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Alfaddagh A, Khraishah H, Romeo GR, Kassab MB, McMillan Z, Chandra-Strobos N, Blumenthal R, Albaghdadi M. Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India. Glob Heart 2024; 19:37. [PMID: 38681971 PMCID: PMC11049669 DOI: 10.5334/gh.1290] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Abstract
Background Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). Methods We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Conclusion Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. Clinical Trial registration ClinicalTrials.gov Unique identifier: NCT02256658.
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Affiliation(s)
- Abdulhamied Alfaddagh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Giulio R. Romeo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, US
| | - Mohamad B. Kassab
- Cardiovascular research center, Massachusetts General Hospital, Boston, MA, US
| | - Zeb McMillan
- Department of Anesthesiology, Division of Critical Care, UC San Diego, San Diego, CA, USA
| | - Nisha Chandra-Strobos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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2
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Esdaile H, Hill N, Mayet J, Oliver N. Glycaemic control in people with diabetes following acute myocardial infarction. Diabetes Res Clin Pract 2023; 199:110644. [PMID: 36997029 DOI: 10.1016/j.diabres.2023.110644] [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: 12/21/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Diabetes is a highly prevalent disease associated with considerable cardiovascular end organ damage and mortality. Despite significant changes to the management of acute myocardial infarction over the last two decades, people with diabetes remain at risk of complications and mortality following a myocardial infarct for a multitude of reasons, including increased coronary atherosclerosis, associated coronary microvascular dysfunction, and diabetic cardiomyopathy. Dysglycaemia causes significant endothelial dysfunction and upregulation of inflammation within the vasculature and epigenetic changes mean that these deleterious effects may persist despite subsequent efforts to tighten glycaemic control. Whilst clinical guidelines advocate for the avoidance of both hyper- and hypoglcyaemia in the peri-infarct period, the evidence base is lacking, and currently there is no consensus on the benefits of glycaemic control beyond this period. Glycaemic variability contributes to the glycaemic milieu and may have prognostic importance following myocardial infarct. The use of continuous glucose monitoring means that glucose trends and parameters can now be captured and interrogated, and its use, along with newer medicines, may provide novel opportunities for intervention after myocardial infarction in people with diabetes.
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Affiliation(s)
- Harriet Esdaile
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial Centre for Translational and Experimental Medicine, Imperial College London, Du Cane Road, London, W12 0NN, London, United Kingdom.
| | - Neil Hill
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction Imperial College London, London, United Kingdom
| | - Jamil Mayet
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nick Oliver
- Faculty of Medicine, Department of Metabolism Digestion and Reproduction, Imperial College London, London, United Kingdom
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3
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Kerola AM, Semb AG, Juonala M, Palomäki A, Rautava P, Kytö V. Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction. Cardiovasc Diabetol 2022; 21:177. [PMID: 36068573 PMCID: PMC9450422 DOI: 10.1186/s12933-022-01608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74–2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and ≥ 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01608-3.
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Affiliation(s)
- Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Helsinki, Finland. .,Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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4
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The ceRNA Crosstalk between mRNAs and lncRNAs in Diabetes Myocardial Infarction. DISEASE MARKERS 2022; 2022:4283534. [PMID: 35592708 PMCID: PMC9112177 DOI: 10.1155/2022/4283534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Competitive endogenous RNA regulation suggests an intricate network of all transcriptional RNAs that have the function of repressing miRNA function and regulating mRNA expression. Today, the specific ceRNA regulatory mechanisms of lncRNA–miRNA–mRNA in patients who have diabetes mellitus (DM) and myocardial infarction (MI) are still unknown. Two data sets, GSE34198 and GSE112690, were rooted in the Gene Expression Omnibus database to search for changes of lncRNA, miRNA, and mRNA in MI patients with diabetes. Weighted gene correlation network analysis (WGCNA) was used to identify the modules related to the development of diabetes in patients with MI. Target genes of miRNAs were predicted using miRWalk, TargetScan, mirDB, RNA22, and miRanda. Then, functional and enrichment analyses were performed to build the lncRNA–miRNA–mRNA interaction network. We built ceRNA regulatory networks with three lncRNAs, two miRNAs, and nine mRNAs. Differentially expressed genes enriched in biological process, including neutrophil activation, refer to immune response and positive system of defense feedback. Besides, there is significant enrichment in molecular function of calcium toll−like receptor binding, icosanoid binding, RAGE receptor binding, and arachidonic acid binding. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis enriched differentially expressed genes (DEGs) in pathways that were well known in MI, indicating inflammation and immune response. Pathways associated with diabetes were also significantly enriched. We confirmed significantly altered lncRNA, miRNA, and mRNA in MI patients with diabetes, which might serve as biomarkers for the progress and development of diabetic cardiovascular diseases. We constructed a ceRNA regulatory network of lncRNA–miRNA–mRNA, which will enable us to understand the novel molecular mechanisms included in the initiation, progression, and interaction between DM and MI, laying the foundation for clinical diagnosis and treatment.
