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Zhang R, Thor D, Han X, Anderson L, Rahimian R. Sex differences in mesenteric endothelial function of streptozotocin-induced diabetic rats: a shift in the relative importance of EDRFs. Am J Physiol Heart Circ Physiol 2012; 303:H1183-98. [PMID: 22982780 DOI: 10.1152/ajpheart.00327.2012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several studies suggest that diabetes affects male and female vascular beds differently. However, the mechanisms underlying the interaction of sex and diabetes remain to be investigated. This study investigates whether there are 1) sex differences in the development of abnormal vascular responses and 2) changes in the relative contributions of endothelium-derived relaxing factors in modulating vascular reactivity of mesenteric arteries taken from streptozotocin (STZ)-induced diabetic rats at early and intermediate stages of the disease (1 and 8 wk, respectively). We also investigated the mesenteric expression of the mRNAs for endothelial nitric oxide (NO) synthase (eNOS) and NADPH oxidase (Nox) in STZ-induced diabetes in both sexes. Vascular responses to acetylcholine (ACh) in mesenteric arterial rings precontracted with phenylephrine were measured before and after pretreatment with indomethacin (cyclooxygenase inhibitor), N(ω)-nitro-L-arginine methyl ester (NOS inhibitor), or barium chloride (K(ir) blocker) plus ouabain (Na(+)-K(+)-ATPase inhibitor). We demonstrated that ACh-induced relaxations were significantly impaired in mesenteric arteries from both male and female diabetic rats at 1 and 8 wk. However, at 8 wk the extent of impairment was significantly greater in diabetic females than diabetic males. Our data also showed that in females, the levels of eNOS, Nox2, and Nox4 mRNA expression and the relative importance of NO to the regulation of vascular reactivity were substantially enhanced, whereas the importance of endothelium-derived hyperpolarizing factor (EDHF) was significantly reduced at both 1 and 8 wk after the induction of diabetes. This study reveals the predisposition of female rat mesenteric arteries to vascular injury after the induction of diabetes may be due to a shift away from a putative EDHF, initially the major vasodilatory factor, toward a greater reliance on NO.
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Affiliation(s)
- Rui Zhang
- Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA
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52
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Madssen E, Vatten L, Nilsen TI, Midthjell K, Wiseth R, Dale AC. Abnormal glucose regulation and gender-specific risk of fatal coronary artery disease in the HUNT 1 study. SCAND CARDIOVASC J 2012; 46:219-25. [DOI: 10.3109/14017431.2012.664646] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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53
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Bozorgmanesh M, Hadaegh F, Sheikholeslami F, Azizi F. Cardiovascular risk and all-cause mortality attributable to diabetes: Tehran lipid and glucose study. J Endocrinol Invest 2012; 35:14-20. [PMID: 21586894 DOI: 10.3275/7728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To quantify the burden of cardiovascular diseases (CVD), and all-cause mortality attributable to diabetes. SUBJECTS AND METHODS Data on an 8.6-yr follow-up of 6331 participants (2741 men), free of CVD at baseline, were analyzed to determine the burden of CVD and all-cause mortality attributable to self-reported and screen-detected diabetes mellitus (SRDM and SDDM, respectively). Risks of events of interest were separately assessed for women and men using Cox-proportional-hazard model. RESULTS The mean age at baseline was 47 yr with 997 (15.7%) of participants having diabetes (men 14.8%, women 16.5%). SRDM and SDDM prevailed in 9.7% (men 9.2, women 10.2%) and 6.0% of participants (men 5.7, women 6.3%), respectively. During follow up (52,404 person-yr), we observed 447 incident cases of CVD [387 had coronary heart disease (CHD)] and 209 deaths. Among men, participants with SDDM had increased relative hazard for all-cause mortality translated to a population attributable risk fraction (PAF) of 10.1%. Among women, SDDM was associated with CVD and CHD but not with all-cause mortality; so that 9.3% and 8.8% of CVD and CHD events were respectively attributable to the SDDM. If SRDM had been eliminated from the population, the incidences of CVD, CHD, and death would have decreased by 10.5, 9.5, and 17.3% in men; and 22.0, 24.2, and 17.8% in women, respectively. CONCLUSION SDDM and SRDM have high PAF for all-cause mortality and CVD. Besides diabetes treatment and prevention, screening to detect undiagnosed diabetes should warrant high priority among the public health strategies to lower the incidence of CVD and mortality.
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Affiliation(s)
- M Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nilsson G, Hedberg P, Öhrvik J. Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds. BMJ Open 2011; 1:e000012. [PMID: 22021724 PMCID: PMC3191391 DOI: 10.1136/bmjopen-2010-000012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 03/08/2011] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To study the relationship between body mass index (BMI) and mortality among 75-year-olds with and without diabetes mellitus type 2 (DM) or impaired fasting glucose (IFG). DESIGN Prospective population-based cohort study with a 10-year follow-up. PARTICIPANTS A random sample of 618 of the 1100 inhabitants born in 1922 and living in the city of Västerås in 1997 were invited to participate in a cardiovascular health survey; 70% of those invited agreed to participate (432 individuals: 210 men, 222 women). OUTCOME MEASURES All-cause and cardiovascular mortality. RESULTS 163 of 432 (38%) participants died during the 10-year follow-up period. The prevalence of DM or IFG was 41% (35% among survivors, 48% among non-survivors). The prevalence of obesity/overweight/normal weight/underweight according to WHO definitions was 12/45/42/1% (14/43/42/1% among survivors, 9/47/42/2% among non-survivors). The hazard rate for death decreased by 10% for every kg/m(2) increase in BMI in individuals with DM/IFG (HR 0.91, 95% CI 0.86 to 0.97; p=0.003). After adjustment for sex, current smoking, diagnosed hypertension, diagnosed angina pectoris, previous myocardial infarction and previous stroke/transient ischaemic attack, the corresponding decrease in mortality was 9% (HR 0.92, 95% CI 0.86 to 0.99; p=0.017). These findings remained after exclusion of individuals with BMI<20 or those who died within 2-year follow-up. In individuals without DM/IFG, BMI had no effect on mortality (HR 1.01, 95% CI 0.95 to 1.07; p=0.811). The HR for BMI differed significantly between individuals with and without DM/IFG (p interaction=0.025). The increased all-cause mortality in individuals with DM/IFG in combination with lower BMI was driven by cardiovascular death. CONCLUSION High all-cause and cardiovascular mortality was associated with lower BMI in 75-year-olds with DM/IFG but not in those without DM/IFG. Further studies on the combined effect of obesity/overweight and DM/IFG are needed in order to assess the appropriateness of current guideline recommendations for weight reduction in older people with DM/IFG.
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Affiliation(s)
- Göran Nilsson
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology, Central Hospital, Västerås, Sweden
| | - John Öhrvik
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
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55
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Mata-Cases M, De Prado-Lacueva C, Salido-Valencia V, Fernández-Bertolín E, Casermeiro-Cortés J, García-Durán M, Jabalera-López S, Fernández-Sanmartín MI. Incidence of complications and mortality in a type 2 diabetes patient cohort study followed up from diagnosis in a primary healthcare centre. Int J Clin Pract 2011; 65:299-307. [PMID: 21314867 DOI: 10.1111/j.1742-1241.2010.02503.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS To determine the microvascular and macrovascular complications and mortality incidence rates and to identify the related factors in patients recently diagnosed with type 2 diabetes between 1991 and 2000 and followed until 2006. METHODS Retrospective longitudinal study in a primary healthcare center. Patients without any measure of glycaemia in the 3 years previous to diabetes diagnosis were excluded. Annual incidence rates for microvascular and macrovascular complications and mortality were estimated. Analysis of KaplanMeier survival curves and Cox proportional risk models by gender were done. RESULTS Of 469 patients [mean age: 60.4 (SD 10.7) years, 53.9% women], 80 died principally of tumoral (38.7%) and cardiovascular (30%) causes. The mean follow-up period was 8.81 years. (SD 3.21). The complication rates per 1000 patients/year (95% CI) were: microvascular complications 29.11 (22.97-36.38), macrovascular complications 24.10 (19.05-30.08) and mortality 19.23 (15.25-23.93), all of those being significantly greater in males except for cerebrovascular disease. Complications and mortality were associated with age, HbA1c, HDL-cholesterol, blood pressure and smoking with a different significance for each gender. HbA1c was related to microvascular complications in both sexes and to macrovascular complications only in women. CONCLUSION The annual rates for death and complications in a Mediterranean type 2 diabetic patient cohort followed from diagnosis were lower than those published in Anglo-Saxon countries. Males showed higher death and complication rates except in terms of cerebrovascular disease. Predictors of complication and death were different depending on gender. In terms of mortality, unlike in other studies, only one-third of the deaths were for cardiovascular causes.
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Affiliation(s)
- M Mata-Cases
- Primary Healthcare Center La Mina, SAP Litoral, Barcelona Family and Community Medicine Teaching Unit, Institut Català de la Salut, Sant Adrià de Besòs (Barcelona), Spain.
