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Asser P, Fischer K, Ainla T, Marandi T, Blöndal M, Saar A, Eha J. Examining the impact of renal dysfunction and diabetes on post-myocardial infarction mortality: insights from a comprehensive retrospective cohort study across different age groups. SCAND CARDIOVASC J 2024; 58:2395875. [PMID: 39205475 DOI: 10.1080/14017431.2024.2395875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Aim. Chronic kidney disease (CKD) and diabetes mellitus (DM) contribute significantly to cardiovascular disease (CVD) and mortality, with prevalence increasing. The evolving demographic of myocardial infarction (MI) patients, influenced by sedentary lifestyles and advanced medical care, lacks understanding regarding the interplay of CKD, DM, age, and post-MI mortality. This study aims to address this gap by evaluating the long-term impact of CKD and DM on post-MI mortality across age groups. Methods. A retrospective cohort study utilized data from the Estonian Myocardial Infarction Registry (EMIR), Estonian Population Register (EPR), and six major hospitals in Estonia, covering AMI hospitalizations from 2012 to 2019. Statistical analyses included Cox proportional hazards regression models and Kaplan-Meier's curves. Results. Analysis of 17,085 MI patients revealed age-dependent associations between renal function and mortality. In patients <65 years, even minor decreases in renal function increased both short-term (HR 2.79, 95% CI 1.71-4.55) and long-term (HR 1.24, 95% CI 1.05-1.47) mortality. Mortality significantly increased in patients >80 years only below an estimated glomerular filtration rate (eGFR) of 44 ml/min/1.73 m2. Newly diagnosed DM patients exhibited higher mortality rates (average HR 1.53, 95% CI 1.45-1.62), while pre-DM did not significantly differ from non-DM patients across all age groups. The DM-renal failure interaction did not significantly influence mortality. Conclusions. An age-dependent association between eGFR and post-MI outcomes emphasizes the need for personalized therapeutic approaches considering age-specific eGFR thresholds and comorbidities to optimize patient management.
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Affiliation(s)
- Piret Asser
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Tiia Ainla
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Toomas Marandi
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Mai Blöndal
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - Aet Saar
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Jaan Eha
- Department of Cardiology, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
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Li M, Wang J, Ding S, Ding B, Oketunbi TJ, Song X, Li Y, Niu Q, Shi X, Gao D, Hu S, Jin G, Wang H. Cardiac magnetic resonance imaging-derived pathophysiology and prognosis of diabetes mellitus with acute myocardial infarction after revascularization: a prospective cohort study. Ann Med 2024; 56:2399751. [PMID: 39253848 DOI: 10.1080/07853890.2024.2399751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Little is known about the underlying factors contributing to unfavourable clinical outcomes in patients with diabetes mellitus (DM) complicated by new-onset acute myocardial infarction (AMI). The aim of this study was to investigate the impact of DM on the pathophysiologic features and prognosis of patients with new-onset AMI following successful revascularization by utilizing cardiac magnetic resonance (CMR). METHODS Consecutive patients diagnosed with new-onset AMI between June 2022 and January 2024 were included. All patients underwent culprit vessel revascularization upon admission and CMR imaging 3-7 days later. The primary clinical endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), for which the average follow-up was 10 months. RESULTS A total of 72 patients were divided into a DM group (n = 23) and a non-DM group (n = 49). Multivariate logistic regression analysis revealed that DM was an independent risk factor for the occurrence of microvascular obstruction. Multivariate linear regression analysis found that DM was the influencing factor of global radial strain (B = -4.107, t = -2.328, p = 0.023), while fasting blood glucose influenced infarct segment myocardial radial strain (B = -0.622, t = -2.032, p = 0.046). DM independently contributed to the risk of MACCEs following successful revascularization in patients with AMI (p < 0.05). CONCLUSION Comprehensive phenotypic characterization of myocardial injury and microcirculatory status could enable reliable identification of high-risk MACCEs in DM patients with new-onset AMI following successful revascularization.
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Affiliation(s)
- Miaonan Li
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Jun Wang
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Siyu Ding
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Bin Ding
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Temilola J Oketunbi
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Xilong Song
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Yao Li
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Qilin Niu
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Xiaojun Shi
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Dasheng Gao
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Sigan Hu
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Guoxi Jin
- Department of Endocrine, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Hongju Wang
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
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Rivoire E, Tresson P, Pialoux V, Josset L, Delrieu L, Millon A, Long A. Impact of Isolated Type 2 Endoleak on Subsequent Cardiovascular Events and Mortality. Ann Vasc Surg 2024; 108:307-316. [PMID: 38942363 DOI: 10.1016/j.avsg.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Assess subsequent cardiovascular events and all-cause mortality in patients with intact abdominal aortic aneurysm (AAA) treated by endovascular aneurysm repair (EVAR) according to the existence of isolated endoleak type 2 (EL2) at 1 year after EVAR implantation. METHODS This retrospective, single-center study included patients treated with EVAR between 2010 and 2017 in the vascular surgery department of the University Hospital of Lyon with an infrarenal AAA > 50 mm. The baseline clinical characteristics collected just before EVAR were retrieved from electronic patient records of our institution. AAA characteristics, procedure, and the 1-year postoperative computed tomography angiography (CTA) were reported. Study end points, major adverse cardiovascular events (MACE), major adverse lower-extremity events (MALE), and all-cause mortality were recorded during follow-up. Patients were divided into 2 groups according to the presence of isolated EL2 (EL2 +) or absence (EL2 -) of any endoleak on CTA at 1 year. MACE, MALE, and all-cause mortality were compared between both groups. RESULTS During the study period, 589 patients were treated by endovascular surgery and 207 were included. According to the CTA results at 1 year, 60 patients (29%) were included in the EL2 + group and 147 patients (71%) in the EL2 - group. A total of 109 patients (53%) experienced a MACE or MALE; significantly fewer patients in the EL2 + than in the EL2 - group did so (P = 0.009). There were 47 patients (23%) who experienced at least 1 MALE, and the frequency was significantly lower in the EL2 + group (P = 0.017). CONCLUSIONS Patients with AAA treated by EVAR who did not develop EL2 at 1 year were at higher risk of MALE during follow-up. This might be explained by more frequent symptomatic lower extremity peripheral arterial disease at baseline in this group. These patients therefore require a closer follow-up and strict control of cardiovascular risk factors to prevent cardiovascular morbi-mortality.
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Affiliation(s)
- Emeraude Rivoire
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France; Service de Médecine Interne et de Médecine Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France.
| | - Philippe Tresson
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Vincent Pialoux
- Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Laurie Josset
- Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Lidia Delrieu
- Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Antoine Millon
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France; Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Anne Long
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France; Service de Médecine Interne et de Médecine Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Universite Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
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Giomi A, Bernardini A, Perini AP, Ciliberti D, Zaccaria CS, Signorini U, Padeletti M, Milli M. Clinical impact of smoking on atrial fibrillation recurrence after pulmonary vein isolation. Int J Cardiol 2024; 413:132342. [PMID: 38971534 DOI: 10.1016/j.ijcard.2024.132342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The clinical impact of smoking on atrial fibrillation (AF) recurrences after pulmonary vein isolation (PVI) have contradictory results in previous studies, performed on Asian populations. METHODS AND AIM Smoking habit and other cardiovascular risk-factors were assessed in patients who underwent their first radiofrequency PVI for symptomatic AF. The study aims to assess the clinical impact of smoking on AF recurrences after PVI in a contemporary European cohort of patients. RESULTS The study included 186 consecutive patients (135 males [72.6%]) with a mean age of 63.4 ± 9.7 years. Current smokers resulted 29 (15.7%). No statistically significant baseline differences were detected between current smokers and non-current smokers. After a follow-up of 418 ± 246 days, AF recurrence was higher in currently smoking patients vs. non-currently smoker patients, the latter intended as a combination between previous smokers and never smokers (34.5% vs. 14% p = 0.01). A previous smoking habit was not associated with increased risk of AF recurrence when compared with patients who never smoked (13.2% vs. 14.6%, p = 0.23), while a current smoking habit impacted on AF recurrence in comparison with previous smokers (p = 0.01) and never smokers (p = 0.04). The increased incidence of AF recurrence in current smokers was consistent also considering only paroxysmal AF (31.4% vs 9.6%, p = 0.012) or persistent AF (50% vs 31.2%, p = 0.03). Smoking (HR =2.96 95% CI 1.32-6.64) and persistent AF (HR =2.64 95% CI 1.22-5.7) resulted independent predictors of AF recurrence. CONCLUSION Cigarette smoking is associated with an increased risk of AF recurrences after PVI, both in paroxysmal and in persistent AF.
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Affiliation(s)
- Andrea Giomi
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy
| | - Andrea Bernardini
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Alessandro Paoletti Perini
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy
| | - Davide Ciliberti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Cristiano Salvatore Zaccaria
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Umberto Signorini
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy
| | - Margherita Padeletti
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy
| | - Massimo Milli
- Cardiology and Electrophysiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy
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Sourij H, Azhar K, Aziz F, Kojzar H, Sourij C, Fasching P, Clodi M, Ludvik B, Mader JK, Resl M, Rega-Kaun G, Ress C, Stechemesser L, Stingl H, Tripolt NJ, Wascher T, Kaser S. Metabolic risk factor targets in relation to clinical characteristics and comorbidities among individuals with type 2 diabetes treated in primary care - The countrywide cross-sectional AUSTRO-PROFIT study. Diabetes Obes Metab 2024. [PMID: 39359208 DOI: 10.1111/dom.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024]
Abstract
AIMS This study assessed the achievement rates of metabolic risk factor targets and their association with clinical characteristics and comorbidities among individuals with type 2 diabetes (T2D) treated in the primary care in Austria. MATERIALS AND METHODS A countrywide cross-sectional study, the AUSTRO-PROFIT, was conducted in Austria from 2021 to 2023 on 635 individuals with T2D. Metabolic risk factor targets were defined as the percentage of people achieving low-density lipoprotein cholesterol (LDL-C) <70 mg/dL (or < 55 mg/dL if cardiovascular or microvascular disease was present), glycated haemoglobin (HbA1c) <7% (53 mmol/mol) and blood pressure < 140/90 mmHg. RESULTS The mean age of the participants was 65.7 ± 11.2 years; the median duration of T2D was 8 (4-14) years; and 58.7% of the participants were male. The percentages of participants achieving LDL-C, HbA1c, blood pressure and all targets were 44%, 53%, 57% and 13%, respectively. Older age, longer T2D duration, cardiovascular disease and microvascular complications were associated with suboptimal achievement of metabolic risk factor targets. CONCLUSIONS The AUSTRO-PROFIT study revealed notable variations in metabolic targets achievement with respect to clinical characteristics and comorbidities. These findings underscore the importance of establishing national diabetes registries and implementing multifactorial targeted and individualized interventions to further improve the quality of T2D care in primary care settings in Austria.