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Morton JI, Ilomäki J, Wood SJ, Bell JS, Huynh Q, Magliano DJ, Shaw JE. Treatment gaps, 1-year readmission and mortality following myocardial infarction by diabetes status, sex and socioeconomic disadvantage. J Epidemiol Community Health 2022; 76:637-645. [PMID: 35470260 DOI: 10.1136/jech-2021-218042] [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: 09/08/2021] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS We evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage. METHODS We included all people aged ≥30 years who were discharged alive from hospital following MI between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=43 272). We assessed receipt of inpatient procedures and discharge dispensing of cardioprotective medications for each admission, as well as 1-year all-cause, cardiovascular, and MI readmission rates and 1-year all-cause mortality. RESULTS Risk of all-cause (HR: 1.22 (1.19-1.26)), cardiovascular (1.29 (1.25-1.34)), MI (1.52 (1.43-1.62)) and heart failure readmission (1.62 (1.50-1.75)) and mortality (1.18 (1.11-1.26)) were higher in people with diabetes. Males and people in more disadvantaged areas were at increased risk of readmission and mortality following MI. People with diabetes (vs without) were more likely to receive coronary artery bypass grafting (CABG) but less likely to receive percutaneous coronary intervention (PCI) during, or within 30 days of, their index admission. Females were less likely to receive either (eg, 87% of males with a STEMI received PCI or CABG vs 70% of females), and people in more disadvantaged areas were less likely to receive PCI. People with diabetes, males and people in more disadvantaged areas were more likely to be dispensed cardioprotective medications at or within 90 days of discharge. CONCLUSIONS Following an MI, people with diabetes and males had poorer outcomes but received more intensive cardiovascular treatments. However, socioeconomic disadvantage was associated with both less intensive inpatient treatment and poorer outcomes.
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Affiliation(s)
- Jedidiah I Morton
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia .,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomäki
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - J Simon Bell
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Quan Huynh
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jonathan E Shaw
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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6
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A predictive model of perioperative myocardial infarction following elective spine surgery. J Clin Neurosci 2021; 95:112-117. [PMID: 34929633 DOI: 10.1016/j.jocn.2021.11.032] [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: 11/11/2019] [Revised: 10/15/2021] [Accepted: 11/27/2021] [Indexed: 11/22/2022]
Abstract
Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m2), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%-0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.
