levels of inflammatory markers were statistically analysed with Mann-Whitney U-test and Spearman correlation, adjusted for confounding effects of baseline factors (sex, age, myocardial infarction, current smoking, diabetes, family history of cardiovascular disease, education, marital status, and periodontal disease). RESULTS Mean age of the cohort was 62 years, and 81% were males. Root fillings were present in 8.4% of the 39 978 examined teeth and were associated with higher levels of hsCRP, fibrinogen, and leukocyte count, but lower levels of IL-2 and IL-12p70. After adjusting for confounders, root filled teeth remained associated with higher levels of fibrinogen, but lower levels of IL-1β, IL-2, IL-6, and IL-12p70. Primary apical periodontitis was found in 1.2% of non-root filled teeth and associated with higher levels of IL-8 (correlation 0.06, p = .025). Secondary apical periodontitis was found in 29.6% of root filled teeth but did not relate to the levels of any of the inflammatory markers. CONCLUSIONS This study supports the notion that inflammation at the periapex is more than a local process and that systemic influences cannot be disregarded. Whether the observed alterations in plasma levels of inflammatory markers have any dismal effects on systemic health is presently unknown but, considering the present results, in demand of further investigation.
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Affiliation(s)
- Dan Sebring
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Kvist
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Lund
- Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Ronaldo Lira-Junior
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Anna Norhammar
- Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Lars Rydén
- Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kåre Buhlin
- Unit of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
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12
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Ferrannini G, Maldonado JM, Raha S, Rao-Melacini P, Khatun R, Atisso C, Shurzinske L, Gerstein HC, Rydén L, Bethel MA. Gender differences in cardiovascular risk, treatment, and outcomes: a post hoc analysis from the REWIND trial. SCAND CARDIOVASC J 2023; 57:2166101. [PMID: 36723445 DOI: 10.1080/14017431.2023.2166101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives. To assess whether the use of cardioprotective therapies for type 2 diabetes varies by gender and whether the risk of cardiovascular events is higher in women versus men in the REWIND trial, including an international type 2 diabetes patient population with a wide range of baseline risk. Design. Gender differences in baseline characteristics, cardioprotective therapy, and the achieved clinical targets at baseline and two years were analyzed. Hazards for cardiovascular outcomes (fatal/nonfatal stroke, fatal/nonfatal myocardial infarction, cardiovascular death, all-cause mortality, and heart failure hospitalization), in women versus men were analyzed using two Cox proportional hazard models, adjusted for randomized treatment and key baseline characteristics respectively. Time-to-event analyses were performed in subgroups with or without history of cardiovascular disease using Cox proportional hazards models that included gender, subgroup, randomized treatment, and gender-by-subgroup interactions. Results. Of 9901 participants, 46.3% were women. Significantly fewer women than men had a cardiovascular disease history. Although most women met treatment targets for blood pressure (96.7%) and lipids (72.8%), fewer women than men met the target for cardioprotective therapies at baseline and after two years, particularly those with prior cardiovascular disease, who used less renin-angiotensin-aldosterone system inhibitors, statins, and aspirin than men. Despite these differences, women had lower hazards than men for all outcomes except stroke. No significant gender and cardiovascular disease history interactions were identified for cardiovascular outcomes. Conclusions. In REWIND, most women met clinically relevant treatment targets, but in lower proportions than men. Women had a lower risk for all cardiovascular outcomes except stroke. Clinical trials.gov registration number: NCT01394952.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Sohini Raha
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Purnima Rao-Melacini
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rutaba Khatun
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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13
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Rydén L, Lindsten M. The 1923 Nobel Prize for the discovery of insulin in a 100-year perspective. J Intern Med 2023; 294:819. [PMID: 37861128 DOI: 10.1111/joim.13734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Lars Rydén
- Karolinska Institutet, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77, Stockholm, Sweden
| | - Magnus Lindsten
- Karolinska Institutet, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77, Stockholm, Sweden
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14
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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15
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Ceriello A, Rodbard HW, Battelino T, Brosius F, Cosentino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Parkin CG, Rydén L, Sheu WHH, Standl E, Vandvik PO, Schnell O. Data from network meta-analyses can inform clinical practice guidelines and decision-making in diabetes management: perspectives of the taskforce of the guideline workshop. Cardiovasc Diabetol 2023; 22:277. [PMID: 37833776 PMCID: PMC10576408 DOI: 10.1186/s12933-023-01993-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
In recent years, several novel agents have become available to treat individuals with type 2 diabetes (T2D), such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), tirzepatide, which is a dual glucose-dependent insulinotropic polypeptide receptor agonist (GIP RA)/glucagon-like peptide-1 receptor agonist (GLP-1 RA), and finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA) that confers significant renal and cardiovascular benefits in individuals with (CKD). New medications have the potential to improve the lives of individuals with diabetes. However, clinicians are challenged to understand the benefits and potential risks associated with these new and emerging treatment options. In this article, we discuss how use of network meta-analyses (NMA) can fill this need.
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Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD, 20852, USA
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724-5022, USA
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, DUMC Box 3850, Durham, NC, 27715, USA
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Germany
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI, 53703, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, 64111, USA
- The George Institute for Global Health and University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV, 89074, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli, 350, Taiwan
| | - Eberhard Standl
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany.
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16
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Fortin E, Lundin M, Mellbin L, Norhammar A, Näsman P, Smetana S, Sörensson P, Ferrannini E, Rydén L, Ferrannini G. Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia : Experiences from the randomized, controlled SOCOGAMI trial. Cardiovasc Diabetol 2023; 22:208. [PMID: 37568149 PMCID: PMC10422806 DOI: 10.1186/s12933-023-01950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM. METHODS Forty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit. RESULTS After 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline. CONCLUSIONS Empagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia. TRIAL REGISTRATION NUMBER EudraCT number 2015-004571-73.
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Affiliation(s)
- Elena Fortin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lundin
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Stina Smetana
- Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Ele Ferrannini
- Department of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- Internal Medicine Unit, Södertälje Hospital, Södertälje, Stockholm Region, Sweden.
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Gulis K, Ellbrant J, Svensjö T, Skarping I, Vallon-Christersson J, Loman N, Bendahl PO, Rydén L. A prospective cohort study identifying radiologic and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy. Eur J Surg Oncol 2023; 49:1189-1195. [PMID: 37019807 DOI: 10.1016/j.ejso.2023.03.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/05/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. MATERIALS AND METHODS This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014-2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis. RESULTS The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS. CONCLUSION The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.
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Affiliation(s)
- K Gulis
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden; Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
| | - J Ellbrant
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - T Svensjö
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - I Skarping
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - J Vallon-Christersson
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Lund University Cancer Centre, Lund, Sweden
| | - N Loman
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - P O Bendahl
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - L Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden
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18
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Rydén L, Ferrannini G, Standl E. Risk prediction in patients with diabetes: is SCORE 2D the perfect solution? Eur Heart J 2023:7192002. [PMID: 37288565 DOI: 10.1093/eurheartj/ehad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Lars Rydén
- Department of Medicine Heart & Vascular Theme S1:02, Karolinska University Hospital, 17 176 Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Heart & Vascular Theme S1:02, Karolinska University Hospital, 17 176 Stockholm, Sweden
| | - Eberhard Standl
- Diabetes Research Group e.V. at Munich Helmholtz Center, Neuherberg, Germany
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19
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Kanumilli N, Butler J, Makrilakis K, Rydén L, Vallis M, Wanner C, Zieroth S, Alhussein A, Cheng A. Guardians For Health: A Practical Approach to Improving Quality of Life and Longevity in People with Type 2 Diabetes. Diabetes Ther 2023:10.1007/s13300-023-01418-0. [PMID: 37199909 DOI: 10.1007/s13300-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
Type 2 diabetes is one of the fastest-growing health emergencies of the twenty-first century, in part due to its association with cardiovascular and renal disease. Successful implementation of evidence-based guidelines for the management of patients with diabetes and pre-diabetes has been shown to improve patient outcomes by controlling risk factors for cardiovascular and renal disease. Recommendations include the early introduction of lifestyle adjustments, supported by pharmacological tools. Despite the availability of regularly updated, evidence-based guidelines, guideline implementation in clinical practice is low. As a result, people living with type 2 diabetes are not consistently receiving ideal clinical care. Improving guideline adherence has the potential to improve quality of life and longevity in patients with type 2 diabetes. This article introduces Guardians For Health, a global initiative that aims to improve guideline adherence by simplifying patient management and encouraging patient participation in the implementation of guidelines for type 2 diabetes. Guardians For Health is supported by a global community of implementers, with tools to support decision-making and quality assurance. Through achieving better guideline adherence, Guardians For Health hopes to achieve its vision to "stop early mortality by reducing cardiovascular and kidney complications in people with type 2 diabetes".
