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Ghosh AK, Hardy R, Francis DP, Mayet J, Chaturvedi N, Kuh D, Deanfied J, Pellerin D, Hughes AD. Age at first detection of overweight and adult lfe course BMI are associated with future increased left ventricular mass index. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van Bussel BCT, Soedamah-Muthu SS, Henry RMA, Schalkwijk CG, Ferreira I, Chaturvedi N, Toeller M, Fuller JH, Stehouwer CDA. Unhealthy dietary patterns associated with inflammation and endothelial dysfunction in type 1 diabetes: the EURODIAB study. Nutr Metab Cardiovasc Dis 2013; 23:758-764. [PMID: 22795869 DOI: 10.1016/j.numecd.2012.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/19/2012] [Accepted: 04/16/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS A healthy diet has been inversely associated with endothelial dysfunction (ED) and low-grade inflammation (LGI). We investigated the association between nutrient consumption and biomarkers of ED and LGI in type 1 diabetes. METHODS AND RESULTS We investigated 491 individuals. Nutrient consumption and lifestyle risk factors were measured in 1989 and 1997. Biomarkers of ED (von Willebrand factor, soluble vascular cell adhesion molecule-1 and soluble endothelial selectin) and LGI (C-reactive protein, interleukin 6 and tumour necrosis factor α) were measured in 1997 and averaged into Z-scores. The nutrient residual method was used to adjust individual nutrient intake for energy intake. Data were analysed with generalised estimation equations. We report increments/decrements in nutrient consumption, averaged over time, per +1 standard deviation (SD) of 1997 ED or LGI Z-scores, after adjustment for sex, age, duration of diabetes, investigation centre, body mass index, energy intake, smoking behaviour, alcohol consumption, and each of the other nutrients. One SD elevation in ED Z-score was associated with a diet lower in fibre [β(95%CI);-0.09(-0.18;-0.004)], polyunsaturated fat [-0.18(-0.31;-0.05)] and vegetable protein [-0.10(-0.20;-0.001)]. For the LGI Z-score results showed associations with fibre [-0.09(-0.17;-0.01)], polyunsaturated fat [-0.14(-0.24;-0.03)] and cholesterol [0.10(0.01; 0.18)]. CONCLUSION In type 1 diabetes, consumption of less fibre, polyunsaturated fat and vegetable protein, and more cholesterol over the study period was associated with more ED and LGI. Following dietary guidelines in type 1 diabetes may reduce cardiovascular disease risk by favourably affecting ED and LGI.
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Tielemans SMAJ, Soedamah-Muthu SS, De Neve M, Toeller M, Chaturvedi N, Fuller JH, Stamatakis E. Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetologia 2013; 56:82-91. [PMID: 23052062 DOI: 10.1007/s00125-012-2743-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 09/12/2012] [Indexed: 12/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the association of physical activity (PA) with all-cause mortality and incident and prevalent cardiovascular disease (CVD) among patients with type 1 diabetes. METHODS The EURODIAB Prospective Complications Study is a cohort including 3,250 male and female patients with type 1 diabetes (mean age 32.7 ± 10.2 years) from 16 European countries, of whom 1,880 participated in follow-up examinations. In analysis 1 (longitudinal), the association of baseline PA (based on the reported number of hours per week spent in mild, moderate and vigorous PA) with all-cause mortality and incident CVD was examined by performing survival analysis. In analysis 2 (cross-sectional), we focused on the association between PA at follow-up (data on sports, walking distance and regular bicycling) and prevalent CVD by performing logistic regression analysis. Adjustments were made for age, sex, BMI, smoking, consumption of alcohol, consumption of certain nutrients and diabetic complications. RESULTS Analysis 1 (longitudinal): participation in moderate or vigorous PA once a week or more was borderline inversely associated with all-cause mortality (men and women combined) (HR 0.66, 95% CI 0.42, 1.03) and incident CVD (women only) (HR 0.66, 95% CI 0.40, 1.08). No association was found in men. Analysis 2 (cross-sectional): total PA (indexed by sports, walking, bicycling) and distance walked were inversely associated with prevalent CVD (OR(totalPA) 0.66, 95% CI 0.45, 0.97; and OR(walking) 0.61, 95% CI 0.42, 0.89). CONCLUSIONS/INTERPRETATION PA showed a borderline inverse association with both all-cause mortality (both sexes) and incident CVD (women only) in patients with type 1 diabetes. Since this is an under-researched clinical population, future longitudinal studies with objective PA measurements are needed to expand on these results.
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Santos Ferreira D, Fraser A, Howe L, Jones S, Tapp R, Lawlor D, Ness A, Smith G, Chaturvedi N, Hughes A. P3.13 ASSOCIATIONS OF CENTRAL AND PERIPHERAL PULSE PRESSURE WITH HEART STRUCTURE, SYSTOLIC AND DIASTOLIC FUNCTION IN ADOLESCENCE: FINDINGS FROM A GENERAL POPULATION COHORT. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Altman M, Bergerot C, Thibault H, Aussoleil A, Skuldadt Davidsen E, Barthelet M, Derumeaux GA, Grapsa J, Zimbarra Cabrita I, Afilalo J, Paschou S, Dawson D, Durighel G, O'regan D, Howard L, Gibbs J, Nihoyannopoulos P, Morenate Navio M, Mesa Rubio M, Ortega MD, Ruiz Ortiz M, Castillo Bernal F, Del Pino CL, Toledano F, Alvarez-Ossorio MP, Ojeda Pineda S, Lezo Cruz-Conde JSD, Jasaityte R, Claus P, Teske A, Herbots L, Verheyden B, Rademakers F, D'hooge J, Tocchetti CG, Coppola C, Rea D, Quintavalle C, Guarino L, Castaldo N, De Lorenzo C, Condorelli G, Arra C, Maurea N, Voilliot D, Huttin O, Camara Y, Djaballah W, Carillo S, Zinzius P, Sellal J, Angioi M, Juilliere Y, Selton-Suty C, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Jurado Roman A, De Dios Perez S, De Nicolas JMM, Diaz Anton B, Rubio Alonso B, Martin Asenjo R, Mayordomo Gomez S, Villagraz Tecedor L, Blazquez L, De Meneses RT, Bernard A, Hernandez AI, Reynaud A, Lerclercq C, Daubert J, Donal E, Arjan Singh R, Sivarani S, Lim S, Azman W, Almeida M, Cardim N, Fonseca V, Carmelo V, Santos S, Santos T, Toste J, Kosmala W, Orda A, Karolko B, Mysiak A, Przewlocka-Kosmala M, Farsalinos K, Tsiapras D, Kyrzopoulos S, Avramidou E, Vassilopoulou D, Voudris V, Hayrapetyan H, Adamyan K, Jurado Roman A, De Dios Perez S, Rubio Alonso B, De Nicolas JMM, Diaz Anton B, Martin Asenjo R, Montero Cabezas J, Granda Nistal C, Garcia Aranda B, Sanchez Sanchez V, Sestito A, Lamendola P, Di Franco A, Lauria C, Lanza G, Kukucka M, Unbehaun A, Buz S, Mladenow A, Kuppe H, Pasic M, Habazettl H, Gemma D, Montoro Lopez N, De Celix MGR, Lopez Fernandez T, De Torres Alba F, Del Valle DI, Ramirez U, Mesa J, Moreno Yanguela M, Lopez Sendon J, Eveborn GW, Schirmer H, Lunde P, Heggelund G, Rasmussen K, Wang Z, Lasota B, Mizia-Stec K, Mizia M, Chmiel A, Adamczyk T, Chudek J, Gasior Z, Venkatesh A, Johnson J, Sahlen A, Brodin L, Winter R, Shahgaldi K, Manouras A, Valbuena S, Iniesta A, Lopez T, De Torres F, Salinas P, Garcia S, Ramirez U, Mesa J, Moreno M, Lopez-Sendon J, Lebid I, Kobets T, Kuzmenko T, Katsanos S, Yiu K, Clavel M, Nina Ajmone N, Van Der Kley F, Rodes Cabau J, Schalij M, Bax J, Pibarot P, Delgado V, Fusini L, Tamborini G, Muratori M, Gripari P, Marsan N, Cefalu' C, Ewe S, Maffessanti F, Delgado V, Pepi M, Hasselberg N, Haugaa K, Petri H, Berge K, Leren T, Bundgaard H, Edvardsen T, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Rimbas R, Mihaila S, Enescu O, Patrascu N, Dragoi R, Rimbas M, Pop C, Vinereanu D, Gustafsson S, Morner S, Gronlund C, Suhr O, Lindqvist P, Di Bella G, Zito C, Minutoli F, Madaffari A, Cusma Piccione M, Mazzeo A, Massimo R, Pasquale M, Vita G, Carerj S, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Pfeiffer B, Rigopoulos A, Seggewiss H, Alvarez Fuente M, Sainz Costa T, Medrano C, Navarro M, Blazquez Gamero D, Ramos J, Mellado M, De Jose M, Munoz M, Maroto E, Gargani L, Gosciniak P, Pratali L, Agoston G, Bruni C, Guiducci S, Matucci Cerinic M, Varga A, Sicari R, Picano E, Yiu K, Zhao C, Mei M, Yeung C, Siu C, Tse H, Florescu M, Enescu O, Magda L, Mincu R, Vinereanu D, Daha I, Stanescu CM, Chirila L, Baicus C, Vlase A, Dan G, Montoro Lopez M, Florez Gomez R, Alonso Ladreda A, Itziar Soto C, Rios Blanco J, Gemma D, De Torres Alba F, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Labyk A, Krupa M, Palczewski P, Pruszczyk P, De Sousa CC, Rangel I, Correia A, Martins E, Vigario A, Pinho T, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Park SJ, Song JE, Lee YJ, Ha MR, Chang SA, Choi JO, Lee SC, Park S, Oh J, Van De Bruaene A, De Meester P, Buys R, Vanhees L, Delcroix M, Voigt J, Budts W, Blundo A, Buccheri S, Monte IP, Leggio S, Tamburino C, Sotaquira M, Fusini L, Maffessanti F, Pepi M, Lang R, Caiani E, Floria M, De Roy L, Xhaet O, Blommaert D, Jamart J, Gerard M, Deceuninck O, Marchandise B, Seldrum S, Schroeder E, Unsworth B, Sohaib S, Kulwant-Kaur K, Malcolme-Lawes L, Kanagaratnam P, Malik I, Ren