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Barnett KN, Ogston SA, McMurdo MET, Morris AD, Evans JMM. A 12-year follow-up study of all-cause and cardiovascular mortality among 10,532 people newly diagnosed with Type 2 diabetes in Tayside, Scotland. Diabet Med 2010; 27:1124-9. [PMID: 20854379 DOI: 10.1111/j.1464-5491.2010.03075.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine absolute and relative risks of all-cause and cardiovascular mortality among patients newly diagnosed with Type 2 diabetes. METHODS In an observational cohort study using record-linkage databases, based in Tayside, Scotland, UK, we identified newly diagnosed patients with Type 2 diabetes in 1993-2004. We also identified a set of non-diabetic comparators from lists of patients registered with a general practice, individually matched to the diabetic patients by sex, age and deprivation. We followed up patients for mortality and cardiovascular mortality over a 12-year period and calculated hazard ratios using Cox regression. RESULTS There were 10,532 patients with Type 2 diabetes and 21,056 non-diabetic comparators. Diabetic patients in every age/sex group had higher absolute mortality rates. Even taking deprivation into account, the hazard ratio for mortality was 1.32 (95% CI 1.25-1.40), decreasing to 1.15 (1.09-1.22) after adjusting for pre-existing cardiovascular disease. The hazard ratios for cardiovascular mortality were higher, decreasing from 1.51 (1.37-1.67) to 1.23 (1.11-1.36) after adjusting for pre-existing cardiovascular disease. The hazard ratios decreased with increasing age at diagnosis, although the difference in absolute rate of mortality increased slightly with age. Increased mortality risks were only evident 2 years after diagnosis and increased thereafter. CONCLUSIONS Patients with Type 2 diabetes have an increased risk of all-cause and cardiovascular mortality compared with non-diabetic comparators, although this is not observable immediately after diagnosis. Age at diagnosis and duration of the disease independently affect absolute and relative mortality risk.
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Affiliation(s)
- K N Barnett
- Division of Clinical and Population Sciences and Education, University of Dundee, UK
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57
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Cederberg H, Saukkonen T, Laakso M, Jokelainen J, Härkönen P, Timonen M, Keinänen-Kiukaanniemi S, Rajala U. Postchallenge glucose, A1C, and fasting glucose as predictors of type 2 diabetes and cardiovascular disease: a 10-year prospective cohort study. Diabetes Care 2010; 33:2077-83. [PMID: 20573752 PMCID: PMC2928368 DOI: 10.2337/dc10-0262] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A1C has been proposed as a new indicator for high risk of type 2 diabetes. The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear. We assessed A1C, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) as predictors of type 2 diabetes and cardiovascular disease (CVD) at 10 years. RESEARCH DESIGN AND METHODS This prospective population-based study of 593 inhabitants from northern Finland, born in 1935, was conducted between 1996 and 2008. An oral glucose tolerance test (OGTT) was conducted at baseline and follow-up, and A1C was determined at baseline. Those with a history of diabetes were excluded from the study. Elevated A1C was defined as 5.7-6.4%. Incident type 2 diabetes was confirmed by two OGTTs. Cardiovascular outcome was measured as incident CVD or CVD mortality. Multivariate log-binomial regression models were used to predict diabetes, CVD, and CVD mortality at 10 years. Receiver operating characteristic curves compared predictive values of A1C, IGT, and IFG. RESULTS Incidence of diabetes during the follow-up was 17.1%. Two of three of the cases of newly diagnosed diabetes were predicted by a raise in >or=1 of the markers. Elevated A1C, IGT, or IFG preceded diabetes in 32.8, 40.6, and 21.9%, respectively. CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women. CONCLUSIONS A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7-6.4% but CVD only in women at A1C >or=6.5%.
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Affiliation(s)
- Henna Cederberg
- Institute of Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
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58
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Prahl U, Wikstrand J, Bergström GML, Behre CJ, Hulthe J, Fagerberg B. Slightly Elevated High-Sensitivity C-Reactive Protein (hsCRP) Concentrations Are Associated With Carotid Atherosclerosis in Women With Varying Degrees of Glucose Tolerance. Angiology 2010; 61:793-801. [DOI: 10.1177/0003319710370959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We examined whether high-sensitivity C-reactive protein (hsCRP) ≥2.0 mg/L was associated with increased intima-media thickness (IMT), plaque burden, and plaque echolucency in carotid arteries. Women (n = 635) from a population sample of 64-year-old females with varying degrees of glucose tolerance underwent risk factor assessment, measurement of hsCRP, and ultrasound examinations of the carotid arteries. Participants with hsCRP levels ≥2.0 mg/L had elevated carotid bulb IMT independently of other cardiovascular risk factors compared with those with hsCRP <2.0 mg/L. The participants with plaques in the highhsCRP group had larger total plaque area compared to those with plaque in the lower hsCRP group. Plaque echolucency did not differ between groups. High-sensitivity CRP levels ≥2.0 mg/L were accompanied by elevated IMT in the carotid bulbs independently of other cardiovascular risk factors. Total plaque area was larger among women with plaques in the high hsCRP group versus the lower hsCRP group.
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Affiliation(s)
- Ulrica Prahl
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - John Wikstrand
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran M. L. Bergström
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Department of Clinical Physiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Carl Johan Behre
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johannes Hulthe
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, AstraZeneca, Mölndal, Sweden
| | - Björn Fagerberg
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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59
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Carro A, de la Hera JM. Impaired glucose homeostasis and acute coronary syndrome. Rev Esp Cardiol 2010; 63:373-374. [PMID: 20197007 DOI: 10.1016/s1885-5857(10)70079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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60
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Carro A, de la Hera JM. Alteraciones de la homeostasia de la glucosa y síndrome coronario agudo. Rev Esp Cardiol (Engl Ed) 2010. [DOI: 10.1016/s0300-8932(10)70105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosano GMC, Maffei S, Andreassi MG, Vitale C, Vassalle C, Gambacciani M, Stramba-Badiale M, Mercuro G. Hormone replacement therapy and cardioprotection: a new dawn? A statement of the Study Group on Cardiovascular Disease in Women of the Italian Society of Cardiology on hormone replacement therapy in postmenopausal women. J Cardiovasc Med (Hagerstown) 2009; 10:85-92. [PMID: 19145119 DOI: 10.2459/jcm.0b013e328313e979] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiovascular disease is the leading cause of death in women in Western countries. Despite preventive strategies, in the past decades the incidence of cardiovascular events has shown a decline in men but a rise in women, matching the growth of the population of postmenopausal women. Several epidemiological findings suggest the causative pathophysiological role of ovarian hormone deficiency in the development of cardiovascular disease in women. Observational and randomized studies have suggested that hormone replacement therapy in early postmenopause could be beneficial from a cardiovascular point of view. Conversely, aging, time since menopause and presence of cardiovascular risk factors or cardiovascular disease may decrease its efficacy and increase the risk of cardiovascular events. It is plausible that the unfavorable effects of the estrogen/progestin combination used in the randomized studies are not related to the hormone preparation per se but rather to the use of hormones in the less receptive group of women, older and with cardiovascular risk factors. Clinical judgment, choice of the right dose and estrogen/progestin combination are of pivotal importance to maximize the beneficial effect of estrogen replacement therapy/hormone replacement therapy, especially if given within a reasonable time after the menopause to women who need the therapy for the relief of menopausal symptoms.
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Affiliation(s)
- Giuseppe M C Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Via della Pisana 234, 00163 Rome, Italy.
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62
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Rosano GMC, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric 2009; 10 Suppl 1:19-24. [PMID: 17364594 DOI: 10.1080/13697130601114917] [Citation(s) in RCA: 285] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Menopause is a risk factor for cardiovascular disease (CVD) because estrogen withdrawal has a detrimental effect on cardiovascular function and metabolism. The menopause compounds many traditional CVD risk factors, including changes in body fat distribution from a gynoid to an android pattern, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, increased sympathetic tone, endothelial dysfunction and vascular inflammation. Many CVD risk factors have different impacts in men and women. In postmenopausal women, treatment of arterial hypertension and glucose intolerance should be priorities. Observational studies and randomized clinical trials suggest that hormone replacement therapy (HRT) started soon after the menopause may confer cardiovascular benefit. In contrast to other synthetic progestogens used in continuous combined HRTs, the unique progestogen drospirenone has antialdosterone properties. Drospirenone can therefore counteract the water- and sodium-retaining effects of the estrogen component of HRT via the renin-angiotensin-aldosterone system, which may otherwise result in weight gain and raised blood pressure. As a continuous combined HRT with 17beta-estradiol, drospirenone has been shown to significantly reduce blood pressure in postmenopausal women with elevated blood pressure, but not in normotensive women. Therefore, in addition to relieving climacteric symptoms, drospirenone/17beta-estradiol may offer further benefits in postmenopausal women, such as improved CVD risk profile.