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Affiliation(s)
- Naresh Kanumilli
- Northenden Group Practice, 489 Palatine Road, Northenden, Manchester, M22 4DH, UK.
| | | | | | - Lars Rydén
- Department for Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Ahmad Alhussein
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Alice Cheng
- University of Toronto Mississauga, Mississauga, Canada
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20
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Shi Q, Nong K, Vandvik PO, Guyatt GH, Schnell O, Rydén L, Marx N, Brosius FC, Mustafa RA, Agarwal A, Zou X, Mao Y, Asadollahifar A, Chowdhury SR, Zhai C, Gupta S, Gao Y, Lima JP, Numata K, Qiao Z, Fan Q, Yang Q, Jin Y, Ge L, Yang Q, Zhu H, Yang F, Chen Z, Lu X, He S, Chen X, Lyu X, An X, Chen Y, Hao Q, Standl E, Siemieniuk R, Agoritsas T, Tian H, Li S. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ 2023; 381:e074068. [PMID: 37024129 PMCID: PMC10077111 DOI: 10.1136/bmj-2022-074068] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. DESIGN Systematic review and network meta-analysis. DATA SOURCES Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. RESULTS The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). CONCLUSIONS This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022325948.
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Affiliation(s)
- Qingyang Shi
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Kailei Nong
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaus Marx
- Clinic for Cardiology, Angiology, and Intensive Care Medicine, RWTH Aachen University, University Hospital Aachen, Aachen, Germany
| | - Frank C Brosius
- Division of Nephrology, University of Arizona College of Medicine Tucson, Tucson, AZ, USA
| | - Reem A Mustafa
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, MI, USA
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Xinyu Zou
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Aminreza Asadollahifar
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Chunjuan Zhai
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Sana Gupta
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Ya Gao
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - João Pedro Lima
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Kenji Numata
- Department of Emergency Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Zhi Qiao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qinlin Fan
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Long Ge
- Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qiuyu Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Hongfei Zhu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Fan Yang
- Department of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China
| | - Zhe Chen
- Evidence-Based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xi Lu
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Siyu He
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangyang Chen
- Department of Endocrinology and Metabolism, First People's Hospital of Shuangliu District, Chengdu, China
| | - Xiafei Lyu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingxing An
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yaolong Chen
- Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qiukui Hao
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Eberhard Standl
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
- Division of General Internal Medicine, Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Haoming Tian
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
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21
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Bowman L, Weidinger F, Albert MA, Fry ETA, Pinto FJ, Bowman L, Casadei B, Collins R, Devereaux PJ, Douglas PS, Frobert O, Goto S, Grines C, Harrington RA, Haynes R, Hochman JS, Charney LH, James S, Kirchhof P, Komajda M, Lam CSP, Landray M, Maggioni A, McMurray J, Medhurst N, Mehran R, Neal B, Rydén L, Thiele H, Van Gelder I, Wallentin L, Yusuf S, Zannad F. Randomized trials fit for the 21st century. A joint opinion from the European Society of Cardiology, American Heart Association, American College of Cardiology, and the World Heart Federation. Eur Heart J 2023; 44:931-934. [PMID: 36525339 PMCID: PMC10011328 DOI: 10.1093/eurheartj/ehac633] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Louise Bowman
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Franz Weidinger
- President, European Society of Cardiology, 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Michelle A Albert
- President, American Heart Association. Walter A. Haas-Lucie Stern Endowed Chair in Cardiology and Admissions Dean, University of California San Francisco Medical School. Director, CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center), San Francisco, CA, USA
| | - Edward T A Fry
- President, American College of Cardiology, Washington, DC, USA.,Chair, Ascension Health Cardiovascular Service Line, Indianapolis, IN, USA
| | - Fausto J Pinto
- President, World Heart Federation, Geneva, Switzerland.,Department of Cardiology, Santa Maria University Hospital, CHULN E.P.E., CCUL, University of Lisbon, Lisbon, Portugal
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22
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Eikelboom JW, Bosch J, Connolly SJ, Tyrwitt J, Fox KAA, Muehlhofer E, Neumann C, Tasto C, Bangdiwala SI, Diaz R, Alings M, Dagenais GR, Leong DP, Lonn EM, Avezum A, Piegas LS, Widimsky P, Parkhomenko AN, Bhatt DL, Branch KRH, Probstfield JL, Lopez-Jaramillo P, Rydén L, Pogosova N, Keltai K, Keltai M, Ertl G, Stoerk S, Dans AL, Lanas F, Liang Y, Zhu J, Torp-Pedersen C, Maggioni AP, Commerford PJ, Guzik TJ, Vanassche T, Verhamme P, O'Donnell M, Tonkin AM, Varigos JD, Vinereanu D, Felix C, Kim JH, Ibrahim KS, Lewis BS, Metsarinne KP, Aboyans V, Steg PG, Hori M, Kakkar A, Anand SS, Lamy A, Sharma M, Yusuf S. Long-Term Treatment with the Combination of Rivaroxaban and Aspirin in Patients with Chronic Coronary or Peripheral Artery Disease: Outcomes During the Open Label Extension of the COMPASS trial. Eur Heart J Cardiovasc Pharmacother 2022; 8:786-795. [PMID: 35383832 DOI: 10.1093/ehjcvp/pvac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 12/29/2022]
Abstract
AIMS To describe outcomes of patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial who were treated with the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily during long-term open-label extension (LTOLE). METHODS AND RESULTS Of the 27 395 patients enrolled in COMPASS, 12 964 (mean age at baseline 67.2 years) from 455 sites in 32 countries were enrolled in LTOLE and treated with the combination of rivaroxaban and aspirin for a median of 374 additional days (range 1-1191 days). During LTOLE, the incident events per 100 patient years were as follows: for the primary outcome [cardiovascular death, stroke, or myocardial infarction (MI)] 2.35 [95% confidence interval (CI) 2.11-2.61], mortality 1.87 (1.65-2.10), stroke 0.62 (0.50-0.76), and MI 1.02 (0.86-1.19), with CIs that overlapped those seen during the randomized treatment phase with the combination of rivaroxaban and aspirin. The incidence rates for major and minor bleeding were 1.01 (0.86-1.19) and 2.49 (2.24-2.75), compared with 1.67 (1.48-1.87) and 5.11 (95% CI 4.77-5.47), respectively, during the randomized treatment phase with the combination. CONCLUSION In patients with chronic CAD and/or PAD, extended combination treatment for a median of 1 year and a maximum of 3 years was associated with incidence rates for efficacy and bleeding that were similar to or lower than those seen during the randomized treatment phase, without any new safety signals.