B, Mulder H, Haak A, Van Stralen M, Szili-Torok T, Pluim J, Geleijnse M, Bosch J, Baglini R, Amaducci A, D'ancona G, Van Den Oord S, Akkus Z, Bosch J, Ten Kate G, Renaud G, Sijbrands E, De Jong N, Van Der Lugt A, Van Der Steen A, Schinkel A, Bjallmark A, Larsson M, Grishenkov D, Brodin LA, Brismar T, Paradossi G, Sveen KA, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Iacoboni C, Agati L, Abdel Moneim SS, Eifert Rain S, Bernier M, Bhat G, Hagen M, Bott-Kitslaar D, Castello R, Wilansky S, Pellikka P, Mulvagh S, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Park W, Hong G, Son J, Lee S, Kim U, Park J, Shin D, Kim Y, Toutouzas K, Drakopoulou M, Aggeli C, Felekos I, Nikolaou C, Synetos A, Stathogiannis K, Tsiamis E, Siores E, Stefanadis C, Plicht B, Kahlert P, Grave T, Buck T, Konorza T, Gursoy M, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Acar R, Kahveci G, Ozkan M, Maffessanti F, Tamborini G, Tsang W, Weinert L, Gripari P, Fusini L, Muratori M, Caiani E, Lang R, Pepi M, Yurdakul S, Avci B, Sahin S, Dilekci B, Aytekin S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Rapisarda O, Calabro' R, Hascoet S, Martin R, Dulac Y, Peyre M, Benzouid C, Hadeed K, Acar P, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Burca J, Ciparyte L, Laucevicius A, Di Salvo G, Rea A, D'aiello A, Del Gaizo F, Pergola V, D'andrea A, Caso P, Pacileo G, Calabro R, Russo M, Dedobbeleer C, Hadefi A, Naeije R, Unger P, Mornos C, Cozma D, Ionac A, Mornos A, Valcovici M, Pescariu S, Petrescu L, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knop S, Ertl G, Bijnens B, Weidemann F, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Dedobbeleer C, Hadefi A, Unger P, Naeije R, Lam W, Tang M, Chan K, Yang Y, Fang F, Sun J, Yu C, Lam Y, Panoulas V, Sulemane S, Bratsas A, Konstantinou K, Nihoyannopoulos P, Cimino S, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Francone M, Iacoboni C, Agati L, Schau T, Seifert M, Ridjab D, Schoep M, Gottwald M, Neuss M, Meyhoefer J, Zaenker M, Butter C, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Maret E, Ahlander BM, Bjorklund PG, Engvall J, Staskiewicz G, Czekajska-Chehab E, Adamczyk P, Siek E, Przybylski P, Maciejewski R, Drop A, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Al-Mallah M, Somg T, Alam S, Chattahi J, Zweig B, Dhanalakota K, Boedeker S, Ananthasubramaniam K, Park C, March K, Jones S, Mayet J, Tillin T, Chaturvedi N, Hughes A, Hamodraka E, Kallistratos E, Karamanou A, Tsoukas T, Mavropoulos D, Kouremenos N, Zaharopoulou I, Nikolaidis N, Kremastinos D, Manolis A, Loboz-Rudnicka M, Jaroch J, Bociaga Z, Kruszynska E, Ciecierzynska B, Dziuba M, Dudek K, Uchmanowicz I, Loboz-Grudzien K, Silva D, Magalhaes A, Jorge C, Cortez-Dias N, Carrilho-Ferreira P, Silva Marques J, Portela I, Pascoa C, Nunes Diogo A, Brito D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B. Poster Session: Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Poulter NR, Chaturvedi N. Commentary: Shaper and Jones, 'Serum-cholesterol, diet and coronary heart-disease in Africans and Asians in Uganda': 50-year-old findings only need interpretational fine tuning to come up to speed! Int J Epidemiol 2012; 41:1228-30. [DOI: 10.1093/ije/dys136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Williams ED, Tillin T, Chaturvedi N. OP31 Ethnic Differences in the Development of Disability Over 20 Years: Results from the Sabre Study. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Islam M, Jafar TH, Wood AR, De Silva NMG, Caulfield M, Chaturvedi N, Frayling TM. Multiple genetic variants explain measurable variance in type 2 diabetes-related traits in Pakistanis. Diabetologia 2012; 55:2193-204. [PMID: 22538361 DOI: 10.1007/s00125-012-2560-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
AIMS/HYPOTHESIS Multiple genetic variants are associated with type 2 diabetes-related traits in Europeans, but their role in South Asian populations needs further study. We hypothesised that genetic variants associated with diabetes-related traits in Europeans would explain a similar proportion of phenotypic variance in a Pakistani population and could be used in Mendelian randomisation analyses. METHODS We used data from 2,131 individuals from the Control of Blood Pressure and Risk Attenuation Trial (COBRA) in Karachi, Pakistan. Individuals were aged 40 years or older. RESULTS Combining information from multiple genetic variants showed that fasting glucose, BMI, triacylglycerol, and systolic and diastolic blood pressure variants explained 2.9%, 0.7%, 5.5%, 1.2% and 1.8% of the variance in those traits respectively. Genetic risk scores of fasting glucose, triacylglycerol, BMI, systolic blood pressure and diastolic blood pressure variants were associated with these traits, with per allele SD effects of 0.057 (95% CI 0.041, 0.074), p=3.44 × 10(-12), 0.130 (95% CI 0.105, 0.155), p=2.9 × 10(-21), 0.04 (95% CI 0.014, 0.072), p=0.004, 0.031 (95% CI 0.016, 0.047), p=7.9 × 10(-5), 0.028 (95% CI 0.015, 0.042), p = 5.5 × 10(-5), respectively. These effects are consistent with those observed in Europeans, except that the effect of triacylglycerol variants in South Asians was slightly lower. Mendelian randomisation provided evidence that genetically influenced, raised triacylglycerol levels do not causally affect type 2 diabetes risk to the extent predicted from observational data (p=0.0003 for difference between observed and instrumental variables correlations). CONCLUSIONS/INTERPRETATION Genetic variants identified in Europeans are associated with type 2 diabetes-related traits in Pakistanis, with comparable effect sizes. Larger studies are needed to perform adequately powered Mendelian randomisation and help dissect the relationships between type 2 diabetes-related traits in diverse South Asian subgroups.
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Schoenaker DAJM, Toeller M, Chaturvedi N, Fuller JH, Soedamah-Muthu SS. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia 2012; 55:2132-41. [PMID: 22526612 PMCID: PMC3390695 DOI: 10.1007/s00125-012-2550-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/29/2012] [Indexed: 11/17/2022]
Abstract
AIMS/HYPOTHESIS Low adherence to recommendations for dietary saturated fatty acid (SFA) and fibre intake in patients with type 1 diabetes mellitus may heighten their increased risk of cardiovascular disease (CVD) and mortality. We examined the relationship of SFA and total, soluble and insoluble fibre with incident CVD and all-cause mortality in type 1 diabetic patients. METHODS A prospective cohort analysis was performed in 2,108 European type 1 diabetic patients aged 15-60 years who were free of CVD at baseline and enrolled in the EURODIAB Prospective Complications Study (51% male). Diet was assessed from a standardised 3 day dietary record. HR were calculated using Cox proportional hazards models. RESULTS During a mean follow-up of 7.3 years, 148 incident cases of fatal and non-fatal CVD and 46 all-cause deaths were documented. No statistically significant association was found between SFA and CVD and all-cause mortality. Total dietary fibre, per 5 g/day, was associated with lower all-cause mortality risk (HR 0.72; 95% CI 0.55, 0.95). This association was stronger for soluble fibre (per 5 g/day, HR 0.34; 95% CI 0.14, 0.80) compared with insoluble fibre (per 5 g/day; HR 0.66; 95% CI 0.45, 0.97). Similar results were found for the association with CVD. CONCLUSIONS/INTERPRETATION This study suggests that reported dietary SFA is not significantly associated with CVD and all-cause mortality in type 1 diabetic patients. On the contrary, higher dietary fibre consumption, especially soluble fibre, within the range commonly consumed by type 1 diabetic patients, may contribute to the prevention of CVD and all-cause mortality in type 1 diabetic patients.
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Ghosh AK, Hughes AD, Chaturvedi N, Francis DP, Pellerin D, Deanfield J, Pierce M, Kuh D, Mayet J, Hardy RJ. 136 Increase in left ventricular mass in type 2 diabetes is dependent on duration of diabetes. BRITISH HEART JOURNAL 2012. [DOI: 10.1136/heartjnl-2012-301877b.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghosh AK, Hardy RJ, Francis DP, Chaturvedi N, Pellerin D, Deanfield J, Kuh D, Mayet J, Hughes AD. 137 Time for a review of the “watch and wait” strategy for young borderline-hypertensives? BRITISH HEART JOURNAL 2012. [DOI: 10.1136/heartjnl-2012-301877b.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Darbyshire J, Sitzia J, Cameron D, Ford G, Littlewood S, Kaplan R, Johnston D, Matthews D, Holloway J, Chaturvedi N, Morgan C, Riley A, Rossor M, Kotting P, McKeith I, Smye S, Gower J, Brown V, Smyth R, Poustie V, van't Hoff W, Wallace P, Ellis T, Wykes T, Burns S, Rosenberg W, Lester N, Stead M, Potts V, Johns C, Campbell H, Hamilton R, Sheffield J, Selby P. Extending the clinical research network approach to all of healthcare. Ann Oncol 2012; 22 Suppl 7:vii36-vii43. [PMID: 22039143 DOI: 10.1093/annonc/mdr424] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.