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Affiliation(s)
- G M C Rosano
- Department of Medical Sciences, Center for Clinical and Basic Research, Cardiovascular Research Unit, IRCCS San Raffaele, Rome, Italy
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Ouhoummane N, Abdous B, Emond V, Poirier P. Impact of diabetes and gender on survival after acute myocardial infarction in the Province of Quebec, Canada--a population-based study. Diabet Med 2009; 26:609-16. [PMID: 19538236 DOI: 10.1111/j.1464-5491.2009.02740.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To examine the impact of diabetes, gender and their interaction on 30-day, 1-year and 5-year post-acute myocardial infarction (AMI) mortality in three age groups (20-64, 65-74 and > or = 75 years). METHODS Retrospective analysis including 23 700 patients aged > or = 20 years (22% with diabetes) admitted to hospital for a first AMI in any hospital in the Province of Quebec, Canada, between April 1995 and March 1997. Administrative databases were used to identify patients and assess outcomes. RESULTS Regarding 30-day mortality, there was non-significant interaction between diabetes and gender. Women aged < 75 years had, independently of diabetes status, at least a 38% (P < 0.05) higher mortality than their male counterparts after adjustment for socio-economic status and co-morbid conditions. Gender difference disappeared, however, after controlling for in-hospital complications. Regarding 1-year mortality (31-365 days), there was no significant gender disparity for all age groups. During the 5-year follow-up, no gender differences were seen in any age group, except for younger (< 65 years) women with diabetes, who had a 52% (P = 0.004) higher mortality than men after controlling for co-variables. This female disadvantage was demonstrated by a significant interaction between diabetes and gender in patients aged < 65 years (P = 0.009). CONCLUSIONS The higher 30-day mortality post-AMI in younger (20-64 years) and middle-aged (65-74 years) women compared with men was not influenced by diabetes status. However, during the 5-year follow-up, the similar gender mortality observed in patients without diabetes seemed to disappear in younger patients with diabetes, which may be explained by the deleterious, long-term, post-AMI impact of diabetes in younger women.
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Affiliation(s)
- N Ouhoummane
- National Public Health Institute of Quebec, Québec, QC, Canada
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64
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Ma RCW, Yang X, Ko GTC, So WY, Kong APS, Ho CS, Lam CWK, Chow CC, Tong PCY, Chan JCN. Effects of systolic and diastolic blood pressures on incident coronary heart disease and all-cause death in Chinese women with Type 2 diabetes: the Hong Kong Diabetes Registry. J Diabetes 2009; 1:90-8. [PMID: 20929505 DOI: 10.1111/j.1753-0407.2009.00023.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Elevated blood pressure (BP) is an important risk factor for the development of coronary heart disease (CHD), although the threshold above which the risk increases has not been clearly defined. The aim of the present study was to examine the full-range association between BP and CHD. METHODS A prospective cohort of 3861 Chinese women with Type 2 diabetes mellitus (T2DM) was followed for a median of 5.61 years. Restricted cubic spline analysis was used to examine the relationship between BP and CHD. RESULTS Subjects who developed CHD were older, more likely to be smokers, had a significantly longer duration of diabetes, higher systolic BP (SBP), glycated hemoglobin, albuminuria, low-density lipoprotein-cholesterol, and triglycerides, and lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol. Mortality was higher in those who developed CHD compared with those who did not, with all-cause death in 30.2% and 7.8% of patients, respectively. Over 21,641 and 22 049 person-years follow up, 4.4% of patients (n = 169) developed CHD and 8.8% (n = 340) died, respectively. The relative risk of SBP for CHD was constant up to 120 mmHg, after which it started to rise: from 130 mmHg, each 10-mmHg increase in SBP was associated with a 1.13-fold increased risk of CHD. CONCLUSIONS We identified 130 mmHg as the threshold of SBP for increased risk of CHD in Chinese female patients with T2DM. It appears that 67-77 mmHg is the optimal range for diastolic BP, within which the risk of CHD is lowest.
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Affiliation(s)
- Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
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65
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Lü Q, Tong N, Liu Y, Li N, Tang X, Zhao J, Cao H, Li D, Gou L, Zhang Y, Wan J, Jiang L. Community-based population data indicates the significant alterations of insulin resistance, chronic inflammation and urine ACR in IFG combined IGT group among prediabetic population. Diabetes Res Clin Pract 2009; 84:319-24. [PMID: 19442860 DOI: 10.1016/j.diabres.2009.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/19/2009] [Accepted: 03/02/2009] [Indexed: 02/05/2023]
Abstract
AIMS To investigate alterations of insulin resistance (IR), chronic inflammation and urine albumin-to-creatinine ratio (ACR) in Chinese community-based prediabetic population. MATERIALS AND METHODS 252 prediabetics [prediabetes (PD), including impaired fasting glucose (IFG), 91; impaired glucose tolerance (IGT), 123; IFG+IGT, 38] and 38 newly diagnosed-diabetics (NDDM) aged over 35 years older were screened from 2336 community individuals. 123 age and gender matched individuals with normal glucose tolerance (NGT) were selected as controls. Serum adiponectin, interleukin-6 (IL-6) levels and urine ACR were determined, HOMA-IR and Gutt's index were calculated to evaluate IR and insulin sensitivity, respectively. RESULTS The data displayed significant difference of serum adiponectin, IL-6, ACR and Gutt's index among PD, NDDM and NGT groups. Adiponectin level and Gutt's index decreased, but IL-6 level and ACR increased gradually among NGT, PD and NDDM groups (P<0.01). Unlike adiponectin and IL-6, ACR analysis indicates a gradual increase from NGT, IFG, IGT, IFG+IGT to NDDM individuals (P<0.01). Gutt's index showed significant difference between IFG and NDDM, IFG+IGT and NDDM (P<0.01), but HOMA-IR index did not. CONCLUSIONS IR, chronic inflammation and endothelial dysfunction dose exist in prediabetic individuals, especially in IFG+IGT population. Gutt's index and ACR might seem to be more sensitive than adiponectin and HOMA-IR index as IR and chronic inflammation maker in prediabetic population.
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Affiliation(s)
- Qingguo Lü
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Tian H, Song G, Xie H, Zhang H, Tuomilehto J, Hu G. Prevalence of diabetes and impaired fasting glucose among 769,792 rural Chinese adults. Diabetes Res Clin Pract 2009; 84:273-8. [PMID: 19375188 DOI: 10.1016/j.diabres.2009.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 03/18/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the prevalence of diabetes and impaired fasting glucose (IFG) among rural Chinese adults. METHODS A cross-sectional whole-population health survey of 364781 men and 405011 women aged 35 years and over was undertaken in 2004 in Tianjin rural area. An overnight fasting capillary whole blood specimen was collected for glucose measurement and information on history of previously diagnosed diabetes was obtained by a standard questionnaire. RESULTS Using the World Health Organization standard, the age-standardized prevalence of IFG (fasting capillary whole blood glucose 5.6-6.0 mmol/l), screen-detected (previously undiagnosed) diabetes (>or=6.1 mmol/l) and previously diagnosed diabetes were 13.7%, 7.9% and 0.4% in men, 14.5%, 9.7% and 0.9% in women, and 14.1%, 8.8% and 0.7% in men and women combined, respectively. The prevalence of IFG, screen-detected diabetes and previously diagnosed diabetes was higher in women than in men (all p<0.001). The prevalence of IFG and diabetes was higher in participants of rural Tianjin than in the overall Chinese rural and urban population based on the Fourth National Nutritional Survey carried out in 2002. CONCLUSION The prevalence of IFG and diabetes is relatively high in the rural population in Tianjin and it has become an important public health problem in China.
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Khalangot M, Hu G, Tronko M, Kravchenko V, Guryanov V. Gender Risk of Nonfatal Stroke in Type 2 Diabetic Patients Differs Depending on the Type of Treatment. J Womens Health (Larchmt) 2009; 18:97-103. [PMID: 19105694 DOI: 10.1089/jwh.2008.0854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Gang Hu
- Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana
| | - Mykola Tronko
- Institute of Endocrinology and Metabolism, Kiev, Ukraine
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Khalangot M, Tronko M, Kravchenko V, Kulchinska J, Hu G. The joint effects of different types of glucose-lowering treatment and duration of diabetes on total and cardiovascular mortality among subjects with type 2 diabetes. Diabetes Res Clin Pract 2008; 82:139-47. [PMID: 18703252 DOI: 10.1016/j.diabres.2008.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 06/30/2008] [Accepted: 07/02/2008] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the joint effects of different types of glucose-lowering treatment (oral drugs, insulin, and both) and duration of diabetes on total and cardiovascular mortality among diabetic patients. METHODS Study cohorts included 30,534 Ukrainian males and 58,909 females with type 2 diabetes. During the mean follow-up of 2.7 years, 7804 deaths were recorded. RESULTS The multivariate-adjusted hazard ratios (HRs) for total mortality among diabetic patients, who used oral glucose-lowering drug (OGLD) only, insulin only, both insulin and OGLD, were 1.00, 2.34, and 2.22 in men, and 1.00, 2.12, and 2.20 in women, respectively. The multivariate-adjusted HRs for total mortality across categories of duration of diabetes (<5, 5-9, 10-14, 15-19, and >/=20 years) were 1.00, 1.17, 1.32, 1.43, and 1.57 (p(trend)<0.001) in men, and 1.00, 1.13, 1.34, 1.74, and 1.68 (p(trend)<0.001) in women, respectively. Diabetic patients who used insulin and reported longer duration of diabetes had the highest risk of total mortality. CONCLUSION Type 2 diabetic patients treated with insulin show a greater risk of death than those treated with OGLD only. Increasing duration of diabetes is associated with an increased death risk. The combination of insulin treatment and longer duration of diabetes identifies a particular high death risk.