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Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Jacqueline Bosch
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Jessica Tyrwitt
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eva Muehlhofer
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Christoph Neumann
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Christoph Tasto
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Rafael Diaz
- Estudios Clínicos Latino América and Instituto Cardiovascular de Rosario, Rosaria, Argentina
| | - Marco Alings
- Division of Cardiology, Amphia ziekenhuis, Breda, Netherlands and Werkgroep Cardiologische centra Nederland (WCN), Utrecht, the Netherlands
| | - Gilles R Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Darryl P Leong
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Eva M Lonn
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Petr Widimsky
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander N Parkhomenko
- Emergency Cardiology Dept., National Scientific Center Institute of Cardiology, Kyiv, Ukraine
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelley R H Branch
- University of Washington Medical Centre, Division of Cardiology, Seattle, WA, USA
| | - Jeffrey L Probstfield
- University of Washington SOM, Division of Cardiology/Department of Medicine, Seattle WA, USA
| | - Patricio Lopez-Jaramillo
- Research Institute, Fundación Oftalmológica de Santander (FOSCAL)-Bucaramanga, Bucaramanga, Colombia
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Katalin Keltai
- Hungarian Cardiovascular Institute, Semmelweis University, Budapest, Hungary
| | - Matyas Keltai
- Hungarian Cardiovascular Institute, Semmelweis University, Budapest, Hungary
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Stoerk
- Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Antonio L Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Fernando Lanas
- Universidad de La Frontera, Division of Cardiology, Internal Medicine Department, Temuco, Chile
| | - Yan Liang
- Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Jun Zhu
- Dept of Clinical Medicine, University of Aalborg, Copenhagen, Denmark
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Patrick J Commerford
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Tomasz J Guzik
- Department of Medicine, Jagiellonian University Medical College Krakow, Poland.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John D Varigos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila; University and Emergency Hospital, Bucharest, Romania
| | - Camillo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Jae-Hyung Kim
- Catholic University of Korea, Department of Medicine, Seoul, South Korea
| | | | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kaj P Metsarinne
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital & INSERM 1094, Limoges, France
| | - Phillippe Gabriel Steg
- Université de Paris, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Masatsugu Hori
- Department of Oncocardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Ajay Kakkar
- Thrombosis Research Institute and University College London, London, UK
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Andre Lamy
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Mukul Sharma
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
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23
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Ferrannini G, Almosawi M, Buhlin K, De Faire U, Kjellström B, Klinge B, Nygren Å, Näsman P, Svenungsson E, Rydén L, Norhammar A. Long-term prognosis after a first myocardial infarction: eight years follow up of the case-control study PAROKRANK. SCAND CARDIOVASC J 2022; 56:337-342. [PMID: 35974709 DOI: 10.1080/14017431.2022.2112072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Objective. To explore long-term cardiovascular outcomes and mortality in patients after a first myocardial infarction (MI) compared with matched controls in a contemporary setting. Methods. During 2010-2014 the Swedish study PAROKRANK recruited 805 patients <75 years with a first MI and 805 age-, gender-, and area-matched controls. All study participants were followed until 31 December 2018, through linkage with the National Patient Registry and the Cause of Death Registry. The primary endpoint was the first of a composite of all-cause death, non-fatal MI, non-fatal stroke, and heart failure hospitalization. Event rates in cases and controls were calculated using a Cox regression model, subsequently adjusted for baseline smoking, education level, and marital status. Kaplan-Meier curves were computed and compared by log-rank test. Results. A total of 804 patients and 800 controls (mean age 62 years; women 19%) were followed for a mean of 6.2 (0.2-8.5) years. The total number of primary events was 211. Patients had a higher event rate than controls (log-rank test p < .0001). Adjusted hazard ratio (HR) for the primary outcome was 2.04 (95% CI 1.52-2.73). Mortality did not differ between patients (n = 38; 4.7%) and controls (n = 35; 4.4%). A total of 82.5% patients and 91.3% controls were event-free during the follow up. Conclusions. In this long-term follow up of a contemporary, case-control study, the risk for cardiovascular events was higher in patients with a previous first MI compared with their matched controls, while mortality did not differ. The access to high quality of care and cardiac rehabilitation might partly explain the low rates of adverse outcomes.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mariam Almosawi
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kåre Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf De Faire
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Section of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Kjellström
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences Lund, Clinical Physiology, and Skåne University Hospital, Lund University, Lund, Sweden
| | - Björn Klinge
- Section of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Åke Nygren
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Görans Hospital, Stockholm, Sweden
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24
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Lundin M, Ferrannini G, Mellbin L, Johansson I, Norhammar A, Näsman P, Shahim B, Smetana S, Venkateshvaran A, Wang A, Sörensson P, Rydén L. SOdium-glucose CO-transporter inhibition in patients with newly detected Glucose Abnormalities and a recent Myocardial Infarction (SOCOGAMI). Diabetes Res Clin Pract 2022; 193:110141. [PMID: 36336088 DOI: 10.1016/j.diabres.2022.110141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/10/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Established dysglycaemia (impaired glucose tolerance [IGT] or type 2 diabetes [T2DM]) is a risk factor for further cardiovascular events in patients with coronary artery disease. Sodium-glucose cotransporter 2 inhibitors reduce this risk. The aim of the present investigation was to test the hypothesis that empagliflozin exerts beneficial effects on myocardial function in patients with a recent acute coronary syndrome and newly detected dysglycaemia. METHODS Forty-two patients (mean age 67.5 years, 81 % male) with recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected IGT (n = 27) or T2DM (n = 15) were randomised to 25 mg of empagliflozin daily (n = 20) or placebo (n = 22) on top of ongoing therapy. They were investigated with oral glucose tolerance tests, stress-perfusion cardiac magnetic resonance imaging (CMR) and echocardiography at three occasions: before randomisation, after seven months on study drug and three months following cessation of such drug. Primary outcome was a change in left ventricular (LV) end-diastolic volume (LVEDV) and secondary outcomes were a change in a) systolic and diastolic LV function; b) coronary flow reserve; c) myocardial extracellular volume (ECV) in non-infarcted myocardium; d) aortic pulse wave velocity. RESULTS Empagliflozin induced a significant decrease in fasting and post load glucose (p < 0.05) and body weight (p < 0.01). Empagliflozin did not influence LVEDV, LV systolic or mass indexes, coronary flow reserve, ECV or aortic pulse wave velocity. Echocardiographic indices of LV diastolic function (E/e' and mitral E/A ratio) were not influenced. No safety concerns were identified. CONCLUSIONS/INTERPRETATION Empagliflozin had predicted effects on the dysglycaemia but did not influence variables expressing LV function, coronary flow reserve and ECV. An explanation may be that the LV function of the patients was within the normal range.
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Affiliation(s)
- Magnus Lundin
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Capio S:t Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Bahira Shahim
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Smetana
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anne Wang
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Ferrannini G, Mellbin LG, Kirabo F, Ramasundarahettige C, Gerstein HC, Rydén L. Dulaglutide and a Composite Outcome Reflecting Atherosclerosis in the REWIND Trial: A Post Hoc Analysis. Diabetes Care 2022; 45:e146-e147. [PMID: 36040063 DOI: 10.2337/dc22-0903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | - Linda G Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Faith Kirabo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
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26
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Rautio E, Gadler F, Gudbjörnsdottir S, Franzén S, Rydén L, Svensson AM, Mellbin LG. Erratum. Patients With Type 2 Diabetes Have an Increased Demand for Pacemaker Treatment: A Comparison With Age- and Sex-Matched Control Subjects From the General Population. Diabetes Care 2020;44:2853-2858. Diabetes Care 2022; 45:2476. [PMID: 35947727 PMCID: PMC9911316 DOI: 10.2337/dc22-er10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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27
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Fortin E, Ferrannini G, Campi B, Mellbin L, Norhammar A, Näsman P, Saba A, Ferrannini E, Rydén L. Plasma mannose as a novel marker of myocardial infarction across different glycaemic states: a case control study. Cardiovasc Diabetol 2022; 21:195. [PMID: 36151569 PMCID: PMC9508730 DOI: 10.1186/s12933-022-01630-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasma mannose, an emerging novel biomarker of insulin resistance, is associated with both diabetes mellitus and coronary atherosclerosis, but the relationship between mannose concentrations and myocardial infarction (MI) across different glycaemic states remains to be elucidated. The aim of this study was to investigate the independent association between mannose and a first MI in a group of subjects characterized according to their glycaemic state. METHODS Fasting plasma mannose concentrations were analysed in 777 patients 6-10 weeks after a first myocardial infarction and in 770 matched controls by means of high-performance liquid chromatography coupled to tandem mass spectrometry. Participants without known diabetes mellitus were categorized by an oral glucose tolerance test (OGTT) as having normal glucose tolerance (NGT, n = 1045), impaired glucose tolerance (IGT, n = 246) or newly detected type 2 diabetes (T2DM, n = 112). The association between mannose and MI was investigated across these glycaemic states by logistic regression. RESULTS Mannose levels increased across the glycaemic states (p < 0.0001) and were significantly associated with a first MI in the whole study population (odds ratio, OR: 2.2; 95% CI 1.4 to - 3.5). Considering the different subgroups separately, the association persisted only in subjects with NGT (adjusted OR: 2.0; 95% CI 1.2-3.6), but not in subgroups with glucose perturbations (adjusted OR: 1.8, 95% CI 0.8-3.7). CONCLUSIONS Mannose concentrations increased across worsening levels of glucose perturbations but were independently associated with a first MI only in NGT individuals. Thus, mannose might be a novel, independent risk marker for MI, possibly targeted for the early management of previously unidentified patients at high cardiovascular risk.