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Park C, March K, Tillin T, Chaturvedi N, Hughes A. P1.12 ETHNIC DIFFERENCES IN LEFT VENTRICLE MYOCARDIAL OXYGEN DEMAND. Artery Res 2012. [DOI: 10.1016/j.artres.2012.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Wanjari MM, Chaturvedi N, Gupta MD, Baroda S, Kumar P, Gaidhani SN. Absence of hypolipidemic effect of Holoptelea integrifolia leaf extract in tyloxapol-induced hyperlipidemic rats. JOURNAL OF PHARMACEUTICAL NEGATIVE RESULTS 2012. [DOI: 10.4103/0976-9234.99641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vijayan S, Khanji M, Ionescu A, Vijayan S, Ionescu A, Podoleanu C, Frigy A, Ugri A, Varga A, Podoleanu D, Incze A, Carasca E, Dobreanu D, Mjolstad O, Dalen H, Graven T, Kleinau J, Hagen B, Fu H, Liu T, Li J, Liu C, Zhou C, Li G, Bordese R, Capriolo M, Brero D, Salvetti I, Cannillo M, Antolini M, Grosso Marra W, Frea S, Morello M, Gaita F, Maffessanti F, Caiani E, Muraru D, Tuveri F, Dal Bianco L, Badano L, Majid A, Soesanto A, Ario Suryo Kuncoro B, Sukmawan R, Ganesja MH, Benedek T, Chitu M, Beata J, Suciu Z, Kovacs I, Bucur O, Benedek I, Hrynkiewicz-Szymanska A, Szymanski F, Karpinski G, Filipiak K, Radunovic Z, Lande Wekre L, Steine K, Bech-Hanssen O, Rundqvist B, Lindgren F, Selimovic N, Jedrzychowska-Baraniak J, Jozwa R, Larysz B, Kasprzak J, Ripp T, Mordovin V, Ripp E, Ciobanu A, Dulgheru R, Dragoi R, Magda S, Florescu M, Mihaila S, Rimbas R, Cinteza M, Vinereanu D, Benavides-Vallve C, Pelacho B, Iglesias O, Castano S, Munoz-Barrutia A, Prosper F, Ortiz De Solorzano C, Manouras A, Sahlen A, Winter R, Vardas P, Brodin L, Sarvari SI, Haugaa KH, Zahid W, Bendz B, Aaberge L, Edvardsen T, Di Bella G, Pedri S, Donato R, Madaffari A, Zito C, Stapf D, Schreckenberg M, Carerj S, Yoshikawa H, Suzuki M, Kusunose Y, Hashimoto G, Otsuka T, Nakamura M, Sugi K, Grapsa J, Dawson D, Gin-Sing W, Howard L, Gibbs J, Nihoyannopoulos P, Smith B, Grapsa J, Dawson D, Coulter T, Rendon A, Gorissen W, Nihoyannopoulos P, Shiran A, Asmer I, Adawi S, Ganaeem M, Shehadeh J, Cameli M, Lisi M, Righini F, Maccherini M, Sani G, Galderisi M, Mondillo S, Kalimanovska-Ostric D, Nastasovic T, Jovanovic I, Milakovic B, Dostanic M, Stosic M, Sasic I, Sveen K, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Holte E, Vegsundvaag J, Hole T, Hegbom K, Wiseth R, Ikonomidis I, Lekakis J, Tritakis V, Papadakis I, Kadoglou N, Tzortzis S, Trivilou P, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Aaberge L, Edvardsen T, Muraru D, Beraldo M, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Dores H, Abecasis J, Carvalho M, Santos M, Andrade M, Ribeiras R, Reis C, Horta E, Gouveia R, Mendes M, Zaliaduonyte-Peksiene D, Mizariene V, Cesnaite G, Tamuleviciute E, Jurkevicius R, Vaskelyte J, Zaliunas R, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Trifunovic D, Sobic-Saranovic D, Stankovic S, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic I, Peovska I, Srbinovska E, Maksimovic J, Andova V, Arnaudova F, Hristova E, Otljanska M, Vavlukis M, Jovanova S, Tamborini G, Fusini L, Gripari P, Muratori M, Pontone G, Andreini D, Bertella E, Ghulam Ali S, Bartorelli A, Pepi M, Zito C, Cusma-Piccione M, Salvia J, Antonini-Canterin F, Lentini S, Di Bella G, Donato D, Miceli M, Oreto G, Carerj S, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shnapp M, Gaspar T, Marchese A, Deste W, Sanfilippo A, Aruta P, Patane M, Millan G, Ussia G, Tamburino C, Banovic M, Vujisic-Tesic B, Kujacic V, Obradovic S, Nedeljkovic I, Trifunovic D, Petrovic M, Crkvenac Z, Ostojic M, Bernard A, Piquemal M, Muller G, Arbeille P, Charbonnier B, Broyd C, Davies J, Mikhail G, Mayet J, Francis D, Rosca M, Magne J, Szymanski C, Popescu B, Ginghina C, Pierard L, Lancellotti P, Gonzalez-Mansilla A, Solis J, Angulo R, Perez-David E, Madrid G, Garcia-Robles J, Yotti R, Prieto R, Bermejo J, Fernandez-Aviles F, Otsuka T, Suzuki M, Yoshikawa H, Ishikawa Y, Ishida T, Osaki T, Matsuyama M, Yamashita H, Ozaki S, Sugi K, Stevanella M, Votta E, Fusini L, Veronesi F, Tamborini G, Pepi M, Maffessanti F, Alamanni F, Redaelli A, Caiani E, Park SD, Lee J, Shin S, Woo S, Kim D, Park K, Kwan J, Tsang W, Chandra S, Weinert L, Gayat E, Djelassi M, Balbach T, Mor-Avi V, Lang R, De Meester P, Van De Bruaene A, Delcroix M, Budts W, Abid L, Frikha Z, Makni K, Rekik H, Znazen A, Mourad H, Kammoun S, Sargento L, Satendra M, Sousa C, Lopes S, Longo S, Lousada N, Palma Reis R, Fouad D, Shams Eldeen R, Rosca M, Popescu B, Beladan C, Calin A, Voinea F, Enache R, Jurcut R, Coman I, Ghionea M, Ginghina C, Tesic M, Djordjevic-Dikic A, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic M, Boricic M, Giga V, Ostojic M, Vujisic-Tesic B, Pisciella L, Lanzillo C, Minati M, Caselli S, Di Roma M, Fratini S, Romano S, Calo' L, Lioy E, Penco M, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Sinagra G, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Dilenarda A, Sinagra G, Comenale Pinto S, Ancona R, Caso P, Cavallaro C, Vecchione F, D'onofrio A, Fero' M, Calabro' R, Gustafsson S, Ihse E, Henein M, Westermark P, Suhr O, Lindqvist P, Oliva Sandoval M, Gonzalez Carrillo M, Garcia Navarro M, Garcia-Molina Saez E, Sabater Molina M, Saura Espin D, Lacunza Ruiz J, Gimeno Blanes J, De La Morena Valenzuela G, Valdes Chavarri M, Prinz C, Faber L, Horstkotte D, Hoetz H, Voigt J, Dores H, Gandara F, Correia M, Abecasis J, Rosario I, Fonseca C, Arroja I, Aleixo A, Martins A, Mendes M, Radulescu L, Dan Radulescu D, Parv Andreea P, Duncea Caius D, Ciuleanu T C, Mitrea Paulina M, Frea S, Capriolo M, Grosso Marra W, Cali Quaglia F, Bordese R, Ribezzo M, Boffini M, Rinaldi M, Gaita F, Morello M, Maceira Gonzalez AM, Cosin-Sales J, Dalli E, Diago J, Aguilar J, Ruvira J, Sousa C, Goncalves S, Gomes A, Pinto F, Tsai WC, Liu YW, Shih JY, Huang YY, Chen JY, Tsai LM, Chen JH, Sargento L, Satendra M, Longo S, Lousada N, Palma Reis R, Ribeiro S, Doroteia D, Goncalves S, Santos L, David C, Vinhas De Sousa G, Almeida A, Iwase M, Itou Y, Yasukochi S, Shiino K, Inuzuka H, Sugimoto K, Ozaki Y, Gieszczyk-Strozik K, Sikora-Puz A, Mizia M, Lasota B, Chmiel A, Lis-Swiety A, Michna J, Brzezinska-Wcislo L, Mizia-Stec K, Gasior Z, Luijendijk P, De Bruin-Bon H, Zwiers C, Vriend J, Van Den Brink R, Mulder B, Bouma B, Brigido S, Gianfagna P, Proclemer A, Plicht B, Kahlert P, Kaelsch H, Buck T, Erbel R, Konorza T, Yoon H, Kim K, Ahn Y, Jeong M, Cho J, Park J, Kang J, Rha W, Jansen Klomp WW, Brandon Bravo Bruinsma G, Van 'T Hof A, Spanjersberg S, Nierich A, Bombardini T, Gherardi S, Picano E, Ciarka A, Herbots L, Eroglu E, Van Cleemput J, Droogne W, Jasityte R, Meyns B, Voigt J, D'hooge J, Vanhaecke J, Al Barjas M, Iskreva R, Morris R, Davar J, Zhao Y, Lindqvist P, Holmgren A, Morner S, Henein M, Nedeljkovic I, Ostojic M, Giga V, Stepanovic J, Djordjevic-Dikic A, Beleslin B, Nedeljkovic M, Banovic M, Mazic S, Stojanov V, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Tomaszewski A, Kutarski A, Tomaszewski M, Eibel S, Hasheminejad E, Mukherjee C, Tschernich H, Ender J, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Van Den Oord S, Ten Kate G, Akkus Z, Renaud G, Sijbrands E, Ten Cate F, De Jong N, Bosch J, Van Der Steen A, Schinkel A, Lisowska A, Knapp M, Tycinska A, Sawicki R, Kralisz P, Sobkowicz B, Chang SA, Lee SC, Kim EY, Hahm SH, Ahn GT, Sohn MK, Park SJ, Choi JO, Park SW, Oh JK, Gursoy MO, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Kahveci G, Yildiz M, Ozkan M, Muraru D, Dal Bianco L, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Skidan V, Borowski A, Park M, Thomas J, Ranjbar S, Hassantash S, Karvandi M, Foroughi M, Davidsen ES, Cramariuc D, Bleie O, Gerdts E, Matre K, Cusma' Piccione M, Zito C, Bagnato G, Di Bella G, Mohammed M, Piluso S, Oreto L, Oreto G, Bagnato G, Carerj S, Prinz C, Bitter T, Faber L, Horstkotte D, Dores H, Abecasis J, Carvalho S, Santos M, Andrade M, Ribeiras R, Canada M, Reis C, Gouveia R, Mendes M, Santisteban Sanchez De Puerta M, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Pena Pena ML, Puentes Chiachio M, Suarez De Lezo Cruz-Conde J, Pan Alvarez-Ossorio M, Mazuelos Bellido F, Suarez De Lezo Herreros De Tejada J, Altekin E, Yanikoglu A, Karakas S, Oncel C, Akdemir B, Belgi Yildirim A, Cilli A, Yilmaz H, Lenartowska L, Furdal M, Knysz B, Konieczny A, Lewczuk J, Comenale Pinto S, Ancona R, Caso P, Severino S, Cavallaro M, Coppola M, Calabro' R, Motoki H, To A, Bhargava M, Wazni O, Marwick T, Klein A, Sinkovskaya E, Horton S, Abuhamad A, Mingo Santos S, Monivas Palomero V, Beltran Correas B, Mitroi C, Gutierrez Landaluce C, Garcia Lunar I, Gonzalez Mirelis J, Cavero M, Segovia Cubero J, Alonso Pulpon L, Gurel E, Karaahmet T, Tigen K, Kirma C, Dundar C, Pala S, Isiklar I, Cevik C, Kilicgedik A, Basaran Y, Brambatti M, Romandini A, Barbarossa A, Molini S, Urbinati A, Giovagnoli A, Cipolletta L, Capucci A, Park S, Choi E, Ahn C, Hong S, Kim M, Lim D, Shim W, Xie J, Fang F, Zhang Q, Chan J, Yip G, Sanderson J, Lam Y, Yan B, Yu C, Jorge Perez P, De La Rosa Hernandez A, Hernandez Garcia C, Duque Garcia A, Barragan Acea A, Arroyo Ucar E, Jimenez Rivera J, Lacalzada Almeida J, Laynez Cerdena I, Maffessanti F, Gripari P, Pontone G, Andreini D, Tamborini G, Carminati C, Pepi M, Caiani E, Capoulade R, Larose E, Clavel M, Dumesnil J, Arsenault M, Bedard E, Mathieu P, Pibarot P, Gargani L, Baldi G, Forfori F, Caramella D, D'errico L, Abramo A, Sicari R, Picano E, Giunta F, Lee WN, Larrat B, Messas E, Pernot M, Tanter M, Velagic V, Cikes M, Matasic R, Skorak I, Skorak I, Samardzic J, Puljevic D, Lovric Bencic M, Biocina B, Milicic D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B, Ghosh A, Hardy R, Chaturvedi N, Francis D, Deanfield J, Pellerin D, Kuh D, Hughes A, Malmgren A, Dencker M, Stagmo M, Gudmundsson P, Seo Y, Ishizu T, Aonuma K, Schuuring MJ, Vis J, Bouma B, Van Dijk A, Van Melle J, Pieper P, Vliegen H, Sieswerda G, Mulder B, Foukarakis E, Pitarokilis A, Kafarakis P, Kiritsi A, Klironomos E, Manousakis A, Fragiadaki X, Papadakis E, Dermitzakis A. Poster Session 1: Thursday 8 December 2011, 08:30-12:30 * Location: Poster Area. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011. [DOI: 10.1093/ejechocard/jer206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kenny C, Adhya S, Dworakowski R, Brickham B, Maccarthy P, Monaghan M, Guzzo A, Innocenti F, Vicidomini S, Lazzeretti D, Squarciotta S, De Villa E, Donnini C, Bulletti F, Guerrini E, Pini R, Bendjelid K, Viale J, Duperret S, Piriou V, Jacques D, Shahgaldi K, Silva C, Pedro F, Deister L, Brodin LA, Sahlen A, Manouras A, Winter R, Berjeb N, Cimadevilla C, Dreyfus J, Cueff C, Malanca M, Chiampan A, Vahanian A, Messika-Zeitoun D, Muraru D, Peluso D, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Almuntaser I, King G, Norris S, Daly C, Ellis E, Murphy R, Erdei T, Denes M, Kardos A, Foldesi C, Temesvari A, Lengyel M, Bouzas Mosquera A, Broullon F, Alvarez-Garcia N, Peteiro J, Barge-Caballero G, Lopez-Perez M, Lopez-Sainz A, Castro-Beiras A, Luotolahti M, Luotolahti H, Kantola I, Viikari J, Andersen M, Ersboell M, Bro-Jeppesen J, Gustafsson F, Koeber L, Hassager C, Moller J, Coisne D, Diakov C, Vallet F, Lequeux B, Blouin P, Christiaens L, Esposito R, Santoro A, Schiano Lomoriello V, Raia R, Santoro C, De Simone G, Galderisi M, Sahlen A, Abdula G, Winter R, Kosmala W, Szczepanik-Osadnik H, Przewlocka-Kosmala M, Mysiak A, O' Moore-Sullivan T, Marwick T, Tan YT, Wenzelburger F, Leyva F, Sanderson J, Pichler P, Syeda B, Hoefer P, Zuckermann A, Binder T, Fijalkowski M, Koprowski A, Galaska R, Blaut K, Sworczak K, Rynkiewicz A, Lee S, Kim W, Jung L, Yun H, Song M, Ko J, Khalifa EA, Szymanski P, Lipczynska M, Klisieiwcz A, Hoffman P, Jorge C, Silva Marques J, Robalo Martins S, Calisto C, Mieiro M, Vieira S, Correia M, Carvalho De Sousa J, Almeida A, Nunes Diogo A, Park C, March K, Tillin T, Mayet J, Chaturvedi N, Hughes A, Di Bello V, Giannini C, Delle Donne M, De Sanctis F, Spontoni P, Cucco C, Corciu A, Grigoratos C, Bogazzi F, Balbarini A, Enescu O, Suran B, Florescu M, Cinteza M, Vinereanu D, Higuchi Y, Iwakura K, Okamura A, Date M, Fujii K, Jorge C, Cortez-Dias N, Silva D, Carrilho-Ferreira P, Silva Marques J, Magalhaes A, Ribeiro S, Goncalves S, Fiuza M, Pinto F, Jorge C, Cortez-Dias N, Silva D, Silva Marques J, Carrilho-Ferreira P, Placido R, Bordalo A, Goncalves S, Fiuza M, Pinto F, Grzywocz P, Mizia-Stec K, Chudek J, Gasior Z, Maceira Gonzalez AM, Cosin Sales J, Dalli E, Igual B, Diago J, Aguilar J, Ruvira J, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Boccalini F, Mattatelli A, Hiramoto Y, Iacoboni C, Agati L, Trifunovic D, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Boricic-Kostic M, Draganic G, Tesic M, Petrovic M, Gavina C, Lopes R, Lourenco A, Almeida J, Rodrigues J, Pinho P, Zamorano J, Leite-Moreira A, Rocha-Goncalves F, Clavel MA, Capoulade R, Dumesnil J, Mathieu P, Despres JP, Pibarot P, Bull S, Pitcher A, Augustine D, D'arcy J, Karamitsos T, Rai A, Prendergast B, Becher H, Neubauer S, Myerson S, Magne J, Donal E, Davin L, O'connor K, Pirlet C, Rosca M, Szymanski C, Cosyns B, Pierard L, Lancellotti P, Calin A, Rosca M, Popescu B, Beladan C, Enache R, Lupascu L, Sandu C, Lancellotti P, Pierard L, Ginghina C, Kamperidis V, Hadjimiltiadis S, Sianos G, Anastasiadis K, Grosomanidis V, Efthimiadis G, Karvounis H, Parharidis G, Styliadis I, Gonzalez Canovas C, Munoz-Esparza C, Bonaque Gonzalez J, Fernandez A, Salar Alcaraz M, Saura Espin D, Pinar Bermudez E, Oliva-Sandoval M, De La Morena Valenzuela G, Valdes Chavarri M, Dreyfus J, Brochet E, Lepage L, Attias D, Cueff C, Detaint D, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Pirat B, Little S, Chang S, Tiller L, Kumar R, Zoghbi W, Lee APW, Hsiung M, Wan S, Wong R, Luo F, Fang F, Xie J, Underwood M, Sun J, Yu C, Jansen R, Tietge W, Sijbrandij K, Cramer M, De Heer L, Kluin J, Chamuleau SAJ, Oliveras Vila T, Ferrer Sistach E, Delgado Ramis L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Garcia Alonso C, Teis Soley A, Ruyra Baliarda X, Bayes Genis A, Negrea S, Alexandrescu C, Bourlon F, Civaia F, Dreyfus G, Paetzold S, Luha O, Hoedl R, Stoschitzky G, Pfeiffer K, Zweiker D, Pieske B, Maier R, Sevilla T, Revilla A, Lopez J, Vilacosta I, Arnold R, Gomez I, San Roman J, Nikcevic G, Djordjevic Dikic A, Djordjevic S, Raspopovic S, Jovanovic V, Kircanski B, Pavlovic S, Milasinovic G, Ruiz-Zamora I, Cabrera Bueno F, Molina M, Fernandez-Pastor J, Pena J, Linde A, Barrera A, Alzueta J, Bremont C, Bensaid A, Alonso H, Zaghden O, Nahum J, Dubois-Rande J, Gueret P, Lim P, Lee SP, Park K, Kim HR, Lee JH, Ahn HS, Kim JH, Kim HK, Kim YJ, Sohn DW, Niemann M, Herrmann S, Hu K, Liu D, Beer M, Ertl G, Wanner C, Takenaka T, Tei C, Weidemann F, Silva D, Madeira H, Mendes Pedro M, Nunes Diogo A, Brito D, Schiano Lomoriello V, Ippolito R, Santoro A, Esposito R, Raia R, De Palma D, Galderisi M, Gati S, Oxborough D, Reed M, Zaidi A, Ghani S, Sheikh N, Papadakis M, Sharma S, Chow V, Ng A, Pasqualon T, Zhao W, Hanzek D, Chung T, Yeoh T, Kritharides L, Florescu M, Magda L, Enescu O, Mihalcea D, Suran B, Jinga D, Mincu R, Cinteza M, Vinereanu D, Ferrazzi E, Segato G, Folino F, Famoso G, Senzolo M, Bellu R, Corbetti F, Iliceto S, Tona F, Azevedo O, Quelhas I, Guardado J, Fernandes M, Pereira V, Medeiros R, Lourenco A, Sousa P, Santos W, Pereira S, Marques N, Mimoso J, Marques V, Jesus I, Rustad L, Nytroen K, Gullestad L, Amundsen B, Aakhus S, Linhartova K, Sterbakova G, Necas J, Kovalova S, Cerbak R, Nelassov N, Korotkijan N, Shishkina A, Gagieva B, Nagaplev M, Eroshenko O, Morgunov M, Parmon S, Velthuis S, Van Gent M, Post M, Westermann C, Mager J, Snijder R, Koyalakonda SP, Anderson M, Burgess M, Bergenzaun L, Chew M, Ohlin H, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Rutz T, Kuehn A, Petzuch K, Pekala M, Elmenhorst J, Fratz S, Mueller J, Hager A, Hess J, Vogt M, Van Der Linde D, Van De Laar I, Wessels M, Bekkers J, Moelker A, Tanghe H, Van Kooten F, Oldenburg R, Bertoli-Avella A, Roos-Hesselink J, Cresti A, Fontani L, Calabria P, Capati E, Severi S, Lynch M, Saraf S, Sandler B, Yoon S, Kim S, Ko C, Ryu S, Byun Y, Seo H, Ciampi Q, Rigo F, Pratali L, Gherardi S, Villari B, Picano E, Sicari R, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Sinicyna J, Gruodyte G, Janonyte K, Laucevicius A, O'driscoll J, Schmid K, Marciniak A, Saha A, Gupta S, Smith R, Sharma R, Bouzas Mosquera A, Alvarez Garcia N, Peteiro J, Broullon F, Prada O, Rodriguez Vilela A, Barge Caballero G, Lopez Perez M, Lopez Sainz A, Castro Beiras A, Kochanowski J, Scislo P, Piatkowski R, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Van De Heyning CM, Magne J, O'connor K, Mahjoub H, Pibarot P, Pirlet C, Pierard L, Lancellotti P, Clausen H, Basaggianis C, Newton J, Del Pasqua A, Carotti A, Di Carlo D, Cetrano E, Toscano A, Iacobelli R, Esposito C, Chinali M, Pongiglione G, Rinelli G, Larsson M, Larsson M, Bjallmark A, Winter R, Caidahl K, Brodin L, Velthuis S, Van Gent M, Mager J, Westermann C, Snijder R, Post M, Gao H, Coisne D, Lugiez M, Guivier C, Rieu R, D'hooge J, Lugiez M, Hang G, D'hooge J, Guerin C, Christiaens L, Menard M, Voigt JU, Coisne D, Dungu J, Campos G, Jaffarulla R, Gomes-Pereira S, Sutaria N, Baker C, Nihoyannopoulos P, Bellamy M, Adhya S, Harries D, Walker N, Pearson P, Reiken J, Batteson J, Kamdar R, Murgatroyd F, Monaghan M, D'andrea A, Riegler L, Scarafile R, Pezzullo E, Salerno G, Bossone E, Limongelli G, Russo M, Pacileo G, Calabro' R, Kang Y, Cui J, Chen H, Pan C, Shu X, Kiotsekoglou A, Saha S, Toole R, Govind S, Gopal A, Crispi F, Bijnens B, Sepulveda-Swatson E, Rojas-Benavente J, Dominguez J, Illa M, Eixarch E, Sitges M, Gratacos E, Prinz C, Faludi R, Walker A, Amzulescu M, Gao H, Uejima T, Fraser A, Voigt J, Esmaeilzadeh M, Maleki M, Amin A, Vakilian F, Noohi F, Ojaghi Haghighi Z, Nakhostin Davari P, Bakhshandeh Abkenar H, Rimbas R, Dulgheru R, Margulescu A, Florescu M, Vinereanu D, Toscano A, Chinali M, D' Asaro M, Iacobelli R, Del Pasqua A, Esposito C, Mizzon C, Parisi F, Pongiglione G, Rinelli G, Jung BC, Lee BY, Kang HJ, Kim S, Kim M, Kim Y, Cho D, Park S, Hong S, Lim D, Shim W, Bellsham-Revell H, Tibby S, Bell AJ, Miller OI, Greil G, Simpson JM, Providencia RA, Trigo J, Botelho A, Gomes P, Seca L, Barra S, Faustino A, Costa G, Quintal N, Leitao-Marques A, Nestaas E, Stoylen A, Fugelseth D, Mornos C, Ionac A, Petrescu L, Cozma D, Dragulescu D, Mornos A, Pescariu S, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Laser K, Faber L, Fischer M, Koerperich H, Kececioglu D, Elnoamany MF, Dawood A, Elhabashy M, Khalil Y, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Piriou N, Warin-Fresse K, Caza M, Fau G, Crochet D, Xhabija N, Allajbeu I, Petrela E, Heba M, Barreiro Perez M, Martin Fernandez M, Renilla Gonzalez A, Florez Munoz J, Fernandez Cimadevilla O, Alvarez Pichel I, Velasco Alonso E, Leon Duran D, Benito Martin E, Secades Gonzalez S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Silva Ferreira A, Bettencourt N, Matos P, Oliveira L, Almeida A, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Lopez Lereu M, Monmeneu J, Estornell J, Tsverava M, Tsverava D, Varela A, Salagianni M, Galani I, Andreakos E, Davos C, Ikonomidis I, Lekakis J, Tritakis V, Kadoglou N, Papadakis J, Trivilou P, Tzortzis S, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Kim G, Youn H, Park C, Ibrahimi P, Bajraktari G, Jashari F, Ahmeti A, Poniku A, Haliti E, Henein M, Pezo Nikolic B, Jurin H, Lovric D, Baricevic Z, Ivanac Vranesic I, Lovric Bencic M, Ernst A, Separovic Hanzevacki J. Poster Session 3: Friday 9 December 2011, 08:30-12:30 * Location: Poster Area. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011. [DOI: 10.1093/ejechocard/jer214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Park C, Bathula R, Shore AC, Tillin T, Strain WD, Chaturvedi N, Hughes AD. Impaired post-ischaemic microvascular hyperaemia in Indian Asians is unexplained by diabetes or other cardiovascular risk factors. Atherosclerosis 2011; 221:503-7. [PMID: 22341592 DOI: 10.1016/j.atherosclerosis.2011.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/07/2011] [Accepted: 11/18/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE People of Indian Asian descent have an increased risk of cardiovascular disease (CVD) that cannot be explained by diabetes and other established CVD risk factors. We investigated if microcirculatory function was impaired in a population-based sample of people of Indian Asian descent compared with Europeans in the UK and whether any differences could be accounted for by diabetes or other CVD risk factors. RESEARCH DESIGN AND METHODS Cutaneous microvascular function was assessed using laser Doppler fluximetry in response to heating to 42 °C (maximum hyperaemia) and 3 min arterial occlusion (post occlusive reactive hyperaemia: PORH) in 148 Indian Asians and 147 Europeans. Blood pressure, anthropometry and fasting bloods were also measured. RESULTS Maximum hyperaemia and minimum resistance did not differ significantly by ethnicity. Resting flux and PORH were lower in Indian Asians and time to peak of PORH was prolonged. Diabetes was associated with reduced maximum hyperaemia and PORH. Adjustment for diabetes accounted for differences in resting flux and time to peak but not differences in PORH (Europeans = 45.0 (40.3, 50.1)au, Indian Asians = 35.6 (31.9, 39.7)au, mean (95% confidence interval); p = 0.008 after adjustment). Differences in conventional CVD risk factors did not account for interethnic differences in microvascular responses. CONCLUSIONS People of Indian Asian descent have impaired post-occlusive reactive hyperaemia unexplained by diabetes, dysglycaemia or other CVD risk factors. Abnormal microvascular function in response to ischaemia could represent a novel mechanism contributing to the elevated risk of CVD in Indian Asians.