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Affiliation(s)
- Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Kehkishan Azhar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Peter Fasching
- Division of Endocrinology, Rheumatology and Acute Geriatrics, Clinic Ottakring, Vienna, Austria
| | - Martin Clodi
- Clinical Division of Internal Medicine, Saint John of God Hospital, Linz, Austria
| | - Bernhard Ludvik
- Department of Internal Medicine and Karl Landsteiner Institute of Obesity and Metabolic Disorders, Landstrasse Clinic, Vienna, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Michael Resl
- Clinical Division of Internal Medicine, Saint John of God Hospital, Linz, Austria
| | - Gersina Rega-Kaun
- Division of Endocrinology, Rheumatology and Acute Geriatrics, Clinic Ottakring, Vienna, Austria
| | - Claudia Ress
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Lars Stechemesser
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Harald Stingl
- Division of Internal Medicine, Hospital Mödling, Mödling, Austria
| | - Norbert J Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Thomas Wascher
- First Medical Department of Hanusch-Krankenhaus, Vienna, Austria
| | - Susanne Kaser
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
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Lu X, Xie Q, Pan X, Zhang R, Zhang X, Peng G, Zhang Y, Shen S, Tong N. Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy. Signal Transduct Target Ther 2024; 9:262. [PMID: 39353925 DOI: 10.1038/s41392-024-01951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/21/2024] [Accepted: 08/06/2024] [Indexed: 10/03/2024] Open
Abstract
Type 2 diabetes (T2D) is a disease characterized by heterogeneously progressive loss of islet β cell insulin secretion usually occurring after the presence of insulin resistance (IR) and it is one component of metabolic syndrome (MS), and we named it metabolic dysfunction syndrome (MDS). The pathogenesis of T2D is not fully understood, with IR and β cell dysfunction playing central roles in its pathophysiology. Dyslipidemia, hyperglycemia, along with other metabolic disorders, results in IR and/or islet β cell dysfunction via some shared pathways, such as inflammation, endoplasmic reticulum stress (ERS), oxidative stress, and ectopic lipid deposition. There is currently no cure for T2D, but it can be prevented or in remission by lifestyle intervention and/or some medication. If prevention fails, holistic and personalized management should be taken as soon as possible through timely detection and diagnosis, considering target organ protection, comorbidities, treatment goals, and other factors in reality. T2D is often accompanied by other components of MDS, such as preobesity/obesity, metabolic dysfunction associated steatotic liver disease, dyslipidemia, which usually occurs before it, and they are considered as the upstream diseases of T2D. It is more appropriate to call "diabetic complications" as "MDS-related target organ damage (TOD)", since their development involves not only hyperglycemia but also other metabolic disorders of MDS, promoting an up-to-date management philosophy. In this review, we aim to summarize the underlying mechanism, screening, diagnosis, prevention, and treatment of T2D, especially regarding the personalized selection of hypoglycemic agents and holistic management based on the concept of "MDS-related TOD".
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Affiliation(s)
- Xi Lu
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qingxing Xie
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Pan
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Ruining Zhang
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyi Zhang
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yuwei Zhang
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sumin Shen
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, Research Centre for Diabetes and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
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Elías-López D, Wadström BN, Vedel-Krogh S, Kobylecki CJ, Nordestgaard BG. Impact of Remnant Cholesterol on Cardiovascular Risk in Diabetes. Curr Diab Rep 2024:10.1007/s11892-024-01555-1. [PMID: 39356419 DOI: 10.1007/s11892-024-01555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE OF REVIEW Individuals with diabetes face increased risk of atherosclerotic cardiovascular disease (ASCVD), in part due to hyperlipidemia. Even after LDL cholesterol-lowering, residual ASCVD risk persists, part of which may be attributed to elevated remnant cholesterol. We describe the impact of elevated remnant cholesterol on ASCVD risk in diabetes. RECENT FINDINGS Preclinical, observational, and Mendelian randomization studies robustly suggest that elevated remnant cholesterol causally increases risk of ASCVD, suggesting remnant cholesterol could be a treatment target. However, the results of recent clinical trials of omega-3 fatty acids and fibrates, which lower levels of remnant cholesterol in individuals with diabetes, are conflicting in terms of ASCVD prevention. This is likely partly due to neutral effects of these drugs on the total level of apolipoprotein B(apoB)-containing lipoproteins. Elevated remnant cholesterol remains a likely cause of ASCVD in diabetes. Remnant cholesterol-lowering therapies should also lower apoB levels to reduce risk of ASCVD.
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Affiliation(s)
- Daniel Elías-López
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Endocrinology and Metabolism and Research Center of Metabolic Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc. 16, Tlalpan, 14080, México City, México
| | - Benjamin Nilsson Wadström
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Camilla Jannie Kobylecki
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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8
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Rosén HC, Mohammad MA, Jernberg T, James S, Oldgren J, Erlinge D. SGLT2 inhibitors for patients with type 2 diabetes mellitus after myocardial infarction: a nationwide observation registry study from SWEDEHEART. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101032. [PMID: 39262451 PMCID: PMC11387207 DOI: 10.1016/j.lanepe.2024.101032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/13/2024]
Abstract
Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce rates of heart failure hospitalisations and cardiovascular death in patients with type 2 diabetes and prior cardiovascular disease. We hypothesised that SGLT2 inhibitors could provide cardiovascular benefits in the post-myocardial infarction setting. We aimed to investigate cardiovascular outcomes of SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus after myocardial infarction in a Swedish nationwide registry. Methods We included all patients with type 2 diabetes surviving a type 1 acute myocardial infarction from January 1, 2018 to December 31, 2021. Patients were included if they were discharged with an estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2 in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. We identified all patients discharged with or without an SGLT2 inhibitor prescription 120 days before or within three days after discharge from the cardiac care unit. The primary outcome measure was a composite of death and first hospitalisation for heart failure after one year analysed using an adjusted Cox regression. Findings A total of 11,271 patients were included. Of these, 2498 (22.2%) received SGLT2 inhibitor treatment. Patients who were prescribed SGLT2 inhibitors were younger, more often presented with a STEMI and had worse left ventricular ejection fraction at index hospitalisation. SGLT2 inhibitor use was associated with lower rates of the composite outcome (hazard ratio (HR) of 0.70 (95% confidence interval (CI) 0.59-0.82). Interpretation Treatment with SGLT2 inhibitors after myocardial infarction in patients with type 2 diabetes was associated with a lower rate of cardiovascular events. Funding This work was supported by Hjärt-Lungfonden, Vetenskapsrådet, Knut and Alice Wallenberg Foundation, ALF, the Bundy Academy, and Skåne University Hospital funds.
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Affiliation(s)
- Hans Christian Rosén
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd, Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Jonas Oldgren
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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9
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Da Porto A, Candido R, Rocca A, Manicardi V, Nicolucci A, Miranda C, Cimino E, Di Bartolo P, Di Cianni G, Russo G. Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals. J Endocrinol Invest 2024; 47:2595-2602. [PMID: 38436903 DOI: 10.1007/s40618-024-02327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. METHODS This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. RESULTS Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. CONCLUSIONS In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.
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Affiliation(s)
- A Da Porto
- Diabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy.
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | | | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - C Miranda
- Endocrinology and Diabetes Unit, ASFO, Pordenone, Italy
| | - E Cimino
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - P Di Bartolo
- Ravenna Diabetes Center-Romagna Local Health Authority, Ravenna, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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10
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Abdin A, Böhm M, Shahim B, Karlström P, Kulenthiran S, Skouri H, Lund LH. Heart failure with preserved ejection fraction epidemiology, pathophysiology, diagnosis and treatment strategies. Int J Cardiol 2024; 412:132304. [PMID: 38944348 DOI: 10.1016/j.ijcard.2024.132304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
The prevalence of HF with preserved ejection raction (HFpEF, with EF ≥50%) is increasing across all populations with high rates of hospitalization and mortality, reaching up to 80% and 50%, respectively, within a 5-year timeframe. Comorbidity-driven systemic inflammation is thought to cause coronary microvascular dysfunction and increased epicardial adipose tissue, leading to downstream friborsis and molecular changes in the cardiomyocyte, leading to increased stiffness and diastolic dynsfunction. HFpEF poses unique challenges in terms of diagnosis due to its complex and diverse nature. The diagnosis of HFpEF relies on a combination of clinical assessment, imaging studies, and biomarkers. An additional important step in diagnosing HFpEF involves excluding certain cardiac diagnoses that may be specific underlying causes of HFpEF or may be masquerading as HFpEF and require specific alternative treatment approaches. In addition to administering sodium-glucose cotransporter 2 inhibitors to all patients, the most effective approach to enhance clinical outcomes may involve tailored therapy based on each patient's unique clinical profile. Exercise should be recommended for all patients to improve the quality of life. Glucagon-like peptide-1 1 agonists are a promising treatment option in obese HFpEF patients. Novel approaches targeting inflammation are also in early phase trials.
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Affiliation(s)
- Amr Abdin
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Bahira Shahim
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patric Karlström
- Department of Internal Medicine, Ryhov County Hospital, Jönköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hadi Skouri
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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11
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Karakasis P, Fragakis N, Patoulias D, Theofilis P, Kassimis G, Karamitsos T, El-Tanani M, Rizzo M. Effects of Glucagon-Like Peptide 1 Receptor Agonists on Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-analysis. Adv Ther 2024; 41:3749-3756. [PMID: 39141282 DOI: 10.1007/s12325-024-02959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Despite the technological advancements in catheter ablation strategies, the recurrence of atrial fibrillation (AF) post-ablation remains a concern that requires further investigation. Glucagon-like peptide 1 (GLP-1) receptor agonists have shown a significant effect on weight reduction, which in turn is associated with freedom from AF recurrence in both patients who are obese and not obese undergoing ablation. Therefore, we aimed to summarize the available evidence on the efficacy of GLP-1 receptor agonists in maintaining sinus rhythm post-ablation. METHODS Medline, Cochrane Library, and Scopus were searched until June 9, 2024. Double-independent study selection, data extraction, and quality assessment were performed. Evidence was pooled using DerSimonian-Laird random effects meta-analysis. RESULTS Three propensity score-matched studies (n = 6031 participants) were analyzed. Over a 12-months follow-up, the use of GLP-1 receptor agonists was associated with a significant reduction in AF recurrence compared to controls, hazard ratio (HR) = 0.549, 95% confidence interval (CI) = [0.315, 0.956], P = 0.034; I2 = 57%. No significant heterogeneity was observed (Q statistic = 4.6, heterogeneity P = 0.1). CONCLUSION The use of GLP-1 receptor agonists is associated with a lower risk of AF recurrence in patients receiving AF ablation therapy. Further large-scale randomized trials are necessary to explore the efficacy of GLP-1 receptor agonists in maintaining ablation outcomes over the long term.
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Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
- Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, General Hospital of Athens "Hippocratio", University of Athens Medical School, Athens, Greece
| | - George Kassimis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, Aristotle University Medical School, AHEPA University General Hospital, Thessaloniki, Greece
| | - Mohamed El-Tanani
- College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, P.O. Box 11172, Ras Al Khaimah, United Arab Emirates
| | - Manfredi Rizzo
- College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, P.O. Box 11172, Ras Al Khaimah, United Arab Emirates
- School of Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Palermo, Italy
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12
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Matthews DR. Sodium-glucose co-transporter-2 inhibitors: A paradigm shift in treatment for type 2 diabetes. Diabetes Obes Metab 2024; 26 Suppl 5:3-4. [PMID: 39340438 DOI: 10.1111/dom.15963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Affiliation(s)
- David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
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13
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Roubille F, Fauconnier J. Gliflozins pleiotropic protective effects including the vascular tree: Is it the common trunk? Atherosclerosis 2024; 397:118525. [PMID: 38964982 DOI: 10.1016/j.atherosclerosis.2024.118525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Affiliation(s)
- François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France.