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Affiliation(s)
- Mykola Khalangot
- V.P. Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine
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Abstract
OBJECTIVES Type 2 diabetes mellitus is characterized histopathologically by islet amyloid deposits formed from islet amyloid polypeptide. The aim of this study was to investigate sex difference in islet amyloid of type 2 diabetic patients. METHODS Pancreas specimens were collected from 235 autopsies with type 2 diabetes mellitus. Islet amyloid was identified with Congo red stain. The load of islet amyloid deposits was assessed by prevalence (percentage of cases with islet amyloid deposits), frequency (percentage of islets containing amyloid deposits), and severity (percentage of islet area occupied by amyloid deposits). RESULTS Women (n = 80) and men (n = 155) had similar age of death, duration of diabetes, body mass index, and hemoglobin (Hb)A1c level. Islet amyloid was found in 30.0% of the women and in 44.5% of the men (P = 0.035). None of 9 women younger than 50 years had islet amyloid. Frequency of amyloid-affected islets was 31.5% +/- 13.1% in women and 41.1% +/- 14.3% in men (P = 0.008). Severity of amyloid-affected islet area was 29.0% +/- 12.5% in women and 38.5% +/- 14.6% in men (P = 0.007). CONCLUSIONS Sex is a determinant of the development of islet amyloid in type 2 diabetes mellitus. This sex difference in islet amyloid may be related to a potential benefit of female sex hormones.
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Kato M, Dote K, Sasaki S, Ueda K, Nakano Y, Naganuma T, Watanabe Y, Yokoyama H. Impact of metabolic syndrome on coronary plaque vulnerability in Japanese women with acute coronary syndrome. Circ J 2008; 72:940-5. [PMID: 18503220 DOI: 10.1253/circj.72.940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous study has demonstrated that metabolic syndrome (MetS) can predict cardiovascular mortality in men, but the prediction was weak for women. In the present study predictors for multiple complex coronary lesions were investigated to clarify the impact of MetS in Japanese women with acute coronary syndrome (ACS). METHODS AND RESULTS Subjects were Japanese women with ACS (n=81) who underwent emergency coronary angiography and B-mode carotid ultrasonography. They were divided into 2 groups based on the number of complex plaques. Although the MetS prevalence identified using the Japanese criteria was similar between the 2 groups, using the modified ATP III criteria it was more in patients with multiple coronary lesions than in those with a single coronary lesion (p<0.02). The prevalence of diabetes mellitus (DM) in the multiple group was higher than that in the single group (p<0.008). Significant independent predictors for multiple complex coronary lesions were DM (odds ratio (OR) 4.78, p<0.03) and carotid artery remodeling (OR 8.81, p<0.02). Among the components of MetS, a low level of high-density lipoprotein-cholesterol (<50 mg/dl) was a significant independent predictor (p<0.007). CONCLUSIONS DM and carotid artery remodeling are useful markers for coronary vulnerability in Japanese women. Gender-specific pathophysiological differences may exist for components of MetS.
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Affiliation(s)
- Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
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71
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Hsieh MH, Yeh KM, Lo PH, Lee KW, Tsui HC, Lin JJ, Wang HJ, Chen CC. Subjects with coronary artery disease are at high risk for glucometabolic abnormality. Diabetes Res Clin Pract 2008; 81:e20-1. [PMID: 18565610 DOI: 10.1016/j.diabres.2008.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 05/04/2008] [Indexed: 10/21/2022]
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Rydén L. What are the risk factors for progression of coronary artery calcification in patients with type 2 diabetes? ACTA ACUST UNITED AC 2008; 5:370-1. [DOI: 10.1038/ncpcardio1208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 02/18/2008] [Indexed: 02/06/2023]
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73
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Goel A, Thor D, Anderson L, Rahimian R. Sexual dimorphism in rabbit aortic endothelial function under acute hyperglycemic conditions and gender-specific responses to acute 17beta-estradiol. Am J Physiol Heart Circ Physiol 2008; 294:H2411-20. [PMID: 18326804 DOI: 10.1152/ajpheart.01217.2007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epidemiological data suggest that hyperglycemia abrogates the gender-based cardiovascular protection possibly associated with estrogens. This study was designed to investigate 1) whether rabbit aortic rings show gender differences in the development of abnormal endothelium-dependent vasodilation (EDV) under acute hyperglycemic conditions, 2) the potential role of PKC isoforms and superoxide (O2-) in acute hyperglycemia-induced vascular dysfunction, and 3) the effect of acute estrogen administration on hyperglycemia-induced endothelial dysfunction in male and female rabbits. EDV to ACh was determined before and after 3 h of treatment with high glucose (HG) in phenylephrine-precontracted aortic rings from male and female New Zealand White rabbits. Similar experiments were conducted in the presence of inhibitors of PKC-alpha, PKC-beta, and PKC-delta or an O2- scavenger. The effect of acute estrogen administration was evaluated in the presence and absence of HG. Finally, mRNA expression of PKC isoforms was measured by real-time PCR. We found that 1) 3 h of incubation with HG impairs EDV to a greater extent in female than male aorta, 2) inhibition of PKC-beta or O2- prevents HG-induced impairment of EDV in female aorta, 3) acute 17beta-estradiol aggravates HG-induced endothelial dysfunction in female, but not male, aorta, and 4) PKC-alpha and PKC-beta expression are significantly higher in female than male aorta. This study reveals the predisposition of female rabbit aorta to vascular injury under hyperglycemic conditions, possibly via activation of PKC-beta and O2- production. Furthermore, it suggests that, under hyperglycemic conditions, acute estrogen treatment is detrimental to endothelial function in female rabbits.
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Affiliation(s)
- Aditya Goel
- Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA
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74
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Sui X, Hooker SP, Lee IM, Church TS, Colabianchi N, Lee CD, Blair SN. A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care 2008; 31:550-5. [PMID: 18070999 PMCID: PMC3410433 DOI: 10.2337/dc07-1870] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the independent and joint associations of cardiorespiratory fitness (CRF) and BMI with the incidence of type 2 diabetes in women. RESEARCH DESIGN AND METHODS An observational cohort of 6,249 women aged 20-79 years was free of baseline cardiovascular disease, cancer, and diabetes. CRF was measured using a maximal treadmill exercise test. BMI was computed from measured height and weight. The incidence of type 2 diabetes was identified primarily by 1997 American Diabetes Association criteria. RESULTS During a 17-year follow-up, 143 cases of type 2 diabetes occurred. Compared with the least fit third, the multivariate (including BMI)-adjusted hazard ratio (HR) (95% CI) was 0.86 (0.59-1.25) for the middle third and 0.61 (0.38-0.96) for the upper third of CRF. For BMI, the multivariate (including CRF)-adjusted HR (95% CI) was 2.34 (1.55-3.54) for overweight individuals and 3.70 (2.12-6.44) for obese individuals, compared with normal-weight patients. In the combined analyses, overweight/obese unfit (the lowest one-third of CRF) women had significantly higher risks compared with normal-weight fit (the upper two-thirds of CRF) women. CONCLUSIONS Low CRF and higher BMI were independently associated with incident type 2 diabetes. The protective effect of CRF was observed in individuals who were overweight or obese, but CRF did not eliminate the increased risk in these groups. These findings underscore the critical importance of promoting regular physical activity and maintaining normal weight for diabetes prevention.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.
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Does the constellation of risk factors with and without abdominal adiposity associate with different cardiovascular mortality risk? Int J Obes (Lond) 2008; 32:757-62. [PMID: 18209738 DOI: 10.1038/sj.ijo.0803797] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate whether the metabolic syndrome (MetS) defined by the International Diabetes Federation (IDF) criteria, which has abdominal adiposity as a mandatory element, predicts cardiovascular disease (CVD) mortality better than the cluster of other IDF-defined abnormalities not including abdominal adiposity. METHODS Data from nine European population-based studies, including 7782 men and 7739 women (aged 30-89 years), with a median follow-up of 8.55 years, were jointly analyzed. Hazard ratios for CVD mortality were calculated with Cox regression models. RESULTS In total, 41% of the men and 38% of the women had the IDF MetS. Individuals with the IDF MetS were by definition more obese and had a higher prevalence of diabetes than non-obese subjects with > or = 2 IDF abnormalities; whereas non-obese men with > or = 3 factors had more atherogenic lipid profiles. Multivariate adjusted hazard ratio for CVD death in men and women with the IDF MetS was 2.44 (1.69-2.98) and 2.32 (1.27-4.23); in non-obese men with 2 and > or = 3 factors the hazard ratio was 1.60 (1.12-2.30) and 2.44 (1.62-3.66), respectively, and in non-obese women with 2 factors the hazard ratio was 2.41 (1.09-5.33). CONCLUSIONS The cluster of the CVD risk factors predicted CVD mortality regardless of the presence or absence of the abdominal adiposity. Inclusion of abdominal adiposity as a prerequisite will miss those non-obese individuals who have increased CVD mortality.