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Rees SD, Islam M, Hydrie MZI, Chaudhary B, Bellary S, Hashmi S, O'Hare JP, Kumar S, Sanghera DK, Chaturvedi N, Barnett AH, Shera AS, Weedon MN, Basit A, Frayling TM, Kelly MA, Jafar TH. An FTO variant is associated with Type 2 diabetes in South Asian populations after accounting for body mass index and waist circumference. Diabet Med 2011; 28:673-80. [PMID: 21294771 PMCID: PMC3095685 DOI: 10.1111/j.1464-5491.2011.03257.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS A common variant, rs9939609, in the FTO (fat mass and obesity) gene is associated with adiposity in Europeans, explaining its relationship with diabetes. However, data are inconsistent in South Asians. Our aim was to investigate the association of the FTO rs9939609 variant with obesity, obesity-related traits and Type 2 diabetes in South Asian individuals, and to use meta-analyses to attempt to clarify to what extent BMI influences the association of FTO variants with diabetes in South Asians. METHODS We analysed rs9939609 in two studies of Pakistani individuals: 1666 adults aged ≥40 years from the Karachi population-based Control of Blood Pressure and Risk Attenuation (COBRA) study and 2745 individuals of Punjabi ancestry who were part of a Type 2 diabetes case-control study (UK Asian Diabetes Study/Diabetes Genetics in Pakistan; UKADS/DGP). The main outcomes were BMI, waist circumference and diabetes. Regression analyses were performed to determine associations between FTO alleles and outcomes. Summary estimates were combined in a meta-analysis of 8091 South Asian individuals (3919 patients with Type 2 diabetes and 4172 control subjects), including those from two previous studies. RESULTS In the 4411 Pakistani individuals from this study, the age-, sex- and diabetes-adjusted association of FTO variant rs9939609 with BMI was 0.45 (95%CI 0.24-0.67) kg/m(2) per A-allele (P=3.0 × 10(-5) ) and with waist circumference was 0.88 (95% CI 0.36-1.41) cm per A-allele (P=0.001). The A-allele (30% frequency) was also significantly associated with Type 2 diabetes [per A-allele odds ratio (95%CI) 1.18 (1.07-1.30); P=0.0009]. A meta-analysis of four South Asian studies with 8091 subjects showed that the FTO A-allele predisposes to Type 2 diabetes [1.22 (95%CI 1.14-1.31); P=1.07 × 10(-8) ] even after adjusting for BMI [1.18 (95%CI 1.10-1.27); P=1.02 × 10(-5) ] or waist circumference [1.18 (95%CI 1.10-1.27); P=3.97 × 10(-5) ]. CONCLUSIONS The strong association between FTO genotype and BMI and waist circumference in South Asians is similar to that observed in Europeans. In contrast, the strong association of FTO genotype with diabetes is only partly accounted for by BMI.
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Porta M, Hainer JW, Jansson SO, Malm A, Bilous R, Chaturvedi N, Fuller JH, Klein R, Orchard T, Parving HH, Sjølie AK. Exposure to candesartan during the first trimester of pregnancy in type 1 diabetes: experience from the placebo-controlled DIabetic REtinopathy Candesartan Trials. Diabetologia 2011; 54:1298-303. [PMID: 21225239 DOI: 10.1007/s00125-010-2040-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS The teratogenic consequences of angiotensin-converting enzyme inhibitors angiotensin receptor blockers (ARBs) during the second and third trimesters of pregnancy are well described. However, the consequences of exposure during the first trimester are unclear, especially in diabetes. We report the experience from DIRECT (DIabetic REtinopathy and Candesartan Trials), three placebo-controlled studies designed to examine the effects of an ARB, candesartan, on diabetic retinopathy. METHODS Over 4 years or longer, 178 normotensive women with type 1 diabetes (86 randomised to candesartan, 32 mg once daily, and 92 assigned to placebo) became pregnant (total of 208 pregnancies). RESULTS More than half of patients were exposed to candesartan or placebo prior to or in early pregnancy, but all discontinued it at an estimated 8 weeks from the last menstrual period. Full-term pregnancies (51 vs 50), premature deliveries (21 vs 27), spontaneous miscarriages (12 vs 15), elective terminations (15 vs 14) and other outcomes (1 vs 2) were similar in the candesartan and placebo groups. There were two stillbirths and two 'sick babies' in the candesartan group, and one stillbirth, eight 'sick babies' and one cardiac malformation in the placebo group. CONCLUSIONS/INTERPRETATION The risk for fetal consequences of ARBs in type 1 diabetes may not be high if exposure is clearly limited to the first trimester. Long-term studies in fertile women can be conducted with ARBs during pregnancy, provided investigators diligently stop their administration upon planning or detection of pregnancy. TRIAL REGISTRATION ClinicalTrials.gov DIRECT-Prevent 1 NCT00252733; DIRECT-Protect 1 NCT00252720; DIRECT-Protect 2 NCT00252694. FUNDING The study was funded jointly by AstraZeneca and Takeda.
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Sjølie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH, Bilous R, Aldington S, Chaturvedi N. Retinal microaneurysm count predicts progression and regression of diabetic retinopathy. Post-hoc results from the DIRECT Programme. Diabet Med 2011; 28:345-51. [PMID: 21309844 DOI: 10.1111/j.1464-5491.2010.03210.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the association between baseline retinal microaneurysm score and progression and regression of diabetic retinopathy, and response to treatment with candesartan in people with diabetes. METHODS This was a multicenter randomized clinical trial. The progression analysis included 893 patients with Type 1 diabetes and 526 patients with Type 2 diabetes with retinal microaneurysms only at baseline. For regression, 438 with Type 1 and 216 with Type 2 diabetes qualified. Microaneurysms were scored from yearly retinal photographs according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Retinopathy progression and regression was defined as two or more step change on the ETDRS scale from baseline. Patients were normoalbuminuric, and normotensive with Type 1 and Type 2 diabetes or treated hypertensive with Type 2 diabetes. They were randomized to treatment with candesartan 32 mg daily or placebo and followed for 4.6 years. RESULTS A higher microaneurysm score at baseline predicted an increased risk of retinopathy progression (HR per microaneurysm score 1.08, P < 0.0001 in Type 1 diabetes; HR 1.07, P = 0.0174 in Type 2 diabetes) and reduced the likelihood of regression (HR 0.79, P < 0.0001 in Type 1 diabetes; HR 0.85, P = 0.0009 in Type 2 diabetes), all adjusted for baseline variables and treatment. Candesartan reduced the risk of microaneurysm score progression. CONCLUSIONS Microaneurysm counts are important prognostic indicators for worsening of retinopathy, thus microaneurysms are not benign. Treatment with renin-angiotensin system inhibitors is effective in the early stages and may improve mild diabetic retinopathy. Microaneurysm scores may be useful surrogate endpoints in clinical trials.
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Abstract
AIM To examine knowledge and management of diabetes by older people. METHODS A representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed. RESULTS The majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes. CONCLUSIONS Most older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment.
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Tillin T, Park C, March K, Coady E, Chaturvedi N, Hughes A. P7.03 SUBCLINICAL MEASURES OF ATHEROSCLEROSIS ASSOCIATE DIFFERENTLY WITH PREVALENT CORONARY HEART DISEASE IN INDIAN ASIANS AND EUROPEANS. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lawlor DA, Chaturvedi N. Methods of measurements in epidemiology--call for a new type of paper in the IJE. Int J Epidemiol 2010. [DOI: 10.1093/ije/dyq178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bathula R, Hughes AD, Panerai R, Potter J, Thom SAM, Francis DP, Shore AC, Kooner J, Chaturvedi N. Indian Asians have poorer cardiovascular autonomic function than Europeans: this is due to greater hyperglycaemia and may contribute to their greater risk of heart disease. Diabetologia 2010; 53:2120-8. [PMID: 20549180 DOI: 10.1007/s00125-010-1818-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/11/2010] [Indexed: 01/21/2023]
Abstract
AIMS/HYPOTHESIS A high prevalence of diabetes contributes to excess CHD in Indian Asians, but the underlying mechanisms are unclear. Heart rate, heart rate variability (HRV) and baroreflex sensitivity (BRS) are measures of cardiac autonomic function that are disturbed by hyperglycaemia and predict CHD. We compared these measures in Indian Asians and Europeans, and sought explanations for the observed differences. METHODS A representative sample of 149 Europeans and 151 Indian Asians was recruited from primary care, 66% of them men (aged 35-75 years), 34% women (aged 55-75 years). Heart rate, HRV, BRS and cardio-metabolic profiles were measured over four successive 5 min periods with continuous ECG and blood pressure monitoring. RESULTS Indian Asians were hyperglycaemic compared with Europeans (HbA(1c) (mean +/- SD) 6.5 +/- 1.2% vs 5.9 +/- 1.0%, p = 0.001). They had shorter mean RR intervals ((mean +/- SE) 969 +/- 13 vs 1,022 +/- 12 ms, p = 0.002), lower total RR interval power ((geometric mean, 95% CI) 925 [796-1075] vs 1,224 [1,064-1,422] ms(2), p = 0.008) and lower BRS ((mean +/- SE) 5.7 +/- 1.0 vs 6.6 +/- 1.0 ms/mmHg, p = 0.01). All measures of cardiac autonomic dysfunction were significantly associated with hyperglycaemia (mean RR interval vs HbA(1c) r = -0.22; p < 0.001). Ethnic differences in cardiac autonomic function persisted after adjustment for age, blood pressure and medication (mean RR interval 973 vs 1,021 ms, p = 0.004), but were attenuated or abolished by adjusting for HbA(1c) (979 vs 1,014 ms, p = 0.06) or other markers of hyperglycaemia. CONCLUSIONS/INTERPRETATION Indian Asians from the general population have impaired cardiovascular autonomic function compared with Europeans. This is due to greater hyperglycaemia in Indian Asians and may determine their increased CHD risk.
