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¿Debe equipararse el abordaje preventivo del riesgo cardiovascular en la diabetes mellitus tipo 2 a la prevención secundaria? (II). ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1134-2072(05)75193-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kapur A, Malik IS, Bagger JP, Anderson JR, Kooner JS, Thomas M, Punjabi P, Mayet J, Millane T, Goedicke J, Jamrozik K, de Belder MA, Hall RJ, Beatt KJ. The Coronary Artery Revascularisation in Diabetes (CARDia) trial: background, aims, and design. Am Heart J 2005; 149:13-9. [PMID: 15660030 DOI: 10.1016/j.ahj.2004.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with diabetes have an increased incidence and severity of ischemic heart disease, which leads to an increased requirement for coronary revascularization. Comparative information regarding mode of revascularization--coronary artery bypass graft surgery surgery (CABG) or percutaneous coronary intervention (PCI)--is limited, mainly confined to a subanalysis of the Bypass Angioplasty Revascularization (BARI) trial, suggesting a mortality benefit of CABG over PCI. No prospective trial has specifically compared these modes of revascularization in patients with diabetes. OBJECTIVE The Coronary Artery Revascularisation in Diabetes (CARDia) trial is designed to address the hypothesis that optimal PCI is not inferior to modern CABG as a revascularization strategy for diabetics with multivessel or complex single-vessel coronary disease. The primary end point is a composite of death, nonfatal myocardial infarction, and cerebrovascular accident at 1 year. METHOD A total of 600 patients with diabetes are to be randomized to either PCI or CABG, with few protocol restrictions on operative techniques or use of new technology. This gives a power of 80% to detect non-inferiority of PCI assuming that the PCI 1-year event rate is 9%. A cardiac surgeon and a cardiologist must agree that a patient is suitable for revascularization by either technique prior to recruitment into the study. Twenty-one centers in the United Kingdom and Ireland are recruiting patients. Data on cost effectiveness, quality of life, and neurocognitive function are being collected. Long-term (3-5 year) follow-up data will also be collected.
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Affiliation(s)
- A Kapur
- Hammersmith Hospital, London, United Kingdom.
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Asleh R, Levy AP. In vivo and in vitro studies establishing haptoglobin as a major susceptibility gene for diabetic vascular disease. Vasc Health Risk Manag 2005; 1:19-28. [PMID: 17319095 PMCID: PMC1993923 DOI: 10.2147/vhrm.1.1.19.58930] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hemoglobin (Hb) released during hemolysis is a potent oxidant. Extracorpuscular Hb may enter the vessel wall and mediate low-density lipoprotein oxidation, thereby promoting the development and progression of atherosclerosis. Haptoglobin (Hp) is an antioxidant protein as a result of its ability to bind Hb and block Hb-induced oxidative damage. Hp also facilitates the removal of Hb from the extravascular compartment via the CD163 macrophage scavenger receptor. In man, there are two common alleles for Hp denoted 1 and 2, and correspondingly, three different possible genotypes: Hp1-1, Hp2-1, and Hp2-2. We have recently demonstrated in several longitudinal studies that Hp genotype is an independent risk factor for diabetic vascular complications. Specifically, we have shown that diabetic individuals with Hp2-2 are more likely to develop nephropathy, retinopathy, and cardiovascular disease as compared with those with Hp2-1 or Hp1-1. Mechanistically, we have found significant Hp type differences in the antioxidant and CD163-mediated scavenging and activation functions of the different Hp protein types. Furthermore, we have demonstrated that these functions are modified in the diabetic state. In this review, we focus on the clinical studies associating the Hp polymorphism and diabetic vascular complications, and the molecular basis behind this interaction.
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Affiliation(s)
- Rabea Asleh
- Faculty of Medicine,Technion-Israel Institute of Technology, Haifa, Israel
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Severson DL. Diabetic cardiomyopathy: recent evidence from mouse models of type 1 and type 2 diabetes. Can J Physiol Pharmacol 2004; 82:813-23. [PMID: 15573141 DOI: 10.1139/y04-065] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diabetic cardiomyopathy is defined as ventricular dysfunction of the diabetic heart in the absence of coronary artery disease. With the use of both in vivo and ex vivo techniques to assess cardiac phenotype, reduced contractile performance can be observed in experiments with mouse models of both type 1 (insulin-deficient) and type 2 (insulin-resistant) diabetes. Both systolic dysfunction (reduced left ventricular pressures and decreased cardiac output) and diastolic dysfunction (impaired relaxation) is observed in diabetic hearts, along with enhanced susceptibility to ischemic injury. Metabolism is also altered in diabetic mouse hearts: glucose utilization is reduced and fatty acid utilization is increased. The use of geneticallyengineered mice has provided a powerful experimental approach to test mechanisms that may be responsible for the deleterious effects of diabetes on cardiac function.Key words: cardiac function, cardiac metabolism, cardiac phenotype.
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Affiliation(s)
- David L Severson
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Calgary, AB, Canada.