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14
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Nyström T. Key results from observational studies and real-world evidence of sodium-glucose cotransporter-2 inhibitor effectiveness and safety in reducing cardio-renal risk. Diabetes Obes Metab 2024; 26 Suppl 5:35-57. [PMID: 38859661 DOI: 10.1111/dom.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/12/2024]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, originally designed to manage blood sugar levels in individuals with type 2 diabetes (T2D), have emerged as a crucial class of drugs for managing cardio-renal diseases. These drugs work by targeting the SGLT2 protein in the kidneys, promoting the excretion of glucose and influencing metabolic pathways beyond glucose control. The relationship between cardio-renal diseases and SGLT2 inhibitors has been explored through landmark trials and real-world evidence (RWE) studies, demonstrating significant reductions in cardio-renal complications. This review discusses the importance of RWE studies alongside randomized controlled trials in understanding the real-world effectiveness and safety of SGLT2 inhibitors. It outlines the advantages and disadvantages of RWE compared to RCTs, highlighting their complementary roles in providing comprehensive insights into treatment outcomes. By examining a range of RWE studies, the review underscores the cardio-renal benefits of SGLT2 inhibitors across various patient populations. Safety assessments indicate that SGLT2 inhibitors are generally well tolerated, with severe adverse events being rare. Common issues, such as genital mycotic infections and urinary tract infections, are acknowledged, alongside less frequent but significant adverse events including diabetic ketoacidosis, lower-limb amputations, and bone fractures. In summary, SGLT2 inhibitors show promising cardio-renal protective effects in real-world scenarios across diverse populations in T2D, indicating their potential as early intervention measures. Continued research is essential for gaining a thorough understanding of their long-term effects and safety profiles.
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Affiliation(s)
- Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Internal Medicine, Section of Endocrinology and Diabetology, Södersjukhuset, Stockholm, Sweden
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15
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Geng XF, Shang WY, Qi ZW, Zhang C, Li WX, Yan ZP, Fan XB, Zhang JP. The mechanism and promising therapeutic strategy of diabetic cardiomyopathy dysfunctions: Focus on pyroptosis. J Diabetes Complications 2024; 38:108848. [PMID: 39178624 DOI: 10.1016/j.jdiacomp.2024.108848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 08/26/2024]
Abstract
Diabetes is a major risk factor for cardiovascular diseases, and myocardial damage caused by hyperglycemia is the main cause of heart failure. However, there is still a lack of systematic understanding of myocardial damage caused by diabetes. At present, we believe that the cellular inflammatory damage caused by hyperglycemia is one of the causes of diabetic cardiomyopathy. Pyroptosis, as a proinflammatory form of cell death, is closely related to the occurrence and development of diabetic cardiomyopathy. Therefore, this paper focuses on the important role of inflammation in the occurrence and development of diabetic cardiomyopathy. From the perspective of pyroptosis, we summarize the pyroptosis of different types of cells in diabetic cardiomyopathy and its related signaling pathways. It also summarizes the treatment of diabetic cardiomyopathy, hoping to provide methods for the prevention and treatment of diabetic cardiomyopathy by inhibiting pyroptosis.
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Affiliation(s)
- Xiao-Fei Geng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Wen-Yu Shang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Zhong-Wen Qi
- Postdoctoral Research Station of China Academy of Chinese Medical Sciences, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Chi Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Wen-Xiu Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Zhi-Peng Yan
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Xin-Biao Fan
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Jun-Ping Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China.
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16
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Telo GH, Matzenbacher LS, Fontoura LF, Avila GO, Gheno V, Brum MAB, Teixeira JB, Erthal IN, Schneiders J, Schaan BD, Alessi J, Telo GH. Hidden barriers: obesity bias in hypertension treatment. Int J Obes (Lond) 2024; 48:1506-1512. [PMID: 39160218 DOI: 10.1038/s41366-024-01613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Individuals with obesity often face obesity bias, which may influence the delivery of appropriate medical care. Our aim is to evaluate the adequacy of therapeutic decisions regarding the pharmacological treatment for hypertension in patients with diabetes, both with and without obesity. METHODS This is a multicentric cross-sectional study of patients with type 2 diabetes and arterial hypertension who received outpatient care in Southern Brazil. Participants were stratified into two groups according to their body mass index (BMI): lower weight (BMI < 25.0 kg/m2) and with obesity (BMI ≥ 30.0 kg/m2). The primary outcome evaluated was the difference in pharmacological treatment decisions for hypertension between groups, considering individualized hypertension targets from American Diabetes Association (ADA), European Society of Hypertension (ESH), and European Society of Cardiology (ESC) guidelines. Data were analyzed as a binary endpoint (failure to receive treatment intensification vs. receiving treatment intensification when necessary) and groups were compared using multivariable logistic regression. RESULTS This study included 204 participants, of which 53 were at a lower weight and 151 had obesity. Patients with obesity more frequently failed to receive appropriate treatment intensification when compared to individuals with lower weight. The differences between the study groups were observed when considering the blood pressure target of three societies: ESH (adjusted OR 2.28 [95% CI 1.12-4.63], p = 0.022), ESC (adjusted OR 2.13 [95% CI 1.05-4.31], p = 0.035), and ADA (adjusted OR 2.33 [95% CI 1.13-4.77], p = 0.021). CONCLUSION These findings suggest that patients with obesity may face potential disparities in hypertension management, and obesity status may be related to therapeutic inertia in the management of arterial hypertension in this group.
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Affiliation(s)
- Guilherme Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Lucas Friedrich Fontoura
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Julia Belato Teixeira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Josiane Schneiders
- The Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- The Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Janine Alessi
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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17
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Fazekas-Pongor V, Domján BA, Major D, Péterfi A, Horváth VJ, Mészáros S, Vokó Z, Vásárhelyi B, Szabó AJ, Burián K, Merkely B, Tabák AG. Prevalence and determinants of diagnosed and undiagnosed diabetes in Hungary based on the nationally representative cross-sectional H-UNCOVER study. Diabetes Res Clin Pract 2024; 216:111834. [PMID: 39168185 DOI: 10.1016/j.diabres.2024.111834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/02/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024]
Abstract
AIMS To estimate prevalence of diagnosed (dDM) and undiagnosed diabetes (uDM) in Hungary and investigate determinants of uDM. METHODS Data was obtained from the nationally representative H-UNCOVER study. As laboratory measurements were available for 11/19 Hungarian counties, n = 5,974/17,787 people were eligible. After exclusions, 5,673 (representing 4,976,097 people) were included. dDM was defined by self-reporting, while uDM as negative self-reporting and elevated fasting glucose (≥7 mmol/l) and/or HbA1c (≥48 mmol/mol). Logistic regression for complex samples was used to calculate comparisons between dDM and uDM adjusted for age and BMI. RESULTS Diabetes prevalence was 12.0 %/11.9 % (women/men, 95 %CI:10.7-13.4 %/10.7-13.2 %), while 2.2 %/2.8 % (1.7-2.8 %/2.2-3.6 %) of women/men were uDM. While the proportion of uDM vs. dDM was similar for women ≥ 40, men in their forties had the highest odds for uDM. Neither unemployment (women/men OR:0.58 [0.14-2.45]/0.50 [0.13-1.92]), nor education level (tertiary vs. primary; women/men OR: 1.16 [0.53-2.56]/ 0.53 [0.24-1.18]) were associated with uDM. The risk of uDM was lower in both sexes with chronic morbidities. CONCLUSIONS We report higher prevalence of diabetes and undiagnosed diabetes than previous Hungarian estimates. The finding that socioeconomic factors are not associated to uDM suggests that universal health care could provide equitable access to diabetes diagnosis.
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Affiliation(s)
- Vince Fazekas-Pongor
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary.
| | - Beatrix A Domján
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Dávid Major
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Anna Péterfi
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Viktor J Horváth
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Szilvia Mészáros
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; Syreon Research Institute, Mexikói út 65/A, Budapest H-1126, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Attila J Szabó
- Pediatric Center, Semmelweis University, Bókay János u. 53-54, Budapest H-1083, Hungary
| | - Katalin Burián
- Department of Clinical Microbiology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Adam G Tabák
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; UCL Brain Sciences, University College London, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
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18
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Handelsman Y, Anderson JE, Bakris GL, Ballantyne CM, Bhatt DL, Bloomgarden ZT, Bozkurt B, Budoff MJ, Butler J, Cherney DZI, DeFronzo RA, Del Prato S, Eckel RH, Filippatos G, Fonarow GC, Fonseca VA, Garvey WT, Giorgino F, Grant PJ, Green JB, Greene SJ, Groop PH, Grunberger G, Jastreboff AM, Jellinger PS, Khunti K, Klein S, Kosiborod MN, Kushner P, Leiter LA, Lepor NE, Mantzoros CS, Mathieu C, Mende CW, Michos ED, Morales J, Plutzky J, Pratley RE, Ray KK, Rossing P, Sattar N, Schwarz PEH, Standl E, Steg PG, Tokgözoğlu L, Tuomilehto J, Umpierrez GE, Valensi P, Weir MR, Wilding J, Wright EE. DCRM 2.0: Multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases. Metabolism 2024; 159:155931. [PMID: 38852020 DOI: 10.1016/j.metabol.2024.155931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/10/2024]
Abstract
The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), dyslipidemias, hypertension, and associated comorbidities such as pulmonary diseases and metabolism dysfunction-associated steatotic liver disease and metabolism dysfunction-associated steatohepatitis (MASLD and MASH, respectively, formerly known as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis [NAFLD and NASH]). Because cardiorenal and metabolic diseases share pathophysiologic pathways, two or more are often present in the same individual. Findings from recent outcome trials have demonstrated benefits of various treatments across a range of conditions, suggesting a need for practice recommendations that will guide clinicians to better manage complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. To meet this need, we formed an international volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM 2.0 Practice Recommendations, an updated and expanded revision of a previously published multispecialty consensus on the comprehensive management of persons living with DCRM. The recommendations are presented as 22 separate graphics covering the essentials of management to improve general health, control cardiorenal risk factors, and manage cardiorenal and metabolic comorbidities, leading to improved patient outcomes.
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Affiliation(s)
| | | | | | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Zachary T Bloomgarden
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Biykem Bozkurt
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | - Stefano Del Prato
- Interdisciplinary Research Center "Health Science", Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | | | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Finnish Institute for Health and Helsinki University HospitalWelfare, Folkhälsan Research Center, Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Charles University, Prague, Czech Republic
| | | | - Paul S Jellinger
- The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA
| | | | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Norman E Lepor
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Chantal Mathieu
- Department of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christian W Mende
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | - Jorge Plutzky
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus at the Technische Universität/TU Dresden, Dresden, Germany
| | - Eberhard Standl
- Munich Diabetes Research Group e.V. at Helmholtz Centre, Munich, Germany
| | - P Gabriel Steg
- Université Paris-Cité, Institut Universitaire de France, AP-HP, Hôpital Bichat, Cardiology, Paris, France
| | | | - Jaakko Tuomilehto
- University of Helsinki, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris-Nord University, Paris, France
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Wilding
- University of Liverpool, Liverpool, United Kingdom
| | - Eugene E Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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19
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Fazzini L, Ghirardi A, Limonta R, Calabrese A, D'Elia E, Canova P, Fontana A, Grosu A, Iacovoni A, Ferrari P, De Maria R, Gavazzi A, Montisci R, Senni M, Gori M. Long-term outcomes of phenoclusters in preclinical heart failure with preserved and mildly reduced ejection fraction. ESC Heart Fail 2024; 11:3350-3359. [PMID: 38965689 PMCID: PMC11424346 DOI: 10.1002/ehf2.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
AIMS The identification of subjects at higher risk for incident heart failure (HF) with preserved ejection fraction (EF) suitable for more intensive preventive programmes remains challenging. We applied phenomapping to the DAVID-Berg population, comprising subjects with preclinical HF, aiming to refine HF risk stratification. METHODS The DAVID-Berg study prospectively enrolled 596 asymptomatic outpatients with EF > 40% with hypertension, diabetes mellitus or known cardiovascular disease. In this cohort, we performed an unsupervised cluster analysis on 591 patients, including clinical, laboratory, electrocardiographic and echocardiographic parameters. We tested the association between each cluster and a composite outcome of HF/death. RESULTS The median age was 70 years, 55.5% were males and the median EF was 61.0%. Phenomapping provided three different clusters. Subjects in Cluster 3 were the oldest and had the highest prevalence of atrial fibrillation, the lowest estimated glomerular filtration rate (eGFR), the highest N-terminal pro-brain natriuretic peptide (NT-proBNP) and the largest left atrium. During a median follow-up of 5.7 years, 13.4% of subjects experienced HF/death events (N = 79). Compared with Clusters 1 and 2, Cluster 3 had the worst prognosis (log-rank test: Cluster 3 vs. 1 P < 0.001; Cluster 3 vs. 2 P = 0.008). Cluster 3 was associated with a risk of HF/death 2.5 times higher than Cluster 1 [adjusted hazard ratio (HR) = 2.46, 95% confidence interval (CI) 1.24-4.90]. CONCLUSIONS Based on phenomapping, older patients with lower kidney function and worse diastolic function might represent a subset of preclinical HF with EF > 40% who deserve more efforts to prevent clinical HF.