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Landis RC, Evans BJ, Chaturvedi N, Haskard DO. Persistence of TNFalpha in diabetic wounds. Diabetologia 2010; 53:1537-8. [PMID: 20419448 DOI: 10.1007/s00125-010-1766-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
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Vergouwe Y, Soedamah-Muthu SS, Zgibor J, Chaturvedi N, Forsblom C, Snell-Bergeon JK, Maahs DM, Groop PH, Rewers M, Orchard TJ, Fuller JH, Moons KGM. Progression to microalbuminuria in type 1 diabetes: development and validation of a prediction rule. Diabetologia 2010; 53:254-62. [PMID: 19908023 PMCID: PMC2797626 DOI: 10.1007/s00125-009-1585-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/23/2009] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Microalbuminuria is common in type 1 diabetes and is associated with an increased risk of renal and cardiovascular disease. We aimed to develop and validate a clinical prediction rule that estimates the absolute risk of microalbuminuria. METHODS Data from the European Diabetes Prospective Complications Study (n = 1115) were used to develop the prediction rule (development set). Multivariable logistic regression analysis was used to assess the association between potential predictors and progression to microalbuminuria within 7 years. The performance of the prediction rule was assessed with calibration and discrimination (concordance statistic [c-statistic]) measures. The rule was validated in three other diabetes studies (Pittsburgh Epidemiology of Diabetes Complications [EDC] study, Finnish Diabetic Nephropathy [FinnDiane] study and Coronary Artery Calcification in Type 1 Diabetes [CACTI] study). RESULTS Of patients in the development set, 13% were microalbuminuric after 7 years. Glycosylated haemoglobin, AER, WHR, BMI and ever smoking were found to be the most important predictors. A high-risk group (n = 87 [8%]) was identified with a risk of progression to microalbuminuria of 32%. Predictions showed reasonable discriminative ability, with c-statistic of 0.71. The rule showed good calibration and discrimination in EDC, FinnDiane and CACTI (c-statistic 0.71, 0.79 and 0.79, respectively). CONCLUSIONS/INTERPRETATION We developed and validated a clinical prediction rule that uses relatively easily obtainable patient characteristics to predict microalbuminuria in patients with type 1 diabetes. This rule can help clinicians to decide on more frequent check-ups for patients at high risk of microalbuminuria in order to prevent long-term chronic complications.
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Park C, March K, Ghosh A, Tillin T, Mayet J, Lowe A, Chaturvedi N, Hughes A. P8.08 A METHOD COMPARISON OF CENTRAL BLOOD PRESSURE MEASUREMENTS BY PULSECOR AND SPHYGMOCOR DEVICES. Artery Res 2010. [DOI: 10.1016/j.artres.2010.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gruden G, Bruno G, Chaturvedi N, Burt D, Pinach S, Schalkwijk C, Stehouwer CD, Witte DR, Fuller JH, Cavallo-Perin P. ANTI-HSP60 and ANTI-HSP70 antibody levels and micro/ macrovascular complications in type 1 diabetes: the EURODIAB Study. J Intern Med 2009; 266:527-36. [PMID: 19563392 DOI: 10.1111/j.1365-2796.2009.02129.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The heat shock proteins 60 and 70 (HSP60, HSP70) play an important role in cytoprotection. Under stress conditions they are released into the circulation and elicit an immune response. Anti-HSP60 and anti-HSP70 antibody levels have been associated with cardiovascular disease. Type 1 diabetes is associated with a greatly increased risk of micro- and macrovascular complications. Therefore, we investigated whether anti-HSP60 and anti-HSP70 antibody levels were associated with micro- and macrovascular complications in type 1 diabetic patients. DESIGN A cross-sectional nested case-control study from the EURODIAB Study of 531 type 1 diabetic patients was performed. SUBJECTS Cases (n = 363) were defined as those with one or more complications of diabetes; control subjects (n = 168) were all those with no evidence of any complication. We measured anti-HSP60 and anti-HSP70 antibody levels and investigated their cross-sectional associations with diabetic complications. RESULTS Anti-HSP70 antibody levels were significantly greater in control than in case subjects, whereas anti-HSP60 antibody levels were similar in the two groups. In logistic regression analysis, anti-HSP70 levels in the upper quartiles were associated with a 47% reduced odds ratio of micro/macrovascular complications, independently of conventional risk factors, markers of inflammation and endothelial dysfunction [odds ratio (OR) = 0.53, 95% confidence intervals (CI): 0.28-1.02]. CONCLUSIONS In this large cohort of type 1 diabetic subjects, we found an independent and inverse association between serum anti-HSP70 antibody levels and diabetic micro/macrovascular complications. This suggests that anti-HSP70 antibody levels may be a novel marker of protection from chronic diabetic complications.
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Sharp AS, Tapp RJ, Thom SAM, Francis DP, Hughes AD, Stanton AV, Zambanini A, O'Brien E, Chaturvedi N, Lyons S, Byrd S, Poulter NR, Sever PS, Mayet J. Tissue Doppler E/E' ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J 2009; 31:747-52. [DOI: 10.1093/eurheartj/ehp498] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Nin JWM, Ferreira I, Schalkwijk CG, Prins MH, Chaturvedi N, Fuller JH, Stehouwer CDA. Levels of soluble receptor for AGE are cross-sectionally associated with cardiovascular disease in type 1 diabetes, and this association is partially mediated by endothelial and renal dysfunction and by low-grade inflammation: the EURODIAB Prospective Complications Study. Diabetologia 2009; 52:705-14. [PMID: 19183936 DOI: 10.1007/s00125-009-1263-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 12/29/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Plasma soluble receptor for AGE (sRAGE) may reflect the activity of the AGE-RAGE axis, which has been proposed as a potential mechanism linking hyperglycaemia to vascular complications in diabetes. We have therefore investigated: (1) whether sRAGE is associated with greater prevalence of cardiovascular disease (CVD) and microvascular complications in type 1 diabetic individuals; and (2) the extent to which any such associations are explained by markers of endothelial and renal dysfunction and inflammation. METHODS The study included 477 individuals (234 women; mean age 42 +/- 10 [SD] years) from the EURODIAB Prospective Complications Study. We used linear regression analyses to investigate the differences in sRAGE levels between individuals with and without vascular complications. All analyses were adjusted for age, sex, HbA(1c), duration of diabetes and other risk factors. RESULTS Individuals with CVD (n = 116) had higher levels of sRAGE than those without CVD or any microvascular complications (n = 178): beta = 0.15 (95% CI 0.04-0.27). Further adjustments for markers of endothelial (beta = 0.13 [0.02-0.24]) and renal dysfunction (beta = 0.10 [-0.01, 0.20]) and inflammation (beta = 0.12 [0.01-0.23]) attenuated these differences; altogether these variables explained about 50% of the association between sRAGE and prevalent CVD. sRAGE levels tended to be higher in the presence and across the levels of severity of albuminuria (p for trend = 0.087) and retinopathy (p for trend = 0.057); adjustments for endothelial and renal dysfunction and inflammation also attenuated these differences. CONCLUSIONS/INTERPRETATION sRAGE is associated with greater prevalence of CVD in type 1 diabetic individuals, and these associations may be partly explained by endothelial and renal dysfunction and low-grade inflammation.
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Jessani S, Hatcher J, Chaturvedi N, Jafar TH. Effect of low vs. high dietary sodium on blood pressure levels in a normotensive Indo-Asian population. Am J Hypertens 2008; 21:1238-44. [PMID: 18772855 DOI: 10.1038/ajh.2008.256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor, and while sodium restriction in hypertensive patients appears effective, its role in normotensive individuals remains unclear. We assessed the effect of a low vs. high-sodium diet on blood pressure in normotensive Indo-Asian adults. METHODS A randomized, controlled, crossover trial was conducted on 200 normotensive subjects randomly selected from the general population in Karachi, Pakistan. Participants were randomized to either a low (20 mEq/day) or a high-sodium diet (220 mEq/day) for 1 week, followed by 1 week of washout, then the alternate diet for 1 week. The primary outcome was difference in systolic blood pressure (SBP) measured at the end of each phase in the overall population. RESULTS Mean (95% confidence interval) decline in 24-h urinary sodium excretion was 81.0 (69.6-92.4) mEq/day (P < 0.001), and in SBP was 1 (0-3)mm Hg (P = 0.17) between high and low-sodium phase. A significant interaction was detected (P = 0.001) between dietary sodium and baseline SBP with a greater adjusted mean (95% confidence interval) decline in SBP (6 (2-9)mm Hg) among participants with high-normal SBP (130-139 mm Hg) and no significant change (-1(-2 to 1)) in those with normal baseline SBP (<130 mm Hg), respectively. CONCLUSIONS Reducing sodium intake has a beneficial effect on blood pressure in Indo-Asians with high-normal SBP, at least in the short term. Given the ubiquity of high-normal blood pressure (BP), and frank hypertension in this population, we argue that primary prevention strategies, targeted at use of discretionary sodium, should now be designed and evaluated.
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Beulens JWJ, Kruidhof JS, Grobbee DE, Chaturvedi N, Fuller JH, Soedamah-Muthu SS. Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study. Diabetologia 2008; 51:1631-8. [PMID: 18626626 DOI: 10.1007/s00125-008-1091-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the association between alcohol consumption and risk of microvascular complications (retinopathy, neuropathy, nephropathy) in type 1 diabetes mellitus patients in the EURODIAB Prospective Complications Study. METHODS The EURODIAB Prospective Complications Study is a follow-up study including 3,250 type 1 diabetes mellitus patients from 16 different European countries. We investigated the cross-sectional association between moderate alcohol consumption and risk of retinopathy, neuropathy and nephropathy among 1,857 of these patients. RESULTS We documented 304 cases of proliferative retinopathy, 660 cases of neuropathy and 157 cases of nephropathy (macroalbuminuria). Alcohol consumption was associated with risk of proliferative retinopathy, neuropathy and macroalbuminuria in a U-shaped fashion. Moderate consumers (30-70 g alcohol per week) had a lower risk of microvascular complications with odds ratios of 0.60 (95% CI 0.37-0.99) for proliferative retinopathy, 0.61 (0.41-0.91) for neuropathy and 0.36 (0.18-0.71) for macroalbuminuria in multivariate-adjusted models. These results were similar when excluding patients who had been advised to drink less alcohol because of their health. The relation was most pronounced for alcohol consumption from wine. Drinking frequency was significantly, inversely associated with risk of neuropathy, but a similar trend was visible for proliferative retinopathy and macroalbuminuria. Alcohol consumption was not associated with occurrence of ketoacidosis or hypoglycaemic attacks. CONCLUSIONS/INTERPRETATION Consistent with its effects on macrovascular complications, moderate alcohol consumption is associated with a lower risk of all microvascular complications among type 1 diabetes patients.