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55
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Smaoui M, Hammami S, Chaaba R, Attia N, Hamda KB, Masmoudi AS, Mahjoub S, Bousslama A, Farhat MB, Hammami M. Lipids and lipoprotein(a) concentrations in Tunisian type 2 diabetic patients; Relationship to glycemic control and coronary heart disease. J Diabetes Complications 2004; 18:258-63. [PMID: 15337498 DOI: 10.1016/s1056-8727(03)00075-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2002] [Revised: 05/05/2003] [Accepted: 06/17/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate plasma lipoprotein(a) [Lp(a)] concentrations in Tunisian patients with type 2 diabetes mellitus (DM), to correlate the values with other lipid parameters, and to examine the relationship to glycemic control and coronary heart disease (CHD). Diabetic patients with and without CHD (n=200) had significantly higher levels of Lp(a) (327.94+/-239.93 mg/l) and a greater proportion of elevated (>300 mg/l) Lp(a) concentrations (46%) compared with 100 healthy nondiabetic controls (269.83+/-225.6 mg/l, P<.01, and 26%, P<.01), while there were no statistically significant difference between diabetics without CHD (n=100) and controls. No significant association of Lp(a) with glycemic control (HbAlc or fasting blood glucose) was noted in diabetic patients. Positive correlations were observed between Lp(a) levels and total cholesterol and LDL-C in all diabetic patients and particularly in diabetic men. Male patients with CHD showed significantly higher plasma Lp(a) levels than those without CHD (P=.023), and 57.3% of patients with CHD showed increase (>300 mg/l) Lp(a) compared with 33.3% of patients without CHD. Elevated levels of Lp (a) and abnormal lipid profile in diabetic men suggest their involvement in atherogenesis and subsequent development of CHD.
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Affiliation(s)
- M Smaoui
- Laboratoire de Biochimie, Faculté de Médecine, 5019 Monastir, Tunisia
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Abstract
PROVEN EFFICACY Since their launch on the French market in 2002, thiazolidinediones ("glitazones") prescribing conditions and therapeutic indications have progressively widened, although remaining strictly defined by the marketing licence. Clinical efficacy on glycemic control (HbA1c and glycemia), as well as beneficial metabolic effects (on lipids, insulinresistance and beta-cellular function) are now well established. Their side effects, generally minor or mild, are also well known. The problem of cardiovascular adverse events, although of a low incidence, should be known and recognized, notably fluid retention (and oedema) and risk of heart failure, more frequent in diabetic than in non diabetic patients. Clinicians must know and take into account the particular risk factors, clinical and diagnosis characteristics, possible pathophysiological mechanisms and their main preventive measures. POTENTIAL BENEFICIAL EFFECTS: On the other hand, numerous experimental and/or preliminary data in type 2 diabetic patients, including favourable effects on the various pathophysiological mechanisms involved in atherosclerosis and effects on cardiovascular risk factors or markers, justifies further large prospective long term clinical studies to assess glitazone effects on cardiovascular morbidity and mortality in type 2 diabetic patients at high cardiovascular risk. Several controlled studies are currently ongoing with rosiglitazone (ADOPT, BARI-2D, DREAM, RECORD, etc.), their results within the next coming Years will answer the questions on the anticipated benefits of rosiglitazone in terms of cardiovascular prevention and/or protection in type 2 diabetic patients.
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Affiliation(s)
- Claude Le Feuvre
- Institut de cardiologie CHU Pitié-Salpêtrière 75651 Paris Cedex 13.
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Abstract
Beneficial metabolic effects of rosiglitazone are now well established and its adverse events, generally minor or mild well known too. Following a brief review of these metabolic effects and main adverse events, we mainly describe fluid retention (and edema) and the heart failure risk, their risk factors, clinical and diagnosis characteristics, possible pathophysiological mechanisms and the main preventive measures are reviewed. Numerous experimental data and/or preliminary studies in type 2 diabetic patients, including effects on cardiovascular risk factors or markers, justify to conduct a large prospective long term clinical program to assess rosiglitazone effects on cardiovascular morbidity and mortality in type 2 diabetic patients at high cardiovascular risk, these studies are briefly described.
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Affiliation(s)
- C Le Feuvre
- Institut de Cardiologie, CHU Pitié-Salpêtrière, F-75651 Paris Cedex 13.
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Abbasi F, Chu JW, McLaughlin T, Lamendola C, Leary ET, Reaven GM. Effect of metformin treatment on multiple cardiovascular disease risk factors in patients with type 2 diabetes mellitus. Metabolism 2004; 53:159-64. [PMID: 14767866 DOI: 10.1016/j.metabol.2003.07.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In light of the conflicting results of the recent United Kingdom Prospective Study (UKPDS), where diabetic patients on metformin monotherapy had lower all-cause mortality and the addition of metformin in sulfonylurea-treated patients was associated with an increased risk of diabetes-related death, we sought to compare the effects on cardiovascular disease (CVD) risk factors of metformin monotherapy with metformin treatment when added to a sulfonylurea compound in patients with type 2 diabetes. Thirty-one volunteers with type 2 diabetes mellitus, 16 on dietary therapy and 15 on sulfonylurea monotherapy (SU), were treated with metformin for 12 weeks. Measurements were made of (1) fasting plasma glucose, hemoglobin A(1c) (HbA(1c)), lipid, remnant lipoprotein cholesterol (RLP-C) levels, and low-density lipoprotein (LDL) particle size; (2) daylong plasma glucose, insulin, free fatty acid (FFA), triglyceride (TG), and RLP-C concentrations; and (3) fasting levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble E-selectin (sE-selectin). Fasting plasma glucose concentrations decreased to a similar degree after treatment with metformin in both the metformin monotherapy group (12.45 +/- 0.48 v 9.46 +/- 0.47 mmol/L, P <.001) and the combined SU and metformin therapy group (14.09 +/- 0.51 v 10.57 +/- 0.85 mmol/L, P =.001). Fasting plasma lipid concentrations and LDL particle size did not significantly change in either treatment group, whereas fasting RLP-C concentrations were significantly lower in the metformin monotherapy group (0.43 +/- 0.09 v 0.34 +/- 0.07 mmol/L, P =.02). Daylong concentrations of plasma glucose, FFA, TG, and RLP-C were lower to a similar degree in both treatment groups, whereas daylong plasma insulin concentrations were unchanged. Fasting plasma sVCAM-1 levels were significantly lower in both the metformin monotherapy group (484 +/- 19 v 446 +/- 18 ng/mL, P =.02) and the combined SU and metformin therapy group (496 +/- 29 v 456 +/- 31 ng/mL, P =.05), whereas fasting plasma sICAM-1 and sE-selectin levels were essentially unchanged. Administration of metformin, either as monotherapy or in combination with a sulfonylurea drug, improved glycemic control and led to a decrease in several CVD risk factors in patients with type 2 diabetes.
