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Quaiyoom A, Kumar R. An Overview of Diabetic Cardiomyopathy. Curr Diabetes Rev 2024; 20:e121023222139. [PMID: 37842898 DOI: 10.2174/0115733998255538231001122639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 10/17/2023]
Abstract
Diabetic cardiomyopathy (DCM) is a myocardial disorder that is characterised by structural and functional abnormalities of the heart muscle in the absence of hypertension, valvular heart disease, congenital heart defects, or coronary artery disease (CAD). After witnessing a particular form of cardiomyopathy in diabetic individuals, Rubler et al. came up with the moniker diabetic cardiomyopathy in 1972. Four stages of DCM are documented, and the American College of Cardiology/American Heart Association Stage and New York Heart Association Class for HF have some overlap. Diabetes is linked to several distinct forms of heart failure. Around 40% of people with heart failure with preserved ejection fraction (HFpEF) have diabetes, which is thought to be closely associated with the pathophysiology of HFpEF. Diabetes and HF are uniquely associated in a bidirectional manner. When compared to the general population without diabetes, those with diabetes have a risk of heart failure that is up to four times higher. A biomarker is a trait that is reliably measured and assessed as a predictor of healthy biological activities, pathological processes, or pharmacologic responses to a clinical treatment. Several biomarker values have been discovered to be greater in patients with diabetes than in control subjects among those who have recently developed heart failure. Myocardial fibrosis and hypertrophy are the primary characteristics of DCM, and structural alterations in the diabetic myocardium are often examined by non-invasive, reliable, and reproducible procedures. An invasive method called endomyocardial biopsy (EMB) is most often used to diagnose many cardiac illnesses.
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Affiliation(s)
- Abdul Quaiyoom
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
| | - Ranjeet Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Das SR, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Kosiborod MN, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S179-S218. [PMID: 38078592 PMCID: PMC10725811 DOI: 10.2337/dc24-s010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Patel R, Peesay T, Krishnan V, Wilcox J, Wilsbacher L, Khan SS. Prioritizing the primary prevention of heart failure: Measuring, modifying and monitoring risk. Prog Cardiovasc Dis 2024; 82:2-14. [PMID: 38272339 PMCID: PMC10947831 DOI: 10.1016/j.pcad.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/27/2024]
Abstract
With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.
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Affiliation(s)
- Ruchi Patel
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tejasvi Peesay
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vaishnavi Krishnan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Wilcox
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Wilsbacher
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Panchal K, Lawson C, Chandramouli C, Lam C, Khunti K, Zaccardi F. Diabetes and risk of heart failure in people with and without cardiovascular disease: systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 207:111054. [PMID: 38104900 DOI: 10.1016/j.diabres.2023.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND People with diabetes have an increased risk of heart failure (HF), compared to those without diabetes. However, no comprehensive systematic review and meta-analysis has explored whether these associations could differ in relation to prevalent cardiovascular disease (CVD). AIMS To estimate the association between diabetes and incident heart failure (HF), compared to without diabetes, in individuals with and without CVD. METHODS PubMed, Scopus, and Web of Science were searched for observational cohort studies from the earliest dates to 22nd March 2023. A random-effects model calculated the pooled relative risk (RR). RESULTS Of 11,609 articles, 31 and 6 studies reported data in people with type 2 diabetes (T2D) and type 1 diabetes (T1D) respectively. Individuals with T2D had an increased risk of HF irrespective of CVD prevalence: 1.61 (95% CI: 1.35-1.92) in those with CVD; 1.78 (1.60-1.99) without CVD; and 2.02 (1.75-2.33) with unspecified CVD prevalence. Meta-regression did not identify a significant difference comparing HF risk in T2D individuals with vs. without CVD (p = 0.232). CONCLUSION Peoplewith T2D, compared to those without diabetes, have similar increased risk of HF, regardless of CVD prevalence. Strategiesproven to lower HF risk in T2D individuals should be prioritized for those with and without CVD.
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Affiliation(s)
- Kajal Panchal
- University of Leicester, Leicester Diabetes Centre, UK.
| | - Claire Lawson
- University of Leicester, Department of Cardiovascular Sciences, UK.
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Khan SS, Coresh J, Pencina MJ, Ndumele CE, Rangaswami J, Chow SL, Palaniappan LP, Sperling LS, Virani SS, Ho JE, Neeland IJ, Tuttle KR, Rajgopal Singh R, Elkind MSV, Lloyd-Jones DM. Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1982-2004. [PMID: 37947094 DOI: 10.1161/cir.0000000000001191] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.
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Nagori A, Segar MW, Keshvani N, Patel L, Patel KV, Chandra A, Willett D, Pandey A. Prevalence and Predictors of Subclinical Cardiomyopathy in Patients With Type 2 Diabetes in a Health System. J Diabetes Sci Technol 2023:19322968231212219. [PMID: 38063209 DOI: 10.1177/19322968231212219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Diabetic cardiomyopathy (DbCM) is characterized by subclinical abnormalities in cardiac structure/function and is associated with a higher risk of overt heart failure (HF). However, there are limited data on optimal strategies to identify individuals with DbCM in contemporary health systems. The aim of this study was to evaluate the prevalence of DbCM in a health system using existing data from the electronic health record (EHR). METHODS Adult patients with type 2 diabetes mellitus free of cardiovascular disease (CVD) with available data on HF risk in a single-center EHR were included. The presence of DbCM was defined using different definitions: (1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); (2) intermediate restrictive: ≥2 echocardiographic abnormalities; (3) most restrictive: 3 echocardiographic abnormalities. DbCM prevalence was compared across age, sex, race, and ethnicity-based subgroups, with differences assessed using the chi-squared test. Adjusted logistic regression models were constructed to evaluate significant predictors of DbCM. RESULTS Among 1921 individuals with type 2 diabetes mellitus, the prevalence of DbCM in the overall cohort was 8.7% and 64.4% in the most and least restrictive definitions, respectively. Across all definitions, older age and Hispanic ethnicity were associated with a higher proportion of DbCM. Females had a higher prevalence than males only in the most restrictive definition. In multivariable-adjusted logistic regression, higher systolic blood pressure, higher creatinine, and longer QRS duration were associated with a higher risk of DbCM across all definitions. CONCLUSIONS In this single-center, EHR cohort, the prevalence of DbCM varies from 9% to 64%, with a higher prevalence with older age and Hispanic ethnicity.
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Affiliation(s)
- Aditya Nagori
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - DuWayne Willett
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zeng F, Zhou P, Wang M, Xie L, Huang X, Wang Y, Huang J, Shao X, Yang Y, Liu W, Gu M, Yu Y, Sun F, He M, Li Y, Zhang Z, Gong W, Wang Y. ACMSD mediated de novo NAD + biosynthetic impairment in cardiac endothelial cells as a potential therapeutic target for diabetic cardiomyopathy. Diabetes Res Clin Pract 2023; 206:111014. [PMID: 37977551 DOI: 10.1016/j.diabres.2023.111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECT The highly conserved α-amino-β-carboxymuconate-ε-semialdehyde decarboxylase (ACMSD) is the key enzyme that regulates the de novo NAD+ synthesis from tryptophan. NAD+ metabolism in diabetic cardiomyopathy (DCM) was not elucidated yet. METHODS Mice were assigned to non-diabetic (NDM) group, streptozocin (STZ)-induced diabetic (DM) group, and nicotinamide (NAM) treated (DM + NAM) group. ACMSD mediated NAD+ metabolism were studied both in mice and patients with diabetes. RESULTS NAD+ level was significantly lower in the heart of DM mice than that of the NDM group. Supplementation with NAM could partially increased myocardial capillary density and ameliorated myocardial fibrosis by increasing NAD+ level through salvage pathway. Compared with NDM mice, the expression of ACMSD in myocardial endothelial cells of DM mice was significantly increased. It was further confirmed that in endothelial cells, high glucose promoted the expression of ACMSD. Inhibition of ACMSD could increase de novo NAD+ synthesis and improve endothelial cell function by increasing Sirt1 activity. Targeted mass spectrometry analysis indicated increased ACMSD enzyme activity in diabetic patients, higher ACMSD activity increased risk of heart diastolic dysfunction. CONCLUSION In summary, increased expression of ACMSD lead to impaired de novo NAD+ synthesis in diabetic heart. Inhibition of ACMSD could potentially improve DCM.
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Affiliation(s)
- Fangfang Zeng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Peng Zhou
- Department of Cardiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lijie Xie
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xinmei Huang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yilin Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jinya Huang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaoqing Shao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yeping Yang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wenjuan Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Maocheng Gu
- Department of Cardiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Yifei Yu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Fei Sun
- Department of Endocrinology and Metabolism, Pudong New Area Gongli Hospital, Shanghai 200135, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wei Gong
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Yi Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Pop-Busui R. Autonomic diabetic neuropathies: A brief overview. Diabetes Res Clin Pract 2023; 206 Suppl 1:110762. [PMID: 38245325 DOI: 10.1016/j.diabres.2023.110762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
This article summarizes the latest epidemiology of diabetic autonomic neuropathy (DAN), and provides a brief overview on epidemiology, current outcomes measures for screening and diagnosis in research and clinical settings, the latest evidence on effective management, and novel perspectives on the impacts of social determinants of health in development and management of DAN. Among the various forms of diabetic neuropathy, distal symmetric polyneuropathy and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy, are by far the most studied. However, emerging data highlight the impact of other forms of autonomic neuropathies such as gastrointestinal and urogenital autonomic neuropathies, on healthcare and patients' reported outcomes [1].
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Affiliation(s)
- Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA.
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Banerjee M. Epicardial Fat Paradox and Differential Effects of GLP-1 Receptor Agonists Across Heart Failure Phenotypes. Circ Heart Fail 2023; 16:e010966. [PMID: 38010208 DOI: 10.1161/circheartfailure.123.010966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Mainak Banerjee
- Department of Endocrinology, Ramakrishna Mission Seva Pratishthan Vivekandanda Institute of Medical Sciences, Kolkata, India (M.B.)
- Narayana Health, Rabindranath Tagore International Institute of Cardiac Sciences, Mukundapur, Kolkata, India (M.B.)
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He S, Yu C, Kuang M, Qiu J, Yang R, Zhang S, Sheng G, Zou Y. Alanine aminotransferase to high- density lipoprotein cholesterol ratio is positively correlated with the occurrence of diabetes in the Chinese population: a population-based cohort study. Front Endocrinol (Lausanne) 2023; 14:1266692. [PMID: 38089616 PMCID: PMC10715265 DOI: 10.3389/fendo.2023.1266692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Both alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDL-C) are closely related to glucose homeostasis in the body, and the main objective of this study was to investigate the association between ALT to HDL-C ratio (ALT/HDL-C ratio) and the risk of diabetes in a Chinese population. Methods The current study included 116,251 participants who underwent a healthy physical examination, and the study endpoint was defined as a diagnosis of new-onset diabetes. Multivariate Cox regression models and receiver operator characteristic curves were used to assess the association of the ALT/HDL-C ratio with diabetes onset. Results During the average observation period of 3.10 years, a total of 2,674 (2.3%) participants were diagnosed with new-onset diabetes, including 1,883 (1.62%) males and 791 (0.68%) females. After fully adjusting for confounding factors, we found a significant positive association between the ALT/HDL-C ratio and the risk of diabetes [Hazard ratios 1.06, 95% confidence intervals: 1.05, 1.06], and this association was significantly higher in males, obese individuals [body mass index ≥ 28 kg/m2] and individuals aged < 60 years (All P interaction < 0.05). In addition, the ALT/HDL-C ratio was significantly better than its components ALT and HDL-C in predicting diabetes in the Chinese population. Conclusion There was a positive relationship between ALT/HDL-C ratio and diabetes risk in the Chinese population, and this relationship was significantly stronger in males, obese individuals, and individuals younger than 60 years old.