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Affiliation(s)
- Elena Fortin
- Division of Cardiology, Department of Medicine K2, Karolinska Institutet, Norrbacka S1:02, 171 76, Stockholm, Sweden.
| | - Giulia Ferrannini
- Division of Cardiology, Department of Medicine K2, Karolinska Institutet, Norrbacka S1:02, 171 76, Stockholm, Sweden
| | - Beatrice Campi
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Linda Mellbin
- Division of Cardiology, Department of Medicine K2, Karolinska Institutet, Norrbacka S1:02, 171 76, Stockholm, Sweden.,Heart Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Division of Cardiology, Department of Medicine K2, Karolinska Institutet, Norrbacka S1:02, 171 76, Stockholm, Sweden.,Capio St Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Alessandro Saba
- Mass Spectrometry Laboratory, Department of Pathology, University of Pisa, Pisa, Italy.,Clinical Pathology Laboratory, Santa Chiara University Hospital, Pisa, Italy
| | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Lars Rydén
- Division of Cardiology, Department of Medicine K2, Karolinska Institutet, Norrbacka S1:02, 171 76, Stockholm, Sweden
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Affiliation(s)
- Lars Rydén
- From the Department of Medicine, Solna, Karolinska Institutet, Stockholm (L.R.), and the Diabetes Research Group at Munich, Helmholtz Center, Neuherberg, Germany (E.S.)
| | - Eberhard Standl
- From the Department of Medicine, Solna, Karolinska Institutet, Stockholm (L.R.), and the Diabetes Research Group at Munich, Helmholtz Center, Neuherberg, Germany (E.S.)
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29
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Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population. Diabetes Care 2022; 45:2111-2117. [PMID: 35771773 DOI: 10.2337/dc22-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Göran's Hospital, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Terhi Vihervaara
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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30
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De Bacquer D, Jennings CS, Mirrakhimov E, Lovic D, Bruthans J, De Smedt D, Gotcheva N, Dolzhenko M, Fras Z, Pogosova N, Lehto S, Hasan-Ali H, Jankowski P, Kotseva K, De Backer G, Wood D, Rydén L. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. Eur Heart J Qual Care Clin Outcomes 2022; 8:568-576. [PMID: 34315174 DOI: 10.1093/ehjqcco/qcab043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
AIMS Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. METHODS AND RESULTS Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month. CONCLUSIONS The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Erkin Mirrakhimov
- Department of Cardiology and Internal Diseases, Kyrgyz State Medical Academy, Akhunbaev str. 92, 720020, Bishkek, Kyrgyzstan.,National Centre of Cardiology and Internal Medicine Named After Academician Mirrakhimov MM, Togolok Moldo str. 3, 720040, Bishkek, Kyrgyzstan
| | - Dragan Lovic
- Cardiology Department, Singidunum University, School of Medicine, Clinic for Internal Disease Intermedica, Jovana Ristica str. 20/2, 18000 Nis, Serbia
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Nina Gotcheva
- National Heart Hospital, Department of Cardiology, Konjovitza str. 65, 1309 Sofia, Bulgaria
| | - Maria Dolzhenko
- Shupyk National Medical Academy of Postgraduate Education, Dorohozhytska 9, 04112, Kyiv, Ukraine
| | - Zlatko Fras
- Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Zaloška 7, SI-1525 Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nana Pogosova
- National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, 3-rd Cherepkovskaya str. 15A, 121552 Moscow, Russia
| | - Seppo Lehto
- Department of Internal Medicine, Lapland Central Hospital, Ounasrinteentie 22, 96400 Rovaniemi, Finland
| | - Hasan Hasan-Ali
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut University Campus, 71515 Assiut, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, 2 Jakubowski Str., 30-688 Kraków, Poland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, FoU - Tema Hjärta och Kärl, S1:02, Karolinska Universitetssjukhuset/Solna, SE-171 76, Stockholm, Sweden
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Cukierman-Yaffe T, Gerstein HC, Basile J, Bethel MA, Cardona-Muñoz EG, Conget I, Dagenais G, Franek E, Hall S, Hancu N, Jansky P, Lakshmanan M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pirags V, Pogosova N, Probstfield J, Rao-Melacini P, Ramasundarahettige C, Raubenheimer PJ, Riddle MC, Rydén L, Shaw JE, Sheu WHH, Temelkova-Kurktschiev T. Novel Indices of Cognitive Impairment and Incident Cardiovascular Outcomes in the REWIND Trial. J Clin Endocrinol Metab 2022; 107:e3448-e3454. [PMID: 35446415 DOI: 10.1210/clinem/dgac200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Low cognitive scores are risk factors for cardiovascular outcomes. Whether this relationship is stronger using novel cognitive indices is unknown. METHODS Participants in the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial who completed both the Montreal Cognitive Assessment (MoCA) score and Digit Substitution Test (DSST) at baseline (N = 8772) were included. These scores were used to identify participants with baseline substantive cognitive impairment (SCI), defined as a baseline score on either the MoCA or DSST ≥ 1.5 SD below either score's country-specific mean, or SCI-GM, which was based on a composite index of both scores calculated as their geometric mean (GM), and defined as a score that was ≥ 1.5 SD below their country's average GM. Relationships between these measures and incident major adverse cardiovascular events (MACE), and either stroke or death were analyzed. RESULTS Compared with 7867 (89.7%) unaffected participants, the 905 (10.3%) participants with baseline SCI had a higher incidence of MACE (unadjusted hazard ratio [HR] 1.34; 95% CI 1.11, 1.62; P = 0.003), and stroke or death (unadjusted HR 1.60; 95% CI 1.33, 1.91; P < 0.001). Stronger relationships were noted for SCI-GM and MACE (unadjusted HR 1.61; 95% CI 1.28, 2.01; P < 0.001), and stroke or death (unadjusted HR 1.85; 95% CI 1.50, 2.30; P < 0.001). For SCI-GM but not SCI, all these relationships remained significant in models that adjusted for up to 10 SCI risk factors. CONCLUSION Country-standardized SCI-GM was a strong independent predictor of cardiovascular events in people with type 2 diabetes in the REWIND trial.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Endocrinology Institute, Sheba Medical Center, Ramat-Gan, and Epidemiology Department, Sackler School of Medicine, Herceg Institute of Aging, Tel Aviv University, Tel Aviv, Israel
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Jan Basile
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | | | - Ignacio Conget
- Endocrinology and Nutrition Dpt. Hospital Clinic i Universitari, Barcelona, Spain
| | - Gilles Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences and Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Stephanie Hall
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Nicolae Hancu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | | | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Valdis Pirags
- University of Latvia, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | | | - Matthew C Riddle
- Department of Medicine, Oregon Health & Science University Portland, OR, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | - Wayne H-H Sheu
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Meziani S, Ferrannini G, Bjerre M, Hansen TK, Ritsinger V, Norhammar A, Gyberg V, Näsman P, Rydén L, Mellbin LG. Mannose-binding lectin does not explain the dismal prognosis after an acute coronary event in dysglycaemic patients. A report from the GAMI cohort. Cardiovasc Diabetol 2022; 21:129. [PMID: 35804351 PMCID: PMC9270763 DOI: 10.1186/s12933-022-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Mannose binding lectin (MBL) has been suggested to be associated with an impaired cardiovascular prognosis in dysglycaemic conditions, but results are still contrasting. Our aims are (i) to examine whether MBL levels differ between patients with an acute myocardial infarction (MI) and healthy controls and between subgroups with different glucose tolerance status, and (ii) to investigate the relation between MBL and future cardiovascular events. Methods MBL levels were assessed at discharge and after 3 months in 161 AMI patients without any previously known glucose perturbations and in 183 age- and gender-matched controls from the Glucose metabolism in patients with Acute Myocardial Infarction (GAMI) study. Participants were classified as having dysglycaemia, i.e. type 2 diabetes or impaired glucose tolerance, or not by an oral glucose tolerance test. The primary outcome was a composite of cardiovascular events comprising cardiovascular death, AMI, stroke or severe heart failure during 11 years of follow-up. Total and cardiovascular mortality served as secondary outcomes. Results At hospital discharge patients had higher MBL levels (median 1246 μg/L) than three months later (median 575 μg/L; p < 0.01), the latter did not significantly differ from those in the controls (801 μg/L; p = 0.47). MBL levels were not affected by dysglycaemia either in patients or controls. Independent of glycaemic state, increasing MBL levels did not predict any of the studied outcomes in patients. In unadjusted analyses increasing MBL levels predicted cardiovascular events (hazard ratio HR: 1.67, 95% confidence interval CI 1.06–2.64) and total mortality (HR 1.53, 95% CI 1.12–2.10) in the control group. However, this did not remain in adjusted analyses. Conclusions Patients had higher MBL levels than controls during the hospital phase of AMI, supporting the assumption that elevated MBL reflects acute stress. MBL was not found to be independently associated with cardiovascular prognosis in patients with AMI regardless of glucose state. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01562-0.