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Affiliation(s)
- Fahim Abbasi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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59
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Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med 2004; 21:142-9. [PMID: 14984449 DOI: 10.1046/j.1464-5491.2003.01086.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To compare the effects of a high-carbohydrate (CHO) diet and a high-monounsaturated fatty acid (MUFA) diet on LDL oxidative resistance in free-living individuals with Type 2 diabetes mellitus. METHODS Twenty-two men and women out-patients with Type 2 diabetes, with mean age 61 years and in fair metabolic control (HbA1c<8.0%), were enrolled at a university hospital lipid clinic in a randomized, crossover feeding trial comparing two isocaloric diets for 6 weeks each: CHO (fat, 28% energy) and MUFA (fat, 40% energy) based on virgin olive oil. Outcome measurements were changes in LDL susceptibility to oxidation, body weight, glycaemic control, and lipoprotein profiles. RESULTS Planned and observed diets were well matched. Participants preferred the MUFA diet over the CHO diet. The lag time of conjugated diene formation during Cu2+-induced LDL oxidation was similar after the CHO and MUFA diets (36.4 +/- 12.2 min and 36.0 +/- 13.7 min, respectively). Body weight, glycaemic control, total triglycerides, and total, LDL- and HDL-cholesterol levels also were similar after the two diets. Compared with the CHO diet, the MUFA diet lowered VLDL-cholesterol by 35% (P=0.023) and VLDL triglyceride by 16% (P=0.016). CONCLUSIONS Natural food-based high-CHO and high-MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes. A MUFA diet is a good alternative to high-CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance.
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Affiliation(s)
- C Rodríguez-Villar
- Lipid Clinic, Nutrition and Dietetics Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínico, Barcelona, Spain
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Aardenburg R, Spaanderman ME, Ekhart TH, Eijndhoven HW, Heijden OW, Peeters LL. Low plasma volume following pregnancy complicated by pre-eclampsia predisposes for hypertensive disease in a next pregnancy. BJOG 2003. [DOI: 10.1111/j.1471-0528.2003.02536.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Andrew Neil
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, The Churchill Hospital, Oxford, UK.
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62
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Ros E. Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes. Am J Clin Nutr 2003; 78:617S-625S. [PMID: 12936956 DOI: 10.1093/ajcn/78.3.617s] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Whether low-fat, high-carbohydrate (CHO) diets or moderately high-fat, high-monounsaturated fatty acid (MUFA) diets are preferable for the treatment and prevention of diabetes has been a matter of debate. High-fat diets based on MUFA-rich oils or whole foods have been compared with high-CHO diets for effects on several cardiovascular risk outcomes in diabetic subjects. Early studies using metabolic diets with wide differences in total fat content (15-25% of energy) generally found a beneficial effect of MUFA diets on glycemic control and serum lipids. Recent studies using prescribed diets with a difference of </= 15% of energy in total fat between low-fat and high-MUFA diets show similar effects on glycemic profiles but still favor MUFA diets for effects on triacylglycerols and HDL cholesterol. It is unclear whether postprandial fat clearance is impaired by CHO diets and improved by MUFA diets, independent of effects on fasting triacylglycerol concentrations. Unless one diet contains abundant antioxidants, the 2 dietary approaches appear to have similar effects on LDL oxidation. Low-fat diets, however, are associated with atherogenic, dense LDL particles, while normal, buoyant LDL predominate with high-fat diets irrespective of fatty acid composition. Limited experimental evidence suggests that MUFA diets favorably influence blood pressure, coagulation, endothelial activation, inflammation, and thermogenic capacity. Energy-controlled high-MUFA diets do not promote weight gain and are more acceptable than low-fat diets for weight loss in obese subjects. Thus, there is good scientific support for MUFA diets as an alternative to low-fat diets for medical nutrition therapy in diabetes.
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Affiliation(s)
- Emilio Ros
- Lipid Clinic, Nutrition & Dietetics Service, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínico, University of Barcelona, Barcelona, Spain.