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Affiliation(s)
- Shiming He
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Changhui Yu
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Maobin Kuang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Jiajun Qiu
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Ruijuan Yang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Shuhua Zhang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Chaikijurajai T, Rincon-Choles H, Tang WHW. Natriuretic peptide testing strategies in heart failure: A 2023 update. Adv Clin Chem 2023; 118:155-203. [PMID: 38280805 DOI: 10.1016/bs.acc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Natriuretic peptides (NPs), including B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), have been recommended as standard biomarkers for diagnosing heart failure (HF), and one of the strongest risk predictors for mortality and HF hospitalization regardless of ejection fraction (EF) and etiology of HF. BNP is an active neurohormone opposing renin-angiotensin-aldosterone and sympathetic nervous system overactivated in HF, whereas NT-proBNP is an inactive prohormone released from cardiomyocytes in response to wall stress. Despite substantial advances in the development of guideline-directed medical therapy (GDMT) for HF with reduced EF, studies demonstrating direct benefits of NP-guided chronic HF therapy on mortality, HF hospitalization, and GDMT optimization have yielded conflicting results. However, accumulating evidence shows that achieving prespecified BNP or NT-proBNP target over time is significantly associated with favorable outcomes, suggesting that benefits of serially measured NPs may be limited to particular groups of HF patients, such as those with extreme levels of baseline BNP or NT-proBNP, which could represent severe phenotypes of HF associated with natriuretic peptide resistance or cardiorenal syndrome. Over the past decade, clinical utilization of BNP and NT-proBNP has been expanded, especially using serial NP measurements for guiding HF therapy, optimizing GDMT and identifying at-risk patients with HF phenotypes who may be minimally symptomatic or asymptomatic.
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Affiliation(s)
- Thanat Chaikijurajai
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hernan Rincon-Choles
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - W H Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States.
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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Swamy S, Noor SM, Mathew RO. Cardiovascular Disease in Diabetes and Chronic Kidney Disease. J Clin Med 2023; 12:6984. [PMID: 38002599 PMCID: PMC10672715 DOI: 10.3390/jcm12226984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic kidney disease (CKD) is a common occurrence in patients with diabetes mellitus (DM), occurring in approximately 40% of cases. DM is also an important risk factor for cardiovascular disease (CVD), but CKD is an important mediator of this risk. Multiple CVD outcomes trials have revealed a greater risk for CVD events in patients with diabetes with CKD versus those without. Thus, reducing the risk of CKD in diabetes should result in improved CVD outcomes. To date, of blood pressure (BP) control, glycemic control, and inhibition of the renin-angiotensin system (RASI), glycemic control appears to have the best evidence for preventing CKD development. In established CKD, especially with albuminuria, RASI slows the progression of CKD. More recently, sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP1RA) have revolutionized the care of patients with diabetes with and without CKD. SGLT2i and GLP1RA have proven to reduce mortality, heart failure (HF) hospitalizations, and worsening CKD in patients with diabetes with and without existing CKD. The future of limiting CVD in diabetes and CKD is promising, and more evidence is forthcoming regarding combinations of evidence-based therapies to further minimize CVD events.
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Affiliation(s)
- Sowmya Swamy
- Department of Medicine, School of Medicine, George Washington University, Washington, DC 20052, USA
| | - Sahibzadi Mahrukh Noor
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA 92350, USA
| | - Roy O. Mathew
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA 92350, USA
- Department of Medicine, Loma Linda VA Healthcare System, 11201 Benton Street, Loma Linda, CA 92357, USA
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Li AL, Lian L, Chen XN, Cai WH, Fan XB, Fan YJ, Li TT, Xie YY, Zhang JP. The role of mitochondria in myocardial damage caused by energy metabolism disorders: From mechanisms to therapeutics. Free Radic Biol Med 2023; 208:236-251. [PMID: 37567516 DOI: 10.1016/j.freeradbiomed.2023.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
Myocardial damage is the most serious pathological consequence of cardiovascular diseases and an important reason for their high mortality. In recent years, because of the high prevalence of systemic energy metabolism disorders (e.g., obesity, diabetes mellitus, and metabolic syndrome), complications of myocardial damage caused by these disorders have attracted widespread attention. Energy metabolism disorders are independent of traditional injury-related risk factors, such as ischemia, hypoxia, trauma, and infection. An imbalance of myocardial metabolic flexibility and myocardial energy depletion are usually the initial changes of myocardial injury caused by energy metabolism disorders, and abnormal morphology and functional destruction of the mitochondria are their important features. Specifically, mitochondria are the centers of energy metabolism, and recent evidence has shown that decreased mitochondrial function, caused by an imbalance in mitochondrial quality control, may play a key role in myocardial injury caused by energy metabolism disorders. Under chronic energy stress, mitochondria undergo pathological fission, while mitophagy, mitochondrial fusion, and biogenesis are inhibited, and mitochondrial protein balance and transfer are disturbed, resulting in the accumulation of nonfunctional and damaged mitochondria. Consequently, damaged mitochondria lead to myocardial energy depletion and the accumulation of large amounts of reactive oxygen species, further aggravating the imbalance in mitochondrial quality control and forming a vicious cycle. In addition, impaired mitochondria coordinate calcium homeostasis imbalance, and epigenetic alterations participate in the pathogenesis of myocardial damage. These pathological changes induce rapid progression of myocardial damage, eventually leading to heart failure or sudden cardiac death. To intervene more specifically in the myocardial damage caused by metabolic disorders, we need to understand the specific role of mitochondria in this context in detail. Accordingly, promising therapeutic strategies have been proposed. We also summarize the existing therapeutic strategies to provide a reference for clinical treatment and developing new therapies.
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Affiliation(s)
- Ao-Lin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Lu Lian
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xin-Nong Chen
- Department of Traditional Chinese Medicine, Tianjin First Central Hospital, Tianjin, 300190, China
| | - Wen-Hui Cai
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xin-Biao Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ya-Jie Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ting-Ting Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ying-Yu Xie
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Jun-Ping Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China.
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Hosseinpoor S, Kalroozi F, Nezamzadeh M, Pishgooie SA. Examining the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients: A randomized control study. Health Sci Rep 2023; 6:e1733. [PMID: 38028699 PMCID: PMC10680056 DOI: 10.1002/hsr2.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims One of the new types of dressings is the polyurethane dressing containing silver particles. This study was designed to evaluate the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients in a military hospital. Methods This was a randomized clinical trial study on 48 patients with diabetic foot ulcers who were referred to the wound clinic of Shahid Dr. Chamran Hospital in 2022. The qualified samples were divided into two groups of silver polyurethane dressing and simple sterile dressing based on a randomization block method. The wounds of both groups of patients were initially cleaned with normal saline and in the first round of dressing, and a sample of tissue secretions was collected by the researcher using a sterile swab from the wounds of the patients on two occasions, superficially and deeply. The patients' wounds in the intervention group were dressed with polyurethane foam dressing containing silver particles, while the simple sterile routine dressing was used in the control group. The rate of infection and wound secretions were examined and recorded on the first, seventh, fourteenth, and twenty-first days from the start of dressing in both groups. To collect data, the IDSA tool was used. Results The rates of wound infection before the intervention showed no significant differences in the two groups (p = 0.242). However, these rates changed on the 7th, 14th, and 21st days after the intervention. Moreover, the infection rate was significantly lower in the polyurethane dressing group containing silver particles (p < 0.001 and F = 30.31). Conclusions Using polyurethane dressing was proven to be more effective in this study on the rate of diabetic ulcer infection in patients compared to the simple sterile dressing. Thus, nurses can use this dressing for faster treatment of diabetic foot ulcers infection.
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Affiliation(s)
| | - Fatemeh Kalroozi
- Department of Pediatric Nursing, College of NursingAja University of Medical SciencesTehranIran
| | - Maryam Nezamzadeh
- Department of Critical Care NursingAja University of Medical SciencesTehranIran
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Qin YN, Zheng XP. Association of frailty index with congestive heart failure, all-cause and cardiovascular mortality among individuals with type 2 diabetes: a study from National Health and Nutrition Examination Surveys (NHANES), 1999-2018. Diabetol Metab Syndr 2023; 15:210. [PMID: 37875981 PMCID: PMC10594933 DOI: 10.1186/s13098-023-01165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Both type 2 diabetes mellitus (T2DM) and frailty are strongly associated with congestive heart failure (CHF). Individuals with T2DM and CHF have a high frailty burden. The association of frailty with HF, all-cause, and cardiovascular mortality in patients with T2DM has not been thoroughly explored. METHODS This study included 2894 adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) database over ten cycles (1999-2018) and followed up for all-cause and cardiovascular mortality through 31 December 2019. The frailty index (FI) was calculated using a 46-item deficit model to assess frailty status. Weighted multivariable logistic regression was performed to explore the relationship between frailty and CHF in patients with T2DM. Weighted restricted cubic splines were used to evaluate the non-linear relationship between FI and outcome. All-cause mortality and cardiovascular mortality association with FI was assessed using the Kaplan-Meier curve and COX proportional hazards regression accounting for sampling weights. Subgroup and sensitivity analyses were performed to evaluate the robustness of the results. RESULTS After the adjustment of essential confounders, a higher frailty index in T2DM was associated with increased odds of CHF (odds ratio [OR] for per 1-SD increase, 2.02, 95% confidence interval [CI] 1.67-2.45; P < 0.0001). The presence of frailty T2DM (OR, 3.60; 95% CI 2.34-5.54; P < 0.0001) was associated with a significant increase in the prevalence of CHF compared to non-frailty T2DM in a fully adjusted model. During the median follow-up of 6.75 years, per 1-SD increase in FI was associated with a 41% higher risk of all-cause mortality and a 30% higher risk of cardiovascular mortality after being adjusted for all confounders. Similar results were observed when sensitivity analyses were performed. There was also a non-linear relationship between FI and all-cause mortality. In a weighted multivariate COX proportional model adjusted for full confounders, frailty T2DM increased all-cause (HR, 1.86; 95% CI 1.55-2.24; P < 0.0001) and cardiovascular (HR 1.66; 95% CI 1.18-2.33; P = 0.003) mortality and compared to non-frailty T2DM. The positive association of frailty index and all-cause mortality was only in participants without CHF. The positive association of frailty index and cardiovascular mortality was only in non-anti-diabetic drug users. CONCLUSIONS Frailty index in T2DM was positively associated with CHF in linear fashions. The Frailty index was positively correlated with all-cause and cardiovascular death in patients with T2DM. Frailty T2DM was positively associated with CHF, all-cause mortality, and cardiovascular mortality compared to non-frailty T2DM. Promoting frailty measurement and management in T2DM may be beneficial to reduce the burden of CHF and mortality.