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Affiliation(s)
- Sara Meziani
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.
| | - Mette Bjerre
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Troels K Hansen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Viveca Ritsinger
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Anna Norhammar
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Capio St. Görans Hospital, Stockholm, Sweden
| | - Viveca Gyberg
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 171 76, Stockholm, Sweden.,Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
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Vallon-Christersson J, Staaf J, Häkkinen J, Hegardt C, Saal L, Ehinger A, Larsson C, Loman N, Rydén L, Malmberg M, Borg Å. 52P RNA sequencing-based single sample predictors of molecular subtype and risk of recurrence for clinical assessment of early-stage breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Schnell O, Battelino T, Bergenstal R, Blüher M, Böhm M, Brosius F, Carr RD, Ceriello A, Forst T, Giorgino F, Guerci B, Heerspink HJL, Itzhak B, Ji L, Kosiborod M, Lalić N, Lehrke M, Marx N, Nauck M, Rodbard HW, Rosano GMC, Rossing P, Rydén L, Santilli F, Schumm-Draeger PM, Vandvik PO, Vilsbøll T, Wanner C, Wysham C, Standl E. Report from the CVOT Summit 2021: new cardiovascular, renal, and glycemic outcomes. Cardiovasc Diabetol 2022; 21:50. [PMID: 35395808 PMCID: PMC8990484 DOI: 10.1186/s12933-022-01481-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/07/2023] Open
Abstract
The 7th Cardiovascular Outcome Trial (CVOT) Summit on Cardiovascular, Renal, and Glycemic Outcomes, was held virtually on November 18–19, 2021. Pursuing the tradition of the previous summits, this reference congress served as a platform for in-depth discussion and exchange on recently completed CVOTs. This year’s focus was placed on the outcomes of EMPEROR-Preserved, FIGARO-DKD, AMPLITUDE-O, SURPASS 1–5, and STEP 1–5. Trial implications for diabetes and obesity management and the impact on new treatment algorithms were highlighted for endocrinologists, diabetologists, cardiologists, nephrologists, and general practitioners. Discussions evolved from outcome trials using SGLT2 inhibitors as therapy for heart failure, to CVOTs with nonsteroidal mineralocorticoid receptor antagonists and GLP-1 receptor agonists. Furthermore, trials for glycemic and overweight/obesity management, challenges in diabetes management in COVID-19, and novel guidelines and treatment strategies were discussed. Trial registration The 8th Cardiovascular Outcome Trial Summit will be held virtually on November 10–11, 2022 (http://www.cvot.org)
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e. V., Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Munich, Germany.
| | - Tadej Battelino
- University Medical Center, Ljubljana, Slovenia.,University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Richard Bergenstal
- International Diabetes Center at Park Nicollet, Health Partners, Minneapolis, MN, USA
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Frank Brosius
- College of Medicine, University of Arizona, Tuscon, AZ, USA
| | | | | | - Thomas Forst
- CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Bruno Guerci
- Department of Endocrinology Diabetology and Nutrition, Nancy University Hospital, Nancy, France.,Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Baruch Itzhak
- Clalit Health Services and Technion Faculty of Medicine, Haifa, Israel
| | - Linong Ji
- Peking University People's Hospital, Xicheng District, Beijing, China
| | - Mikhail Kosiborod
- Cardiometabolic Center of Excellence, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nebojša Lalić
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Michael Lehrke
- Department of Internal Medicine I, University Hospital Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, Aachen, Germany
| | - Michael Nauck
- Diabetes Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Francesca Santilli
- Department of Medicine and Aging, Hospital and, University of Chieti, Chieti, Italy
| | | | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerupn, Denmark
| | | | - Carol Wysham
- Section of Endocrinology and Metabolism, MultiCare Rockwood Clinic, Spokane, WA, USA
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Munich, Germany
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Raubenheimer PJ, Cushman WC, Avezum A, Basile J, Conget I, Dagenais G, Hoover A, Jansky P, Lanas F, Leiter LA, Lopez-Jaramillo P, Pogosova N, Probstfield J, Rao-Melacini P, Rydén L, Sheu WHH, Temelkova-Kurktschiev T, C Gerstein H. Dulaglutide and incident atrial fibrillation or flutter in patients with type 2 diabetes: A post hoc analysis from the REWIND randomized trial. Diabetes Obes Metab 2022; 24:704-712. [PMID: 34984808 DOI: 10.1111/dom.14634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/10/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
AIM To assess the occurrence of atrial fibrillation or atrial flutter (atrial arrhythmias [AA]) in patients with type 2 diabetes treated with once-weekly subcutaneous dulaglutide versus placebo. MATERIALS AND METHODS Patients without electrocardiographic (ECG)-confirmed AA at baseline and randomized in the REWIND trial were assessed for the development of AA based on an annual ECG. Additional analyses included whether dulaglutide compared with placebo reduced the composite outcome of AA or death, AA or cardiovascular death, AA or stroke and AA or heart failure. RESULTS Among 9543 participants (mean age 66 ± 7 years, with cardiovascular risk factors and 31% with previous cardiovascular disease) without AA at entry in the trial, 524 patients (5.5%) had at least one episode of AA during the median 5.4 years of follow-up. Incident AA occurred in 269 of the 4769 participants allocated to dulaglutide (5.6%), at a rate of 10.7 per 1000 person-years, versus 255 of the 4774 allocated to placebo (5.3%), at a rate of 10.5 per 1000 person-years (P = .59). There was also no effect of dulaglutide on the composite outcome of AA and death or AA and heart failure. CONCLUSION This post hoc analysis of data from the REWIND trial showed that treatment with dulaglutide was not associated with a reduced incidence of AA in this at-risk group of patients with type 2 diabetes.