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63
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Morel S, Berthonneche C, Tanguy S, Toufektsian MC, Foulon T, de Lorgeril M, de Leiris J, Boucher F. Insulin resistance modifies plasma fatty acid distribution and decreases cardiac tolerance to in vivo ischaemia/reperfusion in rats. Clin Exp Pharmacol Physiol 2003; 30:446-51. [PMID: 12823257 DOI: 10.1046/j.1440-1681.2003.03858.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The early stage of insulin resistance, also termed the 'prediabetic state', is characterized by the development of hyperinsulinaemia, which maintains normoglycaemia under fasting conditions. The metabolic disorders induced in myocardial cells during this stage of the disease may constitute a basis for an alteration of the tolerance of the heart to ischaemia and reperfusion. 2. To test this hypothesis, male Wistar rats were fed a 66% fructose diet for 4 weeks, inducing a prediabetic state. Rats were then subjected to in vivo left coronary artery ligation followed by reperfusion. Blood samples were collected for plasma lipid profile determination. 3. The prediabetic state significantly increased the severity of ischaemia-induced arrhythmias (arrhythmia score 1.4 +/- 0.2 vs 2.0 +/- 0.0 in control and fructose-fed rats, respectively; P < 0.05) and the size of infarction (infarct size 41.2 +/- 3.0 vs 56.0 +/- 2.0% in control and fructose-fed rats, respectively; P < 0.01). This alteration of the tolerance to in vivo ischaemia/reperfusion may be the consequence of an increase in mono-unsaturated fatty acids and a decrease in omega3 polyunsaturated fatty acids in fructose-fed-rats. 4. In conclusion, because it is known that the prediabetic state increases the incidence of cardiovascular diseases by promoting coronaropathy, our study suggests that this metabolic disorder may also affect the prognosis of heart disease by decreasing the tolerance of cardiomyocytes to ischaemic insults.
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Affiliation(s)
- S Morel
- Laboratoire Stress Cardiovasculaires et Pathologies Associées, Université Joseph Fourier and Département de Biologie Intégrée du CHU, Grenoble, France
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64
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Takeo E, Yoshida H, Tada N, Shingu T, Matsuura H, Murata Y, Yoshikawa S, Ishikawa T, Nakamura H, Ohsuzu F, Kohda H. Sweet elements of Siraitia grosvenori inhibit oxidative modification of low-density lipoprotein. J Atheroscler Thromb 2003; 9:114-20. [PMID: 12236315 DOI: 10.5551/jat.9.114] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study examined the ability of sweet elements extracted from Siraitia grosvenori (SG) to inhibit the oxidation of LDL. We monitored the formation of conjugated diene during copper-mediated LDL oxidation in the presence or absence of sweet elements of whole extract of SG (SG extract) or cucurbitane glycosides (CGs) purified from SG extract as sweet elements. CGs consist of Mogroside IV (Mog.IV), Mogroside V (Mog.V), 11-Oxo-mogroside V (11-Oxo-mog.V), and Siamenoside I (Sia.I). In addition, the effect of these elements on human umbilical vein endothelial cell (HUVEC)- mediated LDL oxidation was tested by measuring production of lipid peroxides. SG extract inhibited copper-mediated LDL oxidation in a dose-dependent fashion, but neither glucose nor erythritol suppressed the oxidation. Among CGs, 11-Oxo-mog.V significantly inhibited LDL oxidation, and prolongation of the lag time during LDL oxidation by 11-Oxo-mog.V was dose-dependent. The lag time (119.7 +/- 8.9 min) in the presence of 200 microM 11-Oxo-mog.V was significantly longer than that (76.8 +/- 5.5 min) of control (p < 0.01). In addition, SG extract and 11-Oxo-mog.V inhibited HUVEC-mediated LDL oxidation in a dose-dependent manner. These results demonstrate that SG extract can inhibit LDL oxidation and that 11-Oxo-mog.V, a sweet element of SG extract, provides the anti-oxidative property of SG which might reduce the atherogenic potential of LDL.
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Affiliation(s)
- Eiichiro Takeo
- First Department of Internal Medicine, Hiroshima University School of Medicine, Japan
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65
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Hoff JA, Quinn L, Sevrukov A, Lipton RB, Daviglus M, Garside DB, Ajmere NK, Gandhi S, Kondos GT. The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 2003; 41:1008-12. [PMID: 12651050 DOI: 10.1016/s0735-1097(02)02975-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to examine the age and gender distribution of coronary artery calcium (CAC) by diabetes status in a large cohort of asymptomatic individuals. BACKGROUND Among individuals with diabetes, coronary artery disease (CAD) is a major cause of morbidity and mortality. Electron-beam tomography (EBT) quantifies CAC, a marker for atherosclerosis. METHODS Screening for CAC by EBT was performed in 30,904 asymptomatic individuals stratified by their self-reported diabetes status, gender, and age. The distribution of CAC across the strata and the association between diabetes and CAC were examined. RESULTS Compared with nondiabetic individuals (n = 29,829), those with diabetes (n = 1,075) had higher median CAC scores across all but two age groups (women 40 to 44 years old and men and women > or =70 years old). Overall, the likelihood of having a CAC score in the highest age/gender quartile was 70% greater for diabetic individuals than for their nondiabetic counterparts. CONCLUSIONS Younger diabetic individuals appear to have calcified plaque burden comparable to that of older individuals without diabetes. These findings call for future research to determine if EBT-CAC screening has an incremental value over the current CAD risk assessment of individuals with diabetes.