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7
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Yandrapalli S, Malik AH, Namrata F, Pemmasani G, Bandyopadhyay D, Vallabhajosyula S, Aronow WS, Frishman WH, Jain D, Cooper HA, Panza JA. Influence of diabetes mellitus interactions with cardiovascular risk factors on post-myocardial infarction heart failure hospitalizations. Int J Cardiol 2021; 348:140-146. [PMID: 34864085 DOI: 10.1016/j.ijcard.2021.11.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/01/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a paucity of information regarding how cardiovascular risk factors (RF) modulate the impact of diabetes mellitus (DM) on the heart failure hospitalization (HFH) risk following an acute myocardial infarction (AMI). METHODS Adult survivors of an AMI were retrospectively identified from the 2014 US Nationwide Readmissions Database. The impact of DM on the risk for a 6-month HFH was studied in subgroups of RFs using multivariable logistic regression to adjust for baseline risk differences. Individual interactions of DM with RFs were tested. RESULTS Of 237,549 AMI survivors, 37.2% patients had DM. Primary outcome occurred in 12,934 patients (5.4%), at a 106% higher rate in DM patients (7.9% vs 4.0%, p < 0.001), which was attenuated to a 45% higher adjusted risk. Higher HFH risk in DM patients was consistent across subgroups and significant interactions were present between DM and other RFs. The increased HFH risk with DM was more pronounced in patients without certain HF RFs compared with those with these RFs [age < 65: OR for DM 1.84 (1.58-2.13) vs age ≥ 65: OR 1.34 (1.24-1.45); HF absent during index AMI: OR for DM 1.87 (1.66-2.10) vs HF present: OR 1.24 (1.14-1.34); atrial fibrillation absent: OR for DM 1.57 (1.46-1.68) vs present: OR 1.19 (1.06-1.33); Pinteraction < 0.001 for all]. Similar results were noted for hypertension and chronic kidney disease. CONCLUSIONS AMI survivors with DM had a higher risk of 6-month HFHs. The impact of DM on the increased HFH risk was more pronounced in patients without certain RFs suggesting that more aggressive preventive strategies related to DM and HF are needed in these subgroups to prevent or delay the onset of HFHs.
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Affiliation(s)
- Srikanth Yandrapalli
- Division of Cardiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Fnu Namrata
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Gayatri Pemmasani
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | | | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Diwakar Jain
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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8
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Li C, Liu Z. Bioinformatic Analysis for Potential Biomarkers and Therapeutic Targets of T2DM-related MI. Int J Gen Med 2021; 14:4337-4347. [PMID: 34413670 PMCID: PMC8370113 DOI: 10.2147/ijgm.s325980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM), a major risk factor of coronary heart disease, is associated with an approximately twofold increase in the risk of myocardial infarction (MI). We studied co-expressed genes to demonstrate relationships between DM and MI and revealed the potential biomarkers and therapeutic targets of T2DM-related MI. Methods DM and MI-related differentially expressed genes (DEGs) were identified by bioinformatic analysis, Gene Expression Omnibus (GEO) datasets GSE42148 and GSE61144 of MI patients, and the normal control and GSE26168 and GSE15932 of DM patients and normal controls, respectively. Further target prediction and network analysis method were used to detect protein-protein interaction (PPI) networks, gene ontology (GO) terms, and pathway enrichment of DEGs. Co-expressed DEGs of T2DM-related MI were analyzed as well. Results We identified 210 upregulated and 127 downregulated DEGs in T2DM, as well as 264 upregulated and 242 downregulated DEGs in MI. Eighteen upregulated and four downregulated DEGs were identified as co-DEGs of T2DM and MI. Functional analysis revealed that T2DM-related DEGs were mostly enriched in the viral process and ubiquitin-mediated proteolysis, while MI-related DEGs were mostly enriched in protein phosphorylation and TNF signaling pathway. MPO, MMP9, CAMP, LTF, AZU1, DEFA4, STAT3, and PECAM1 were recognized as the hub genes of the co-DEGs with acceptable diagnostic values in T2DM and MI datasets. Adenosine receptor agonist IB-MECA was predicted to be a potential drug for T2DM-related MI with the highest CMap connectivity score. Conclusion Our study identified that the co-DEGs of MPO, MMP9, CAMP, LTF, AZU1, DEFA4, STAT3, and PECAM1 are significantly associated with novel biomarkers involved in T2DM-related MI. However, more experimental research and clinical trials are demanded to verify our results.