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76
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Berry JD, Dyer A, Carnethon M, Tian L, Greenland P, Lloyd-Jones DM. Association of traditional risk factors with cardiovascular death across 0 to 10, 10 to 20, and >20 years follow-up in men and women. Am J Cardiol 2008; 101:89-94. [PMID: 18157971 DOI: 10.1016/j.amjcard.2007.07.079] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 11/26/2022]
Abstract
Previous studies have evaluated the strength of the association between traditional risk factors and cardiovascular disease (CVD) across varying lengths of follow-up in men. However, to our knowledge, little is known regarding the behavior of these risk factors across time in women. Thus, we sought to determine the association between traditional risk factors in men and women across follow-up periods of 0 to 10, 10 to 20, and >20 years. We studied 9,033 men and 7,575 women (ages 40 to 59 years) from 1967 to 1973 from the Chicago Heart Association Detection Project in Industry. Multivariable-adjusted Cox proportional hazard models were constructed to compare the hazard ratios (HRs) and 95% confidence intervals (CI) for CVD risk factors measured at baseline across different periods of follow-up (0 to 10, 10 to 20, and >20 years). In women, the HRs for smoking and diabetes mellitus were strongest at 0 to 10 years (HR 5.38, 95% CI 2.99 to 9.67 and 3.84, 95% CI 1.82 to 8.13, respectively) but decreased at >20 years (HR 1.71, 95% CI 1.48 to 1.97 and 1.60, 95% CI 1.10 to 2.32, respectively). In men, the HR (per 4 kg/m(2)) for body mass index appeared to increase (0 to 10 years, 1.01, 95% CI 0.90 to 1.14; >20 years, 1.20, 95% CI 1.13 to 1.28). In women, the association was similar across all follow-up periods. For both men and women, the HR for total serum cholesterol remained unchanged across the follow-up. In conclusion, we found gender differences in the patterns of association between risk factors measured at baseline and CVD death across different periods of follow-up. In women, the increased risk associated with both diabetes mellitus and smoking was most prominent in the early follow-up periods.
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ISHIKAWA S, KARIO K, KAYABA K, GOTOH T, NAGO N, NAKAMURA Y, TSUTSUMI A, KAJII E. Continued High Risk of Stroke in Treated Hypertensives in a General Population: The Jichi Medical School Cohort Study. Hypertens Res 2008; 31:1125-33. [DOI: 10.1291/hypres.31.1125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bentley-Lewis R, Koruda K, Seely EW. The metabolic syndrome in women. ACTA ACUST UNITED AC 2007; 3:696-704. [PMID: 17893688 PMCID: PMC4428566 DOI: 10.1038/ncpendmet0616] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 07/09/2007] [Indexed: 12/14/2022]
Abstract
The metabolic syndrome is estimated to be present in 47 million US residents with a similar age-adjusted prevalence in men (24%) and women (23%). The consideration of various metabolic risk factors as a single entity in the metabolic syndrome provides clinicians with a tool by which they can identify a population at increased risk for type 2 diabetes mellitus and increased cardiovascular morbidity and mortality. Cardiovascular disease is the leading cause of mortality in women in the US. To reduce the risk of cardiovascular disease, efforts have focused on modifying the metabolic risk factors that constitute the metabolic syndrome: abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. In addition, because of several circumstances specific to women, including pregnancy, polycystic ovary syndrome, oral contraceptive therapy use, and menopause, there are special considerations regarding risk factor identification, modification, and clinical management. This article provides a review of diagnostic and therapeutic issues that clinicians should consider when caring for women at risk for developing or diagnosed with the metabolic syndrome.
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Affiliation(s)
- Rhonda Bentley-Lewis
- Harvard Medical School, Brigham and Women's Hospital, Division of Endocrinology, Diabetes, and Hypertension, Boston, MA 02115, USA.
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González-Clemente JM, Palma S, Arroyo J, Vilardell C, Caixàs A, Giménez-Palop O, Delgado-Rodríguez M. ¿La diabetes mellitus es un equivalente de riesgo coronario? Resultados de un metaanálisis de estudios prospectivos. Rev Esp Cardiol 2007. [DOI: 10.1157/13111789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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80
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Protopsaltis I, Nikolopoulos G, Dimou E, Brestas P, Kokkoris S, Korantzopoulos P, Melidonis A. Metabolic syndrome and its components as predictors of all-cause mortality and coronary heart disease in type 2 diabetic patients. Atherosclerosis 2007; 195:189-94. [PMID: 17064711 DOI: 10.1016/j.atherosclerosis.2006.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 09/20/2006] [Accepted: 09/27/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is no consistent evidence regarding the prognostic value of metabolic syndrome (MS) in predicting all-cause mortality and coronary heart disease (CHD) risk among type 2 diabetic patients. We sought to investigate whether individual or various combinations of MS components have a different predictive value than the presence of MS in this setting. METHODS Six hundred type 2 diabetic patients (mean age 60.4+/-9 years, 54% males) without known CHD were prospectively followed-up for a mean period of 10.06 years. The presence of MS was examined using the National Cholesterol Education Program (NCEP) definition. Statistical analyses were performed using Kaplan-Meier estimator and Cox proportional Hazard models. RESULTS MS was present in 62.4% of the patients while 142 died during follow-up. Significant predictors for all-cause mortality were the presence of MS (HR 1.75), sex (HR 1.69), age (HR 1.09), and diabetes duration (HR 1.02). Regarding CHD incidents, HDL (HR 0.98), systolic blood pressure (HR 1.01), sex (HR 2.05), and total cholesterol (HR 1.005) were significant predictors while the presence of MS was not. Subjects fulfilling the triad consisting of diabetes, hypertension, and low HDL or the combination of diabetes, hypertension, low HDL, and high triglyceride levels had the highest probability for developing CHD events (HR 1.79, 1.73, respectively). CONCLUSIONS The presence of MS in type 2 diabetic patients without known CHD reduces the 10-year survival while specific combinations of its components have different impact on CHD risk.
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Does diagnosis of the metabolic syndrome detect further men at high risk of cardiovascular death beyond those identified by a conventional cardiovascular risk score? The DECODE Study. ACTA ACUST UNITED AC 2007; 14:192-9. [PMID: 17446796 DOI: 10.1097/01.hjr.0000230107.78524.da] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is not known whether the metabolic syndrome detects further individuals at high risk of death from cardiovascular disease (CVD), beyond those identified by a conventional cardiovascular risk score. DESIGN A prospective study. METHODS A total of 2790 men without diabetes, aged 50-69 years from seven population-based European cohorts participating in the DECODE Study, were followed for CVD mortality over 10 years. RESULTS Some 51% of the men had an estimated 10-year risk of fatal CVD under 5%, using the European SCORE project equation, and 22% of them had the metabolic syndrome, as defined by the National Cholesterol Education Program Adult Treatment Panel III. In the low-risk men, the hazards ratio for fatal CVD, after adjusting for age and study centre, was 2.71 (1.33-5.51) for men with the syndrome (P<0.01) compared with men without the syndrome. A large waist circumference (>102 cm) carried an odds ratio of 2.24 (1.05-4.76) in the low CVD risk men. CONCLUSIONS Men with a low cardiovascular risk score and the metabolic syndrome had a significantly higher risk of fatal CVD than those without the syndrome. The use of the metabolic syndrome in clinical practice is thus justified in men, but waist circumference provided a simpler diagnostic tool with similar fatal CVD risk in these low-risk men. A large waist circumference could be used for prescreening, and could be included in CVD risk scores.
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Goel A, Zhang Y, Anderson L, Rahimian R. Gender difference in rat aorta vasodilation after acute exposure to high glucose: involvement of protein kinase C beta and superoxide but not of Rho kinase. Cardiovasc Res 2007; 76:351-60. [PMID: 17678882 PMCID: PMC2128745 DOI: 10.1016/j.cardiores.2007.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 06/25/2007] [Accepted: 06/28/2007] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Several reports suggest that acute hyperglycemia affects male and female vascular beds differently. However, little is known about the interactions between hyperglycemia and gender in the vasculature. The objectives of our study were to investigate if there is a gender-based difference in the relaxation response of rat aorta after acute exposure to high glucose concentration, and the potential role of protein kinase C-beta (PKCbeta), superoxide, and Rho kinase in the gender-specific effect of acute high glucose on the relaxation response. METHODS Endothelium-dependent dilator responses to acetylcholine (ACh, 10(-8) to 10(-5) M) were obtained before and after 3 h treatment with Krebs' solution containing high glucose (46 mM) in aortic rings pre-contracted with phenylephrine (2 microM) taken from female and male Sprague-Dawley rats. Similar experiments were generated in the presence of 1 microM LY379196, a selective PKCbeta inhibitor, 25 microM MnTMPyP, a superoxide dismutase mimetic, or 1 microM Fasudil, a Rho kinase inhibitor. Furthermore, protein expression of PKCbeta isoforms was measured by Western blotting. RESULTS We demonstrated that a 3 h incubation with elevated level of glucose impairs ACh responses only in the female rat aortic rings. Inhibition of PKCbeta or superoxide production but not Rho kinase prevents the high glucose-induced impairment of endothelium-dependent relaxation of female rat aorta. In addition, PKCbeta2 expression is significantly higher in the female rat aorta than that in male rat aorta. CONCLUSION These results suggest that the gender difference in the impairment of endothelium-dependent vasodilation after acute exposure to high glucose in rat aorta is possibly due to differences in PKCbeta2 expression.