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Tillin T, Evans RM, Witt NW, Sharp PS, McKeigue PM, Chaturvedi N, Hughes AD. Ethnic differences in retinal microvascular structure. Diabetologia 2008; 51:1719-22. [PMID: 18626625 DOI: 10.1007/s00125-008-1096-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 06/12/2008] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS People of African origin have increased risk of stroke and retinal microvascular disease compared with populations of European origin. We compared quantitative measures of retinal microvasculature in British white Europeans and African Caribbeans. METHODS Population-based study of 215 (45% male) British African-Caribbean migrants and 323 (48% male) white Europeans aged 40-69 years. Digitised retinal images were analysed using a validated semi-automated system. RESULTS Arteriolar optimality deviation, an indicator of endothelial dysfunction, was greater in African Caribbeans (age- and sex-adjusted means [95% CIs]: 0.06 [0.05-0.06] vs 0.04 [0.04-0.05], p = 0.004); this was unexplained by conventional risk factors. Arteriolar diameters were narrower in African Caribbeans (age- and sex-adjusted means [95% CIs]: 18.4 [18.1-18.6] vs 17.9 [17.6-18.2], p = 0.011). These ethnic differences in diameters were attenuated on adjustment for systolic BP (SBP) (adjusted means: 18.2 vs 18.1, p = 0.31). However, there was a significant interaction (p = 0.011) between diabetes and SBP, such that SBP was strongly associated with arteriolar diameter in people without diabetes, but not in those with diabetes (adjusted beta-coefficients for SBP: Europeans: -0.42, p = 0.002 vs 0.17, p = 0.69, African Caribbeans: -0.35, p = 0.023 vs 0.01, p = 0.96). Other measures of retinal vasculature did not differ by ethnicity. CONCLUSIONS/INTERPRETATION British African Caribbeans appear to have poorer retinal arteriolar endothelial function than white Europeans. Higher BPs explained the narrower arterioles in African Caribbeans; however, patterns of association between arteriolar narrowing and BP suggest the possibility that cerebral autoregulation and/or remodelling might be adversely affected by diabetes in both ethnic groups.
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Jafar TH, Qadri Z, Islam M, Hatcher J, Bhutta ZA, Chaturvedi N. Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Arch Dis Child 2008; 93:373-8. [PMID: 17942586 PMCID: PMC2532954 DOI: 10.1136/adc.2007.125641] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Childhood obesity is an emerging global public health challenge. Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We conducted these analyses to determine the trends in nutritional status of school-aged children in urban Pakistan. METHODS Data on the nutritional status of children aged 5 to 14 years from two independent population-based representative surveys, the urban component of the National Health Survey of Pakistan (NHSP; 1990-1994) and the Karachi survey (2004-2005), were analysed. Using normative data from children in the United States as the reference, trends for age- and gender-standardised prevalence (95% CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more than 2 SD below the height-for-age reference) and overweight and obese (body mass index (BMI) 85(th) percentile or greater) children were compared for the two surveys. The association between physical activity and being overweight or obese was analysed in the Karachi survey using logistical regression analysis. RESULTS 2074 children were included in the urban NHSP and 1675 in the Karachi survey. The prevalence of underweight children was 29.7% versus 27.3% (p = 0.12), stunting was 16.7% versus 14.3% (p = 0.05), and prevalence of overweight and obese children was 3.0 versus 5.7 (p<0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32-0.80 for those who engaged in more than 30 minutes of physical activity versus those engaged in less than 30 minutes' activity). CONCLUSIONS Our study highlights the challenge faced by Pakistani school-aged children. There has been a rapid rise in the number of overweight and obese children despite a persistently high burden of undernutrition. Focus on prevention of obesity in children must include strategies for promoting physical activity.
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Soedamah-Muthu SS, Chaturvedi N, Pickup JC, Fuller JH. Relationship between plasma sialic acid and fibrinogen concentration and incident micro- and macrovascular complications in type 1 diabetes. The EURODIAB Prospective Complications Study (PCS). Diabetologia 2008; 51:493-501. [PMID: 18183363 PMCID: PMC2668586 DOI: 10.1007/s00125-007-0905-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 11/22/2007] [Indexed: 11/18/2022]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is associated with an increased risk of vascular complications. This increased risk could be explained by sialic acid and/or fibrinogen. It is also not clear what explains the abolition of sex-related differences affecting risk of CHD in the presence of type 1 diabetes. Therefore, we examined whether fibrinogen and sialic acid are related to incident micro- and macrovascular complications in patients with type 1 diabetes. METHODS A subset (n=2329) of the EURODIAB Prospective Complications Study was analysed. Sialic acid and fibrinogen concentrations were measured at baseline. The main outcomes after 7 years were development of albuminuria, retinopathy, neuropathy and CHD. RESULTS Univariable and multivariable models using Cox proportional survival analyses showed that an SD unit increase in sialic acid and fibrinogen levels was significantly associated with CHD in men only. Adjusted standardised hazard ratios (sHRs) were 1.50 (95% CI 1.05-2.15) and 1.40 (95% CI 1.06-1.86) for sialic acid and fibrinogen, respectively. Initial associations between (1) sialic acid and incident retinopathy [standardised odds ratio (sOR) men 1.68, 95% CI 1.10-2.57], (2) fibrinogen and retinopathy (sOR women 1.37, 95% CI 1.06-1.78) and (3) sialic acid and neuropathy (sOR men 1.37, 95% CI 1.06-1.77) were shown, but became non-significant in multivariable models. CONCLUSIONS/INTERPRETATION Sialic acid and fibrinogen are strong predictors of CHD in men with type 1 diabetes, beyond the effect of established risk factors. The associations found with microvascular complications were not independent of other risk factors.
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Dotsenko O, Chaturvedi N, Thom SAM, Wright AR, Mayet J, Shore A, Schalkwijk C, Hughes AD. Platelet and leukocyte activation, atherosclerosis and inflammation in European and South Asian men. J Thromb Haemost 2007; 5:2036-42. [PMID: 17883700 PMCID: PMC2650817 DOI: 10.1111/j.1538-7836.2007.02711.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased platelet activation occurs in ischemic heart disease (IHD), but increased platelet activation is also seen in cerebrovascular atherosclerosis and peripheral artery disease. It is not clear therefore whether platelet activation is an indicator of IHD or a marker of generalized atherosclerosis and inflammation. South Asian subjects are at high risk of IHD, but little is known regarding differences in platelet and leukocyte function between European and South Asian subjects. METHODS Fifty-four male subjects (age 49-79 years) had coronary artery calcification measured by multislice computed tomography (CT), aortic atherosclerosis assessed by measurement of carotid-femoral pulse wave velocity (aortic PWV), and femoral and carotid atherosclerosis measured by B-mode ultrasound. Platelet and leukocyte activation was assessed by flow cytometry of platelet-monocyte complexes (PMC), platelet expression of PAC-1 binding site and CD62P, and expression of L-selectin on leukocytes. RESULTS Elevated circulating PMC correlated significantly with elevated aortic PWV and PMC were higher in subjects with femoral plaques. In contrast PMC did not differ by increasing coronary artery calcification category or presence of carotid plaques. Higher numbers of PMC were independently related to elevated levels of C-reactive protein (CRP), higher aortic PWV, hypertension and smoking in a multivariate model. Markers of platelet and leukocyte activation did not differ significantly by ethnicity. CONCLUSIONS Increased PMC are related to the extent of aortic and femoral atherosclerosis rather than coronary or carotid atherosclerosis. The association between elevated CRP and increased PMC suggests that inflammation in relation to generalized atherosclerosis may play an important role in PMC activation.
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Marzouk D, Sass J, Bakr I, El Hosseiny M, Abdel-Hamid M, Rekacewicz C, Chaturvedi N, Mohamed MK, Fontanet A. Metabolic and cardiovascular risk profiles and hepatitis C virus infection in rural Egypt. Gut 2007; 56:1105-10. [PMID: 16956918 PMCID: PMC1955512 DOI: 10.1136/gut.2006.091983] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS To investigate the relationship between lipid profiles and diabetes with past and chronic hepatitis C virus (HCV) infection among village residents of Egypt. PATIENTS AND METHODS Fasting lipids and glucose profiles were compared among adults never infected with HCV (negative HCV antibodies), infected in the past (positive HCV antibodies and negative HCV RNA) and chronically infected (positive HCV antibodies and HCV RNA). RESULTS Of the 765 participants, 456 (59.6%) were female, and median age was 40 (range 25-88) years. Chronic HCV infection was present in 113 (14.8%) and past infection in 67 (8.8%). After adjustment for age and sex, participants with chronic HCV infection had lower plasma low density lipoproteins (LDL) cholesterol and triglyceride levels compared with those never infected (age and sex adjusted differences (95% CI) were -19.0 (-26.3 to -11.7) mg/dl and -26.2 (-39.0 to -13.3) mg/dl, respectively). In contrast, participants with cleared HCV infection had higher triglyceride levels compared with those never infected (age and sex adjusted difference (95% CI) was +16.0 (0.03 to 31.9) mg/dl). In multivariate analysis, participants with chronic HCV infection were more likely to have diabetes (OR 3.05, 95% CI 1.19 to 7.81) compared with those never infected, independent of LDL cholesterol levels. CONCLUSION In conclusion, this community based study has shown that in a single population, chronic HCV infection is associated with glucose intolerance and, despite that, a favourable lipid pattern. An intriguing finding was the high triglyceride levels observed among participants with past infection, suggesting that elevated triglycerides at the time of acute infection may facilitate viral clearance.
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Tillin T, Chaturvedi N, Forouhi NG, Smith GD, McKeigue PM. Cardiovascular disease mortality in relation to childhood and adulthood socioeconomic markers in British South Asian men. Heart 2007; 94:476-81. [PMID: 17646197 DOI: 10.1136/hrt.2006.109165] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the effects of childhood and adulthood socioeconomic position (SEP) including length of education on rates of cardiovascular disease (CVD) mortality in British South Asians. DESIGN Cross-sectional study with ongoing mortality follow-up. SETTING West London Borough of Ealing, population-based study. PATIENTS 1400 South Asian men (52% Punjabi Sikh origin) aged 40-69, first studied 1988-1990 and followed for mortality to October 2006. MAIN OUTCOME MEASURES Deaths due to cardiovascular disease. RESULTS 143 men have died from CVD. Men in non-manual adult occupations were less likely to die from CVD than those in unskilled manual occupations (age-adjusted hazard ratio (HR) 0.55 (95% CI 0.35 to 0.88)). Men with 11+ years of education had reduced risk compared with those with <11 years of education (HR 0.66 (95% CI 0.47 to 0.94)). Men who had both non-manual occupations and 11+ years of education were less likely to die from CVD (15 deaths, 282 men; HR 0.39, 95% CI 0.21 to 0.73) than those who were most socially disadvantaged during childhood and adulthood (27 deaths, 187 men). These associations remained after adjustment for other markers of SEP, lifestyle and conventional risk factors. Similar, but weaker, associations were observed when paternal occupation defined childhood SEP. CONCLUSIONS Years of education, and to a lesser extent paternal occupation, as markers of childhood SEP, had cumulative effects with adulthood socioeconomic circumstances on risk of CVD death; these cumulative effects were strongest in men whose own occupation was non-manual and were unexplained by conventional risk factors measured in middle age.
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Jafar TH, Qadri Z, Chaturvedi N. Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart 2007; 94:408-13. [PMID: 17646192 PMCID: PMC2565583 DOI: 10.1136/hrt.2007.120774] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Indo-Pakistani populations have one of the highest risks of coronary artery disease (CAD) in the world. A population-based, cross-sectional survey was conducted on 3143 adults aged >or=40 years from 12 randomly selected communities in Karachi, Pakistan. Apart from smoking, women had more CAD risk factors (diabetes, hypertension, obesity, dyslipidaemia) than men. Definite CAD (history and Q waves on ECG) was more prevalent in men than in women (6.1% vs 4.0%; p = 0.009). In contrast, ischaemic and major ECG changes were twice as prevalent in women as in men (29.4% vs 15.6%, and 21.0% vs 10.5%; p<0.001 for each, respectively). All measures of CAD were strongly predicted by the metabolic syndrome, but that failed to account for the greater prevalence of ECG abnormalities in women than in men. The findings indicate that one in five middle-aged adults in urban Pakistan may have underlying CAD. Women are at greater risk than men. TRIAL REGISTRATION NUMBER NCT00327574.