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Affiliation(s)
- Julie Anne Hoff
- Department of Medicine, Section of Cardiology, University of Illinois College of Medicine, 840 S. Wood Street (m/c 715), Chicago, IL 60612, USA.
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Gresele P, Guglielmini G, De Angelis M, Ciferri S, Ciofetta M, Falcinelli E, Lalli C, Ciabattoni G, Davì G, Bolli GB. Acute, short-term hyperglycemia enhances shear stress-induced platelet activation in patients with type II diabetes mellitus. J Am Coll Cardiol 2003; 41:1013-20. [PMID: 12651051 DOI: 10.1016/s0735-1097(02)02972-8] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of our study was to assess whether acute, short-term hyperglycemia affects platelet reactivity in patients with Type II diabetes mellitus (T2DM). BACKGROUND Hyperglycemic spikes are thought to precipitate ischemic events in T2DM. Previous studies have shown in vivo platelet activation in diabetes; however, no studies have assessed whether acute in vivo hyperglycemia induces further activation of platelets. METHODS In a cross-over, randomized, double-blind study, 12 patients with T2DM underwent 4 h of either acute hyperglycemia (13.9 mmol/l, 250 mg/dl) or euglycemia (5.5 mmol/l, 100 mg/dl). Shear stress-induced platelet activation, P-selectin and lysosomal integral membrane protein (LIMP) expression on platelets in the bleeding-time blood, urinary 11-dehydro-thromboxane B(2) (TxB(2)) excretion, von Willebrand factor:antigen (vWF:Ag), and von Willebrand factor:activity (vWF:activity) were measured before and after hyperglycemia or euglycemia. RESULTS Shear stress-induced platelet activation, P-selectin and LIMP expression on platelets in the bleeding-time blood, and urinary 11-dehydro-TxB(2) excretion increased significantly after hyperglycemic clamping, whereas no changes were observed after euglycemic clamping. Plasma vWF:Ag and vWF:activity increased strikingly in parallel fashion after hyperglycemic clamping, whereas no changes were observed after euglycemic clamping. CONCLUSIONS Our data demonstrate that acute, short-term hyperglycemia induces an increased activation of platelets exposed to high shear stress conditions in vitro (filtration method) or in vivo (bleeding time). In vivo platelet activation is reflected by an increased urinary excretion of 11-dehydro-TxB(2). The increased levels of vWF in the circulation correlate with the increase in platelet activation markers and may indicate some degree of causation. Acute, short-term hyperglycemia in T2DM may precipitate vascular occlusions by facilitating platelet activation.
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Affiliation(s)
- Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, via E. Dal Pozzo, snc-06126, Perugia, Italy.
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67
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Di Bari M, Zacchei S, Kritchevsky SB, Anichini M, Cesaretti S, Chiarlone M, Masotti G, Marchionni N. Anti-oxidized LDL antibodies and wine consumption: a population-based epidemiological study in Dicomano, Italy. Ann Epidemiol 2003; 13:189-95. [PMID: 12604163 DOI: 10.1016/s1047-2797(02)00262-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE In previous studies, higher levels of oxidized low-density lipoprotein (ox-LDL) have been reported to increase the risk of cardiovascular disease. Furthermore, the anti-oxidative properties of red wine have been invoked to explain the paradox of low cardiovascular mortality, in spite of high-fat intake, in the French population. However, the distribution of ox-LDL-antibodies (ox-LDL-Ab) in the unselected population and its relationship with red wine consumption are unknown. This study was carried out to identify factors associated with ox-LDL-Ab, with particular emphasis on the association with wine consumption. METHODS We performed a cross-sectional study of 551 unselected, community-dwelling older adults (aged 65 to 94 years) living in Dicomano (Italy). Ox-LDL-Ab titre was measured with an ELISA method. RESULTS In the whole study sample, ox-LDL-Ab increased with age and was unrelated to blood lipids, HbA(1c), and smoking habit. A significant inverse relationship was found between ox-LDL-Ab titre and daily wine intake, which persisted after adjusting for possible confounders or in subgroup analyses of participants who reported to drink wine or were free from significant morbidity. CONCLUSIONS These results suggest that wine affects ox-LDL-Ab titre in older populations, possibly because of its antioxidant properties.
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Affiliation(s)
- Mauro Di Bari
- Department of Critical Care Medicine and Surgery, Section of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.