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Affiliation(s)
- Aditya Goel
- AG, YZ, RR, Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific (Stockton, CA 95211)
| | - Yingmin Zhang
- AG, YZ, RR, Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific (Stockton, CA 95211)
| | - Leigh Anderson
- LA, Department of Anatomical Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific (San Francisco, CA 94115)
| | - Roshanak Rahimian
- AG, YZ, RR, Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific (Stockton, CA 95211)
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Abstract
Blood pressure control and prevention of glucose intolerance are primary factors in overcoming the increased cardiovascular risks in menopausal women. This heightened risk may partially be explained by the metabolic syndrome - a precursor of type 2 diabetes - in which the renin-angiotensin-aldosterone system may play a pivotal role. Once diabetes occurs, the cardiovascular risk is considerably greater in postmenopausal women than in men - especially if hypertension is also present. An additional risk factor, weight gain, is common in postmenopausal women not treated with hormone replacement therapy. Rigorous control of blood pressure has been shown to be particularly beneficial in women with metabolic syndrome; a reduction in blood pressure can reduce the mortality rate of ischemic stroke. The administration of hormone replacement therapy can also reduce the likelihood of coronary heart disease in postmenopausal women; therefore therapy should be started early in the menopausal transition to maximize cardiovascular protection. As such, an ideal hormone replacement therapy that can overcome hypertension, prevent body weight gain and control serum triglycerides offers an important advance in cardiovascular risk management during the menopause.
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Affiliation(s)
- G M Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy
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84
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Guías de práctica clínica sobre diabetes, prediabetes y enfermedades cardiovasculares: versión resumida. Rev Esp Cardiol 2007. [DOI: 10.1016/s0300-8932(07)75070-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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85
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Ferreira I, Boreham CA, Twisk JWR, Gallagher AM, Young IS, Murray LJ, Stehouwer CDA. Clustering of metabolic syndrome risk factors and arterial stiffness in young adults: the Northern Ireland Young Hearts Project. J Hypertens 2007; 25:1009-20. [PMID: 17414665 DOI: 10.1097/hjh.0b013e3280a94e76] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study aimed to investigate whether the clustering of the risk factors of the metabolic syndrome (MetS) is associated with stiffness of central and peripheral arterial segments; whether these associations are similar in men and women; and whether insulin resistance and low-grade inflammation mediate any such associations. BACKGROUND Increased arterial stiffness may explain, at least in part, the increased cardiovascular and diabetes risk associated with the MetS. However, the mechanisms linking the MetS to an increased arterial stiffness are incompletely understood, and gender differences may exist. METHODS Cross-sectional analyses of data on 313 young men and women (mean age 23 years) from the Northern Ireland Young Hearts Project. Subjects were categorized according to the number of traits of the MetS; in addition a continuous MetS score was calculated. Arterial stiffness was assessed by measuring pulse wave velocity (PWV) in three arterial segments using a non-invasive optical method. RESULTS The prevalence of the MetS was similar for men (10.6%) and women (10.5%). After adjustment for potential confounders and other cardiovascular risk factors, PWV of the three arterial segments investigated increased with increasing traits of the MetS in women only. Women with the MetS, as compared to those without risk factors of the syndrome, had greater PWV of the aorto-iliac (+14.0%, P = 0.016), the aorto-radial (+13.2%, P = 0.010) and aorto-dorsalis pedis (+11.8%, P = 0.011) segments. A great deal (up to 75%) of the association between the MetS and aortic-iliac PWV was mediated by heart rate, inflammation markers [C-reactive protein (CRP) and fibrinogen] and insulin resistance [homeostatic model assessment-insulin resistance (HOMA-IR)], whereas these variables did not explain much of the association between the MetS and PWV of the peripheral segments. CONCLUSIONS Young women with the MetS show increased stiffness of peripheral and central arteries, a mechanism that may explain their increased cardiovascular risk. Low-grade inflammation, insulin resistance and sympathetic activation explain much of the adverse impact of the MetS on central, but not peripheral, arterial stiffness.
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Affiliation(s)
- Isabel Ferreira
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands.
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86
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Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender Disparities in the Quality of Cardiovascular Disease Care in Private Managed Care Plans. Womens Health Issues 2007; 17:120-30. [PMID: 17448685 DOI: 10.1016/j.whi.2007.03.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/11/2007] [Accepted: 03/13/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations. METHODS Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans' clustering effects. RESULTS Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at <100 mg/dL in those who have diabetes (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86) or a history of CVD (OR, 0.72; CI 95%, 0.64-0.82). The difference between men and women in meeting the LDL control measures was 5.74% among those with diabetes (44.3% vs. 38.5%) and 8.53% among those with a history of CVD (55.1% vs. 46.6%). However, women achieved higher performance than men in controlling blood pressure (OR, 1.12; 95% CI, 1.02-1.21), where the rate of women meeting this quality indicator exceeded that of men by 1.94% (70.8% for women vs. 68.9% for men). CONCLUSIONS Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. Poor performance in LDL control was seen in both men and women, with a lower rate of control in women suggesting the possibility of less intensive cholesterol treatment in women. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities.
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Affiliation(s)
- Ann F Chou
- Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73120, USA.
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87
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Hu G, Jousilahti P, Bidel S, Antikainen R, Tuomilehto J. Type 2 diabetes and the risk of Parkinson's disease. Diabetes Care 2007; 30:842-7. [PMID: 17251276 DOI: 10.2337/dc06-2011] [Citation(s) in RCA: 316] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether type 2 diabetes at baseline is a risk factor for Parkinson's disease. RESEARCH DESIGN AND METHODS We prospectively followed 51,552 Finnish men and women 25-74 years of age without a history of Parkinson's disease at baseline. History of diabetes and other study parameters were determined at baseline using standardized measurements. Ascertainment of the Parkinson's disease status was based on the nationwide Social Insurance Institution's drug register data. Hazard ratios of incident Parkinson's disease associated with the history of type 2 diabetes were estimated. RESULTS During a mean follow-up period of 18.0 years, 324 men and 309 women developed incident Parkinson's disease. Age- and study year-adjusted hazard ratios of incident Parkinson's disease among subjects with type 2 diabetes, compared with those without it, were 1.80 (95% CI 1.03-3.15) in men, 1.93 (1.05-3.53) in women, and 1.85 (1.23-2.80) in men and women combined (adjusted also for sex). Further adjustment for BMI, systolic blood pressure, total cholesterol, education, leisure-time physical activity, smoking, alcohol drinking, and coffee and tea consumption affected the results only slightly. The multivariate adjusted association between type 2 diabetes and the risk of Parkinson's disease was also confirmed in stratified subgroup analysis. CONCLUSIONS These data suggest that type 2 diabetes is associated with an increased risk of Parkinson's disease. Surveillance bias might account for higher rates in diabetes. The mechanism behind this association between diabetes and Parkinson's disease is not known.
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Affiliation(s)
- Gang Hu
- Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki, Finland.
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88
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Kuch B, von Scheidt W, Peter W, Döring A, Piehlmeier W, Landgraf R, Meisinger C. Sex-specific determinants of left ventricular mass in pre-diabetic and type 2 diabetic subjects: the Augsburg Diabetes Family Study. Diabetes Care 2007; 30:946-52. [PMID: 17392555 DOI: 10.2337/dc06-2123] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Obesity and hypertension are regarded as the most important determinants of left ventricular mass in the community. Little is known about sex-specific influences of obesity, hypertension, and other risk factors on left ventricular mass in pre-diabetic or diabetic subjects. RESEARCH DESIGN AND METHODS We examined how body composition, blood pressure, and other factors are related to left ventricular structure in elderly subjects (mean age 62 years, 88% of women postmenopausal) with pre-diabetes (impaired fasting glucose or impaired glucose tolerance; n = 112) and diabetes with (n = 181) and without (n = 213) overt cardiovascular disease (CVD). RESULTS Neither microalbuminuria nor physical activity was significantly associated with left ventricular mass. In pre-diabetic as well as diabetic subjects with CVD, mainly BMI and fat mass, particularly in women, were correlated with left ventricular mass. In the diabetic group without overt CVD, fat mass was only slightly correlated with left ventricular mass. In the latter group waist-to-hip-ratio, and, only in men, systolic blood pressure, glucose, and A1C were moderately correlated with left ventricular mass. Multiregression analysis over all groups again revealed fat mass as the main determinant of left ventricular mass in women. In women but not men obesity was associated with a significantly increased prevalence of concentric left ventricular hypertrophy. CONCLUSIONS In pre-diabetic and diabetic elderly subjects fat mass is the major determinant of left ventricular mass in women but not in men. These results may partly explain sex differences in CVD mortality in obese elderly diabetic subjects and underscore the need for activities focused on weight reduction.
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Affiliation(s)
- Bernhard Kuch
- Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Augsburg, Germany.