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Affiliation(s)
- Luca Fazzini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raul Limonta
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Alice Calabrese
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emilia D'Elia
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Canova
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Aurelia Grosu
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Attilio Iacovoni
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Ferrari
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Renata De Maria
- National Research Council Clinical Physiology Institute, Pisa, Italy
| | - Antonello Gavazzi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberta Montisci
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michele Senni
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Gori
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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20
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Li B, Zhang J, Huang A, Chen Y, Wei Q. Safety evaluation of bempedoic acid: A pharmacovigilance analysis using FDA adverse event reporting system data. Int J Cardiol 2024; 412:132305. [PMID: 38944350 DOI: 10.1016/j.ijcard.2024.132305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Bempedoic acid exhibits promising potential in hyperlipidemia therapy and preventing cardiovascular events. However, investigations into its adverse drug reactions remain scant. This study seeks to utilize data mining techniques with the FDA Adverse Event Reporting System (FAERS) database to assess adverse drug events (ADEs) linked to bempedoic acid. METHODS Based on the drug's market release timeline, we extracted data from the FAERS database covering the fourth quarter of 2020 through the fourth quarter of 2023 for disproportionality analysis. RESULTS This study gathered a total of 5,797,543 adverse event case reports, of which 735 were linked to bempedoic acid. These reports covered 19 System Organ Classes (SOCs) and 22 Preferred Terms (PTs). Predominantly, the musculoskeletal and nervous systems were implicated in these adverse events. By conducting PT-level screening, various signals for ADEs were detected, including myalgia (ROR 30.33, PRR 28.51, IC 4.83, EBGM 28.47), arthralgia (n = 34, ROR 6.34, PRR 6.09, IC 2.61, EBGM 6.09), tendon disorders (ROR 99.57, PRR 98.75, IC 6.62, EBGM 98.28), and dizziness (ROR 3.18, PRR 3.13, IC 1.65, EBGM 3.13). Particularly noteworthy was the hypertensive crisis (ROR 28.63, PRR 28.51, IC 4.83, EBGM 28.47), which exhibited a robust signal strength, an observation previously unreported in clinical studies and drug labeling. CONCLUSION While our results are largely consistent with the drug's specifications, several new adverse reaction signals, such as hypertensive crisis, have not been previously documented. Therefore, further investigations are necessary to assess these unlabeled adverse reactions, offering crucial support for the clinical utilization of bempedoic acid.
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Affiliation(s)
- Bing Li
- Department of Cardiology, Zhumadian Central Hospital, Zhumadian, China
| | - Jin Zhang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
| | - Anan Huang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
| | - Yuwen Chen
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China.
| | - Qucheng Wei
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China.
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21
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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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22
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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23
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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24
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Nicholas SB, Correa-Rotter R, Desai NR, Guo L, Navaneethan SD, Pantalone KM, Wanner C, Hamacher S, Fatoba ST, Horvat-Broecker A, Garreta-Rufas A, Gay A, Merz M, Wheeler DC. First interim results from FINE-REAL: a prospective, non-interventional, phase 4 study providing insights into the use and safety of finerenone in a routine clinical setting. J Nephrol 2024:10.1007/s40620-024-02070-y. [PMID: 39340711 DOI: 10.1007/s40620-024-02070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/08/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). The FINE-REAL study (NCT05348733) aims to evaluate the characteristics and treatment patterns of participants treated with finerenone in clinical practice. METHODS FINE-REAL is a prospective, single-arm, non-interventional study of patients initiated on finerenone as part of their routine care in accordance with country-approved labels. The study, initiated in June 2022, is expected to be completed by January 2028. The cutoff for this pre-specified interim analysis was June 13, 2023. RESULTS Participants were recruited across nephrology, endocrinology, cardiology, and primary care settings. Of 556 participants enrolled in the study by the cut-off date, 504 were included in this analysis (median follow-up duration of 7 months [finerenone treatment initiation to last recorded observation]). At baseline, 76.1% of participants were in the high or very high (KDIGO) CKD risk categories. Angiotensin converting enzyme inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter 2 inhibitors were prescribed to 71.8% and 46.6% of participants, respectively. Based on prescribing information, 87.9% and 12.1% of participants initiated finerenone at doses of 10 and 20 mg, respectively. Finerenone treatment was uninterrupted in 92.3% of participants after 7 months' median follow-up. Treatment-emergent adverse events occurred in 110 (21.8%) participants. Hyperkalemia occurred in 25 (5.0%) participants, with no cases leading to death, dialysis, or hospitalization. CONCLUSION At this interim analysis, finerenone was initiated in patients with CKD and T2D across various clinical practices participating in the study. Treatment discontinuation and hyperkalemia occurred infrequently.
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Affiliation(s)
- Susanne B Nicholas
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 7-155 Factor Bldg, 10833 LeConte Blvd, Los Angeles, CA, 90095, USA.
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Lixin Guo
- Department of Endocrinology, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Sciences, Beijing, China
| | | | - Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Antonio Garreta-Rufas
- Medical Affairs Cardio-Renal, Pharmaceuticals, Bayer Vital GmbH, Leverkusen, Germany
| | - Alain Gay
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - Martin Merz
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
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25
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Valensi P. Evidence of a bi-directional relationship between heart failure and diabetes: a strategy for the detection of glucose abnormalities and diabetes prevention in patients with heart failure. Cardiovasc Diabetol 2024; 23:354. [PMID: 39342254 PMCID: PMC11439233 DOI: 10.1186/s12933-024-02436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
Prevalence of heart failure (HF) and diabetes are markedly increasing globally. In a population of HF patients, approximately 40% have diabetes which is associated with a more severe HF, poorer cardiovascular outcomes and higher hospitalization rates for HF than HF patients without diabetes. Similar trends were shown in HF patients with prediabetes. In addition, the association between HF and renal function decline was demonstrated in patients with or without diabetes. However, the exact prevalence of dysglycemia in HF patients requires further investigation aiming to clarify the most accurate test to detect dysglycemia in this population. The relationship between HF and diabetes is complex and probably bidirectional. In one way, patients with diabetes have a more than two-fold risk of developing incident HF with reduced or preserved ejection fraction than those without diabetes. In the other way, patients with HF, when compared with those without HF, show an increased risk for the onset of diabetes due to several mechanisms including insulin resistance (IR), which makes HF emerging as a precursor for diabetes development. This article provides epidemiological evidence of undetected dysglycemia (prediabetes or diabetes) in HF patients and reviews the pathophysiological mechanisms which favor the development of IR and the risks associated with these disorders in HF patients. This review also offers a discussion of various strategies for the prevention of diabetes in HF patients, based first on fasting plasma glucose and HbA1c measurement and if normal on an oral glucose tolerance test as diagnostic tools for prediabetes and unknown diabetes that should be performed more extensively in those patients. It discusses the implementation of diabetes prevention measures and well-structured management programs for HF patients who are generally overweight or obese, as well as current pharmacotherapeutic options for prediabetes, including sodium-glucose cotransporter 2 inhibitors which are among the pillars of HF treatment and which recently showed a benefit in the reduction of incident diabetes in HF patients. Thus, there is an urgent need of routine screening for dysglycemia in all HF patients, which should contribute to reduce the incidence of diabetes and to treat earlier diabetes when already present.
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Affiliation(s)
- Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris Nord University, Bobigny, France.
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26
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Scheen AJ. GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 2 Diabetes: Pleiotropic Cardiometabolic Effects and Add-on Value of a Combined Therapy. Drugs 2024:10.1007/s40265-024-02090-9. [PMID: 39342059 DOI: 10.1007/s40265-024-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 10/01/2024]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven efficacy and safety in randomized clinical trials and observational real-life studies. Besides improving glucose control, reducing body weight, and lowering arterial blood pressure (surrogate endpoints), the breakthroughs were the demonstration of a significant reduction in cardiovascular and renal events in patients with type 2 diabetes at high risk. GLP-1RAs reduce events linked to atherogenic cardiovascular disease (especially ischemic stroke) and also renal outcomes (FLOW trial with semaglutide), with a limited effect on heart failure. The most striking protective effects of SGLT2is were a marked reduction in hospitalization for heart failure and a remarkable reduced progression of chronic kidney disease. These benefits have been attributed to numerous pleiotropic effects beyond glucose-lowering action. Underlying mechanisms contributing to cardiovascular and renal protection are at least partially different between GLP-1RAs (mainly anti-atherogenic and vascular effects) and SGLT2is (mainly systemic and intrarenal hemodynamic changes). Thus, patients at high risk may benefit from complementary actions when being treated with a GLP-1RA/SGLT2i combination. Such combination has proven its efficacy on surrogate endpoints. Furthermore, post hoc subgroup analyses of cardiovascular outcome trials have suggested a greater cardiorenal protection in patients treated with a combination versus either monotherapy. The benefits of a combined therapy have been confirmed in a few retrospective cohort studies. A dedicated prospective trial comparing a combined therapy versus either monotherapy is ongoing (PRECIDENTD); however, several challenges still remain, especially the higher cost of a combined therapy and the worldwide underuse of either GLP-1RAs or SGLT2is in clinical practice, even in patients at high cardiorenal risk.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, Liège, Belgium.
- Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liège, Belgium.