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Affiliation(s)
- Peter J Raubenheimer
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - William C Cushman
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jan Basile
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gilles Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec. Université Laval Institute, Quebec City, Quebec, Canada
| | | | - Petr Jansky
- University Hospital Motol, Prague, Czech Republic
| | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lars Rydén
- Department of Medicine, Karolinska Institut, Stockholm, Sweden
| | - Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Ferrannini G, De Bacquer D, Gyberg V, De Backer G, Kotseva K, Mellbin LG, Risebrink R, Tuomilehto J, Wood D, Rydén L. Saving time by replacing the standardised two-hour oral glucose tolerance test with a one-hour test: Validation of a new screening algorithm in patients with coronary artery disease from the ESC-EORP EUROASPIRE V registry. Diabetes Res Clin Pract 2022; 183:109156. [PMID: 34843858 DOI: 10.1016/j.diabres.2021.109156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS An oral glucose tolerance test (OGTT) combining fasting (FPG) and 2-hour plasma glucose (2hPG) is the most sensitive method for detecting type 2 diabetes (T2DM). Since it is considered time-consuming, we aim at validating a previously proposed screening algorithm based on a 1-hour plasma glucose (1hPG) with a 12 mmol/L threshold. METHODS Nine-hundred-eighteen patients with coronary artery disease (CAD) without known T2DM from the EUROASPIRE V cross-sectional survey underwent an OGTT. The reference for T2DM was 2hPG ≥ 11.1 mmol/L. T2DM diagnosis by HbA1c ≥ 6.5%(48 mmol/mol), FPG ≥ 7.0 mmol/L, and 1hPG ≥ 12 mmol/L were compared with the outcome of 2hPG. RESULTS Mean FPG, HbA1c and 2hPG were 6.1 mmol/L, 5.6%(38 mmol/mol) and 7.8 mmol/L respectively. Ninety-six patients (10%) were diagnosed with T2DM according to 2hPG. Using this definition, in the group with FPG < 6.5 mmol/L and 1hPG < 12 only 5 (1%) were misdiagnosed as false negatives. All patients with a FPG > 8.0 mmol/L and 1hPG > 15.0 mmol/L were identified as having T2DM. According to the algorithm, in 79% of patients T2DM could be excluded by combining FPG < 6.5 mmol/L and 1hPG < 12 mmol/L. CONCLUSIONS T2DM Screening by means of an algorithm combining FPG and 1hPG limits the demand of a 2hOGTT in 79% of CAD patients without known T2DM. HbA1c did not add to the information derived from this algorithm.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Viveca Gyberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, UK; St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Risebrink
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Rydén L, Ferrannini G. Is the impact of add on heart failure therapy influenced by background therapy? Lancet Diabetes Endocrinol 2022; 10:3-5. [PMID: 34861151 DOI: 10.1016/s2213-8587(21)00311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Giulia Ferrannini
- Department of Medicine K2, Karolinska Institutet, Stockholm SE-171 76, Sweden
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38
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Narbe U, Bendahl PO, Fernö M, Ingvar C, Dihge L, Rydén L. St Gallen 2019 guidelines understage the axilla in lobular breast cancer: a population-based study. Br J Surg 2021; 108:1465-1473. [PMID: 34636842 PMCID: PMC10364867 DOI: 10.1093/bjs/znab327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The St Gallen 2019 guidelines for primary therapy of early breast cancer recommend omission of completion axillary lymph node dissection (cALND), regardless of histological type, in patients with one or two sentinel lymph node (SLN) metastases. Concurrently, adjuvant chemotherapy is endorsed for luminal A-like disease with four or more axillary lymph node (ALN) metastases. The aim of this study was to estimate the proportion of patients with invasive lobular cancer (ILC) versus invasive ductal cancer of no special type (NST) with one or two SLN metastases for whom cALND would have led to a recommendation for adjuvant chemotherapy. METHODS Patients with ILC and NST who had surgery between 2014 and 2017 were identified in the National Breast Cancer Register of Sweden. After exclusion of patients with incongruent or missing data, those who fulfilled the St Gallen 2019 criteria for cALND omission were included in the population-based study cohort. RESULTS Some 1886 patients in total were included in the study, 329 with ILC and 1507 with NST. Patients with ILC had a higher metastatic nodal burden and were more likely to have a luminal A-like subtype than those with NST. The prevalence of at least four ALN metastases was higher in ILC (31.0 per cent) than NST (14.9 per cent), corresponding to an adjusted odds ratio of 2.26 (95 per cent c.i. 1.59 to 3.21). Luminal A-like breast cancers with four or more ALN metastases were over-represented in ILC compared with NST, 52 of 281 (18.5 per cent) versus 43 of 1299 (3.3 per cent) (P < 0.001). CONCLUSION Patients with ILC more often have luminal A-like breast cancer with at least four nodal metastases. Omission of cALND in patients with luminal A-like invasive lobular cancer and one or two SLN metastases warrants future attention as there is a risk of nodal understaging and undertreatment in one-fifth of patients.
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Affiliation(s)
- U Narbe
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden.,Department of Oncology, Växjö Central Hospital, Växjö, Sweden
| | - P-O Bendahl
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - M Fernö
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - C Ingvar
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - L Dihge
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden.,Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - L Rydén
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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Sebring D, Buhlin K, Norhammar A, Rydén L, Jonasson P, Lund H, Kvist T. Endodontic inflammatory disease: A risk indicator for a first myocardial infarction. Int Endod J 2021; 55:6-17. [PMID: 34561889 DOI: 10.1111/iej.13634] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
AIM To study the association between endodontic inflammatory disease and a first myocardial infarction (MI). METHODOLOGY The study comprised 805 patients with recent experience of a first MI, each gender, age and geographically matched with a control. Panoramic radiographs were available for 797 patients and 796 controls. Endodontic inflammatory disease was assessed radiographically. The sum of decayed, missing and filled teeth (DMFT) was calculated, and the number of root filled teeth and teeth with periapical lesions were recorded. The associated risk of a first MI was expressed as odds ratios (OR) with 95% confidence intervals (CI), unadjusted and adjusted for confounders (family history of cardiovascular disease, smoking habits, marital status, education and diabetes). RESULTS Patients who had suffered a first MI had higher DMFT (mean 22.5 vs. 21.9, p = .013) and more missing teeth (mean 7.5 vs. 6.3; p < .0001) than the healthy controls. The number of missing teeth was associated with an increased risk of a first MI (adjusted OR 1.04; CI 1.02-1.06). Conversely, decay-free, filled teeth were associated with decreased risk (adjusted OR 0.98; CI 0.96-1.00). Analysis based on age disclosed the following variables to be associated with an increased risk of a first MI: number of decayed teeth (adjusted OR 1.18; CI 1.02-1.37, in patients <60 years), any primary periapical lesion (adjusted OR 1.57; CI 1.08-2.29, in patients <65 years) and the proportion of root filled teeth (adjusted OR 1.18; CI 1.03-1.36, in patients ≥65 years). CONCLUSIONS More missing teeth was independently associated with an increased risk of a first MI. In addition, endodontic inflammatory disease may contribute as an independent risk factor to cardiovascular disease since untreated caries, periapical lesions and root fillings, depending on age, were significantly associated with a first MI.
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Affiliation(s)
- Dan Sebring
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kåre Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Anna Norhammar
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Capio St Görans Hospital, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Jonasson
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Henrik Lund
- Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Kvist
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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40
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Ellbrant J, Gulis K, Plasgård E, Svensjö T, Bendahl PO, Rydén L. Validated prediction model for positive resection margins in breast-conserving surgery based exclusively on preoperative data. BJS Open 2021; 5:6382014. [PMID: 34611702 PMCID: PMC8493005 DOI: 10.1093/bjsopen/zrab092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background Positive margins after breast-conserving surgery (BCS) and subsequent second surgery are associated with increased costs and patient discomfort. The aim of this study was to develop a prediction model for positive margins based on risk factors available before surgery. Methods Patients undergoing BCS for in situ or invasive cancer between 2015 and 2016 at site A formed a development cohort; those operated during 2017 in site A and B formed two validation cohorts. MRI was not used routinely. Preoperative radiographic and tumour characteristics and method of operation were collected from patient charts. Multivariable logistic regression was used to develop a prediction model for positive margins including variables with discriminatory capacity identified in a univariable model. The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed. Results There were 432 patients in the development cohort, and 190 and 157 in site A and B validation cohorts respectively. Positive margins were identified in 77 patients (17.8 per cent) in the development cohort. A non-linear transformation of mammographic tumour size and six variables (visible on mammography, ductal carcinoma in situ, lobular invasive cancer, distance from nipple–areola complex, calcification, and type of surgery) were included in the final prediction model, which had an area under the curve of 0.80 (95 per cent c.i. 0.75 to 0.85). The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed. Conclusion The prediction model showed good ability to predict positive margins after BCS and might, after further validation, be used before surgery in centres without the routine use of preoperative MRI. Presented in part to the San Antonio Breast Cancer Symposium, San Antonio, Texas, USA, December 2018 and the Swedish Surgical Society Annual Meeting, Helsingborg, Sweden, August 2018.