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Affiliation(s)
- Yu-Nan Qin
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, People's Republic of China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Xiao-Pu Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, People's Republic of China.
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China.
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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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Fung E, Chan EYS, Ng KH, Yu KM, Li H, Wang Y. Towards clinical application of GlycA and GlycB for early detection of inflammation associated with (pre)diabetes and cardiovascular disease: recent evidence and updates. J Inflamm (Lond) 2023; 20:32. [PMID: 37814278 PMCID: PMC10563214 DOI: 10.1186/s12950-023-00358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023] Open
Abstract
Cardiometabolic diseases are associated with low-grade inflammation early in life and persists into old age. The long latency period presents opportunities for early detection, lifestyle modification and intervention. However, the performance of conventional biomarker assays to detect low-grade inflammation has been variable, particularly for early-stage cardiometabolic disorder including prediabetes and subclinical atherosclerotic vascular inflammation. During the last decade, the application of nuclear magnetic resonance (NMR) spectroscopy for metabolic profiling of biofluids in translational and epidemiological research has advanced to a stage approaching clinical application. Proton (1H)-NMR profiling induces no destructible physical changes to specimens, and generates quantitative signals from deconvoluted spectra that are highly repeatable and reproducible. Apart from quantitative analysis of amino acids, lipids/lipoproteins, metabolic intermediates and small proteins, 1H-NMR technology is unique in being able to detect composite signals of acute-phase and low-grade inflammation indicated by glycosylated acetyls (GlycA) and N-acetylneuraminic acid (sialic acid) moieties (GlycB). Different from conventional immunoassays that target epitopes and are susceptible to conformational variation in protein structure and binding, GlycA and GlycB signals are stable over time, and maybe complementary as well as superior to high-sensitivity C-reactive protein and other inflammatory cytokines. Here we review the physicochemical principles behind 1H-NMR profiling of GlycA and GlycB, and the available evidence supporting their potential clinical application for the prediction of incident (pre)diabetes, cardiovascular disease, and adverse outcomes.
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Affiliation(s)
- Erik Fung
- Department of Medicine & Therapeutics, Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, and Centre for Cardiovascular Genomics & Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong SAR, China.
- Neural, Vascular, and Metabolic Biology Programme, and Ministry of Education Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
- Department of Epidemiology & Biostatistics, School of Public Health, St Mary's Campus, Imperial College London, London, UK.
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China.
- Prince of Wales Hospital, Room 124010, 10/F, LCWCSB, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China.
| | - Eunice Y S Chan
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
| | - Kwan Hung Ng
- Department of Medicine & Therapeutics, Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, and Centre for Cardiovascular Genomics & Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong SAR, China
| | - Ka Man Yu
- Department of Medicine & Therapeutics, Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, and Centre for Cardiovascular Genomics & Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong SAR, China
| | - Huijun Li
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
| | - Yulan Wang
- Singapore Phenome Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Wen W, Zheng H, Li W, Huang G, Chen P, Zhu X, Cao Y, Li J, Huang X, Huang Y. Transcription factor EB: A potential integrated network regulator in metabolic-associated cardiac injury. Metabolism 2023; 147:155662. [PMID: 37517793 DOI: 10.1016/j.metabol.2023.155662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
With the worldwide pandemic of metabolic diseases, such as obesity, diabetes, and non-alcoholic fatty liver disease (NAFLD), cardiometabolic disease (CMD) has become a significant cause of death in humans. However, the pathophysiology of metabolic-associated cardiac injury is complex and not completely clear, and it is important to explore new strategies and targets for the treatment of CMD. A series of pathophysiological disturbances caused by metabolic disorders, such as insulin resistance (IR), hyperglycemia, hyperlipidemia, mitochondrial dysfunction, oxidative stress, inflammation, endoplasmic reticulum stress (ERS), autophagy dysfunction, calcium homeostasis imbalance, and endothelial dysfunction, may be related to the incidence and development of CMD. Transcription Factor EB (TFEB), as a transcription factor, has been extensively studied for its role in regulating lysosomal biogenesis and autophagy. Recently, the regulatory role of TFEB in other biological processes, including the regulation of glucose homeostasis, lipid metabolism, etc. has been gradually revealed. In this review, we will focus on the relationship between TFEB and IR, lipid metabolism, endothelial dysfunction, oxidative stress, inflammation, ERS, calcium homeostasis, autophagy, and mitochondrial quality control (MQC) and the potential regulatory mechanisms among them, to provide a comprehensive summary for TFEB as a potential new therapeutic target for CMD.
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Affiliation(s)
- Weixing Wen
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China.
| | - Weiwen Li
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Guolin Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Peng Chen
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Xiaolin Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China.
| | - Yue Cao
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Jiahuan Li
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Xiaohui Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation Research, Guangzhou, China; Medical Research Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), NO. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China.
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Abdelhamid M, Al Ghalayini K, Al‐Humood K, Altun B, Arafah M, Bader F, Ibrahim M, Sabbour H, Shawky Elserafy A, Skouri H, Yilmaz MB. Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey. ESC Heart Fail 2023; 10:2773-2787. [PMID: 37530028 PMCID: PMC10567674 DOI: 10.1002/ehf2.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co-morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5-16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co-morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium-glucose co-transporter-2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co-morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.
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Affiliation(s)
| | | | | | - Bülent Altun
- Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Feras Bader
- Cleveland ClinicAbu DhabiUnited Arab Emirates
| | | | | | | | - Hadi Skouri
- Sheikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
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Banerjee M, Maisnam I, Pal R, Mukhopadhyay S. Mineralocorticoid receptor antagonists with sodium-glucose co-transporter-2 inhibitors in heart failure: a meta-analysis. Eur Heart J 2023; 44:3686-3696. [PMID: 37605637 DOI: 10.1093/eurheartj/ehad522] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND AIMS To investigate the cardiovascular effects of sodium-glucose co-transporter-2 inhibitors (SGLT2i) with concomitant mineralocorticoid receptor antagonist (MRA) use in heart failure (HF) regardless of ejection fraction (EF) and explore the risk of MRA-associated adverse events in individuals randomized to SGLT2i vs. placebo. METHODS PubMed/MEDLINE, Web of Science, Embase, and clinical trial registries were searched for randomized controlled trials/post-hoc analyses evaluating SGLT2i in HF with or without MRA use (PROSPERO: CRD42023397129). The main outcomes were composite of first hospitalization or urgent visit for HF/cardiovascular death (HHF/CVD), HHF, and CVD. Others were all-cause mortality, composite renal and safety outcomes. Hazard ratios (HR)/risk ratios were extracted. Fixed-effects meta-analyses and subgroup analyses were performed. RESULTS Five eligible studies were included, pooling data from 21 947 people with HF (type 2 diabetes mellitus, n = 10 805). Compared to placebo, randomization to SGLT2i showed a similar reduction in HHF/CVD and HHF in people who were or were not using MRAs [HHF/CVD: hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.68-0.81 vs. HR 0.79; 95% CI 0.72-0.86; P-interaction = .43; HHF: HR 0.74; 95% CI 0.67-0.83 vs. HR 0.71; 95% CI 0.63-0.80; P-interaction = .53], with a suggestion of greater relative reduction in CVD in chronic HF people randomized to SGLT2i and using MRAs irrespective of EF (HR 0.81; 95% CI 0.72-0.91 vs. HR 0.98; 95% CI 0.86-1.13; P-interaction = .034). SGLT2i reduced all-cause mortality (P-interaction = .27) and adverse renal endpoints regardless of MRA use (P-interaction = .73) despite a higher risk of volume depletion with concomitant MRAs (P-interaction = .082). SGLT2i attenuated the risk of mild hyperkalaemia (P-interaction < .001) and severe hyperkalaemia (P-interaction = .051) associated with MRA use. CONCLUSIONS MRAs did not influence SGLT2i effects on the composite of HHF/CVD, HHF or all-cause mortality; however, findings hinted at a more pronounced relative reduction in CVD in chronic HF patients regardless of EF who were randomized to SGLT2i and receiving an MRA compared to those randomized to SGLT2i and not receiving MRAs. SGLT2i attenuated the risk of MRA-associated treatment-emergent hyperkalaemia. These findings warrant further validation in well-designed randomized controlled trials.
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Affiliation(s)
- Mainak Banerjee
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, 244, AJC Bose Rd, Kolkata, West Bengal 700020, India
| | - Indira Maisnam
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, 244, AJC Bose Rd, Kolkata, West Bengal 700020, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, 244, AJC Bose Rd, Kolkata, West Bengal 700020, India
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Celik A, Ural D, Sahin A, Colluoglu IT, Kanik EA, Ata N, Arugaslan E, Demir E, Ayvali MO, Ulgu MM, Temizhan A, Cavusoglu Y, Acar RD, Nalbantgil S, Asarcikli LD, Murat S, Birinci S, Yilmaz MB. Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100723. [PMID: 37953995 PMCID: PMC10636276 DOI: 10.1016/j.lanepe.2023.100723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/14/2023]
Abstract
Background Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Türkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES). Methods We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates. Findings The estimated prevalence of HF was 2.114% in Türkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8 ± 13.9 years vs. 66.8 ± 13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region. Interpretation The prevalence, incidence, and survival rates of HF in Türkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT. Funding None.
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Affiliation(s)
- Ahmet Celik
- Department of Cardiology, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Dilek Ural
- Department of Cardiology, Koç University, Faculty of Medicine, Istanbul, Türkiye
| | - Anil Sahin
- Department of Cardiology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Türkiye
| | - Inci Tugce Colluoglu
- Department of Cardiology, Karabük University, Faculty of Medicine, Karabük, Türkiye
| | - Emine Arzu Kanik
- Department of Biostatistics and Medical Informatics, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Naim Ata
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Emre Arugaslan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Emre Demir
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Mustafa Okan Ayvali
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mustafa Mahir Ulgu
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Ahmet Temizhan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Yuksel Cavusoglu
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Rezzan Deniz Acar
- Department of Cardiology, Health Science University, Faculty of Medicine, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Lale Dinc Asarcikli
- Department of Cardiology, Health Science University, Faculty of Medicine, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selda Murat
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Suayip Birinci
- Deputy Minister of Health, Ministry of Health, Ankara, Türkiye
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Türkiye
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Confederat LG, Condurache MI, Alexa RE, Dragostin OM. Particularities of Urinary Tract Infections in Diabetic Patients: A Concise Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1747. [PMID: 37893465 PMCID: PMC10608443 DOI: 10.3390/medicina59101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients are more likely to develop infections, including many common infections, but also pathognomonic ones such as emphysematous pyelonephritis, malignant otitis externa, mucormycosis and Fournier's gangrene. Considering the fact that diabetic patients experience more frequently urinary tract infections (UTIs) with a worse prognosis than non-diabetic people, we conducted a review study based on data in the literature, following the particularities of UTIs in this group of patients, the risk factors, the mechanisms involved and the challenges in their management. The findings highlight that UTI in diabetic patients have some particularities, including a more frequent evolution to bacteremia, increased hospitalizations, and elevated rates of recurrence and mortality than non-diabetic patients. The possible risk factors identified seem to be female gender, pregnancy, older age, UTI in the previous six months, poor glycemic control and duration of diabetes. The mechanisms involved are related to glucosuria and bladder dysfunction, factors related to bacterial strains and host response. The bacterial strains involved in UTIs in diabetic patients and their antibiotic susceptibility profile are, with some exceptions, similar to those in non-diabetic people; however, the antimicrobial agents should be carefully chosen and the duration of the treatment should be as those required for a complicated UTI. The data related to the risk of developing UTIs in patients treated with SGLT-2 inhibitors, a new class of oral hypoglycaemic agents with cardiovascular and renal benefits, are controversial; overall, it was evidenced that UTIs occurred at the initiation of the treatment, recurrent infection was uncommon and the majority of UTIs responded to treatment with standard antibiotics. Moreover, interruption or discontinuation of SGLT-2 inhibitor as a result of UTI was rare and SGLT-2 inhibitors did not increase the risk of severe infections such as urosepsis and pyelonephritis.