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27
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Ferrannini G, Tuomilehto J, De Backer G, Kotseva K, Mellbin L, Schnell O, Wood D, De Bacquer D, Rydén L. Dysglycaemia screening and its prognostic impact in patients with coronary artery disease: experiences from the EUROASPIRE IV and V cohort studies. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00201-8. [PMID: 39326426 DOI: 10.1016/s2213-8587(24)00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Glucose perturbations can be detected by fasting plasma glucose (FPG), HbA1c, and the oral glucose tolerance test (OGTT). The highest yield is provided by OGTT. HbA1c is considered more practical. We compare the diagnostic and predictive performance of these glycaemic indicators based on combined data from the EUROASPIRE IV (EAIV) and V (EAV) studies. METHODS This cohort study was conducted in 79 centres in 24 European countries (EAIV) and 131 centres in 27 European countries (EAV). Eligible patients were aged 18-80 years, did not have diabetes, and were diagnosed with coronary artery disease 6-36 months (EAIV) or 6-24 months (EAV) before the investigation. Patients were investigated with OGTT (FPG and 2 h post-load glucose [2-hPG]) and HbA1c. Follow-up of subsequent cardiovascular events was done by means of a questionnaire at least 1 year after the baseline investigation. Analyses were done in patients with both OGTT and HbA1c data available. Outcome analysis in these patients was restricted to those with valid follow-up data available. FINDINGS 16 259 patients were interviewed in EAIV (2012-13) and EAV (2016-17). 8364 patients had both OGTT and HbA1C data and were included in the analysis population (3932 in EAIV and 4432 in EAV). Information on cardiovascular events was available in 7892 patients. Follow-up was for a median 1·6 years (IQR 1·2-2·0). The average patient age was 63·3 years (SD 9·8), and 6346 (75·9%) of 8364 patients were men. At baseline, 1856 (22·5%) of 8263 patients were determined to have newly detected type 2 diabetes using OGTT alone, compared with 346 (4·2%) using HbA1c alone. New dysglycaemia, defined as newly detected type 2 diabetes or impaired glucose tolerance (IGT), was present in 3896 (47·1%) of the patients according to 2hPG. 2hPG 9 mmol/L or greater (162 mg/dL, adjusted hazard ratio [aHR] 1·58; 95% CI 1·27-1·95, p<0·0001), and HbA1c 5·9% or greater (41 mmol/mol, aHR 1·48, 1·19-1·84; p=0·0010) were the strongest predictors of cardiovascular events, while FPG did not predict. A multivariable model showed that the effect of HbA1c on cardiovascular events was mainly explained by 2hPG (aHR for 1 unit increase in HbA1c 1·13, 0·98-1·30; p=0·11; and aHR for 1 unit increase in Ln[2hPG] 1·37, 1·08-1·74; p=0·0042). INTERPRETATION 2hPG appears better than HbA1c in detecting dysglycaemia and predicting its impact on future cardiovascular events in patients with coronary artery disease and should be recommended as the primary screening tool. FUNDING Swedish Heart-Lung Foundation, Region Stockholm (ALF), the Erling Persson Foundation, the Baltic Child Foundation.
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Affiliation(s)
- Giulia Ferrannini
- Södertälje hospital, Stockholm, Sweden; Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, UK; University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, Ireland
| | - Linda Mellbin
- Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Oliver Schnell
- Forschergruppe Diabetes e V, Helmholtz Center Munich, Neuherberg, Germany
| | - David Wood
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Lars Rydén
- Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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28
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Ianoș RD, Cozma A, Lucaciu RL, Hangan AC, Negrean V, Mercea DC, Ciulei G, Pop C, Procopciuc LM. Role of Circulating Biomarkers in Diabetic Cardiomyopathy. Biomedicines 2024; 12:2153. [PMID: 39335666 PMCID: PMC11428922 DOI: 10.3390/biomedicines12092153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/18/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has alarmingly increased in incidence in recent decades. One of the most serious complications of T2DM is diabetic cardiomyopathy (DCM), an often underrecognized yet severe condition that is a leading cause of mortality among diabetic patients. In the early stages of DCM, patients typically show no symptoms and maintain normal systolic and diastolic left ventricle function, making early detection challenging. Currently available clinical markers are often not specific enough to detect the early stage of DCM. Conventional biomarkers of cardiac mechanical stress and injury, such as natriuretic peptides (NPs) and cardiac troponin I (cTnI), have shown limited predictive value for patients with T2DM. NPs have proven efficacy in detecting diastolic dysfunction in diabetic patients when used alongside 2D echocardiography, but their utility as biomarkers is limited to symptomatic individuals. While cTnI is a reliable indicator of general cardiac damage, it is not specific to cardiac injury caused by high glucose levels or T2DM. This underscores the need for research into biomarkers that can enable early diagnosis and management of DCM to reduce mortality rates. Promising novel biomarkers that showed good performance in detecting diastolic dysfunction or heart failure in diabetic patients include galectin-3, ST2, FGF-21, IGFBP-7, GDF-15, and TGF-β. This review summarizes the current understanding of DCM biomarkers, aiming to generate new ideas for the early recognition and treatment of DCM by exploring related pathophysiological mechanisms.
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Affiliation(s)
- Raluca Diana Ianoș
- Department of Cardiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
| | - Angela Cozma
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Roxana Liana Lucaciu
- Department of Pharmaceutical Biochemistry and Clinical Laboratory, Faculty of Pharmacy, “Iuliu-Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Adriana Corina Hangan
- Department of Inorganic Chemistry, Faculty of Pharmacy, “Iuliu-Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Vasile Negrean
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Delia Corina Mercea
- Department of Cardiology, Emergency County Hospital, 430031 Baia Mare, Romania; (D.C.M.); (C.P.)
| | - George Ciulei
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Călin Pop
- Department of Cardiology, Emergency County Hospital, 430031 Baia Mare, Romania; (D.C.M.); (C.P.)
- Faculty of Medicine Arad, “Vasile Goldis” Western University, 310045 Arad, Romania
| | - Lucia Maria Procopciuc
- Department of Medical Biochemistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania;
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Salmen T, Pietrosel VA, Reurean-Pintilei D, Iancu MA, Cimpeanu RC, Bica IC, Dumitriu-Stan RI, Potcovaru CG, Salmen BM, Diaconu CC, Cretoiu SM, Stoian AP. Assessing Cardiovascular Target Attainment in Type 2 Diabetes Mellitus Patients in Tertiary Diabetes Center in Romania. Pharmaceuticals (Basel) 2024; 17:1249. [PMID: 39338411 PMCID: PMC11434711 DOI: 10.3390/ph17091249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/20/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) share a bidirectional link, and the innovative antidiabetic molecules GLP-1 Ras and SGLT-2is have proven cardiac and renal benefits, respectively. This study aimed to evaluate CV risk categories, along with lipid-lowering and antidiabetic treatments, in patients with T2DM from a real-life setting in Romania. MATERIAL AND METHODS A cross-sectional evaluation was conducted on 405 consecutively admitted patients with T2DM in an ambulatory setting, assessing them according to the 2019 ESC/EAS guidelines for moderate, high, and very high CV risk categories. RESULTS The average age of the group was 58 ± 9.96 years, with 38.5% being female. The mean HbA1C level was 7.2 ± 1.7%. Comorbidities included HBP in 88.1% of patients, with a mean SBP and DBP of 133.2 ± 13.7 mm Hg and 79.9 ± 9 mm Hg, respectively, and obesity in 66.41%, with a mean BMI of 33 ± 6.33 kg/m2. The mean LDL-C levels varied by CV risk category: 90.1 ± 34.22 mg/dL in very high risk, 98.63 ± 33.26 mg/dL in high risk, and 105 ± 37.1 mg/dL in moderate risk. Prescribed treatments included metformin (100%), statins (77.5%), GLP-1 Ras (29.4%), and SGLT-2is (29.4%). CONCLUSIONS In Romania, patients with T2DM often achieve glycemic control targets but fail to meet composite targets that include glycemic, BP, and lipid control. Additionally, few patients benefit from innovative glucose-lowering therapies with proven cardio-renal benefits or from statins.
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Affiliation(s)
- Teodor Salmen
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Delia Reurean-Pintilei
- Department of Medical-Surgical and Complementary Sciences, Faculty of Medicine and Biological Sciences, "Ștefan cel Mare" University, 720229 Suceava, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Consulted Medical Centre, 700544 Iasi, Romania
| | - Mihaela Adela Iancu
- Department of Internal, Family and Occupational Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | | | - Ioana-Cristina Bica
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | | | - Bianca-Margareta Salmen
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Sanda Maria Cretoiu
- Department of Morphological Sciences, Cell and Molecular Biology and Histology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Li Y, Yan M, Cai Q, Tse LA, Liu Z, Lang X, Wang B, Ma Q, Li M, Qiu Q, Li W. Achievement of recommended targets for cardiovascular disease prevention in adults with diabetes in 38 low- and middle-income countries. J Glob Health 2024; 14:04148. [PMID: 39301596 DOI: 10.7189/jogh.14.04148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
Background Implementation of guideline recommendations for cardiovascular disease (CVD) prevention in people with diabetes in low- and middle-income countries (LMICs) is unclear. We assessed the achievement of CVD prevention targets among patients with diabetes in LMICs. Methods We pooled nationally representative cross-sectional surveys from 38 LMICs. We evaluated three targets according to the World Health Organization's (WHO) recommendations: treatment (glucose-lowering drugs, statins, antihypertensive drugs, and aspirin); metabolism (blood glucose, body mass index, blood pressure, and cholesterol); and lifestyle (non-smoking, non-drinking, physical activity, and diet). We used multivariable Poisson regression models to assess sociodemographic factors influencing adherence to guideline recommendations. Results The study included 110 083 participants, of whom 6789 (6.0%) had self-reported diabetes. The prevalence of achieving the treatment, metabolic and lifestyle targets for all components were 9.9%, 8.1%, and 7.2%, respectively. The components with the lowest prevalence of the three targets were 11.1% for statin use, 27.3% for body mass index control, and 19.5% for sufficient consumption of fruit and vegetables, respectively. Upper-middle-income countries were better at achieving the treatment, non-drinking, and dietary targets than lower-middle-income countries. Women, middle-aged and older patients, and highly educated patients had a lower prevalence of metabolic adherence. Conclusions In LMICs, the prevalence of patients with diabetes meeting WHO-recommended treatment, metabolic and lifestyle targets for CVD prevention was low. Our findings highlighted the need to strengthen the prevention of CVD in patients with diabetes in LMICs.
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Affiliation(s)
- Yang Li
- Interventional Centre of Valvular Heart Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Minghai Yan
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiujing Cai
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Zhiguang Liu
- Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinyue Lang
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Biyan Wang
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuyan Ma
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengya Li
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Qiu
- Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Medical Research and Biometrics Centre, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cimellaro A, Cavallo M, Mungo M, Suraci E, Spagnolo F, Addesi D, Pintaudi M, Pintaudi C. Cardiovascular Effectiveness and Safety of Antidiabetic Drugs in Patients with Type 2 Diabetes and Peripheral Artery Disease: Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1542. [PMID: 39336583 PMCID: PMC11434261 DOI: 10.3390/medicina60091542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 09/11/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Abstract
Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more arduous, often due to bilateral, multi-vessel, and distal vascular involvement, in addition to increased systemic polyvascular atherosclerotic burden. On the other hand, the pathophysiological link between PAD and T2D is very complex, involving mechanisms such as endothelial dysfunction and increased subclinical inflammation in addition to chronic hyperglycemia. Therefore, the clinical approach should not ignore vascular protection with the aim of reducing limb and overall CV events besides a mere glucose-lowering effect. However, the choice of the best medications in this setting is challenging due to low-grade evidence or lacking targeted studies in PAD patients. The present review highlighted the strong relationship between T2D and PAD, focusing on the best treatment strategy to reduce CV risk and prevent PAD occurrence and worsening in patients with T2D. The Medline databases were searched for studies including T2D and PAD up to June 2024 and reporting the CV effectiveness and safety of the most used glucose-lowering agents, with no restriction on PAD definition, study design, or country. The main outcomes considered were MACE-including nonfatal acute myocardial infarction, nonfatal stroke, and CV death-and MALE-defined as lower-limb complications, amputations, or need for revascularization. To the best of our current knowledge, GLP-1 receptor agonists and SGLT2 inhibitors represent the best choice to reduce CV risk in T2D and PAD settings, but a personalized approach should be considered. GLP-1 receptor agonists should be preferred in subjects with prevalent atherosclerotic burden and a history of previous MALE, while SGLT2 inhibitors should be used in those with heart failure if overall CV benefits outweigh the risk of lower-limb complications.