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68
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Cole JH, Miller JI, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003; 41:521-8. [PMID: 12598059 DOI: 10.1016/s0735-1097(02)02862-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study evaluated long-term survival and predictors of elevated risk for young adults diagnosed with coronary artery disease (CAD). BACKGROUND Coronary artery disease is rarely seen in young adults. Traditional cardiac risk factors have been studied in small series; however, many questions exist. METHODS We identified 843 patients under age 40 with CAD diagnosed by coronary angiography from 1975 to 1985. Death, hypertension, gender, family history, prior myocardial infarction (MI), diabetes, heart failure, angina class, number of diseased vessels, ejection fraction (EF), Q-wave infarction, in-hospital death, and initial therapy were studied. Patients were followed for 15 years. RESULTS The mean age was 35 for women (n = 94) and 36 for men (n = 729). The average EF was 55%. Fifty-eight percent of the subjects had single-vessel disease, and 10% were diabetic. The strongest predictors of long-term mortality were a prior MI (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.00 to 1.73), New York Heart Association class II heart failure (HR 1.75, 95% CI 1.03 to 2.97), and active tobacco use (HR 1.59, 95% CI 1.14 to 2.21). Revascularization, rather than medical therapy, was associated with lower mortality (coronary angioplasty: HR 0.51, 95% CI 0.32 to 0.81; coronary artery bypass graft: HR 0.68, 95% CI 0.50 to 0.94). Overall mortality was 30% at 15 years. Patients with diabetes had 15-year mortality of 65%. Those with prior MI had 15-year mortality of 45%, and patients with an EF <30% a mortality of 83% at 15 years. CONCLUSIONS Coronary disease in young adults can carry a poor long-term prognosis. A prior MI, diabetes, active tobacco abuse, and lower EF predict a significantly higher mortality.
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Affiliation(s)
- Jason H Cole
- Emory Center for Outcomes Research and Section of Preventive Cardiology, Division of Cardiology, Emory University School of Medicine, Emory University, 1525 Clifton Road, Atlanta, GA 30322, USA
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McLaughlin T, Abbasi F, Lamendola C, Liang L, Reaven G, Schaaf P, Reaven P. Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation 2002; 106:2908-12. [PMID: 12460870 DOI: 10.1161/01.cir.0000041046.32962.86] [Citation(s) in RCA: 244] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Plasma C-reactive protein (CRP) concentrations are increased in obese and/or hyperinsulinemic individuals. The goal of this study was to determine if the relation between insulin resistance and CRP was independent of obesity. METHODS AND RESULTS Plasma CRP concentrations were measured before and after 3 months of calorie restriction in 38 healthy, obese women. Steady-state plasma glucose (SSPG) concentration during a 180-minute infusion of octreotide, glucose, and insulin was used to stratify participants into insulin-resistant (IR, n=20) or insulin-sensitive (n=18) groups, similar in terms of mean age (46+/-2 versus 44+/-2 years), body mass index (32.0+/-0.4 versus 31.4+/-0.3 kg/m2), and waist circumference (96+/-2 versus 95+/-2 cm). Mean CRP (0.39+/-0.08 versus 0.12+/-0.03 mg/dL, P=0.003) concentrations were higher in the IR group, as were day-long plasma glucose and insulin responses (P<0.001). There was a significant correlation at baseline between CRP and day-long plasma integrated insulin response (r=0.47, P=0.001) but not between CRP and body mass index (r=0.14) or waist circumference (r=0.10). Weight loss was similar in the two groups (8.7+/-0.9 versus 8.4+/-0.8 kg) but was associated with significant (P<0.001) decreases in SSPG and CRP concentrations in the IR group only. Regression analysis showed that SSPG and day-long plasma insulin response were the only significant predictors of CRP concentration. CONCLUSIONS CRP concentrations are elevated predominantly in obese individuals who are also insulin resistant and fall in parallel with weight loss-associated improvements in insulin resistance. The relation between CRP concentrations and insulin resistance is independent of obesity.
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Bermudez OI, Velez-Carrasco W, Schaefer EJ, Tucker KL. Dietary and plasma lipid, lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes. Am J Clin Nutr 2002; 76:1214-21. [PMID: 12450885 DOI: 10.1093/ajcn/76.6.1214] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There are limited data about dietary intakes and plasma lipids of elderly US Hispanics. OBJECTIVE The disparity in prevalence of type 2 diabetes among population groups underscored our need to assess dietary and plasma risk factors for cardiovascular disease. DESIGN Plasma lipids and apolipoproteins and dietary intakes of macronutrients were measured in elderly subjects (60-98 y): 490 Hispanics of Caribbean origin (Puerto Ricans and Dominicans) and 163 non-Hispanic whites. Plasma values were related to ethnicity and to macronutrient intake. Differences in plasma lipids due to diabetes were assessed among the Hispanics. RESULTS Intakes of carbohydrate and polyunsaturated fatty acids were higher and intakes of cholesterol and saturated and monounsaturated fatty acids were lower in Hispanics than in non-Hispanic whites. Concentrations of total cholesterol, HDL cholesterol, and apolipoprotein A-I were significantly lower among Hispanic women than among non-Hispanic white women; a similar trend was seen in men. Dyslipidemia (high triacylglycerols and low HDL cholesterol) was more prevalent among Hispanics with than without diabetes. CONCLUSIONS Ethnic differences in serum lipids exist and appear to be associated with differences in dietary intakes. However, both Hispanics and non-Hispanic whites had lipid profiles indicating a high risk of cardiovascular disease. Hispanics with diabetes were at higher risk of dyslipidemia than were those without diabetes. Our data suggest that lifestyle changes, including diet modification and exercise, could be of significant benefit to both ethnic groups.
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Affiliation(s)
- Odilia I Bermudez
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA.