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Affiliation(s)
- Luminita-Georgeta Confederat
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Mihaela-Iustina Condurache
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Raluca-Elena Alexa
- “Sfântul Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania;
| | - Oana-Maria Dragostin
- Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania;
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Kostopoulos G, Doundoulakis I, Toulis KA, Karagiannis T, Tsapas A, Haidich AB. Prognostic models for heart failure in patients with type 2 diabetes: a systematic review and meta-analysis. Heart 2023; 109:1436-1442. [PMID: 36898704 DOI: 10.1136/heartjnl-2022-322044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/07/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE To provide a systematic review, critical appraisal, assessment of performance and generalisability of all the reported prognostic models for heart failure (HF) in patients with type 2 diabetes (T2D). METHODS We performed a literature search in Medline, Embase, Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus (from inception to July 2022) and grey literature to identify any study developing and/or validating models predicting HF applicable to patients with T2D. We extracted data on study characteristics, modelling methods and measures of performance, and we performed a random-effects meta-analysis to pool discrimination in models with multiple validation studies. We also performed a descriptive synthesis of calibration and we assessed the risk of bias and certainty of evidence (high, moderate, low). RESULTS Fifty-five studies reporting on 58 models were identified: (1) models developed in patients with T2D for HF prediction (n=43), (2) models predicting HF developed in non-diabetic cohorts and externally validated in patients with T2D (n=3), and (3) models originally predicting a different outcome and externally validated for HF (n=12). RECODe (C-statistic=0.75 95% CI (0.72, 0.78), 95% prediction interval (PI) (0.68, 0.81); high certainty), TRS-HFDM (C-statistic=0.75 95% CI (0.69, 0.81), 95% PI (0.58, 0.87); low certainty) and WATCH-DM (C-statistic=0.70 95% CI (0.67, 0.73), 95% PI (0.63, 0.76); moderate certainty) showed the best performance. QDiabetes-HF demonstrated also good discrimination but was externally validated only once and not meta-analysed. CONCLUSIONS Among the prognostic models identified, four models showed promising performance and, thus, could be implemented in current clinical practice.
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Affiliation(s)
- Georgios Kostopoulos
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
| | - Ioannis Doundoulakis
- Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos A Toulis
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas Karagiannis
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, Oxfordshire, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Cao W, Deng Y, Lv L, Liu X, Luo A, Yin L, Li Z. Assessment of left ventricular function in patients with type 2 diabetes mellitus by non-invasive myocardial work. Front Endocrinol (Lausanne) 2023; 14:1241307. [PMID: 37732124 PMCID: PMC10508289 DOI: 10.3389/fendo.2023.1241307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background Diabetes mellitus (DM) is a chronic disease that poses a serious risk of cardiovascular diseases. Therefore, early detection of impaired cardiac function with non-invasive myocardial imaging is critical for improving the prognosis of patients with DM. Purpose This study aimed to assess the left ventricular (LV) function in patients with type 2 diabetes mellitus (T2DM) by non-invasive myocardial work technique. Materials and methods In all, 67 patients with T2DM and 28 healthy controls were included and divided into a DM group and a control group. Two-dimensional dynamic images of apical three-chamber view, apical two-chamber view, and apical four-chamber view were collected from all subjects, consisting of at least three cardiac cycles. LV myocardial strain parameters, including global longitudinal strain (GLS) and peak strain dispersion (PSD), as well as myocardial work parameters, including global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE), were obtained and analyzed. Results A total of 15 subjects were randomly selected to assess intra-observer and inter-observer consistency of myocardial work parameters and strain parameters, which showed excellent results (intra-class correlation coefficients: 0.856 - 0.983, P<0.001). Compared with the control group, the DM group showed significantly higher PSD (37.59 ± 17.18 ms vs. 27.72 ± 13.52 ms, P<0.05) and GWW (63.98 ± 43.63 mmHg% vs. 39.28 ± 25.67 mmHg%, P<0.05), and lower GWE (96.38 ± 2.02% vs. 97.72 ± 0.98%, P<0.001). Furthermore, the PSD was positively correlated with GWW (r = 0.565, P<0.001) and negatively correlated with GWE (r = -0.569, P<0.001). Conclusion Uncoordinated LV myocardial strain, higher GWW, and lower GWE in patients with T2DM may serve as indicators for the early assessment of cardiac impairment in T2DM.
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Affiliation(s)
- Wenjia Cao
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Linyi Lv
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuebing Liu
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Anguo Luo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lixue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhaohuan Li
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Kato T, Murakami T, Yabe D, Harada N. Impact of the angiotensin receptor-neprilysin inhibitor in clinical diabetes management: Potential benefits and pitfalls. J Diabetes Investig 2023; 14:1038-1040. [PMID: 37357546 PMCID: PMC10445196 DOI: 10.1111/jdi.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023] Open
Abstract
The possible mechanism of increased urinary C-peptide due to neprilysin inhibitors is investigated. Neprilysin inhibition blocks degradation of natriuretic peptides, and elicits a natriuretic and antihypertensive effect. Neprilysin inhibition might similarly block degradation of C-peptides in the kidney and thus increase the urinary C-peptide level.
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Affiliation(s)
- Tomoko Kato
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | - Takaaki Murakami
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
- Center for One Medicine Innovative Translational ResearchGifu UniversityGifuJapan
| | - Norio Harada
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
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Januzzi JL, Mohebi R, Liu Y, Sattar N, Heerspink HJL, Tefera E, Vaduganathan M, Butler J, Yavin Y, Li J, Pollock CA, Perkovic V, Neal B, Hansen MK. Cardiorenal Biomarkers, Canagliflozin, and Outcomes in Diabetic Kidney Disease: The CREDENCE Trial. Circulation 2023; 148:651-660. [PMID: 37603600 DOI: 10.1161/circulationaha.123.065251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND People with type 2 diabetes and albuminuria are at an elevated risk for cardiac and renal events. The optimal biomarkers to aid disease prediction and to understand the benefits of sodium-glucose cotransporter-2 inhibition remain unclear. METHODS Among 2627 study participants in the CREDENCE trial (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), concentrations of NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T, growth differentiation factor-15, and IGFBP7 (insulin-like growth factor binding protein 7) were measured. The effect of canagliflozin on biomarker concentrations was evaluated. The prognostic potential of each biomarker on the primary outcome (a composite of end-stage kidney disease [dialysis, transplantation, or a sustained estimated glomerular filtration rate of <15 mL·min-1·1.73 m-2], doubling of the serum creatinine level, or renal death or cardiovascular death) was assessed. RESULTS The median (quartiles 1 and 3) concentration of each biomarker was generally elevated: NT-proBNP, 180 ng/L (82, 442 ng/L); high-sensitivity cardiac troponin T, 19 ng/L (12, 29 ng/L); growth differentiation factor-15, 2595 ng/L (1852, 3775 ng/L); and IGFBP7, 121.8 ng/mL (105.4, 141.5 ng/mL). At 1 year, the biomarkers all rose by 6% to 29% in the placebo arm but only by 3% to 10% in the canagliflozin arm (all P<0.01 in multivariable linear mixed-effect models). Baseline concentrations of each biomarker were strongly predictive of cardiac and renal outcomes. When the biomarkers were analyzed together in a multimarker panel, individuals with high risk scores (hazard ratio [HR], 4.01 [95% CI, 2.52-6.35]) and moderate risk scores (HR, 2.39 [95% CI, 1.48-3.87]) showed a higher risk for the primary outcome compared with those with low risk scores. By 1 year, a 50% increase in NT-proBNP (HR, 1.11 [95% CI, 1.08-1.15]), high-sensitivity cardiac troponin T (HR, 1.86 [95% CI, 1.64-2.10]), growth differentiation factor-15 (HR, 1.45 [95% CI, 1.24-1.70]), and IGFBP7 (HR, 3.76 [95% CI, 2.54-5.56]) was associated with risk of the primary outcome. CONCLUSIONS Multiple cardiorenal stress biomarkers are strongly prognostic in people with type 2 diabetes and albuminuria. Canagliflozin modestly reduced the longitudinal trajectory of rise in each biomarker. Change in the biomarker level in addition to the baseline level augments the primary outcome prediction. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02065791.
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (J.L.J., R.M., Y.L.)
- Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA (J.L.J.)
| | - Reza Mohebi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (J.L.J., R.M., Y.L.)
| | - Yuxi Liu
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (J.L.J., R.M., Y.L.)
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK (N.S.)
| | - Hiddo J L Heerspink
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, the Netherlands (H.J.L.H.)
| | - Eshetu Tefera
- Janssen Research & Development, LLC, Spring House, PA (E.T., Y.Y., M.K.H.)
| | - Muthiah Vaduganathan
- Cardiology Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.V.)
| | - Javed Butler
- University of Mississippi Medical Center, Jackson (J.B.)
- Baylor Scott & White Institute, Dallas, TX (J.B.)
| | - Yshai Yavin
- Janssen Research & Development, LLC, Spring House, PA (E.T., Y.Y., M.K.H.)
| | - Jingwei Li
- Department of Cardiology, People's Liberation Army General Hospital, Beijing, China (J.L.)
- Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China (J.L.)
- The George Institute for Global Health (J.L., V.P., B.N.), UNSW Sydney, Australia
| | - Carol A Pollock
- Kolling Institute, Royal North Shore Hospital University of Sydney, NSW, Australia (C.A.P.)
| | - Vlado Perkovic
- The George Institute for Global Health (J.L., V.P., B.N.), UNSW Sydney, Australia
- Faculty of Medicine (V.P.), UNSW Sydney, Australia
- The Royal North Shore Hospital, Sydney, Australia (V.P.)
| | - Bruce Neal
- The George Institute for Global Health (J.L., V.P., B.N.), UNSW Sydney, Australia
- Charles Perkins Centre, University of Sydney, NSW, Australia (B.N.)
- Imperial College London, UK (B.N.)
| | - Michael K Hansen
- Janssen Research & Development, LLC, Spring House, PA (E.T., Y.Y., M.K.H.)