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Affiliation(s)
- Antonio Cimellaro
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Michela Cavallo
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Marialaura Mungo
- Internal Medicine Unit, Department of Medical and Surgical Sciences, 'Magna Græcia' University of Catanzaro, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy
| | - Edoardo Suraci
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Francesco Spagnolo
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Desirée Addesi
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Medea Pintaudi
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria "Gaetano Martino", 98124 Messina, Italy
| | - Carmelo Pintaudi
- Internal Medicine Unit, Department of Medicine Specialties, "Pugliese-Ciaccio" Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy
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El Din Taha HS, Kandil H, Badran HM, Farag N, Khamis H, Nasr G, Samy M, Abdrabou M, Abuelezz M, Shaker MM. 2024 Egyptian consensus statement on the role of non-statin therapies for LDL cholesterol lowering in different patient risk categories. Egypt Heart J 2024; 76:131. [PMID: 39302613 DOI: 10.1186/s43044-024-00562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The new millennium has witnessed increased understanding of cardiovascular (CV) risk factors and improvement in atherosclerotic cardiovascular disease (ASCVD) management. The role of LDL cholesterol and other atherogenic lipid particles in the development of atherosclerosis is now beyond doubt. MAIN BODY Statins have been widely used and recommended in guidelines for preventing and managing ischemic events. However, statins have side effects, and many patients do not achieve their low-density lipoprotein cholesterol (LDL-C) goals. In recent years, non-statin lipid-lowering agents have gained increasing use as adjuncts to statins or as alternatives in patients who cannot tolerate statins. This consensus proposes a simple approach for initiating non-statin lipid-lowering therapy and provides evidence-based recommendations. Our key advancements include the identification of patients at extreme risk for CV events, the consideration of initial combination therapy of statin and ezetimibe in very high-risk and extreme-risk groups and the extended use of bempedoic acid in patients not reaching LDL-C targets especially in resource-limited settings. CONCLUSIONS Overall, this consensus statement provides valuable insights into the expanding field of non-statin therapies and offers practical recommendations to enhance CV care, specifically focusing on improving LDL-C control in Egypt. While these recommendations hold promise, further research and real-world data are needed for validation and refinement.
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Affiliation(s)
| | | | | | - Nabil Farag
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Gamila Nasr
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mina Samy
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Jiang L, Xu HY, Li Y, Shi K, Fang H, Yan WF, Guo YK, Yang ZG. The differential effects of dyslipidemia status and triglyceride-glucose index on left ventricular global function and myocardial microcirculation in diabetic individuals: a cardiac magnetic resonance study. Cardiovasc Diabetol 2024; 23:345. [PMID: 39300497 DOI: 10.1186/s12933-024-02435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND It remains unclear whether the association between dyslipidemia status and triglyceride-glucose (TyG) index with myocardial damage varies in the context of type 2 diabetes mellitus (T2DM). This study aimed to determine the differential effects of dyslipidemia status and TyG index on left ventricular (LV) global function and myocardial microcirculation in patients with T2DM using cardiac magnetic resonance (CMR) imaging. METHODS A total of 226 T2DM patients and 72 controls who underwent CMR examination were included. The T2DM group was further categorized into subgroups based on the presence or absence of dyslipidemia (referred to as T2DM (DysL+) and T2DM (DysL-)) or whether the TyG index exceeded 9.06. CMR-derived LV perfusion parameters, remodeling index, and global function index (GFI) were assessed and compared among groups. A multivariable linear regression model was employed to evaluate the effects of various variables on LV myocardial microcirculation, remodeling index, and GFI. RESULTS The LV GFI sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (p < 0.001), and was lower (p = 0.003) in T2DM with higher TyG index group than in lower TyG index group. The LV remodeling index was higher in higher TyG index group than in lower TyG index group (p = 0.002), but there was no significant difference in whether the subgroup was accompanied by dyslipidemia. Multivariable analysis revealed that the TyG index, but not dyslipidemia status, was independently associated with LV remodeling index (β coefficient[95% confidence interval], 0.152[0.025, 0.268], p = 0.007) and LV GFI (- 0.159[- 0.281, - 0.032], p = 0.014). For LV myocardial microcirculation, perfusion index, upslope, and max signal intensity sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (all p < 0.001). Dyslipidemia status independently correlated with perfusion index (- 0.147[- 0.272, - 0.024], p = 0.02) and upslope (- 0.200[- 0.320, 0.083], p = 0.001), while TyG index was independently correlated with time to maximum signal intensity (0.141[0.019, 0.257], p = 0.023). CONCLUSIONS Both dyslipidemia status and higher TyG index were associated with further deterioration of LV global function and myocardial microvascular function in the context of T2DM. The effects of dyslipidemia and a higher TyG index appear to be differential, which indicates that not only the amount of blood lipids and glucose but also the quality of blood lipids are therapeutic targets for preventing further myocardial damage.
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Affiliation(s)
- Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Naoum I, Saliba W, Barnett-Griness O, Aker A, Zafrir B. Glucose-Lowering Drugs with Proven Cardiovascular Benefit Following Acute Coronary Syndrome in Patients with Type 2 Diabetes: Treatment Gaps and Outcomes. J Clin Med 2024; 13:5541. [PMID: 39337027 PMCID: PMC11432281 DOI: 10.3390/jcm13185541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/03/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndrome (ACS) are limited. We investigated the utilization and treatment patterns of sodium-glucose contrasporter-2 inhibitors (SGLT2Is) and glucagon-like peptide-1 recepto-agonists (GLP1RAs) in patients with T2D experiencing ACS and analyzed their association with mortality and major adverse cardiovascular events (MACEs) including recurrent ACS, acute revascularization, heart failure, or ischemic stroke. Methods: We carried out a retrospective analysis of 9756 patients with T2D from a nationwide healthcare organization in Israel who were hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90 days, and 1 year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using a time-dependent Cox regression analysis with multivariable adjustment. Results: The prescription rates (pre-hospitalization, 90 days, and 1 year post-hospitalization) of GLP1RAs were 13%, 13.2%, and 18%, and those of SGLT2Is were 23.9%, 33.6%, and 42.7%, respectively. At 1 year, 13.9% of patients were prescribed both treatments. The use of SGLT2Is and/or GLP1RAs was higher in younger age groups and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654-0.801) and 0.974 (0.909-1.043), respectively. Conclusions: In the real-world practice of treating patients with T2D experiencing ACS, the implementation of SGLT2Is, particularly GLP1RAs, was suboptimal when prescribed both early and 1 year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2Is and/or GLP1RAs was associated with a favorable impact on mortality but not MACE.
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Affiliation(s)
- Ibrahim Naoum
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (I.N.); (A.A.)
| | - Walid Saliba
- Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3525433, Israel
| | - Ofra Barnett-Griness
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3525433, Israel
- Statistical Unit, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Amir Aker
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (I.N.); (A.A.)
| | - Barak Zafrir
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (I.N.); (A.A.)
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3525433, Israel
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González-Juanatey JR, Masana L, Dalmau R, Cordero A. The CNIC polypill (Acetylsalicylic acid + Atorvastatin + Rampril) in secondary prevention of cardiovascular disease in patients with type 2 diabetes: A comparative analysis with alternative therapeutic approaches. Int J Cardiol 2024; 418:132578. [PMID: 39306297 DOI: 10.1016/j.ijcard.2024.132578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/26/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Patients with type 2 DM (T2DM) and established cardiovascular disease (CVD) are at high risk of recurrent CV events. We analysed the use of the CNIC-polypill (acetylsalicylic acid, ramipril, and atorvastatin) compared with other therapeutic strategies in patients with T2DM and CVD from the retrospective NEPTUNO study. METHODS Patients were stratified into four therapeutic approaches: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. Outcomes included the 2-year cumulative incidence and risk of recurrent major adverse CV events (MACE) and CV death, risk factors control, medication persistence, and utilisation of healthcare resources and costs. RESULTS After two years, T2DM patients treated with Monocomponents, Equipotent drugs, or Other therapies had increased recurrent MACE risk compared to CNIC-polypill (11 %, 23 %, and 44 %, respectively; P < 0.05) and shorter median time to CV events (305-377 vs. 396 days; P < 0.05). The CNIC-polypill group achieved a significant 11.2 % increase in patients reaching LDL-c targets <70 mg/dL, outperforming other strategies. It also exhibited superior triglyceride control and a higher proportion achieving the <130/80 mmHg blood pressure goal. The CNIC-polypill cohort displayed significantly higher 24-month persistence (71.5 % vs. 54.7 %-58.3 %, p < 0.05) and lower mean adjusted costs per patient (€5083 vs. €6000-€6523; p < 0.05). In a comparative analysis, T2DM patients had lower baseline LDL-c and total cholesterol levels than non-T2DM counterparts yet experienced a higher incidence of recurrent MACE over two years. CONCLUSION The CNIC-polypill (ASA, atorvastatin and ramipril) emerged as a promising treatment for patients with CVD, particularly those with T2DM, offering improved clinical outcomes and economic efficiency.
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Affiliation(s)
- José R González-Juanatey
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Spanish Biomedical Research Centre in Cardiovascular Diseases (CIBERCV), Madrid, Spain; Foundation Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Luís Masana
- Vascular Medicine and Metabolism Unit, Universitat Rovira i Virgili, Hospital Universitario Sant Joan, Reus, Spain; IISPV (Institut d'Investigació Sanitària Pere Virgili), Reus, Spain; CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Madrid, Spain
| | - Regina Dalmau
- Cardiology Department, University Hospital La Paz, Madrid, Spain; IdiPAZ (Instituto de Investigación Hospital Universitario la Paz), Madrid, Spain
| | - Alberto Cordero
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
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Hennies N, Görgens SW, Killer J, Otto T, Richter LM, Müller-Wieland D, Häckl D. Prevalence of obesity and cardiovascular disease in adults with type 2 diabetes and use of diabetes medication in Germany: A claims data study. Diabetes Obes Metab 2024. [PMID: 39300717 DOI: 10.1111/dom.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/22/2024]
Abstract
AIMS To identify the prevalence of cardiovascular disease (CVD) and obesity in patients with type 2 diabetes (T2D) in Germany and to evaluate if antidiabetic treatment patterns varied by comorbidity status. MATERIALS AND METHODS Patients with T2D (aged ≥18 years) were identified during the study period (2014-2020) from medical claims of 4.5 million publicly insured German residents and divided into different cohorts based on CVD and/or obesity diagnosis. Annual prevalence and incidence were estimated for each study year, while characteristics and treatments were assessed in 2020. Data were extrapolated to the German population by age and sex. RESULTS The prevalence of T2D in 2020 was 11.4%. Among patients with T2D, 53.0% had CVD, 39.3% had obesity, and 20.9% had CVD and obesity. Since 2014, CVD increased by 1.4%, obesity by 4.5%, and CVD with obesity by 2.7% in patients with T2D. The incidence of T2D in 2020 was 1.0% (42.9% had CVD, 37.9% had obesity, and 15.8% had CVD and obesity). Among the prevalent T2D population in 2020, 4.9% received glucagon-like peptide-1 receptor agonists (GLP-1RAs), 9.7% received sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 13.0% received GLP-1 RAs and/or SGLT2 inhibitors. Of those with CVD, 12.9% received GLP-1 RAs and/or SGLT2 inhibitors (without CVD, 13.2%). Of those with obesity, 19.4% received GLP-1RAs and/or SGLT2 inhibitors (without obesity, 9.0%). CONCLUSIONS In this retrospective claims database study, more than two thirds of patients with T2D also had CVD, obesity, or both CVD and obesity. GLP-1 RA and SGLT2 inhibitor use remained low.