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89
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Dunstan DW, Salmon J, Healy GN, Shaw JE, Jolley D, Zimmet PZ, Owen N. Association of television viewing with fasting and 2-h postchallenge plasma glucose levels in adults without diagnosed diabetes. Diabetes Care 2007; 30:516-22. [PMID: 17327314 DOI: 10.2337/dc06-1996] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the associations of television viewing time with fasting plasma glucose (FPG) and 2-h postchallenge plasma glucose (2-h PG) levels in Australian adults. RESEARCH DESIGN AND METHODS A total of 8,357 adults aged > 35 years who were free from diagnosed diabetes and who attended a population-based cross-sectional study (Australian Diabetes, Obesity and Lifestyle Study [AusDiab]) were evaluated. Measures of FPG and 2-h PG were obtained from an oral glucose tolerance test. Self-reported television viewing time (in the previous week) was assessed using an interviewer-administered questionnaire. Homeostasis model assessment (HOMA) of insulin sensitivity (HOMA-%S) and beta-cell function (HOMA-%B) were calculated based on fasting glucose and insulin concentrations. RESULTS After adjustment for confounders and physical activity time, time spent watching television in women was positively associated with 2-h PG, log fasting insulin, and log HOMA-%B and inversely associated with log HOMA-%S (P < 0.05) but not with FPG. No significant associations were observed with glycemic measures in men. The beta-coefficients across categories of average hours spent watching television per day (< 1.0, 1.0-1.9, 2.0-2.9, 3.0-3.9, and > or = 4.0) for 2-h PG in women were 0 (reference), 0.009, 0.047, 0.473, and 0.501, respectively (P for trend = 0.02). CONCLUSIONS Our findings highlight the unique deleterious relationship of sedentary behavior (indicated by television viewing time) and glycemic measures independent of physical activity time and adiposity status. These relationships differed according to sex and type of glucose measurement, with the 2-h PG measure being more strongly associated with television viewing. The findings suggest an important role for reducing sedentary behavior in the prevention of type 2 diabetes and cardiovascular disease, especially in women.
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Shalev V, Chodick G, Bialik M, Green MS, Heymann AD. In a population-based cohort of diabetes patients, men and women had similar risks for all-cause mortality. J Clin Epidemiol 2007; 60:86-93. [PMID: 17161759 DOI: 10.1016/j.jclinepi.2006.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 12/08/2005] [Accepted: 04/06/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare death rates of diabetic men and women relative to the general population and to identify sex-specific risk factors for all-cause mortality. STUDY DESIGN AND SETTINGS In the current historical prospective cohort study, standardized mortality ratios (SMRs) were calculated for 19,657 men and women with diabetes in a large Israeli health care organization compared to the mortality in the general population from 1999 to 2003. In addition, sex-specific survival analyses were performed for men and women separately using baseline data obtained between 1995 and 1999. RESULTS During the study follow-up (90,899 person-years), 2,924 deaths were identified. The SMR for diabetic women (1.40; 95% confidence interval [CI]: 1.33, 1.47) was significantly (P<0.01) higher than for diabetic men (1.20; 95% CI: 1.14, 1.26). Age, glycated hemoglobin, serum creatinine, low-density lipoprotein, high-density lipoprotein, dialysis, use of angiotensin-converting enzyme inhibitors, and insulin were similarly associated with mortality in both sexes. Residing in the south of Israel was related with higher risk among men but with decreased risk among women. CONCLUSIONS The study indicates that diabetes seems to eliminate the relative protection against death usually seen in women. It also suggests that most risk factors are comparable between the sexes, underlining the importance of similarly intensive disease management in diabetic women and in diabetic men.
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Affiliation(s)
- Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
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91
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Lavis VR, Picolos MK, Willerson JT. Endocrine Disorders and the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rosano GMC, Vitale C, Fini M. Hormone Replacement Therapy and Cardioprotection: What Is Good and What Is Bad for the Cardiovascular System? Ann N Y Acad Sci 2006; 1092:341-8. [PMID: 17308159 DOI: 10.1196/annals.1365.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The incidence of cardiovascular diseases (CVDs) increases after menopause and at any age postmenopausal women have a significantly higher incidence of CVD compared to premenopausal women. Several epidemiological findings suggest the causative pathogenetic role of ovarian hormone deficiency in the development of CVD in women. Ovarian hormones have several potential protective effects on the cardiovascular system and despite several observational studies have shown the beneficial effect of estrogens and estrogen/progestin associations on CVD, at the present, after the findings of randomized studies, the effect of hormone replacement therapy (HRT) in the prevention of CVD is still under debate. The randomized studies (Heart and Estrogen/Progestin Replacement Study [HERS] and Women's Health Initiative [WHI]) found largely concordant results with the observational studies except for the divergent findings about coronary heart disease (CHD). The discrepancy between the two arms of the WHI study suggests that two factors, time to initiation of HRT since menopause and estrogen/progestin associations, are of pivotal importance to explain the widely divergent findings on the cardiovascular effects of observational studies and randomized clinical studies. Basic science and animal studies together with clinical investigations and the results of clinical studies are concordant in suggesting that a long time since menopause is associated with a reduced protective effect of estrogens while the unfavorable effects upon coagulation remain unaltered. In early postmenopausal women, like the ones included in the observational studies, ovarian hormone replacement may be cardioprotective because of the responsiveness of the endothelium to estrogens that also buffer the detrimental effects upon coagulation. In late postmenopausal women ovarian hormones have either a null effect or even a detrimental effect because of the predominance of the procoagulant or plaque-destabilizing effects over the vasoprotective effects. Therefore, HRT has beneficial cardiovascular effects in younger women while it may have detrimental effect on coagulative balance and vascular inflammation and has little effect on cardiovascular functions in older women.
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Affiliation(s)
- Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Roma Via della Pisana 234, 00163 Rome, Italy.
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93
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Legato MJ, Gelzer A, Goland R, Ebner SA, Rajan S, Villagra V, Kosowski M. Gender-specific care of the patient with diabetes: review and recommendations. ACTA ACUST UNITED AC 2006; 3:131-58. [PMID: 16860272 DOI: 10.1016/s1550-8579(06)80202-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have focused almost exclusively on men. OBJECTIVE The purpose of this review was to survey the literature about the sex-specific features of DM and to make recommendations for the gender-specific care of patients. METHODS An initial literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender, women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search terms were included. The strength of each recommendation was assessed. RESULTS : Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for CAD. Disease management programs for patients with diabetes have been shown to save money and improve outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes available. CONCLUSION Gender-specific care of the patient with diabetes should be informed by evidence-based recommendations.
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Affiliation(s)
- Marianne J Legato
- Partnership for Gender-Specific Medicine at Columbia University, Columbia University College of Medicine, New York, New York, USA.
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94
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Bidel S, Hu G, Qiao Q, Jousilahti P, Antikainen R, Tuomilehto J. Coffee consumption and risk of total and cardiovascular mortality among patients with type 2 diabetes. Diabetologia 2006; 49:2618-26. [PMID: 17019600 DOI: 10.1007/s00125-006-0435-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 07/27/2006] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Higher habitual coffee drinking has been associated with a lower risk of developing type 2 diabetes. The relation between coffee consumption and risk of cardiovascular disease (CVD) has been examined in many studies, but the issue remains controversial. This study was designed to assess the association between coffee consumption and CVD mortality among patients with type 2 diabetes. METHODS We prospectively followed 3,837 randomly ascertained Finnish patients with type 2 diabetes aged 25 to 74 years. Coffee consumption and other study parameters were determined at baseline. The International Classification of Diseases was used to identify CHD, CVD and stroke cases using computerised record linkage to the national Death Registry. The associations between coffee consumption at baseline and risk of total, CVD, CHD, and stroke mortality were analysed by using Cox proportional hazards models. RESULTS During the average follow-up of 20.8 years, 1,471 deaths were recorded, of which 909 were coded as CVD, 598 as CHD and 210 as stroke. The respective multivariate-adjusted hazard ratios in participants who drank 0-2, 3-4, 5-6, and > or =7 cups of coffee daily were 1.00, 0.77, 0.68 and 0.70 for total mortality (P<0.001 for trend), 1.00, 0.79, 0.70 and 0.71 for CVD mortality (P=0.006 for trend), 1.00, 0.78, 0.70 and 0.63 for CHD mortality (p=0.01 for trend), and 1.00, 0.77, 0.64 and 0.90 for stroke mortality (p=0.12 for trend). CONCLUSIONS/INTERPRETATION In this large prospective study we found that in type 2 diabetic patients coffee drinking is associated with reduced total, CVD and CHD mortality.