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Affiliation(s)
- J Ellbrant
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
| | - K Gulis
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - E Plasgård
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - T Svensjö
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - P O Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - L Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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Wang A, Flanagan J, Arver S, Norhammar A, Näsman P, Rydén L, Mellbin LG. Androgen receptor polymorphism, testosterone levels, and prognosis in patients with acute myocardial infarction. Eur Heart J Open 2021; 1:oeab023. [PMID: 35928286 PMCID: PMC9241568 DOI: 10.1093/ehjopen/oeab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 06/15/2023]
Abstract
Aims Low testosterone has been associated with cardiovascular disease in men but with contradictory findings. Testosterone bind to the androgen receptor and polymorphisms of the receptor gene such as CAG repeat length may affect transcriptional activity, possibly mitigating testosterone effects. The aims were to study the CAG repeat length and testosterone levels at four time points following a myocardial infarction (MI) and to analyse possible relationships between CAG repeat length and cardiovascular prognosis. Methods and results Male patients admitted for acute MI (n = 122) from the Glucose in Acute Myocardial Infarction study were included. Blood samples were drawn at four time points (day after admission, at discharge, and at 3 and 12 months post-infarction) for assessment of testosterone levels. Patients were followed for a median of 11.6 years. Cox regression analyses were performed for CAG repeat length by one unit increment and by > vs. ≤median for cardiovascular events and all-cause mortality. Median CAG repeat length was 20. There was no difference in testosterone levels at each time point when dividing the cohort into ≤ vs. >CAG repeat median (=20). There was no association between CAG repeat length either as a continuous or categorical variable in unadjusted and age-adjusted Cox analyses for cardiovascular events. While CAG >20 was associated with all-cause mortality in unadjusted analyses (hazard ratio 2.19, 95% confidence interval 1.13-4.22; P = 0.02), it did not remain significant following adjustment for age. Conclusion CAG repeat length was not associated with testosterone levels or prognosis in men with acute MI.
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Affiliation(s)
- Anne Wang
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm 171 76, Sweden
| | - John Flanagan
- Center for Andrology and Sexual Medicine (ANOVA), Department of Medicine, Huddinge, Karolinska Institutet, Stockholm 141 86, Sweden
| | - Stefan Arver
- Center for Andrology and Sexual Medicine (ANOVA), Department of Medicine, Huddinge, Karolinska Institutet, Stockholm 141 86, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm 171 76, Sweden
- Capio S:t Görans Hospital, Stockholm 113 19, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, SE-100 44, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm 171 76, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm 171 76, Sweden
| | - Linda G Mellbin
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm 171 76, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm 171 76, Sweden
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42
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McEvoy JW, Jennings C, Kotseva K, De Backer G, De Bacquer D, Erlund I, Lip GYH, Ray KK, Rydén L, Adamska A, Wood DA. INTERASPIRE: an International Survey of Coronary Patients; Their Cardiometabolic, Renal and Biomarker Status; and the Quality of Preventive Care Delivered in All WHO Regions : In Partnership with the World Heart Federation, European Society of Cardiology, Asia Pacific Society of Cardiology, InterAmerican Society of Cardiology, and PanAfrican Society of Cardiology. Curr Cardiol Rep 2021; 23:136. [PMID: 34410520 PMCID: PMC8374115 DOI: 10.1007/s11886-021-01568-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/11/2022]
Abstract
Purpose of Review To describe the INTERASPIRE scientific protocol—an international survey of secondary prevention of coronary heart disease (CHD). Recent Findings This international survey is being conducted through National Societies of Cardiology in selected countries from each of the six WHO regions and has the following overall aims: (i) describe prevalence of cardiometabolic and renal risk factors together with biomarkers in CHD patients; (ii) describe current risk factor management through lifestyle changes and cardioprotective drug therapies; (iii) provide an objective assessment of clinical implementation of preventive care by comparison with the lifestyle and risk factor targets defined in international and national guidelines; (iv) investigate the reasons for variation in preventive cardiology practice between regions and countries; and (v) promote the principles of best preventive cardiology practice. Summary This international survey will provide a unique picture of CHD patients; their cardiometabolic, renal and biomarker status; lifestyle and therapeutic management; and the quality of preventive care provided in all WHO regions.
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Affiliation(s)
- John William McEvoy
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland. .,Discipline of Medicine, Clinical Science Institute, National University of Ireland Galway, University Road, Galway, Ireland, H91 TK33.
| | - Catriona Jennings
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Gregory Y H Lip
- Arrhythmia Centre: Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Coordinating Centre for the FH Studies Collaboration: Department of Public Health and Primary Care, Imperial College, London, UK
| | - Lars Rydén
- Diabetes Centre: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Agnieszka Adamska
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David A Wood
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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Ferrannini G, Gerstein H, Colhoun HM, Dagenais GR, Diaz R, Dyal L, Lakshmanan M, Mellbin L, Probstfield J, Riddle MC, Shaw JE, Avezum A, Basile JN, Cushman WC, Jansky P, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pais P, Pīrāgs V, Pogosova N, Raubenheimer PJ, Sheu WHH, Rydén L. Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin. Eur Heart J 2021; 42:2565-2573. [PMID: 33197271 DOI: 10.1093/eurheartj/ehaa777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/27/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. RESEARCH DESIGN AND METHODS Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. RESULTS Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81-1.05) vs. 0.78 (CI 0.61-0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. CONCLUSION This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine K2, Karolinska Institutet, Solnavägen 1, Stockholm SE171 77, Sweden
| | - Hertzel Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Helen Martina Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Crewe Road, Edinburgh EH4 2XU, UK
| | - Gilles R Dagenais
- Department of Medicine, Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Québec City, QC, Canada
| | - Rafael Diaz
- ECLA, Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Paraguay 160, S2000 Rosario, Santa Fe, Argentina
| | - Leanne Dyal
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mark Lakshmanan
- Eli Lilly and Company, 893 Delaware St, Indianapolis, IN 46225, USA
| | - Linda Mellbin
- Department of Medicine K2, Karolinska Institutet, Solnavägen 1, Stockholm SE171 77, Sweden
| | - Jeffrey Probstfield
- Department of Medicine, RR-512, Health Sciences Building, University of Washington, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Matthew Casey Riddle
- Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jonathan Edward Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC 3004, Australia
| | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia and University Santo Amaro, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo - SP, 04012-909, Brazil
| | - Jan Neil Basile
- Division of Cardiology, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA
| | - William C Cushman
- Memphis Veterans Affairs Medical Center, Preventive Medicine Section, 1030 Jefferson Ave, Memphis, TN 38104, USA
| | - Petr Jansky
- Department of Cardiovascular Surgery, University Hospital Motol, V Úvalu 84 150 06 Praha 5, Czech Republic
| | - Mátyás Keltai
- Department of Cardiology, Semmelweis University, Hungarian Institute of Cardiology, Üllői út 26, 1085 Budapest, Hungary
| | - Fernando Lanas
- Department of Internal Medicine, Universidad de La Frontera, Francisco Salazar 1145, Temuco, Araucanía, Chile
| | - Lawrence Alan Leiter
- Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 38 Shuter St, Toronto, ON M5B 1A6, Canada
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander UDES, Calle 70 No 55-210 Bucaramanga, Colombia
| | - Prem Pais
- Division of Clinical Research and Training, St. John's Research Institute, 100 Feet Rd, John Nagar, Koramangala, Bengaluru, Karnataka 560034, India
| | - Valdis Pīrāgs
- Department of Internal Medicine, Latvijas Universitate, Raiņa bulvāris 19, Centra rajons, Riga LV-1586, Latvia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Ulitsa Ostrovityanova, 1, Moscow 117997, Russian Federation
| | | | - Wayne Huey-Herng Sheu
- Department of Medicine, Taichung Veterans General Hospital, Rongguang Road, Puli Township, Nantou County, Taichung 54552, Taiwan
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Solnavägen 1, Stockholm SE171 77, Sweden
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44
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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45
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Smaradottir MI, Andersen K, Gudnason V, Näsman P, Rydén L, Mellbin LG. Copeptin is associated with mortality in elderly people. Eur J Clin Invest 2021; 51:e13516. [PMID: 33569762 DOI: 10.1111/eci.13516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Elevated copeptin, a marker for vasopressin release, has been associated with impaired prognosis in acute myocardial infarction (MI). The aim was to investigate whether this association extends beyond the acute phase and whether it is related to markers of stress (cortisol) and heart failure (NTproBNP). METHODS Copeptin, cortisol and NTproBNP were measured in 926 participants (age: 76.0; male: 48.5%) in the ICELAND MI study whereof 246 had a previous MI (91 recognizable (RMI) and 155 previously unrecognizable (UMI) detected by cardiac magnetic resonance imaging). The primary endpoint was cardiovascular events (CVEs), and secondary endpoints were total mortality, heart failure and MI (median follow-up was 9.1 years). The relation between copeptin and prognosis was assessed with the Cox proportional hazard regression (unadjusted, adjusted for cortisol and NTproBNP, respectively, and a multiple model: copeptin, cortisol, NTproBNP, age, sex, serum creatinine, heart failure). RESULTS Copeptin was higher in participants with MI (8.9 vs. 6.4 pmol/L; P < .01), with no difference between RMI vs. UMI. Increased copeptin correlated with evening cortisol (r = .11; P < .01) and NTproBNP (r = .07; P = .04). Copeptin was associated with CVE and total mortality after adjusting for cortisol and NTproBNP separately, and remained significantly associated with total mortality in the multiple model. CONCLUSIONS Copeptin was higher in subjects with previous MI regardless whether previously recognized or not. Copeptin correlated weakly with cortisol and NTproBNP, and was independently associated with total mortality. This indicates that the prognostic implications of copeptin are not only mediated by heart failure or stress, supporting the assumption that copeptin is a marker of general vulnerability.