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71
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Semeniuk LM, Kryski AJ, Severson DL. Echocardiographic assessment of cardiac function in diabetic db/db and transgenic db/db-hGLUT4 mice. Am J Physiol Heart Circ Physiol 2002; 283:H976-82. [PMID: 12181126 DOI: 10.1152/ajpheart.00088.2002] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Control db/+ and diabetic db/db mice at 6 and 12 wk of age were subjected to echocardiography to determine whether contractile function was reduced in vivo and restored in transgenic db/db-human glucose transporter 4 (hGLUT4) mice (12 wk old) in which cardiac metabolism has been normalized. Systolic function was unchanged in 6-wk-old db/db mice, but fractional shortening and velocity of circumferential fiber shortening were reduced in 12-wk-old db/db mice (43.8 +/- 2.1% and 8.3 +/- 0.5 circs/s, respectively) relative to db/+ control mice (59.5 +/- 2.3% and 11.8 +/- 0.4 circs/s, respectively). Doppler flow measurements were unchanged in 6-wk-old db/db mice. The ratio of E and A transmitral flows was reduced from 3.56 +/- 0.29 in db/+ mice to 2.40 +/- 0.20 in 12-wk-old db/db mice, indicating diastolic dysfunction. Thus a diabetic cardiomyopathy with systolic and diastolic dysfunction was evident in 12-wk-old diabetic db/db mice. Cardiac function was normalized in transgenic db/db-hGLUT4 mice, indicating that altered cardiac metabolism can produce contractile dysfunction in diabetic db/db hearts.
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Affiliation(s)
- Lisa M Semeniuk
- Department of Pharmacology and Therapeutics, University of Calgary, Calgary, Alberta, Canada T2N 4N1
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Aasum E, Belke DD, Severson DL, Riemersma RA, Cooper M, Andreassen M, Larsen TS. Cardiac function and metabolism in Type 2 diabetic mice after treatment with BM 17.0744, a novel PPAR-alpha activator. Am J Physiol Heart Circ Physiol 2002; 283:H949-57. [PMID: 12181123 DOI: 10.1152/ajpheart.00226.2001] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hearts from diabetic db/db mice, a model of Type 2 diabetes, exhibit left ventricular failure and altered metabolism of exogenous substrates. Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) ligands reduce plasma lipid and glucose concentrations and improve insulin sensitivity in db/db mice. Consequently, the effect of 4- to 5-wk treatment of db/db mice with a novel PPAR-alpha ligand (BM 17.0744; 25-38 mg x kg(-1) x day(-1)), commencing at 8 wk of age, on ex vivo cardiac function and metabolism was determined. Elevated plasma concentrations of glucose, fatty acids, and triacylglycerol (34.0 +/- 3.6, 2.0 +/- 0.4, and 0.9 +/- 0.1 mM, respectively) were reduced to normal after treatment with BM 17.0744 (10.8 +/- 0.6, 1.1 +/- 0.1, and 0.6 +/- 0.1 mM). Plasma insulin was also reduced significantly in treated compared with untreated db/db mice. Chronic treatment of db/db mice with the PPAR-alpha agonist resulted in a 50% reduction in rates of fatty acid oxidation, with a concomitant increase in glycolysis (1.7-fold) and glucose oxidation (2.3- fold). Correction of the diabetes-induced abnormalities in systemic and cardiac metabolism after BM 17.0744 treatment did not, however, improve left ventricular contractile function.
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Affiliation(s)
- Ellen Aasum
- Department of Medical Physiology, University of Tromsø, N-9037 Tromsø, Norway.
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Frohlich J, Lear SA. Old and new risk factors for atherosclerosis and development of treatment recommendations. Clin Exp Pharmacol Physiol 2002; 29:838-42. [PMID: 12165052 DOI: 10.1046/j.1440-1681.2002.03733.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The development of atherosclerosis, including the role of the classical and new risk factors, is briefly reviewed an emphasis on the links between some of these risk factors and atherogenesis. 2. While genetic factors are doubtlessly important, they contribute (from the population point of view) little to the overall burden of atherosclerosis. 3. Our studies on the relationship between abdominal obesity and metabolic risk factors in two ethnic groups, namely individuals of Cantonese and European background, suggest that different ranges for at least some of the risk factors should be established for specific ethnic groups (e.g. waist circumference for individuals of Chinese and European background). 4. Using the example of differences between Cantonese heterozygotes for familial hypercholesterolaemia living in Vancouver, Canada, and Canton, China, we demonstrate how the environment can modify a genetic predisposition for atherosclerosis. 5. Gender differences are illustrated by a study of serum lipoprotein (a) as a risk factor in men and women. 6. The principles of current Canadian recommendations for the assessment and treatment of atherosclerosis are outlined; they are based on knowledge gained from both basic and clinical research of atherosclerosis.
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Affiliation(s)
- Jiri Frohlich
- Healthy Heart Program, St Paul's Hospital, 180-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
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Abstract
In the past, the rates of risk factors for atherosclerosis and cardiovascular disease (CVD) as well as the manifestations of coronary heart disease, stroke, and peripheral vascular disease in Native Americans have been relatively low compared to the general United States population. However, over the past several decades the rates of these CVD-associated risk factors have markedly increased with the concomitant development of a significant and alarming rise in the manifestations of atherosclerosis.