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Affiliation(s)
- S Bidel
- Diabetes and Genetic Epidemiology Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
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95
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Hu G, Jousilahti P, Sarti C, Antikainen R, Tuomilehto J. The effect of diabetes and stroke at baseline and during follow-up on stroke mortality. Diabetologia 2006; 49:2309-16. [PMID: 16896934 DOI: 10.1007/s00125-006-0378-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 06/22/2006] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare the magnitude of the effect of diabetes and stroke at baseline and during follow-up on risk of stroke mortality. MATERIALS AND METHODS Study cohorts included 25,155 Finnish men and 26,423 women aged 25-74 years. Data on diabetes and stroke history at baseline, their incidence during follow-up, and stroke death were obtained from national registers. RESULTS During a mean follow-up of 18.9 years, 838 stroke deaths were recorded. In the baseline study, hazard ratios (HRs) for stroke mortality were 5.26 for men with prior diabetes only, 4.76 for men with prior stroke only, and 13.4 for men with both prior diabetes and stroke compared with men without diabetes and stroke at baseline and during follow-up. In women, the corresponding hazard ratios were 7.29, 5.27 and 5.52, respectively. When only diabetes and stroke status during the follow-up were considered, the hazard ratios for stroke mortality were 1.41 for men and 1.56 for women with incident diabetes only, 5.62 for men and 5.58 for women with incident stroke only, and 5.59 for men and 4.48 for women with both incident diabetes and stroke compared with men and women without diabetes and stroke at baseline and during follow-up. CONCLUSIONS/INTERPRETATION Diabetes and stroke, present either at baseline or during follow-up, markedly increase the risk of stroke death. Prior stroke at baseline carries a similar risk of stroke mortality as prior diabetes. There is a greater risk of stroke mortality associated with incident stroke during follow-up than with incident diabetes.
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Affiliation(s)
- G Hu
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
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96
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Zandbergen AAM, Sijbrands EJ, Lamberts SW, Bootsma AH. Normotensive women with type 2 diabetes and microalbuminuria are at high risk for macrovascular disease. Diabetes Care 2006; 29:1851-5. [PMID: 16873791 DOI: 10.2337/dc06-0287] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men. The pathogenesis for this risk difference has not been fully elucidated. We investigated whether female sex was associated with macrovascular disease and death, independently of known risk factors related to type 2 diabetes, nephropathy, or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS We conducted a prospective, prolonged follow-up study of a subgroup of 67 diabetic patients (46 men and 21 women) without established cardiovascular disease who participated in a larger clinical trial. Data were collected on current and past health, medication use, blood pressure, renal function, and HbA(1c) during the follow-up period of 4.7 +/- 0.8 (means +/- SE) years. The end point was a composite of death, cardiovascular disease, cerebrovascular events, and peripheral artery disease. RESULTS Of the women, eight (38.1%) met the end point compared with six (13.4%) of the men (P = 0.02 for difference in event-free survival). The hazard ratio of women relative to men was 3.19 (95% CI 1.11-9.21), which further increased after adjusting for age, systolic blood pressure, BMI, smoking, total-to-HDL cholesterol ratio, urinary albumin excretion, and retinopathy. CONCLUSIONS In our study population of normotensive patients with type 2 diabetes and microalbuminuria, female sex was associated with increased risk of fatal and nonfatal cardiovascular disease, independent of the classical cardiovascular risk factors, the severity of nephropathy or presence of retinopathy, or health care utilization.
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Affiliation(s)
- Adrienne A M Zandbergen
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
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97
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Sarafidis PA, McFarlane SI, Bakris GL. Gender disparity in outcomes of care and management for diabetes and the metabolic syndrome. Curr Diab Rep 2006; 6:219-24. [PMID: 16898575 DOI: 10.1007/s11892-006-0038-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although diabetes lies among the major risk factors for cardiovascular disease (CVD) in both men and women, current evidence suggests that it has a much stronger effect on the risk of coronary heart disease (CHD) in women than in men. Moreover, diabetic women have not experienced the decline in CHD mortality observed in diabetic men and individuals without diabetes over the past three decades. Apart from a more pronounced direct effect of diabetes on the vascular wall, this greater impact of diabetes on CHD risk in women could be associated with a heavier burden of other traditional cardiovascular risk factors within the context of the metabolic syndrome, a stronger effect of the metabolic syndrome on CVD, and a less aggressive management of the various risk factors in diabetic women compared with men. This article discusses the recent evidence on the gender differences in the outcomes of CVD and the management of risk factors associated with diabetes and the metabolic syndrome, highlighting the need for better treatment strategies of diabetes and the other components of the metabolic syndrome in diabetic women.
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98
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Thomas GN, McGhee SM, Schooling CM, Ho SY, Lam KSL, Janus ED, Lam TH. Determinants of normoglycemia and contribution to cardiovascular risk factors in a Chinese population: the Hong Kong Cardiovascular Risk Factor Study. J Endocrinol Invest 2006; 29:528-35. [PMID: 16840831 DOI: 10.1007/bf03344143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Glucose intolerance is clearly associated with increasing risk of cardiovascular disease, but the association among increasing glycemia and cardiovascular risk factors, angina and coronary heart disease in normoglycemic subjects is less clear, particularly in Chinese. METHODS A total of 2763 subjects were recruited and the prevalence of glucose intolerance investigated, using fasting or 2-h 75-g oral glucose tolerance test (OGTT), glucose levels. Subjects normoglycemic by both criteria were selected and the relationship between glycemia and cardiovascular risk factors investigated using analysis of variance and stepwise multiple linear regression analyses. RESULTS 1931 (69.9%) subjects were normoglycemic by both tests. After adjustment for age and gender, quartiles of fasting and post-load glucose levels showed a clear positive relationship with cardiovascular risk factors, including obesity, blood pressure and lipid levels (p<0.001 for all). Additionally, other measures of glycemia and insulin resistance also dose-dependently increased with increasing fasting and post-load glucose levels (p<0.001 for all). Stepwise multiple regression showed that in females, age (standardised regression coefficient beta (beta)=0.23, p<0.001), insulin (beta=0.17, p<0.001), waist circumference (beta=0.11, p=0.007) were independently associated with fasting glucose levels; and body mass index (beta=0.17, p<0.001), age (beta=0.15, p<0.001) and triglycerides (beta=0.15, p<0.001) were independently associated with post-load glucose levels. In males, age (beta=0.19, p<0.001) and insulin (beta=0.18, p<0.001) were independently associated with fasting glucose levels; and waist circumference (beta=0.17, p<0.001), triglycerides (beta=0.16, p<0.001) and insulin (beta=0.12, p=0.001) were independently associated with post-load glucose levels.
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Affiliation(s)
- G Neil Thomas
- Department of Community Medicine and School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
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Akamine EH, Kawamoto EM, Scavone C, Nigro D, Carvalho MHC, de Cássia A Tostes R, Britto LRG, Fortes ZB. Correction of endothelial dysfunction in diabetic female rats by tetrahydrobiopterin and chronic insulin. J Vasc Res 2006; 43:309-20. [PMID: 16682803 DOI: 10.1159/000093196] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 02/19/2006] [Indexed: 11/19/2022] Open
Abstract
Diabetes-induced vascular dysfunction has mainly been studied in males. However, the mechanisms involved may not correspond to those in females. Here we analyzed the effects of tetrahydrobiopterin (BH(4)) and chronic insulin on the physiology of mesenteric arterioles of alloxan-diabetic female rats. The parameters studied were the mesenteric arteriolar reactivity (intravital microscopy), nitric oxide synthase (NOS) activity (conversion of L-arginine to L-citrulline), eNOS gene expression (RT-PCR), NO production (diaminofluorescein), reactive oxygen species (ROS) generation (intravital fluorescence microscopy) and Cu/Zn superoxide dismutase (SOD) activity (spectrophotometry) and gene expression (RT-PCR). The reduced endothelium-dependent vasodilation of diabetic females was corrected by both BH(4) and insulin. NOS activity was decreased by diabetes, but insulin did not correct it. However, NOS expression was not modified by either diabetes or insulin. Arterioles of diabetic rats exhibited lower NO production, which was fully corrected by BH(4) and only partially by insulin. ROS generation was increased in diabetic rats, and both BH(4) and insulin normalized it. Diabetes did not change SOD activity and gene expression. However, insulin increased SOD activity but not its expression. Our data suggest that, similarly to males, endothelial dysfunction in female diabetic rats involves an altered ROS/NO imbalance. In contrast to males, however, insulin does not regulate NOS in the microcirculation of diabetic females.
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Affiliation(s)
- Eliana H Akamine
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Thomas GN, McGhee SM, Schooling M, Ho SY, Lam KSL, Janus ED, Lam TH. Impact of sex-specific body composition on cardiovascular risk factors: the Hong Kong Cardiovascular Risk Factor Study. Metabolism 2006; 55:563-9. [PMID: 16631430 DOI: 10.1016/j.metabol.2005.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2004] [Accepted: 08/04/2005] [Indexed: 11/24/2022]
Abstract
The aim of the study was to analyze the effects of sex-specific distribution of adiposity, particularly emphasizing the independent contribution of waist and hip circumferences relative to body mass index (BMI), on cardiovascular risk factors in a Chinese population. Blood pressure and anthropometric and biochemical parameters were measured in 2510 population-based Chinese subjects. The relative contributions of waist and hip circumferences to the presence of cardiovascular risk factors were determined. The Chinese men were significantly larger than women, with greater BMI and central adiposity. Waist and hip circumferences were both positively associated with the presence of hypertension, dyslipidemia, and diabetes. However, after adjustment for BMI and age, hip circumference exhibited a significant dose-dependent inverse relationship with dyslipidemia and diabetes in women, but not men. Sex-specific differences exist. After adjustment for age and BMI, hip circumferences independently and inversely contribute to cardiovascular risk in women, but not in men. Increasing adjusted waist circumference was associated with increased risk of hypertension and diabetes in Chinese and dyslipidemia in women only.
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Affiliation(s)
- G Neil Thomas
- Department of Community Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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