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Affiliation(s)
| | - Karl Andersen
- Department of Health Sciences, Reykjavík, Iceland.,Icelandic Heart Association, Kópavogur, Iceland
| | - Vilmundur Gudnason
- Department of Health Sciences, Reykjavík, Iceland.,Icelandic Heart Association, Kópavogur, Iceland
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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46
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Verma S, Fainberg U, Husain M, Rasmussen S, Rydén L, Ripa MS, Buse JB. Applying REWIND cardiovascular disease criteria to SUSTAIN 6 and PIONEER 6: An exploratory analysis of cardiovascular outcomes with semaglutide. Diabetes Obes Metab 2021; 23:1677-1680. [PMID: 33606902 PMCID: PMC8251906 DOI: 10.1111/dom.14360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
In the REWIND trial, dulaglutide reduced cardiovascular (CV) risk versus placebo in patients with type 2 diabetes in both the "established CV disease" (CVD) and "CV risk factor" subgroups. The SUSTAIN 6 and PIONEER 6 trials of semaglutide used different criteria for established CVD from those used in REWIND. The present post hoc analysis assessed the effect of semaglutide on major adverse CV events (MACE) in a pooled population of SUSTAIN 6 and PIONEER 6 patients, re-categorized into CV risk subgroups using the REWIND CVD criteria. In the pooled analysis (n = 6480), a lower percentage of patients were in the established CVD subgroup, when using the REWIND CVD criteria, compared with the original trial CVD criteria (66.5% vs. 83.8%, respectively). After re-categorization, the risk of MACE was significantly lower with semaglutide versus placebo in the established CVD subgroup (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.59, 0.92) and nonsignificantly lower in the CV risk factor subgroup (HR 0.84, 95% CI 0.55, 1.28) (P-interaction = 0.60). These results suggest that the CV effects of semaglutide may extend to patients with type 2 diabetes across the CV risk continuum.
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Affiliation(s)
- Subodh Verma
- St Michael's HospitalUniversity of TorontoTorontoOntarioCanada
| | | | - Mansoor Husain
- Department of MedicineTed Rogers Centre for Heart Research, Toronto General Hospital Research Institute, University of TorontoTorontoOntarioCanada
| | | | - Lars Rydén
- Department of Medicine K2Karolinska InstitutetStockholmSweden
| | | | - John B. Buse
- University of North Carolina School of MedicineChapel HillNorth CarolinaUSA
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Majid S, Bendahl PO, Huss L, Manjer J, Rydén L, Dihge L. Validation of the Skåne University Hospital nomogram for the preoperative prediction of a disease-free axilla in patients with breast cancer. BJS Open 2021; 5:6308066. [PMID: 34157725 PMCID: PMC8219350 DOI: 10.1093/bjsopen/zrab027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Axillary staging via sentinel lymph node biopsy (SLNB) is performed for clinically node-negative (N0) breast cancer patients. The Skåne University Hospital (SUS) nomogram was developed to assess the possibility of omitting SLNB for patients with a low risk of nodal metastasis. Area under the receiver operating characteristic curve (AUC) was 0.74. The aim was to validate the SUS nomogram using only routinely collected data from the Swedish National Quality Registry for Breast Cancer at two breast cancer centres during different time periods. METHOD This retrospective study included patients with primary breast cancer who were treated at centres in Lund and Malmö during 2008-2013. Clinicopathological predictors in the SUS nomogram were age, mode of detection, tumour size, multifocality, lymphovascular invasion and surrogate molecular subtype. Multiple imputation was used for missing data. Validation performance was assessed using AUC and calibration. RESULTS The study included 2939 patients (1318 patients treated in Lund and 1621 treated in Malmö). Node-positive disease was detected in 1008 patients. The overall validation AUC was 0.74 (Lund cohort AUC: 0.75, Malmö cohort AUC: 0.73), and the calibration was satisfactory. Accepting a false-negative rate of 5 per cent for predicting N0, a possible SLNB reduction rate of 15 per cent was obtained in the overall cohort. CONCLUSION The SUS nomogram provided acceptable power for predicting a disease-free axilla in the validation cohort. This tool may assist surgeons in identifying and counselling patients with a low risk of nodal metastasis on the omission of SLNB staging.
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Affiliation(s)
- S Majid
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Lund-Malmö, Sweden
| | - P-O Bendahl
- Department of Oncology and Pathology, Clinical Sciences, Lund University, Sweden
| | - L Huss
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - J Manjer
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Lund-Malmö, Sweden
| | - L Rydén
- Department of Surgery, Skåne University Hospital, Lund-Malmö, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - L Dihge
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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48
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Gustafsson N, Ahlqvist J, Norhammar A, Näslund U, Rydén L, Wester P, Levring Jäghagen E. Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:88-99. [PMID: 34305040 DOI: 10.1016/j.oooo.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). METHODS The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. RESULTS CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. CONCLUSIONS Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.
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Affiliation(s)
- Nils Gustafsson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden.
| | - Jan Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Solna, Sweden; Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Solna, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
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Abstract
In 2021 we are celebrating the 100th anniversary of the discovery of insulin, which 1923 was awarded with a Nobel Prize in Physiology or Medicine to Banting and MacLeod. The development of insulin was foregone by an interesting piece of medical history starting with the first known mentioning of a disease resembling diabetes about 1550 BCE in Eberś papyrus. The Indian physician Charaka made the first reference to the sweetness of the urine about 280 BCE while the connection of the sweet taste of urine with an excess of sugar in the blood remained undescribed until 1776 when Dobson published his first experience on this subject. Langerhans description of "islands of clear cells" in the pancreatic gland was of great importance when published 1869. The first connection of pancreas to diabetes was made by Lancereaux 1877. The experiments 1890 by Minkowski and von Mering, depriving dogs of pancreas, noting that they died with symptoms of diabetes was another step forward. A first attempt to isolate pancreatic extract by means of which blood glucose could be normalized in dogs with diabetes was described by Paulescu, but his experiments, interrupted by the First World War, never became acknowledged to the extent that they probably should have been. Instead, it was Banting, who supported by Best, made the experiments that proved that an extract from the Langerhans' islands could keep dogs with diabetes alive for several months in the laboratory of MacLeod. This extract, purified by Collip, saved the life of people dying by diabetes for the first time in January 1922. The discovery of insulin was made in 1921 and the Nobel prize was awarded to Banting and MacLeod already 1923. The correct choice of laureates has, however, been debated. Banting shared his prize money with Best who helped him with the experiments and MacLeod shared his part with Collip who purified the extract. The question arises, who was actually the person discovering insulin and did the right person get the prize? Further insights on this question are revealed via the archives of the Nobel Assembly of the Karolinska Institutet, Stockholm, Sweden.
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Affiliation(s)
- Lars Rydén
- Departments of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Jan Lindsten
- Clinical Genetics, Karolinska Institutet, Stockholm, Sweden
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50
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Standl E, Rydén L. Heart failure at the crossroads of cardiology and diabetology. Diabetes Res Clin Pract 2021; 175:108844. [PMID: 33984710 DOI: 10.1016/j.diabres.2021.108844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Eberhard Standl
- Forschergruppe Diabetes e.V. at Munich Helmholtz Centre, 85764 Neuherberg, Germany.
| | - Lars Rydén
- FoU - Tema Hjärta och Kärl, S1:02, Karolinska Universitetssjukhuset/Solna, SE-171 76 Stockholm, Sweden.
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