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Haji M, Erqou S, Fonarow GC, Echouffo-Tcheugui JB. Type 1 diabetes and risk of heart failure: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 202:110805. [PMID: 37356724 PMCID: PMC10530158 DOI: 10.1016/j.diabres.2023.110805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
AIM Robust data on type 1 diabetes (T1DM) and the risk of heart failure (HF) is scarce. METHODS We searched PubMed and EMBASE for relevant studies, abstracted data on HF incidence rate and adjusted relative risk (aRR) for T1DM, type 2 diabetes (T2DM) and controls, and pooled incidence rates and aRRs for HF across studies. RESULTS Four studies including 61,885 T1DM patients, 4,599,213 non-diabetic controls, and 248,021 T2DM patients (three studies) were included. The pooled average proportions of men were 56%, 54%, and 55%, for T1DM, T2DM, and controls, respectively. The corresponding pooled average participants' ages were 40, 65 and 57 years, respectively. Over a 1 to 12 years follow-up, 1378, 3993, 18,945 HF events occurred among individuals with T1DM, T2DM, and controls, yielding pooled HF incidence rates of 5.8 (95%CI: 4.1-7.6), 10.0 (95% CI: 6.1-13.9), 2.3 (95% CI: 1.5-3.2) per 1000 person-years, respectively. Compared to controls, T1DM patients had a 3-fold higher HF risk (aRR 3.4, 95% CI 2.71-4.26). The RR of HF was ∼ 5-fold higher in women (aRR: 4.9, 95% CI: 4.1-5.9) vs. 3-fold higher in men (aRR: 3.0, 95% CI: 2.2-4.0). CONCLUSIONS Individuals with T1DM had a substantially higher risk of HF compared to those without diabetes.
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Affiliation(s)
- Mohammed Haji
- Department of Medicine, Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Department of Medicine, Brown University, Providence, RI, USA; Department of Medicine, Providence VA Medical Center, Providence, RI, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, John Hopkins University School of Medicine, Baltimore, MD, USA.
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79
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Bozkurt B. Pre-Heart Failure: An Important Opportunity to Prevent a Deadly Disease. JACC. HEART FAILURE 2023; 11:1027-1031. [PMID: 37558381 DOI: 10.1016/j.jchf.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
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80
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Ruiz-García A, Serrano-Cumplido A, Escobar-Cervantes C, Arranz-Martínez E, Turégano-Yedro M, Pallarés-Carratalá V. Heart Failure Prevalence Rates and Its Association with Other Cardiovascular Diseases and Chronic Kidney Disease: SIMETAP-HF Study. J Clin Med 2023; 12:4924. [PMID: 37568326 PMCID: PMC10419820 DOI: 10.3390/jcm12154924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 years and to assess its association with cardiovascular diseases and chronic kidney disease. METHODS A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis. RESULTS The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk. CONCLUSIONS This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.
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Affiliation(s)
- Antonio Ruiz-García
- Pinto Primary Care Center, Lipids and Cardiovascular Prevention Unit, University Health Centre, 28320 Madrid, Spain;
- Department of Medicine, European University of Madrid, 28005 Madrid, Spain
| | | | | | | | | | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Mutual Insurance Union, 12004 Castellon, Spain
- Department of Medicine, Jaume I University, 12006 Castellon, Spain
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81
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McEvoy JW, Daya N, Tang O, Fang M, Ndumele CE, Coresh J, Christenson RH, Selvin E. High-sensitivity troponins and mortality in the general population. Eur Heart J 2023; 44:2595-2605. [PMID: 37264651 PMCID: PMC10361011 DOI: 10.1093/eurheartj/ehad328] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/29/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS Cardiac troponin T and I can be measured using a number of high-sensitivity (hs) assays. This study aimed to characterize correlations between four such assays and test their comparative associations with mortality. METHODS AND RESULTS Among adults without cardiovascular disease in the 1999-2004 National Health and Nutrition Examination Survey, hs-troponin T was measured using one assay (Roche) and hs-troponin I using three assays (Abbott, Siemens, and Ortho). Cox regression was used to estimate associations with all-cause and cardiovascular mortality. Pearson's correlation coefficients comparing concentrations from each assay ranged from 0.53 to 0.77. There were 2188 deaths (488 cardiovascular) among 9810 participants. Each hs-troponin assay [log-transformed, per 1 standard deviation (SD)] was independently associated with all-cause mortality: hazard ratio (HR) 1.20 [95% confidence interval (CI) 1.13-1.28] for Abbott hs-troponin I; HR 1.10 (95% CI 1.02-1.18) for Siemens hs-troponin I; HR 1.23 (95% CI 1.14-1.33) for Ortho hs-troponin I; and HR 1.31 (95% CI 1.21-1.42) for Roche hs-troponin T. Each hs-troponin assay was also independently associated with cardiovascular mortality (HR 1.44 to 1.65 per 1 SD). Associations of hs-troponin T and all-cause and cardiovascular mortality remained significant after adjusting for hs-troponin I. Furthermore, associations of hs-troponin I remained significant after mutually adjusting for hs-troponin I from the other individual assays: e.g. cardiovascular mortality HR 1.46 (95% CI 1.19-1.79) for Abbott after adjustment for the Siemens assay and HR 1.29 (95% CI 1.09-1.53) for Abbott after adjustment for the Ortho assay. CONCLUSION This study demonstrates only modest correlations between hs-troponin T and three hs-troponin I assays and that hs-troponin I assays can provide distinct risk information for mortality in the general population.
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Affiliation(s)
- John W McEvoy
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91-FF68, Connacht, Ireland
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Natalie Daya
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Olive Tang
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Chiadi E Ndumele
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
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Bertoluci MC, Silva Júnior WS, Valente F, Araujo LR, Lyra R, de Castro JJ, Raposo JF, Miranda PAC, Boguszewski CL, Hohl A, Duarte R, Salles JEN, Silva-Nunes J, Dores J, Melo M, de Sá JR, Neves JS, Moreira RO, Malachias MVB, Lamounier RN, Malerbi DA, Calliari LE, Cardoso LM, Carvalho MR, Ferreira HJ, Nortadas R, Trujilho FR, Leitão CB, Simões JAR, Dos Reis MIN, Melo P, Marcelino M, Carvalho D. 2023 UPDATE: Luso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetes. Diabetol Metab Syndr 2023; 15:160. [PMID: 37468901 PMCID: PMC10354939 DOI: 10.1186/s13098-023-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined a joint panel of four leading diabetes societies to update the guideline published in 2020. METHODS The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D without cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefined criteria. RESULTS AND CONCLUSIONS All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible target (up to 8%) should be considered in frail older people. Non-pharmacological approaches are recommended during all phases of treatment. In treatment naïve T2D individuals without cardiorenal complications, metformin is the agent of choice when HbA1c is 7.5% or below. When HbA1c is above 7.5% to 9%, starting with dual therapy is recommended, and triple therapy may be considered. When HbA1c is above 9%, starting with dual therapyt is recommended, and triple therapy should be considered. Antidiabetic drugs with proven CV benefit (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efficacy in weight reduction should be considered when obesity is present. If HbA1c remains above target, intensification is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D and established ASCVD, AD1 agents (SGLT2 inhibitors or GLP-1 RA with proven CV benefit) are initially recommended to reduce CV outcomes, and metformin or a second AD1 may be necessary to improve glycemic control if HbA1c is above the target. In T2D with HF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and mortality and to improve HbA1c. In patients with DKD, SGLT2 inhibitors in combination with metformin are recommended when eGFR is above 30 mL/min/1.73 m2. SGLT2 inhibitors can be continued until end-stage kidney disease.
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Affiliation(s)
- Marcello Casaccia Bertoluci
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna da Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS, 90035-007, Brazil.
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil.
| | - Wellington S Silva Júnior
- Disciplina de Endocrinologia, Departamento de Medicina I, Universidade Federal Maranhão, São Luís, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Fernando Valente
- Faculdade de Medicina do ABC, Santo André, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Levimar Rocha Araujo
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Ruy Lyra
- Universidade Federal de Pernambuco, Recife, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - João Jácome de Castro
- Serviço de Endocrinologia do Hospital Universitário das Forças Armadas, Lisbon, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - João Filipe Raposo
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Paulo Augusto Carvalho Miranda
- Clínica de Endocrinologia e Metabologia da Santa Casa Belo Horizonte, Belo Horizonte, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Cesar Luiz Boguszewski
- Divisão de Endocrinologia (SEMPR), Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Alexandre Hohl
- Departamento de Clínica Médica da Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Rui Duarte
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - João Eduardo Nunes Salles
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - José Silva-Nunes
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Jorge Dores
- Centro Hospitalar e Universitário de Santo António, Lisbon, Portugal
- Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Miguel Melo
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - João Roberto de Sá
- Faculdade de Medicina do ABC, Santo André, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - João Sérgio Neves
- Cardiovascular R&D Centre (UnIC@RISE), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Rodrigo Oliveira Moreira
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
- Faculdade de Medicina, Centro Universitário Presidente Antônio Carlos (UNIPAC/JF), Juiz de Fora, Brazil
- Faculdade de Medicina, Centro Universitário de Valença (UNIFAA), Valença, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | | | - Rodrigo Nunes Lamounier
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Domingos Augusto Malerbi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Luis Eduardo Calliari
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Luis Miguel Cardoso
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Maria Raquel Carvalho
- Hospital CUF, Tejo, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Hélder José Ferreira
- Clínica Grupo Sanfil Medicina, Coimbra, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Rita Nortadas
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Fábio Rogério Trujilho
- Faculdade de Medicina da UniFTC, Salvador, Brazil
- Centro de Diabetes e Endocrinologia da Bahia (CEDEBA), Salvador, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Cristiane Bauermann Leitão
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna da Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS, 90035-007, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - José Augusto Rodrigues Simões
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Mónica Isabel Natal Dos Reis
- Unidade Integrada de Diabetes Mellitus do Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Pedro Melo
- Serviço de Endocrinologia, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade de Endocrinologia, Instituto CUF, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Mafalda Marcelino
- Serviço de Endocrinologia do Hospital Universitário das Forças Armadas, Lisbon, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Davide Carvalho
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
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Yeung AM, Huang J, Pandey A, Hashim IA, Kerr D, Pop-Busui R, Rhee CM, Shah VN, Bally L, Bayes-Genis A, Bee YM, Bergenstal R, Butler J, Fleming GA, Gilbert G, Greene SJ, Kosiborod MN, Leiter LA, Mankovsky B, Martens TW, Mathieu C, Mohan V, Patel KV, Peters A, Rhee EJ, Rosano GMC, Sacks DB, Sandoval Y, Seley JJ, Schnell O, Umpierrez G, Waki K, Wright EE, Wu AHB, Klonoff DC. Biomarkers for the Diagnosis of Heart Failure in People with Diabetes: A Consensus Report from Diabetes Technology Society. Prog Cardiovasc Dis 2023; 79:65-79. [PMID: 37178991 DOI: 10.1016/j.pcad.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Diabetes Technology Society assembled a panel of clinician experts in diabetology, cardiology, clinical chemistry, nephrology, and primary care to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF).