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Affiliation(s)
- Nora Hennies
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Sven W Görgens
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Jonas Killer
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Thorsten Otto
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Lena M Richter
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH) Markt 8, Leipzig, Germany
| | | | - Dennis Häckl
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH) Markt 8, Leipzig, Germany
- Faculty of Economics and Management, Leipzig University, Universitätsstr. 1, Leipzig, Germany
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Zhao Y, Yan Z, Li S, Wang Y, Guo Y, Wang T, Zhang L. A Novel 5-Chloro- N-Phenyl-1 H-Indole-2-carboxamide Derivative as a Glycogen Phosphorylase Inhibitor: Evaluating the Long-Term Drug Effects on Muscle Function for the First Time. Molecules 2024; 29:4448. [PMID: 39339443 PMCID: PMC11434295 DOI: 10.3390/molecules29184448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/15/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Compound 1 was previously identified by our team as a glycogen phosphorylase (GP) inhibitor with glucose-lowering activity and demonstrated to have protective effects against myocardial and cerebral ischemia. However, its impact on muscle function has not been clarified. This study is the first to evaluate the long-term effects of GP inhibitors on muscle function and metabolism. After a 28-day administration of Compound 1, we performed assays to assess muscle function and biochemical parameters in rats. We observed reductions in peak holding force, duration, tetanic contraction force, single-contraction force, and electromyographic signals under 20 s and 10 min contraction stimuli. The metabolic analysis showed no significant effects on muscle glycogen, ATP, lactic acid, and uric acid levels at low doses. In contrast, medium to high doses resulted in increased glycogen, decreased ATP, and reduced lactic acid (only at high doses), without affecting uric acid. These findings suggest that Compound 1 may adversely affect muscle function in rats, potentially due to the glycogen inhibition effects of GP inhibitors. This study provides crucial safety data and insights into the long-term effects of GP inhibitors on rat muscles, which will guide future developments and applications.
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Affiliation(s)
- Yifan Zhao
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
| | - Zhiwei Yan
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
| | - Shuai Li
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
| | - Youde Wang
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
| | - Yachun Guo
- Department of Pathogen Biology, Chengde Medical University, Chengde 067000, China;
| | - Tienan Wang
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
| | - Liying Zhang
- Laboratory of Traditional Chinese Medicine Research and Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde 067000, China; (Y.Z.); (Z.Y.); (S.L.); (Y.W.); (T.W.)
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Makrilakis K, Papachristoforou E. Common mistakes concerning diabetes management in daily clinical practice. Prim Care Diabetes 2024:S1751-9918(24)00190-6. [PMID: 39299897 DOI: 10.1016/j.pcd.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/12/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
Diabetes mellitus is a chronic metabolic disease, potentially leading to dire complications. Although there are numerous pharmaceutical treatments available, management of the disease is frequently not optimal. Managing diabetes in daily clinical practice can be challenging, and several common mistakes may occur. Healthcare providers must be aware of these errors to provide adequate patient care. In this review, some frequent mistakes in diabetes management are analyzed, focusing on factors such as medication management, blood glucose level monitoring, inadequate addressing of complications and comorbidities, lifestyle choices, patient education, and overall health counselling.
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Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece.
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
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39
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Marco M, Luigi U, Valeria R, Ermanno B, Carlo M, Maria R, Aikaterini A, Laura G, Alfonso B, Davide L. Effectiveness of autologous mononuclear cells as adjuvant therapy in patients with ischaemic diabetic foot ulcers receiving indirect lower limb revascularization. Acta Diabetol 2024:10.1007/s00592-024-02375-1. [PMID: 39287795 DOI: 10.1007/s00592-024-02375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/08/2024] [Indexed: 09/19/2024]
Abstract
AIM The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cells (PB-MNCs) therapy for patients with ischaemic diabetic foot ulcers (DFUs) treated through indirect revascularization. METHODS The study is a prospective non-controlled observational study including patients with neuro-ischaemic DFUs who received indirect peripheral revascularization and showed a persistence of wound ischaemia defined by the absence of angiographic collateral vessels and TcPO2 values < 30 mmHg in the wound angiosome area. All patients received 3 cycles of PB-MNCs therapy administered along the wound related artery based on the angiosome theory. The primary outcomes measures were healing, major amputation, and survival after 1 year of follow-up. The secondary outcomes measures were the evaluation of tissue perfusion by TcPO2 and foot pain defined by the Numerical Rating Scale (NRS). RESULTS Overall 52 (9.7%) patients were included. Most patients were aged (> 70 years), all of them were affected by Type 2 Diabetes with a long diabetes duration (> 20 years). Almost 80% were assessed as grade 2D- 3D of Texas University Classification. Forty-four patients (84.6%) patients healed and survived, 2 (3.85%) healed and deceased, 2 (3.85%) not healed and deceased, 4 (7.7%) not healed and survived. No major amputations were recorded. A significant increase of TcPO2 after PB-MNCs therapy were recorded in comparison to the baseline (43 ± 9 vs 18 ± 8 mmHg, p < 0.0001), such as a concomitant reduction of foot pain (1.8 ± 1.2 vs 6.2 ± 2.1, p < 0.0001). CONCLUSIONS PB-MNCs resulted effective to promote wound healing and limb salvage in diabetic patients with ischaemic DFUs who received indirect revascularization.
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Affiliation(s)
- Meloni Marco
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy.
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy.
| | - Uccioli Luigi
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145, Rome, Italy
| | - Ruotolo Valeria
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
| | - Bellizzi Ermanno
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
| | | | - Romano Maria
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
| | - Andreadi Aikaterini
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
| | - Giurato Laura
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145, Rome, Italy
| | - Bellia Alfonso
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
| | - Lauro Davide
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133, Rome, Italy
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Navickas P, Lukavičiūtė L, Glaveckaitė S, Baranauskas A, Šatrauskienė A, Badarienė J, Laucevičius A. PREVENT Equation: The Black Sheep among Cardiovascular Risk Scores? A Comparative Agreement Analysis of Nine Prediction Models in High-Risk Lithuanian Women. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1511. [PMID: 39336552 PMCID: PMC11434335 DOI: 10.3390/medicina60091511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: In the context of female cardiovascular risk categorization, we aimed to assess the inter-model agreement between nine risk prediction models (RPM): the novel Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation, assessing cardiovascular risk using SIGN, the Australian CVD risk score, the Framingham Risk Score for Hard Coronary Heart Disease (FRS-hCHD), the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Materials and Methods: A cross-sectional study was conducted on 6527 40-65-year-old women with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the nine RPMs, and the results were categorized into high-, intermediate-, and low-risk groups. Inter-model agreement was quantified using Cohen's Kappa coefficients. Results: The study uncovered a significant diversity in risk categorization, with agreement on risk category by all models in only 1.98% of cases. The SCORE2 model primarily classified subjects as high-risk (68.15%), whereas the FRS-hCHD designated the majority as low-risk (94.42%). The range of Cohen's Kappa coefficients (-0.09-0.64) reflects the spectrum of agreement between models. Notably, the PREVENT model demonstrated significant agreement with QRISK3 (κ = 0.55) and PCE (κ = 0.52) but was completely at odds with the SCORE2 (κ = -0.09). Conclusions: Cardiovascular RPM selection plays a pivotal role in influencing clinical decisions and managing patient care. The PREVENT model revealed balanced results, steering clear of the extremes seen in both SCORE2 and FRS-hCHD. The highest concordance was observed between the PREVENT model and both PCE and QRISK3 RPMs. Conversely, the SCORE2 model demonstrated consistently low or negative agreement with other models, highlighting its unique approach to risk categorization. These findings accentuate the need for additional research to assess the predictive accuracy of these models specifically among the Lithuanian female population.
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Affiliation(s)
- Petras Navickas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08410 Vilnius, Lithuania;
| | - Laura Lukavičiūtė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Sigita Glaveckaitė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Arvydas Baranauskas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Agnė Šatrauskienė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Jolita Badarienė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
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Anghel L, Stătescu C, Sascău RA, Tudurachi BS, Tudurachi A, Benchea LC, Prisacariu C, Radu R. Impact of Newly Diagnosed Left Bundle Branch Block on Long-Term Outcomes in Patients with STEMI. J Clin Med 2024; 13:5479. [PMID: 39336966 PMCID: PMC11432236 DOI: 10.3390/jcm13185479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: This study assessed the long-term prognostic implications of newly developed left bundle branch block (LBBB) in patients with ST-elevation myocardial infarction (STEMI) and a single coronary lesion, following primary percutaneous coronary intervention (PCI). Methods: Among 3526 patients admitted with acute myocardial infarction between January 2011 and December 2013, 42 were identified with STEMI, a single coronary lesion, and newly diagnosed LBBB. A control group of 42 randomly selected STEMI patients without LBBB was also included. All participants were prospectively evaluated with a median follow-up duration of 9.4 years. Demographic, clinical, and laboratory data were analyzed to assess the impact of LBBB on long-term outcomes. Results: The baseline characteristics were similar between the groups. The STEMI with new LBBB group had significantly higher rates of new myocardial infarction, revascularization, and mortality, highlighting the severe prognostic implications and elevated risk for adverse outcomes compared to STEMI without LBBB. The multivariate Cox regression analysis demonstrated that the presence of LBBB (HR: 2.15, 95% CI: 1.28-3.62, p = 0.003), lower LVEF (HR: 1.45, 95% CI: 1.22-1.72, p < 0.001), and longer pain-to-admission time (HR: 1.32, 95% CI: 1.09-1.61, p = 0.008) were significant independent predictors of adverse outcomes. Conclusions: Newly acquired LBBB in STEMI patients is associated with poorer long-term outcomes. Early identification and management of factors such as reduced LVEF and timely hospital admission, specifically in patients with new-onset LBBB, can improve prognosis.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Radu Andy Sascău
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Bogdan-Sorin Tudurachi
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Andreea Tudurachi
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Laura-Cătălina Benchea
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Cristina Prisacariu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
| | - Rodica Radu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania
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Gadager BB, Tang LH, Doherty P, Svendsen ML, Sibilitz KL, Harrison A, Maribo T. Are cardiac rehabilitation pathways influenced by diabetes: A cohort study. Int J Cardiol 2024; 411:132275. [PMID: 38880427 DOI: 10.1016/j.ijcard.2024.132275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of these patients in CR has been less studied. This study examines the referral, uptake, and completion rates in the CR pathway for ACS patients with and without diabetes to identify potential barriers in the CR pathway. METHODS The study included patients aged 18 or above who were discharged after a diagnosis of ACS in the Central Denmark Region between 1 September 2017 and 31 August 2018. Diabetes information was obtained from three sources. Logistic regression models were used to examine the associations between having diabetes and the three outcomes: non-referral, non-uptake and non-completion. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS A total of 2447 patients were eligible for the study, of which 457 (18.7%) had diabetes. Only non-uptake was found to be significantly associated with diabetes after adjustment for prespecified variables (OR = 1.38, 95% CI 1.01-1.90). Associations for non-referral (OR = 1.11, 95% CI 0.87-1.41) and non-completion (OR = 1.06, 95 %CI 0.73-1.53) were not found to be statistically significant between ACS patients with diabetes and those without diabetes. CONCLUSION This study highlights a significant disparity in the uptake of CR between patients with and without diabetes following ACS, demonstrating that patients with diabetes require early promotion and increased assistance to enrol in CR.