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Affiliation(s)
- Chan Li
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhaoya Liu
- Department of Geriatrics, Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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9
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Zapata D, Halkos M, Binongo J, Puskas J, Guyton R, Lattouf O. Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome. J Card Surg 2020; 35:794-800. [DOI: 10.1111/jocs.14470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- David Zapata
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
| | - Michael Halkos
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
| | - Jose Binongo
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
| | - John Puskas
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
| | - Robert Guyton
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
| | - Omar Lattouf
- Clinical Research Unit, Division of Cardiothoracic SurgeryEmory University Atlanta Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory University Atlanta Georgia
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10
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Shin S, Claggett B, Pfeffer MA, Skali H, Liu J, Aguilar D, Diaz R, Dickstein K, Gerstein HC, Køber LV, Lawson FC, Lewis EF, Maggioni AP, McMurray JJ, Probstfield JL, Riddle MC, Tardif J, Solomon SD. Hyperglycaemia, ejection fraction and the risk of heart failure or cardiovascular death in patients with type 2 diabetes and a recent acute coronary syndrome. Eur J Heart Fail 2020; 22:1133-1143. [DOI: 10.1002/ejhf.1790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sung‐Hee Shin
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
- Inha University Incheon South Korea
| | - Brian Claggett
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
| | - Marc A. Pfeffer
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
| | | | - Jiankang Liu
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
| | - David Aguilar
- University of Texas Health Science Center Houston TX USA
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica Rosario Argentina
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital Stavanger Norway
| | - Hertzel C. Gerstein
- Department of Medicine and Population Health Research Institute McMaster University and Hamilton Health Sciences Ontario Canada
| | - Lars V. Køber
- Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | | | - Eldrin F. Lewis
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
| | - Aldo P. Maggioni
- Research Center of the Italian Association of Hospital Cardiologists Florence Italy
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow UK
| | | | | | | | - Scott D. Solomon
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA USA
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11
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Wallert J, Mitchell A, Held C, Hagström E, Leosdottir M, Olsson EM. Cardiac rehabilitation goal attainment after myocardial infarction with versus without diabetes: A nationwide registry study. Int J Cardiol 2019; 292:19-24. [DOI: 10.1016/j.ijcard.2019.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/12/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
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12
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Coiro S, Girerd N, Sharma A, Rossignol P, Tritto I, Pitt B, Pfeffer MA, McMurray JJV, Ambrosio G, Dickstein K, Moss A, Zannad F. Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non-sudden cardiac death in myocardial infarction survivors with heart failure. Eur J Heart Fail 2019; 21:1248-1258. [PMID: 31476097 DOI: 10.1002/ejhf.1541] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS An implantable cardioverter-defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non-SCD among MI survivors taking account of age and LVEF. METHODS AND RESULTS A total of 17 773 patients from the High-Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m2 , individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non-SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30-35% but no such risk factors (1.7%). However, these patients had also similarly higher non-SCD rates, such that the ratio of SCD to non-SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. CONCLUSION Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non-SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.
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Affiliation(s)
- Stefano Coiro
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.,INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Nicolas Girerd
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,University of Alberta, Edmonton, Alberta, Canada.,Stanford University, Palo Alto, CA, USA
| | - Patrick Rossignol
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | - Marc A Pfeffer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Kenneth Dickstein
- Division of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Arthur Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Faiez Zannad
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
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13