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Affiliation(s)
- Andrea M Yeung
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Jingtong Huang
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Ambarish Pandey
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Ibrahim A Hashim
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - David Kerr
- Diabetes Technology Society, Burlingame, CA, United States of America
| | | | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, United States of America
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Lia Bally
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, CIBERCV, Universitat Autonoma Barcelona, Spain
| | | | - Richard Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi, Jackson, MS, United States of America
| | | | - Gregory Gilbert
- Mills-Peninsula Medical Center, Burlingame, CA, United States of America
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States of America
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Thomas W Martens
- International Diabetes Center and Park Nicollet Clinic, Minneapolis, MN, United States of America
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Anne Peters
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States of America
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - David B Sacks
- National Institutes of Health, Bethesda, MD, United States of America
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | | | - Oliver Schnell
- Forschergruppe Diabetes e.V., Munich-, Neuherberg, Germany
| | | | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | - Eugene E Wright
- Charlotte Area Health Education Center, Charlotte, NC, United States of America
| | - Alan H B Wu
- University of California, San Francisco, San Francisco, CA, United States of America
| | - David C Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, United States of America.
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84
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Lee SH, Park JH. The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus. Diabetes Metab J 2023; 47:470-483. [PMID: 37533197 PMCID: PMC10404522 DOI: 10.4093/dmj.2023.0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/20/2023] [Indexed: 08/04/2023] Open
Abstract
Patients with diabetes mellitus are highly susceptible to cardiovascular complications, which are directly correlated with cardiovascular morbidity and mortality. In addition to coronary artery disease, there is growing awareness of the risk and prevalence of heart failure (HF) in patients with diabetes. Echocardiography is an essential diagnostic modality commonly performed in patients with symptoms suggestive of cardiovascular diseases (CVD), such as dyspnea or chest pain, to establish or rule out the cause of symptoms. Conventional echocardiographic parameters, such as left ventricular ejection fraction, are helpful not only for diagnosing CVD but also for determining severity, treatment strategy, prognosis, and response to treatment. Echocardiographic myocardial strain, a novel echocardiographic technique, enables the detection of early changes in ventricular dysfunction before HF symptoms develop. This article aims to review the role of echocardiography in evaluating CVD in patients with diabetes mellitus and how to use it in patients with suspected cardiac diseases.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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Bueno Junior CR, Bano A, Tang Y, Sun X, Abate A, Hall E, Mitri J, Morieri ML, Shah H, Doria A. Rapid kidney function decline and increased risk of heart failure in patients with type 2 diabetes: findings from the ACCORD cohort : Rapid kidney function decline and heart failure in T2D. Cardiovasc Diabetol 2023; 22:131. [PMID: 37365586 PMCID: PMC10291814 DOI: 10.1186/s12933-023-01869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Impaired kidney function and albuminuria are associated with increased risk of heart failure (HF) in patients with type 2 diabetes (T2D). We investigated whether rapid kidney function decline over time is an additional determinant of increased HF risk in patients with T2D, independent of baseline kidney function, albuminuria, and other HF predictors. METHODS Included in the study were 7,539 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study with baseline urinary albumin-to-creatinine ratio (UACR) data, who had completed 4 years of follow-up and had ≥ 3 eGFR measurements during that period (median eGFR/year = 1.9, IQR 1.7-3.2). The association between rapid kidney function decline (eGFR loss ≥ 5 ml/min/1.73 m2/year) and odds of HF hospitalization or HF death during the first 4 years of follow-up was estimated by logistic regression. The improvement in risk discrimination provided by adding rapid kidney function decline to other HF risk factors was evaluated as the increment in the area under the Receiving Operating Characteristics curve (ROC AUC) and integrated discrimination improvement (IDI). RESULTS Over 4 years of follow-up, 1,573 participants (20.9%) experienced rapid kidney function decline and 255 (3.4%) experienced a HF event. Rapid kidney function decline was associated with a ~ 3.2-fold increase in HF odds (3.23, 95% CI, 2.51-4.16, p < 0.0001), independent of baseline CVD history. This estimate was not attenuated by adjustment for potential confounders, including eGFR and UACR at baseline as well as at censoring (3.74; 95% CI 2.63-5.31). Adding rapid kidney function decline during follow-up to other clinical predictors (WATCH-DM score, eGFR, and UACR at study entry and end of follow-up) improved HF risk classification (ROC AUC = + 0.02, p = 0.027; relative IDI = + 38%, p < 0.0001). CONCLUSIONS In patients with T2D, rapid kidney function decline is associated with a marked increase in HF risk, independent of starting kidney function and/or albuminuria. These findings highlight the importance of serial eGFR measurements over time to improve HF risk estimation in T2D.
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Affiliation(s)
- Carlos Roberto Bueno Junior
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- School of Physical Education and Sport, Medical School, College of Nursing of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, Sao Paulo, Brazil
| | - Arjola Bano
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yaling Tang
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Xiuqin Sun
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Endocrine and Metabolism, Peking University Shuang Hospital, Beijing, China
| | - Alex Abate
- Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Elizabeth Hall
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joanna Mitri
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mario Luca Morieri
- Department of Medicine, Metabolic Disease Unit, University of Padova, University Hospital of Padova, Padova, Italy
| | - Hetal Shah
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alessandro Doria
- Research Division, Joslin Diabetes Center, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.
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86
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Pandey A, Khan MS, Patel KV, Bhatt DL, Verma S. Predicting and preventing heart failure in type 2 diabetes. Lancet Diabetes Endocrinol 2023:S2213-8587(23)00128-6. [PMID: 37385290 DOI: 10.1016/s2213-8587(23)00128-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
The burden of heart failure among people with type 2 diabetes is increasing globally. People with comorbid type 2 diabetes and heart failure often have worse outcomes than those with only one of these conditions-eg, higher hospitalisation and mortality rates. Therefore, it is essential to implement optimal heart failure prevention strategies for people with type 2 diabetes. A detailed understanding of the pathophysiology underlying the occurrence of heart failure in type 2 diabetes can aid clinicians in identifying relevant risk factors and lead to early interventions that can help prevent heart failure. In this Review, we discuss the pathophysiology and risk factors of heart failure in type 2 diabetes. We also review the risk assessment tools for predicting heart failure incidence in people with type 2 diabetes as well as the data from clinical trials that have assessed the efficacy of lifestyle and pharmacological interventions. Finally, we discuss the potential challenges in implementing new management approaches and offer pragmatic recommendations to help overcome these challenges.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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87
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Mohebi R, Wang D, Lau ES, Parekh JK, Allen N, Psaty BM, Benjamin EJ, Levy D, Wang TJ, Shah SJ, Gottdiener JS, Januzzi JL, Ho JE. Effect of 2022 ACC/AHA/HFSA Criteria on Stages of Heart Failure in a Pooled Community Cohort. J Am Coll Cardiol 2023; 81:2231-2242. [PMID: 37286252 PMCID: PMC10319342 DOI: 10.1016/j.jacc.2023.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The 2022 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) clinical practice guideline proposed an updated definition for heart failure (HF) stages. OBJECTIVES This study aimed to compare prevalence and prognosis of HF stages according to classification/definition originally described in 2013 and 2022 ACC/AHA/HFSA definitions. METHODS Study participants from 3 longitudinal cohorts (the MESA [Multi-Ethnic Study of Atherosclerosis], CHS [Cardiovascular Health Study], and the FHS [Framingham Heart Study]), were categorized into 4 HF stages according to the 2013 and 2022 criteria. Cox proportional hazards regression was used to assess predictors of progression to symptomatic HF and adverse clinical outcomes associated with each HF stage. RESULTS Among 11,618 study participants, according to the 2022 staging, 1,943 (16.7%) were healthy, 4,348 (37.4%) were in stage A (at risk), 5,019 (43.2%) were in stage B (pre-HF), and 308 (2.7%) were in stage C/D (symptomatic HF). Compared to the classification/definition originally described in 2013, the 2022 ACC/AHA/HFSA approach resulted in a higher proportion of individuals with stage B HF (increase from 15.9% to 43.2%); this shift disproportionately involved women as well as Hispanic and Black individuals. Despite the 2022 criteria designating a greater proportion of individuals as stage B, the relative risk of progression to symptomatic HF remained similar (HR: 10.61; 95% CI: 9.00-12.51; P < 0.001). CONCLUSIONS New standards for HF staging resulted in a substantial shift of community-based individuals from stage A to stage B. Those with stage B HF in the new system were at high risk for progression to symptomatic HF.
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Affiliation(s)
- Reza Mohebi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Dongyu Wang
- Harvard Medical School, Boston, Massachusetts, USA; CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhi K Parekh
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bruce M Psaty
- Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA; Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA; Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Emelia J Benjamin
- Boston University School of Medicine, Boston, Massachusetts, USA; National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA; Framingham Heart Study, Framingham, Massachusetts, USA
| | - Daniel Levy
- Boston University School of Medicine, Boston, Massachusetts, USA; National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA; Framingham Heart Study, Framingham, Massachusetts, USA; Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Thomas J Wang
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Jennifer E Ho
- Harvard Medical School, Boston, Massachusetts, USA; CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Selvin E, Wang D, Tang O, Fang M, Christenson RH, McEvoy JW. Elevated Cardiac Biomarkers, Erectile Dysfunction, and Mortality in U.S. Men: NHANES 2001 to 2004. JACC. ADVANCES 2023; 2:100380. [PMID: 37427147 PMCID: PMC10328217 DOI: 10.1016/j.jacadv.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The prevalence of elevated cardiac biomarkers and their link to mortality in men with erectile dysfunction in the U.S. population are unknown. OBJECTIVES The purpose of this study was to evaluate the prevalence of elevations in N-terminal prohormone B-type natriuretic peptide, high sensitivity troponin (hs-troponin) T, and 3 hs-troponin I assays and their associations with mortality in U.S. men with and without erectile dysfunction. METHODS We conducted cross-sectional analyses using logistic regression to examine associations of elevated cardiac biomarkers (>90th percentile) with erectile dysfunction in 2,971 male participants aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. We conducted prospective analyses using Cox regression to examine the mortality implications of elevations in cardiac biomarkers in the setting of erectile dysfunction. RESULTS Elevations in hs-troponin T and the 3 hs-troponin I assays were associated with erectile dysfunction, with the strongest association for hs-troponin T (adjusted OR: 2.01; 95% CI: 1.22-3.30). Elevated N-terminal prohormone B-type natriuretic peptide was not significantly associated with erectile dysfunction (OR: 1.22; 95% CI: 0.74-2.03). There were 673 deaths during a median of 16 years of follow-up. Men with erectile dysfunction were at an elevated risk of death (adjusted HR: 1.23; 95% CI: 1.04-1.46). Those men with elevated cardiac biomarkers in the setting of erectile dysfunction were at highest risk of all-cause and cardiovascular mortality (adjusted HRs ranging from ~1.5 to 2.4). CONCLUSIONS In this national study, the association of erectile dysfunction with elevated hs-troponin and excess mortality risk suggests that men with erectile dysfunction should be evaluated and targeted for intensive cardiovascular risk management.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W. McEvoy
- Division of Cardiology & National Institute for Prevention & Cardiovascular Health, National University of Ireland, Galway, Ireland
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89
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Iwase M, Ohkuma T, Fujii H, Oku Y, Higashi T, Oshiro A, Ide H, Nakamura U, Kitazono T. Incidence and risks of coronary heart disease and heart failure in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Diabetes Res Clin Pract 2023:110732. [PMID: 37245724 DOI: 10.1016/j.diabres.2023.110732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
AIMS We prospectively investigated the incidence of coronary heart disease (CHD) and heart failure (HF), risk factors and prognosis in Japanese patients with type 2 diabetes. METHODS A total of 4,874 outpatients with type 2 diabetes (mean age 65 years, male 57%, previous CHD 14%) were registered at multicenter diabetes clinics of a prefecture in 2008-2010 and followed for the development of CHD and HF requiring hospitalization for a median of 5.3 years (follow-up rate 98%). Risk factors were evaluated using multivariable adjusted Cox proportional models. RESULTS The incidence rates per 1,000 person-years were 12.3 for CHD (silent myocardial ischemia 5.8, angina pectoris 4.3, myocardial infarction 2.1) and 3.1 for hospitalized HF, respectively. New-onset CHD was significantly associated with higher serum adiponectin [the highest quartile vs. the lowest quartile HR 1.6 (95%CI 1.0-2.6)]. HF was significantly associated with higher serum adiponectin [the highest quartile vs. the lowest quartile HR 2.4 (95%CI 1.1-5.2)], and lower serum creatinine/cystatin C ratio, a surrogate marker for sarcopenia [lowest quartile vs. the highest quartile HR 4.6 (95%CI 1.9-11.1)]. CONCLUSIONS The incidence of heart disease was low and circulating adiponectin and sarcopenia may predict the development of heart disease in Japanese patients with type 2 diabetes.