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Affiliation(s)
- Birgitte Bitsch Gadager
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Lars Hermann Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | | | | | - Thomas Maribo
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
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Oikonomou EK, Khera R. Artificial intelligence-enhanced patient evaluation: bridging art and science. Eur Heart J 2024; 45:3204-3218. [PMID: 38976371 PMCID: PMC11400875 DOI: 10.1093/eurheartj/ehae415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/23/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
The advent of digital health and artificial intelligence (AI) has promised to revolutionize clinical care, but real-world patient evaluation has yet to witness transformative changes. As history taking and physical examination continue to rely on long-established practices, a growing pipeline of AI-enhanced digital tools may soon augment the traditional clinical encounter into a data-driven process. This article presents an evidence-backed vision of how promising AI applications may enhance traditional practices, streamlining tedious tasks while elevating diverse data sources, including AI-enabled stethoscopes, cameras, and wearable sensors, to platforms for personalized medicine and efficient care delivery. Through the lens of traditional patient evaluation, we illustrate how digital technologies may soon be interwoven into routine clinical workflows, introducing a novel paradigm of longitudinal monitoring. Finally, we provide a skeptic's view on the practical, ethical, and regulatory challenges that limit the uptake of such technologies.
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Affiliation(s)
- Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, 195 Church St, 6th Floor, New Haven, CT 06510, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, 100 College Street, New Haven, 06511 CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, 06510 CT, USA
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44
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Pérez A. [GLP-1 receptor agonists in clinical practice]. Med Clin (Barc) 2024; 163:242-244. [PMID: 38688736 DOI: 10.1016/j.medcli.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición. Hospital de la Santa Creu i Sant Pau; Universidad Autónoma de Barcelona; Institut de Recerca Sant Pau, IIB Sant Pau; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Barcelona, España.
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45
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Shchendrygina A, Rakisheva A, Giverts I, Rustamova Y, Soloveva A. Effects of Glucagon-like Peptide-1 Receptor Agonists on Cardiac Function, Exercise Capacity and Quality of Life. Card Fail Rev 2024; 10:e10. [PMID: 39309521 PMCID: PMC11413987 DOI: 10.15420/cfr.2024.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/23/2024] [Indexed: 09/25/2024] Open
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are emerging glucose-lowering agents primarily used in managing diabetes and obesity. Recently, GLP-1 RAs have garnered attention for their cardiovascular benefits beyond glycaemic control in patients with type 2 diabetes, exhibiting patterns previously seen in cardiovascular outcomes trials on sodium-glucose cotransporter 2 inhibitors, which now receive a high level of recommendation for the treatment of heart failure (HF). GLP-1 RAs have been increasingly investigated in HF cohorts, but mainly in small-scale studies reporting inconclusive findings regarding clinical outcomes and different safety profiles in HF patients with reduced and preserved ejection fractions. This review discusses the effects of GLP-1 RAs on surrogate HF outcomes, such as cardiac structure and function, exercise capacity and quality of life, in HF patients across the spectrum of left ventricular ejection fraction, to provide insights into the potential of these agents to be investigated in large clinical trials to evaluate clinical outcomes.
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Affiliation(s)
- Anastasia Shchendrygina
- Department of Hospital Therapy No. 2, IM Sechenov First Moscow State Medical UniversityMoscow, Russia
| | - Amina Rakisheva
- Department of Cardiology, City Cardiology CenterAlmaty, Kazakhstan
| | - Ilya Giverts
- Department of Internal Medicine, Maimonides Medical CenterBrooklyn, NY, US
- The Cardiovascular Research Center, Massachusetts General CenterBoston, MA, US
| | - Yasmin Rustamova
- Department of Internal Medicine, Educational-Surgery Clinic, Azerbaijan Medical UniversityBaku, Azerbaijan
| | - Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research CentreSt Petersburg, Russia
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Baroutidou A, Arvanitaki A, Pagkopoulou E, Anyfanti P, Ziakas A, Kamperidis V, Giannakoulas G, Dimitroulas T. Nailfold videocapillaroscopy as a non-invasive tool for the assessment of peripheral microangiopathy in cardiovascular diseases. J Hypertens 2024:00004872-990000000-00543. [PMID: 39288254 DOI: 10.1097/hjh.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Cardiovascular disease (CVD) remains the main cause of morbidity and mortality worldwide. Accumulating evidence supports the presence of endothelial and microvascular dysfunction in CVD, which can be assessed using several methods in peripheral organs and tissues. Naifold videocapillaroscopy (NVC) is an established, noninvasive, easily applicable technique for the assessment of peripheral microcirculation. There is limited capillaroscopic data in the field of CVD, though, and the diagnostic or possible prognostic significance of the capillaroscopic alterations in this population is still a matter of research. This review aims to summarize the current knowledge on the capillaroscopic findings in patients with cardiovascular risk factors or established atherosclerotic and nonatherosclerotic CVD, focusing on the possible correlations of these alterations with clinical and laboratory markers of cardiac function.
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Affiliation(s)
| | | | - Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School
| | - Panagiota Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School
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Mennini FS, Scortichini M, Colivicchi F, Maggioni AP, Sciattella P. The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy. Clin Drug Investig 2024:10.1007/s40261-024-01365-z. [PMID: 39249736 DOI: 10.1007/s40261-024-01365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact. OBJECTIVES This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs. METHODS We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents. RESULTS Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757). CONCLUSIONS This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.
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Affiliation(s)
- Francesco S Mennini
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
| | - Matteo Scortichini
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
| | | | - Aldo P Maggioni
- ANMCO Research Center-Heart Care Foundation, Florence, Italy
| | - Paolo Sciattella
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy.
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Caturano A, Galiero R, Rocco M, Tagliaferri G, Piacevole A, Nilo D, Di Lorenzo G, Sardu C, Vetrano E, Monda M, Marfella R, Rinaldi L, Sasso FC. Modern Challenges in Type 2 Diabetes: Balancing New Medications with Multifactorial Care. Biomedicines 2024; 12:2039. [PMID: 39335551 PMCID: PMC11429233 DOI: 10.3390/biomedicines12092039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/01/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and progressive beta cell dysfunction, presenting substantial global health and economic challenges. This review explores recent advancements in diabetes management, emphasizing novel pharmacological therapies and their physiological mechanisms. We highlight the transformative impact of Sodium-Glucose Cotransporter 2 inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA), which target specific physiological pathways to enhance glucose regulation and metabolic health. A key focus of this review is tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors. Tirzepatide illustrates how integrating innovative mechanisms with established physiological pathways can significantly improve glycemic control and support weight management. Additionally, we explore emerging treatments such as glimins and glucokinase activators (GKAs), which offer novel strategies for enhancing insulin secretion and reducing glucose production. We also address future perspectives in diabetes management, including the potential of retatrutide as a triple receptor agonist and evolving guidelines advocating for a comprehensive, multifactorial approach to care. This approach integrates pharmacological advancements with essential lifestyle modifications-such as dietary changes, physical activity, and smoking cessation-to optimize patient outcomes. By focusing on the physiological mechanisms of these new therapies, this review underscores their role in enhancing T2DM management and highlights the importance of personalized care plans to address the complexities of the disease. This holistic perspective aims to improve patient quality of life and long-term health outcomes.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Maria Rocco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Giuseppina Tagliaferri
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Alessia Piacevole
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Davide Nilo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Giovanni Di Lorenzo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
| | - Luca Rinaldi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, Università degli Studi del Molise, 86100 Campobasso, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (R.G.); (G.T.); (A.P.); (D.N.); (G.D.L.); (C.S.); (E.V.); (R.M.)
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Kouidi E, Hanssen H, Anding-Rost K, Cupisti A, Deligiannis A, Grupp C, Koufaki P, Leeson P, Segura-Orti E, Van Craenenbroeck A, Van Craenenbroeck E, Clyne N, Halle M. The role of exercise training on cardiovascular risk factors and heart disease in patients with chronic kidney disease G3-G5 and G5D: a Clinical Consensus Statement of the European Association of Preventive Cardiology of the ESC and the European Association of Rehabilitation in Chronic Kidney Disease. Eur J Prev Cardiol 2024; 31:1493-1515. [PMID: 38593202 DOI: 10.1093/eurjpc/zwae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/23/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
Cardiovascular (CV) morbidity and mortality is high in patients with chronic kidney disease (CKD). Most patients reveal a high prevalence of CV risk factors such as diabetes or arterial hypertension and many have manifest cardiovascular disease (CVD), such as coronary artery disease and chronic heart failure with an increased risk of clinical events including sudden cardiac death. Diabetes mellitus and hypertension contribute to the development of CKD and the prevalence of CKD is in the range of 20-65% in diabetic and 30-50% in hypertensive patients. Therefore, prevention and optimal treatment of CV risk factors and comorbidities are key strategies to reduce CV risk and improve survival in CKD. Beyond common CV risk factors, patients with CKD are often physically inactive and have low physical function leading to subsequent frailty with muscle fatigue and weakness, sarcopenia and increased risk of falling. Consequently, the economic health burden of CKD is high, requiring feasible strategies to counteract this vicious cycle. Regular physical activity and exercise training (ET) have been shown to be effective in improving risk factors, reducing CVD and reducing frailty and falls. Nonetheless, combining ET and a healthy lifestyle with pharmacological treatment is not frequently applied in clinical practice. For that reason, this Clinical Consensus Statement reviews the current literature and provides evidence-based data regarding the role of ET in reducing CV and overall burden in patients with CKD. The aim is to increase awareness among cardiologists, nephrologists, and healthcare professionals of the potential of exercise therapy in order to encourage implementation of ET in clinical practice, eventually reducing CV risk and disease, as well as reducing frailty in patients with CKD G3-G5D.
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Affiliation(s)
- Evangelia Kouidi
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Aristotle University of Thessaloniki, DPESS, Laboratory Building, TEFAA, Thermi, PC 57001, Thessaloniki, Greece
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Sports and Exercise Medicine, Medical Faculty, University of Basel, Basel, Switzerland
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Asterios Deligiannis
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Aristotle University of Thessaloniki, DPESS, Laboratory Building, TEFAA, Thermi, PC 57001, Thessaloniki, Greece
| | - Clemens Grupp
- Medizinische Klinik III mit Zentrum für Altersmedizin, Klinikum der Sozialstiftung Bamberg, Bamberg, Germany
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Eva Segura-Orti
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | | | - Naomi Clyne
- Department of Nephrology, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Wang S, Song S, Gao J, Duo Y, Gao Y, Fu Y, Dong Y, Yuan T, Zhao W. Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: An updated systematic review and meta-analysis. Diabetes Obes Metab 2024. [PMID: 39233504 DOI: 10.1111/dom.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To assess the association between glycated haemoglobin (HbA1c) variability and risk of renal function decline in type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS A comprehensive search was carried out in PubMed, Embase, Web of Science and the Cochrane Library (until 12 March 2024). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines were followed for this meta-analysis. HbA1c variability was presented as indices of the standard deviation (SD), coefficient of variation (CV), HbA1c variability score (HVS) and haemoglobin glycation index (HGI). This meta-analysis was performed using random-effect models. RESULTS Eighteen studies met the objectives of this meta-analysis. The analyses showed positive associations between HbA1c variability and kidney function decline, with hazard ratio (HR) 1.26 (95% confidence interval [CI] 1.15-1.38) for high versus low SD groups, HR 1.47 (95% CI 1.30-1.65) for CV groups, HR 1.32 (95% CI 1.10-1.57) for HVS groups and HR 1.53 (95% CI 1.05-2.23) for HGI groups. In addition, each 1% increase in SD and CV was linked to kidney function decline, with HR 1.26 (95% CI 1.17-1.35), and 1.13 (95% CI 1.03-1.23), respectively. Also, each 1-SD increase in SD of HbA1c was associated with deterioration in renal function, with HR 1.17 (95% CI 1.07-1.29). CONCLUSIONS The four HbA1c variability indicators were all positively associated with renal function decline progression; therefore, HbA1c variability might play an important and promising role in guiding glycaemic control targets and predicting kidney function decline progression in T2DM.
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Affiliation(s)
- Shihan Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuoning Song
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junxiang Gao
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanbei Duo
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuting Gao
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingyue Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weigang Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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