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Affiliation(s)
- James M Galloway
- Native American Cardiology Program, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
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Kulkarni M, Reaven PD. Heart protection study: LDL lowering therapy and cardiovascular outcomes in patients with low cholesterol levels or diabetes. Curr Diab Rep 2002; 2:269-73. [PMID: 12643184 DOI: 10.1007/s11892-002-0094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mrinalini Kulkarni
- Department of Medicine (CS/111E), Carl T. Hayden VAMC, 650 E. Indian School Road, Phoenix, AZ 85012-1892, USA
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Kako Y, Massé M, Huang LS, Tall AR, Goldberg IJ. Lipoprotein lipase deficiency and CETP in streptozotocin-treated apoB-expressing mice. J Lipid Res 2002. [DOI: 10.1016/s0022-2275(20)30460-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chu NV, Kong APS, Kim DD, Armstrong D, Baxi S, Deutsch R, Caulfield M, Mudaliar SR, Reitz R, Henry RR, Reaven PD. Differential effects of metformin and troglitazone on cardiovascular risk factors in patients with type 2 diabetes. Diabetes Care 2002; 25:542-9. [PMID: 11874944 DOI: 10.2337/diacare.25.3.542] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Traditional cardiovascular risk factors (CVRF) only partly explain the excessive risk of cardiovascular disease in patients with type 2 diabetes. There is now an increasing appreciation for many novel CVRF that occur largely as a result of insulin resistance and hyperinsulinemia. Therefore, we investigated whether diabetes medications that vary in their mechanism of action and ability to reduce insulin resistance may differ in their effects on both traditional and novel CVRF. RESEARCH DESIGN AND METHODS We compared the addition of metformin or troglitazone therapy on CVRF in 22 subjects with type 2 diabetes who remained in poor glycemic control (with HbA1c >8.5%) while taking glyburide 10 mg twice daily. Subjects were initially randomized to either metformin 850 mg once daily or troglitazone 200 mg once daily. Both medications were then titrated upward as needed to achieve fasting plasma glucose <120 mg/dl. Measures of glucose control, insulin resistance, and CVRF (blood pressure, lipids, plasminogen activator inhibitor-1, C-reactive protein, fibrinogen, and small dense LDL) were assessed both before and after therapy. RESULTS After 4 months of treatment, both metformin and troglitazone led to similar decreases in fasting plasma glucose and HbA1c. The reduction in insulin resistance determined by hyperinsulinemic-euglycemic clamp was nearly twofold greater with troglitazone than metformin. Metformin did not induce significant changes in blood pressure, LDL cholesterol, LDL size, HDL cholesterol, triglycerides, or plasminogen activator inhibitor-1. However, C-reactive protein did decrease by 33% (6 +/- 1 to 4 +/- 1 mg/l; P < 0.01) [corrected]. Troglitazone therapy was associated with increases in LDL size (26.21 +/- 0.22 to 26.56 +/- 0.25 nm; P=0.04) and HDL cholesterol (33 +/- 3 to 36 +/- 3 mg/dl; P=0.05) and decreases in triglycerides (197 +/- 19 to 155 +/- 23 mg/dl; P=0.07) and C-reactive protein by 60% (8 +/- 3 to 3 +/- 1 mg/l, P < 0.01) [corrected]. CONCLUSIONS For patients with type 2 diabetes in whom maximal sulfonylurea therapy failed, the addition of the insulin sensitizer troglitazone seemed to have greater benefits on several traditional and novel CVRF than metformin therapy. These differences were not related to glycemic improvement but reflected, in part, the greater reduction in insulin resistance obtained with addition of troglitazone. These data suggest that medications that more effectively address this underlying metabolic defect may be more beneficial in reducing cardiovascular risk in type 2 diabetes.
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Affiliation(s)
- Neelima V Chu
- Department of Endocrinology and Metabolism, VA San Diego Healthcare System/University of California, San Diego, California 92161, USA
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Wang Y, Oram JF. Unsaturated fatty acids inhibit cholesterol efflux from macrophages by increasing degradation of ATP-binding cassette transporter A1. J Biol Chem 2002; 277:5692-7. [PMID: 11741998 DOI: 10.1074/jbc.m109977200] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abnormal high density lipoprotein metabolism may contribute to the increased atherosclerosis associated with diabetes and insulin resistance. The ATP-binding cassette transporter ABCA1 mediates cholesterol transport from tissue macrophages to apoA-I, the major high density lipoprotein protein component. Because fatty acids are elevated in diabetes, we examined the effects of fatty acids on ABCA1 activity in cultured macrophages. Results showed that unsaturated fatty acids markedly inhibited ABCA1-mediated cholesterol and phospholipid efflux from macrophages when ABCA1 was induced by a cAMP analog. This was accompanied by a reduction in the membrane content of ABCA1 and a decrease in apoA-I binding to whole cells and to ABCA1. In contrast, saturated fatty acids had no effect on these processes. Fatty acids did not alter ABCA1 mRNA abundance or incorporation of methionine into ABCA1, indicating that decreased ABCA1 transcription, enhanced mRNA decay, or impaired translation efficiency did not account for these inhibitory effects. Unsaturated fatty acids, however, increased ABCA1 turnover when protein synthesis was blocked by cycloheximide. We conclude that unsaturated fatty acids reduce the macrophage ABCA1 content by enhancing its degradation rate. These findings raise the possibility that an increased supply of unsaturated fatty acids in the artery wall promotes atherogenesis by impairing the ABCA1 cholesterol secretory pathway in macrophages.
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Affiliation(s)
- Yutong Wang
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
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