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Chaturvedi N, Bilous R, Hardy R, Remuzzi G, Ruggenenti P, Viberti GC. Misleading meta-analysis: a need to look beyond the headlines. Diabet Med 2007; 24:587-91. [PMID: 17490423 DOI: 10.1111/j.1464-5491.2007.02139.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hughes AD, Coady E, Raynor S, Mayet J, Wright AR, Shore AC, Kooner JS, Thom SAM, Chaturvedi N. Reduced endothelial progenitor cells in European and South Asian men with atherosclerosis. Eur J Clin Invest 2007; 37:35-41. [PMID: 17181565 PMCID: PMC1869046 DOI: 10.1111/j.1365-2362.2007.01743.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Circulating endothelial progenitor cells (EPCs) play a role in the repair and regeneration of the endothelium and may represent a novel cardiovascular risk factor. South Asian subjects have an increased risk of cardiovascular disease which is not fully explained by known risk factors. This study examined associations of EPCs with atherosclerosis and possible ethnic differences in EPCs. MATERIALS AND METHODS A population sample of 58 European and South Asian adult men was enriched with the recruitment of an additional 59 European and South Asian men with known coronary disease. The coronary artery calcification score was measured by multi-slice computerized tomography (CT), carotid and femoral intima-media thickness (IMT), and femoral plaques were measured by ultrasound. The subjects were further subdivided into three categories of coronary artery disease on the basis of coronary artery calcification score and clinical history. Total EPCs and non-senescent EPCs (ns-EPCs) were quantified after 5 days cell culture and the number of late outgrowth colonies was measured over a 6-week test period. Circulating CD34+ haematopoietic precursor cells were measured by flow cytometry. RESULTS Individuals with femoral plaques had reduced total and ns-EPCs. The number of ns-EPCs were reduced in individuals with the most coronary atheroma and were inversely related to the coronary calcification score and femoral IMT. These relationships persisted after multivariate adjustment for other risk factors. The numbers of late outgrowth colonies or circulating CD34+ cells were unrelated to the presence of atherosclerosis. There were no differences in the number of EPCs between European and South Asian subjects. CONCLUSION The number of EPCs are reduced in subjects with atherosclerosis independent of other risk factors. Reduction in EPC numbers may be an independent risk factor for atherosclerosis but does not explain ethnic differences in cardiovascular risk.
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Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia 2006; 49:2580-8. [PMID: 16972045 DOI: 10.1007/s00125-006-0393-2] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 06/30/2006] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS We examined prospectively whether measured risk factors can explain the higher CHD mortality in South Asians compared with Europeans. MATERIALS AND METHODS Conventional CHD risk factors and those associated with insulin resistance were measured in 1,787 European and 1,420 South Asian men aged 40 to 69 years at baseline in the population-based Southall and Brent studies (London) between 1988 and 1990. Participants were followed up for mortality. RESULTS By February 2006, there were 202 CHD deaths (108 Asian, 94 European). South Asian men had double the CHD mortality of European men in Cox regression analyses adjusted for age, smoking, and cholesterol (hazard ratio [HR] 2.14, 95% CI 1.56-2.94, p<0.001). Nearly half of all South Asian CHD deaths versus 13% of deaths among Europeans were among persons with diabetes. Asian men had greater CHD mortality than Europeans, both in the with- and the without-diabetes categories at baseline. CHD mortality remained significantly higher in South Asian men in multivariable models that adjusted for conventional risk factors and diabetes and/or impaired glucose regulation, features of insulin resistance, or the metabolic syndrome (HR 1.6-1.9). Accounting for co-morbidity and socio-economic status did not materially alter the findings. CONCLUSIONS/INTERPRETATION These data confirm that South Asian men have significantly higher CHD mortality than their European counterparts, while indicating that neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome criteria as currently defined can account for this excess risk. The contribution of unmeasured factors to the elevated vascular risk in South Asians should be addressed in future studies.
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Ferriss JB, Webb D, Chaturvedi N, Fuller JH, Idzior-Walus B. Weight gain is associated with improved glycaemic control but with adverse changes in plasma lipids and blood pressure isn Type 1 diabetes. Diabet Med 2006; 23:557-64. [PMID: 16681565 DOI: 10.1111/j.1464-5491.2006.01847.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effects of weight gain on metabolic control, plasma lipids and blood pressure in patients with Type 1 diabetes. METHODS Patients in the EURODIAB Prospective Complications Study (n = 3250) were examined at baseline and 1800 (55%) were re-examined a mean of 7.3 years later. Patients had Type 1 diabetes, defined as a diagnosis made before age 36 years and with a need for continuous insulin therapy within a year of diagnosis. Patients were aged 15-60 years at baseline and were stratified for age, sex and duration of diabetes. RESULTS The change in HbA(1c) from baseline to follow-up examination was significantly more favourable in those who gained 5 kg or more during follow-up ('marked weight gain') than in patients who gained less or no weight or lost weight ('less or no weight gain'). In those with marked weight gain, there was a significantly greater rise in plasma triglycerides and total cholesterol and significantly less favourable changes in low-density lipoprotein and high-density lipoprotein cholesterol compared with those with less or no weight gain, with or without adjustment for HbA(1c). Systolic and diastolic blood pressure also rose significantly more in the group with marked weight gain. CONCLUSION Weight gain in patients with Type 1 diabetes has adverse effects on plasma lipids and blood pressure, despite a small improvement in glycaemic control.
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Tillin T, Dhutia H, Chambers J, Malik I, Coady E, Mayet J, Wright A, Kooner J, Chaturvedi N, Hughes A. Mo-P1:155 Southh Asians have narrower coronary arteries and different remodelling responses to disease compared to white Europeans. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tillin T, Dhutia H, Chambers J, Malik I, Coady E, Mayet J, Wright A, Kooner J, Chaturvedi N, Hughes A. Mo-P1:156 British South Asian men have more adverse plaque morphology despite equivalent atherosclerotic burden to white Europeans. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Marzouk D, Sass J, Mohamed M, Bakr I, El-Houssinie M, Abdel-Hamid M, Rekacewicz C, Chaturvedi N, Fontanet A. P.205 Association between HCV infection and cardio-vascular risk factors in rural Egypt. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vérier-Mine O, Chaturvedi N, Webb D, Fuller JH. Is pregnancy a risk factor for microvascular complications? The EURODIAB Prospective Complications Study. Diabet Med 2005; 22:1503-9. [PMID: 16241914 DOI: 10.1111/j.1464-5491.2005.01682.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To examine the long-term influence of pregnancy on the development and progression of microvascular complications in Type 1 diabetes. METHODS In the EURODIAB Prospective Complications Study (PCS), 793 women potentially child bearing at baseline completed the follow-up (7.3 years) and 163 (21%) gave birth during the follow-up period. We compared risk factors [mean levels of age, duration of diabetes, HbA(1c), systolic blood pressure (SBP) and proportion giving birth] between those that did or did not develop microvascular complications during the follow-up period. RESULTS For the 425 childless women at baseline, 102 gave birth during follow-up. HbA(1c) was a significant risk factor for progression to microalbuminuria but age, duration of diabetes, systolic blood pressure or giving birth were not. Duration of diabetes and high HbA(1c) were significant risk factors for progression to proliferative retinopathy, whereas giving birth was not. Similar results were obtained for progression to any form of retinopathy. Giving birth was not significantly related to the incidence of neuropathy. Similar results were obtained for women with children at baseline giving birth during follow-up (n = 61/368). CONCLUSIONS In this European study, having a first or another pregnancy did not seem to be a risk factor for long-term progression of any microvascular complication. This is in accordance with the findings of the Diabetes Control and Complications Trial (DCCT).
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Strain WD, Chaturvedi N, Nihoyannopoulos P, Bulpitt CJ, Rajkumar C, Shore AC. Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans. Diabetologia 2005; 48:2269-77. [PMID: 16193289 DOI: 10.1007/s00125-005-1950-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 07/16/2005] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is associated with microvascular damage in all populations, but diabetic patients of Black African descent (African Caribbeans) have a greater risk of vascular target organ damage than would be anticipated for any given blood pressure level. We investigated whether this may be due to differences in the microvasculature. MATERIALS AND METHODS To assess the maximum hyperaemic response to heating and the post-ischaemic response, Laser Doppler fluximetry was performed on 51 and 100 Europeans, and on 66 and 88 African Caribbeans with and without diabetes, respectively. Subjects were aged between 40 and 65 years and recruited from the general population. Echocardiographic interventricular septal thickness (IVST) was measured as a proxy for vascular target organ damage. RESULTS In diabetic subjects of both ethnic groups, the maximum hyperaemic response and peak response to ischaemia were attenuated as compared to the corresponding non-diabetic subjects (p=0.08 for diabetic and 0.03 for non-diabetic Europeans; p=0.03 and 0.1 for African Caribbeans). Adjustment for cardiovascular risk factors, in particular insulin and blood pressure, abolished these differences in Europeans (p=0.8 for diabetic and 0.2 for non-diabetic Europeans), but not in African Caribbeans (p=0.03 and 0.05). CONCLUSIONS/INTERPRETATION Persisting microvascular dysfunction in African Caribbeans may contribute to the increased risk of target organ damage observed in diabetes in this population. The weak contribution of conventional cardiovascular risk factors to these disturbances indicates that conventional therapeutic interventions may be less beneficial in these patients. There was a risk-factor-independent, inverse association between IVST and maximal hyperaemia. These ethnic differences in microvascular responses to temperature and arterial occlusion could account for increased target organ damage in African Caribbeans.
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Soedamah-Muthu SS, Chaturvedi N, Teerlink T, Idzior-Walus B, Fuller JH, Stehouwer CDA. Plasma homocysteine and microvascular and macrovascular complications in type 1 diabetes: a cross-sectional nested case-control study. J Intern Med 2005; 258:450-9. [PMID: 16238681 DOI: 10.1111/j.1365-2796.2005.01560.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To examine the independent relationship between plasma total homocysteine (tHcy) and microvascular and macrovascular complications. DESIGN We performed a cross-sectional nested case-control study from the EURODIAB Prospective Complications Study. SETTING A hospital-based multicentre study at 24 centres in 13 European countries. SUBJECTS A total of 533 type 1 diabetic patients, diagnosed at <36 years of age. Cases (n=359) were defined as those with one or more complications of diabetes and control subjects (n=174) were all those with no evidence of any complication. Main outcome measures. Retinopathy, albumin excretion rate (AER), glomerular filtration rate (GFR) estimated by Cockcroft-Gault formula, hypertension and cardiovascular disease (CVD) were assessed. RESULTS In unadjusted models, tHcy (per 5 micromol L(-1)) was significantly associated with nonproliferative retinopathy (OR=1.45, 95% CI: 1.10-1.91), proliferative retinopathy (OR=1.74, 95% CI: 1.34-2.27), macroalbuminuria (OR=1.90, 95% CI: 1.49-2.42), hypertension (OR=2.23, 95% CI: 1.69-2.93) and CVD (OR=1.59, 95% CI: 1.18-2.14). In multivariate models, tHcy was significantly related to macroalbuminuria (OR=1.66, 95% CI: 1.24-2.24) and hypertension (OR=1.57, 95% CI: 1.19-2.07), independent of age, sex, diabetes duration, GFR, microvascular and macrovascular complications and cardiovascular risk factors. There was a significant relationship between tHcy and decreased GFR, independent of established risk factors. The relationship between tHcy and retinopathy was not independent of albuminuria or GFR. The initial positive relationship with CVD was explained by cardiovascular risk factors. CONCLUSION In this large study of European type 1 diabetic subjects, increased concentrations of tHcy were independently related to macroalbuminuria, renal function and hypertension, which suggests that tHcy might play an important role in the pathogenesis of vascular complications in type 1 diabetes.
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