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Affiliation(s)
- Masanori Iwase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Diabetes Center and Clinical Research Center, Hakujyuji Hospital, Fukuoka, Japan.
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroki Fujii
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaro Oku
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Higashi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayaka Oshiro
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitoshi Ide
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Diabetes Center and Clinical Research Center, Hakujyuji Hospital, Fukuoka, Japan
| | - Udai Nakamura
- Diabetes Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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90
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Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Januzzi JL, Yancy CW. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81:1835-1878. [PMID: 37137593 DOI: 10.1016/j.jacc.2023.03.393] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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91
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Zhang L, Zhang H, Xie X, Tie R, Shang X, Zhao Q, Xu J, Jin L, Zhang J, Ye P. Empagliflozin ameliorates diabetic cardiomyopathy via regulated branched-chain amino acid metabolism and mTOR/p-ULK1 signaling pathway-mediated autophagy. Diabetol Metab Syndr 2023; 15:93. [PMID: 37149696 PMCID: PMC10163822 DOI: 10.1186/s13098-023-01061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), has been reported to significantly reduce the risk of heart failure in multiple clinical studies. However, the underlying mechanisms remain elusive. This study aimed to investigate the effect of empagliflozin on branched-chain amino acid (BCAA) metabolism in diabetic cardiomyopathy. METHODS Thirty male 8-week KK Cg-Ay/J mice were used to study diabetic cardiomyopathy; here, 15 were used as the model group, and the remaining 15 were administered empagliflozin (3.75 mg/kg/day) by gavage daily for 16 weeks. The control group consisted of fifteen male 8-week C57BL/6J mice, whose blood glucose and body weight were measured simultaneously with the diabetic mice until 16 weeks without additional intervention. Echocardiography and histopathology were performed to evaluate cardiac structure and function. Proteomic sequencing and biogenic analysis were performed on mouse hearts. Parallel Reaction Monitoring and western blotting were performed to validate the expression levels of differentially expressed proteins. RESULTS The results showed that empagliflozin improved ventricular dilatation and ejection fraction reduction in diabetic hearts, as well as the elevation of myocardial injury biomarkers hs-cTnT and NT-proBNP. At the same time, empagliflozin alleviates myocardial inflammatory infiltration, calcification foci deposition, and fibrosis caused by diabetes. The results of the proteomics assay showed that empagliflozin could improve the metabolism of various substances, especially promoting the BCAA metabolism of diabetic hearts by up-regulating PP2Cm. Furthermore, empagliflozin could affect the mTOR/p-ULK1 signaling pathway by reducing the concentration of BCAA in diabetic hearts. When mTOR/p-ULK1 protein was inhibited, ULK1, the autophagy initiation molecule, increased. Moreover, autophagy substrate p62 and autophagy marker LC3B were significantly reduced, indicating that the autophagy activity of diabetes inhibition was reactivated. CONCLUSIONS Empagliflozin may attenuate diabetic cardiomyopathy-related myocardial injury by promoting the catabolism of BCAA and inhibiting mTOR/p-ULK1 to enhance autophagy. These findings suggest that empagliflozin could be a potential candidate drug against BCAA increase and could be used for other cardiovascular diseases with a metabolic disorder of BCAA.
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Affiliation(s)
- Lin Zhang
- Medical School of Chinese PLA, Department of Geriatric Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Heming Zhang
- Department of Anesthesiology, The 963 Hospital of the PLA Joint Logistics Support Force, Jiamusi, China
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Xiuzhu Xie
- Medical School of Chinese PLA, Department of Geriatric Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruping Tie
- Medical School of Chinese PLA, Department of Geriatric Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaolin Shang
- Department of Pharmacy, Medical Support Center of Chinese PLA General Hospital, Beijing, China
| | - Qianqian Zhao
- Medical School of Chinese PLA, Department of Cardiology, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Junjie Xu
- Health Service Department of the Guard Bureau of the General Office of the Central Committee of the Communist Party of China, Beijing, China
| | - Liyuan Jin
- Department of Geriatric Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Jinying Zhang
- Department of Basic Medicine, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
| | - Ping Ye
- Department of Geriatric Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Garrett V, Gombar S, Huang J, Yeung AM, Klonoff DC. Real-World Evidence Supports Higher Prevalence of Heart Failure Among Persons With Type 1 and Type 2 Diabetes Compared With the General Population. J Diabetes Sci Technol 2023; 17:864-865. [PMID: 36824057 PMCID: PMC10210121 DOI: 10.1177/19322968231155165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
| | | | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula
Medical Center, San Mateo, CA, USA
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93
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Rossing P, Frimodt-Møller M, Persson F. Precision Medicine and/or Biomarker Based Therapy in T2DM: Ready for Prime Time? Semin Nephrol 2023; 43:151430. [PMID: 37862744 DOI: 10.1016/j.semnephrol.2023.151430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Approximately 30-40% of people with type 2 diabetes mellitus develop chronic kidney disease. This is characterised by elevated blood pressure, declining kidney function and enhanced cardiovascular morbidity and mortality. Increased albuminuria and decreasing estimated glomerular function has to be evaluated regularly to diagsnose kidney disease. New biomarkers may facilitate early diagnosis and provide infomation on undlying pathology thereby supporting early precision intervention for the optimal benefit. A number of biomarkers have been suggested but are not yet implemented in clinical practice. iI the future such bimarkers may pave the way for personalized treatment.
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Affiliation(s)
- Peter Rossing
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Frederik Persson
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Shi R, Yang ZG, Guo YK, Qian WL, Gao Y, Li XM, Jiang L, Xu HY, Li Y. The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking. Cardiovasc Diabetol 2023; 22:93. [PMID: 37085847 PMCID: PMC10122304 DOI: 10.1186/s12933-023-01806-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking. METHODS From December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains. RESULTS No differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 ± 4.14 vs. - 24.49 ± 4.47, p = 0.001), RVGCS (- 13.16 ± 3.86 vs. - 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855). CONCLUSIONS In the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.
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Affiliation(s)
- Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Hsu CN, Hsuan CF, Liao D, Chang JKJ, Chang AJW, Hee SW, Lee HL, Teng SIF. Anti-Diabetic Therapy and Heart Failure: Recent Advances in Clinical Evidence and Molecular Mechanism. Life (Basel) 2023; 13:1024. [PMID: 37109553 PMCID: PMC10144651 DOI: 10.3390/life13041024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Diabetic patients have a two- to four-fold increase in the risk of heart failure (HF), and the co-existence of diabetes and HF is associated with poor prognosis. In randomized clinical trials (RCTs), compelling evidence has demonstrated the beneficial effects of sodium-glucose co-transporter-2 inhibitors on HF. The mechanism includes increased glucosuria, restored tubular glomerular feedback with attenuated renin-angiotensin II-aldosterone activation, improved energy utilization, decreased sympathetic tone, improved mitochondria calcium homeostasis, enhanced autophagy, and reduced cardiac inflammation, oxidative stress, and fibrosis. The RCTs demonstrated a neutral effect of the glucagon-like peptide receptor agonist on HF despite its weight-reducing effect, probably due to it possibly increasing the heart rate via increasing cyclic adenosine monophosphate (cAMP). Observational studies supported the markedly beneficial effects of bariatric and metabolic surgery on HF despite no current supporting evidence from RCTs. Bromocriptine can be used to treat peripartum cardiomyopathy by reducing the harmful cleaved prolactin fragments during late pregnancy. Preclinical studies suggest the possible beneficial effect of imeglimin on HF through improving mitochondrial function, but further clinical evidence is needed. Although abundant preclinical and observational studies support the beneficial effects of metformin on HF, there is limited evidence from RCTs. Thiazolidinediones increase the risk of hospitalized HF through increasing renal tubular sodium reabsorption mediated via both the genomic and non-genomic action of PPARγ. RCTs suggest that dipeptidyl peptidase-4 inhibitors, including saxagliptin and possibly alogliptin, may increase the risk of hospitalized HF, probably owing to increased circulating vasoactive peptides, which impair endothelial function, activate sympathetic tones, and cause cardiac remodeling. Observational studies and RCTs have demonstrated the neutral effects of insulin, sulfonylureas, an alpha-glucosidase inhibitor, and lifestyle interventions on HF in diabetic patients.
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Affiliation(s)
- Chih-Neng Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung 824, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840, Taiwan
| | - Daniel Liao
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Jack Keng-Jui Chang
- Biological Programs for Younger Scholar, Academia Sinica, Taipei 115, Taiwan
| | - Allen Jiun-Wei Chang
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Siow-Wey Hee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsiao-Lin Lee
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Sean I. F. Teng
- Department of Cardiology, Ming-Sheng General Hospital, Taoyuan 330, Taiwan
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96
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Gastaldi G, Lucchini B, Thalmann S, Alder S, Laimer M, Brändle M, Wiesli P, Lehmann R. Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023). Swiss Med Wkly 2023; 153:40060. [PMID: 37011604 DOI: 10.57187/smw.2023.40060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
As a first step, the authors emphasise lifestyle changes (increased physical activity, stopping smoking), blood pressure control, and lowering cholesterol). The initial medical treatment should always be a combination treatment with metformin and a sodium-glucose transporter 2 (SGLT-2) inhibitor or a glucagon-like 1 peptide (GLP-1) receptor agonist. Metformin is given first and up-titrated, followed by SGLT-2 inhibitors or GLP-1 receptor agonists. In persons with type 2 diabetes, if the initial double combination is not sufficient, a triple combination (SGLT-2 inhibitor, GLP-1 receptor agonist, and metformin) is recommended. This triple combination has not been officially tested in cardiovascular outcome trials, but there is more and more real-world experience in Europe and in the USA that proves that the triple combination with metformin, SGLT-2 inhibitor, and GLP-1 receptor agonist is the best treatment to reduce 3-point MACE, total mortality, and heart failure as compared to other combinations. The treatment with sulfonylurea is no longer recommended because of its side effects and higher mortality compared to the modern treatment with SGLT-2 inhibitors and GLP-1 receptor agonists. If the triple combination is not sufficient to reduce the HbA1c to the desired target, insulin treatment is necessary. A quarter of all patients with type 2 diabetes (sometimes misdiagnosed) require insulin treatment. If insulin deficiency is the predominant factor at the outset of type 2 diabetes, the order of medications has to be reversed: insulin first and then cardio-renal protective medications (SGLT-2 inhibitors, GLP-1 receptor agonists).
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Affiliation(s)
- Giacomo Gastaldi
- Endocrinology and Diabetes, University Hospital Geneva, Geneva, Switzerland
| | - Barbara Lucchini
- Endocrinology and Diabetes, Regional Hospital Locarno, Locarno, Switzerland
| | | | | | - Markus Laimer
- Endocrinology and Diabetes, University Hospital Berne, Berne, Switzerland
| | - Michael Brändle
- Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter Wiesli
- Internal Medicine and Endocrinology and Diabetes, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Roger Lehmann
- Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zürich, Zürich, Switzerland
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97
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Hikisz P, Jacenik D. Diet as a Source of Acrolein: Molecular Basis of Aldehyde Biological Activity in Diabetes and Digestive System Diseases. Int J Mol Sci 2023; 24:ijms24076579. [PMID: 37047550 PMCID: PMC10095194 DOI: 10.3390/ijms24076579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Acrolein, a highly reactive α,β-unsaturated aldehyde, is a compound involved in the pathogenesis of many diseases, including neurodegenerative diseases, cardiovascular and respiratory diseases, diabetes mellitus, and the development of cancers of various origins. In addition to environmental pollution (e.g., from car exhaust fumes) and tobacco smoke, a serious source of acrolein is our daily diet and improper thermal processing of animal and vegetable fats, carbohydrates, and amino acids. Dietary intake is one of the main routes of human exposure to acrolein, which is a major public health concern. This review focuses on the molecular mechanisms of acrolein activity in the context of its involvement in the pathogenesis of diseases related to the digestive system, including diabetes, alcoholic liver disease, and intestinal cancer.
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Affiliation(s)
- Pawel Hikisz
- Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, ul. Pomorska 141/143, 90-236 Lodz, Poland
| | - Damian Jacenik
- Department of Cytobiochemistry, Faculty of Biology and Environmental Protection, University of Lodz, ul. Pomorska 141/143, 90-236 Lodz, Poland
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98
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Schnell O, Battelino T, Bergenstal R, Birkenfeld AL, Ceriello A, Cheng A, Davies M, Edelman S, Forst T, Giorgino F, Green J, Groop PH, Hadjadj S, J L Heerspink H, Hompesch M, Izthak B, Ji L, Kanumilli N, Mankovsky B, Mathieu C, Miszon M, Mustafa R, Nauck M, Pecoits-Filho R, Pettus J, Ranta K, Rodbard HW, Rossing P, Ryden L, Schumm-Draeger PM, Solomon SD, Škrha J, Topsever P, Vilsbøll T, Wilding J, Standl E. CVOT Summit 2022 Report: new cardiovascular, kidney, and glycemic outcomes. Cardiovasc Diabetol 2023; 22:59. [PMID: 36927451 PMCID: PMC10019427 DOI: 10.1186/s12933-023-01788-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
The 8th Cardiovascular Outcome Trial (CVOT) Summit on Cardiovascular, Kidney, and Glycemic Outcomes was held virtually on November 10-12, 2022. Following the tradition of previous summits, this reference congress served as a platform for in-depth discussion and exchange on recently completed outcomes trials as well as key trials important to the cardiovascular (CV) field. This year's focus was on the results of the DELIVER, EMPA-KIDNEY and SURMOUNT-1 trials and their implications for the treatment of heart failure (HF) and chronic kidney disease (CKD) with sodium-glucose cotransporter-2 (SGLT2) inhibitors and obesity with glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. A broad audience of primary care physicians, diabetologists, endocrinologists, cardiologists, and nephrologists participated online in discussions on new consensus recommendations and guideline updates on type 2 diabetes (T2D) and CKD management, overcoming clinical inertia, glycemic markers, continuous glucose monitoring (CGM), novel insulin preparations, combination therapy, and reclassification of T2D. The impact of cardiovascular outcomes on the design of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) trials, as well as the impact of real-world evidence (RWE) studies on the confirmation of CVOT outcomes and clinical trial design, were also intensively discussed. The 9th Cardiovascular Outcome Trial Summit will be held virtually on November 23-24, 2023 ( http://www.cvot.org ).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e. V., Helmholtz Center Munich, Ingolstaedter Landstraße 1, Neuherberg, 85764, (Munich), Germany.
| | - Tadej Battelino
- University Medical Center, Ljubljana, Slovenia
- University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Richard Bergenstal
- International Diabetes Center at Park Nicollet, Health Partners, Minneapolis, MN, USA
| | - Andreas L Birkenfeld
- Department of Internal Medicine IV, University Clinic Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases at the Eberhard-Karls-University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | | | - Alice Cheng
- Credit Valley Hospital, Mississauga, ON, Canada
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Biomedical Research Centre, Leicester, UK
| | - Steve Edelman
- Taking Control of Your Diabetes, Solana Beach, CA, USA
| | - Thomas Forst
- CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Jennifer Green
- Division of Endocrinology, Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Medical School, Monash University, Melbourne, Australia
| | - Samy Hadjadj
- Thorax Institute, University Hospital of Nantes, Nantes, France
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Baruch Izthak
- Clalit Health Services and Technion Faculty of Medicine, Haifa, Israel
| | - Linong Ji
- Peking University People's Hospital, Xicheng District, Beijing, China
| | | | - Boris Mankovsky
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Chantal Mathieu
- Department of Endocrinology, Catholic University Leuven, Leuven, Belgium
| | | | - Reem Mustafa
- Division of Nephrology and Hypertension, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Michael Nauck
- Diabetes Division, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Jeremy Pettus
- Altman Clinical and Translational Research Institute (ACTRI), La Jolla, CA, USA
| | - Kari Ranta
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ryden
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Scott D Solomon
- Cardiovascular division, Brigham and Women's Hospital, Boston, MA, USA
| | - Jan Škrha
- Third Medical Department and Laboratory for Endocrinology and Metabolism, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - John Wilding
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Helmholtz Center Munich, Ingolstaedter Landstraße 1, Neuherberg, 85764, (Munich), Germany
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99
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Liu L, Sun K, Luo Y, Wang B, Yang Y, Chen L, Zheng S, Wu T, Xiao P. Myocardin-related transcription factor A, regulated by serum response factor, contributes to diabetic cardiomyopathy in mice. Life Sci 2023; 317:121470. [PMID: 36758668 DOI: 10.1016/j.lfs.2023.121470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
AIMS Diabetic cardiomyopathy is a significant contributor to the global pandemic of heart failure. In the present study we investigated the involvement of myocardin-related transcription factor A (MRTF-A), a transcriptional regulator, in this process. MATERIALS AND METHODS Diabetic cardiomyopathy was induced in mice by feeding with a high-fat diet (HFD) or streptozotocin (STZ) injection. KEY FINDINGS We report that MRTF-A was up-regulated in the hearts of mice with diabetic cardiomyopathy. MRTF-A expression was also up-regulated by treatment with palmitate in cultured cardiomyocytes in vitro. Mechanistically, serum response factor (SRF) bound to the MRTF-A gene promoter and activated MRTF-A transcription in response to pro-diabetic stimuli. Knockdown of SRF abrogated MRTF-A induction in cardiomyocytes treated with palmitate. When cardiomyocytes conditional MRTF-A knockout mice (MRTF-A CKO) and wild type (WT) mice were placed on an HFD to induce diabetic cardiomyopathy, it was found that the CKO mice and the WT mice displayed comparable metabolic parameters including body weight, blood insulin concentration, blood cholesterol concentration, and glucose tolerance. However, both systolic and diastolic cardiac function were exacerbated by MRTF-A deletion in the heart. SIGNIFICANCE These data suggest that MRTF-A up-regulation might serve as an important compensatory mechanism to safeguard the deterioration of cardiac function during diabetic cardiomyopathy.
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Affiliation(s)
- Li Liu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing 210023, China; Department of Cardiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China; Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Ke Sun
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing 210023, China
| | - Yajun Luo
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing 210023, China
| | - Bingshu Wang
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Medical Research Center of The First Affiliated Hospital, Hainan Women and Children Medical Center, Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou 571199, China; Department of Pathology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570216, China
| | - Yuyu Yang
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing 210023, China
| | - Long Chen
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing 210023, China
| | - Shaojiang Zheng
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Medical Research Center of The First Affiliated Hospital, Hainan Women and Children Medical Center, Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou 571199, China.
| | - Teng Wu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China.
| | - Pingxi Xiao
- Department of Cardiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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100
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Wang M, Su W, Chen H, Li H. The joint association of diabetes status and NT-ProBNP with adverse cardiac outcomes in patients with non-ST-segment elevation acute coronary syndrome: a prospective cohort study. Cardiovasc Diabetol 2023; 22:46. [PMID: 36871021 PMCID: PMC9985841 DOI: 10.1186/s12933-023-01771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
AIMS To examine the joint association of diabetes status and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with subsequent risk of major adverse cardio-cerebral events (MACCEs) and all-cause mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS A total of 7956 NSTE-ACS patients recruited from the Cardiovascular Center Beijing Friendship Hospital Database Bank were included in this cohort study. Patients were divided into nine groups according to diabetes status (normoglycemia, prediabetes, diabetes) and NT-proBNP tertiles (< 92 pg/ml, 92-335 pg/ml, ≥ 336 pg/ml). Multivariable Cox proportional hazards models were used to estimate the individual and joint association of diabetes status and NT-proBNP with the risk of MACCEs and all-cause mortality. RESULTS During 20,257.9 person-years of follow-up, 1070 MACCEs were documented. In the fully adjusted model, diabetes and a higher level of NT-proBNP were independently associated with MACCEs risk (HR 1.42, 95% CI: 1.20-1.68; HR 1.72, 95% CI: 1.40-2.11) and all-cause mortality (HR 1.37, 95% CI: 1.05-1.78; HR 2.80, 95% CI: 1.89-4.17). Compared with patients with normoglycemia and NT-proBNP < 92 pg/ml, the strongest numerical adjusted hazards for MACCEs and all-cause mortality were observed in patients with diabetes and NT-proBNP ≥ 336 pg/ml (HR 2.67, 95% CI: 1.83-3.89; HR 2.98, 95% CI: 1.48-6.00). The association between MACCEs and all-cause mortality with various combinations of NT-proBNP level, HbA1c, and fasting plasma glucose was studied. CONCLUSIONS Diabetes status and elevated NT-proBNP were independently and jointly associated with MACCEs and all-cause mortality in patients with NSTE-ACS.
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Affiliation(s)
- Man Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Wen Su
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China.
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China. .,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China.
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