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Sharma AN, Deyell JS, Sharma SN, Barseghian A. Role of and Recent Evidence for Antiplatelet Therapy in Prevention of Cardiovascular Disease in Diabetes. Curr Cardiol Rep 2019; 21:78. [PMID: 31254105 DOI: 10.1007/s11886-019-1168-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW When treating patients with diabetes mellitus (DM), the benefits of antiplatelet therapy in preventing cardiovascular disease must be weighed against an increased risk of bleeding. Recent trials have sought to determine both the optimal anti-platelet regimen for patients with DM, and who specifically requires medication among the DM population. This paper will review recent trials and evidence recommending the use of antiplatelet therapy in the prevention of cardiovascular disease in patients with diabetes. RECENT FINDINGS Seven notable trials assessed the effectiveness of antiplatelet therapy in the DM population. The ASCEND trial concluded 100 mg aspirin/day reduced rates of serious vascular events (OR 0.88, p < 0.01) but also increased rates of major bleeding events (OR 1.29, p < 0.01). The DAPT study revealed a longer dual antiplatelet regimen (30 months vs. 18 months) after coronary stent placement was more effective in reducing rates of stent thrombosis (0.5% vs. 1.1%, p = 0.06) and rates of myocardial infarction (3.5% vs. 4.8%, p = 0.06). DECLARE DIABETES showed that adding cilostazol to dual antiplatelet therapy after a coronary stent procedure reduced rates of in-stent and in-segment late loss and increased rates of revascularization (p < 0.04). In PEGASUS-TIMI, daily ticagrelor demonstrated reduced rates of major adverse cardiovascular and cerebrovascular events (OR 0.84, p < 0.04). The DAVID trial compared daily picotamide with daily aspirin therapy, finding reduced mortality rates in the picotamide group (OR 0.55, p < 0.05). Lastly, ACUITY found bivalirudin monotherapy resulted in lower rates of major bleeding events when compared to a glycoprotein IIb/IIa inhibitor and heparin or bivalirudin combination regimen (p < 0.01). Dual antiplatelet therapy guidelines still typically revolve around aspirin, but an increasing number of studies have demonstrated other drugs that may have a role in preventing atherosclerotic cardiovascular disease while decreasing the risk of major bleeding. Overall, it is wise to weigh the cardiovascular risk of a DM patient before prescribing antiplatelet medication. More research is necessary to determine a universal drug or combination of drugs that is safe and effective for DM patients.
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Affiliation(s)
- Ajay Nair Sharma
- School of Medicine, University of California Irvine, Irvine, CA, USA.,Division of Cardiology, UC Irvine, 333 City Blvd West. Ste 400, Orange, CA, 92868, USA
| | - Jacob S Deyell
- School of Medicine, University of California Irvine, Irvine, CA, USA.,Division of Cardiology, UC Irvine, 333 City Blvd West. Ste 400, Orange, CA, 92868, USA
| | | | - Ailin Barseghian
- Division of Cardiology, UC Irvine, 333 City Blvd West. Ste 400, Orange, CA, 92868, USA.
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14
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Tamargo J. Sodium-glucose Cotransporter 2 Inhibitors in Heart Failure: Potential Mechanisms of Action, Adverse Effects and Future Developments. Eur Cardiol 2019; 14:23-32. [PMID: 31131034 PMCID: PMC6523047 DOI: 10.15420/ecr.2018.34.2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Heart failure is a common complication in patients with diabetes, and people with both conditions present a worse prognosis. Sodium–glucose cotransporter 2 inhibitors (SGLT2Is) increase urinary glucose excretion, improving glycaemic control. In type 2 diabetes (T2D), some SGLT2Is reduce major cardiovascular events, heart failure hospitalisations and worsening of kidney function independent of glycaemic control. Multiple mechanisms (haemodynamic, metabolic, hormonal and direct cardiac/renal effects) have been proposed to explain these cardiorenal benefits. SGLT2Is are generally well tolerated, but can produce rare serious adverse effects, and the benefit/risk ratio differs between SGLT2Is. This article analyses the mechanisms underlying the cardiorenal benefits and adverse effects of SGLT2Is in patients with T2D and heart failure and outlines some questions to be answered in the near future.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV Madrid, Spain
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15
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Wolsk E, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber L, Lawson FC, Lewis EF, Maggioni AP, McMurray JJV, Probstfield JL, Riddle MC, Solomon SD, Tardif JC, Pfeffer MA. Increases in Natriuretic Peptides Precede Heart Failure Hospitalization in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus. Circulation 2019; 136:1560-1562. [PMID: 29038210 DOI: 10.1161/circulationaha.117.029503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emil Wolsk
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.).
| | - Rafael Diaz
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Kenneth Dickstein
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Hertzel C Gerstein
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Lars Køber
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Francesca C Lawson
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Eldrin F Lewis
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Aldo P Maggioni
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - John J V McMurray
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Jeffrey L Probstfield
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Matthew C Riddle
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Jean-Claude Tardif
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
| | - Marc A Pfeffer
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.)
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Abstract
Heart failure (HF) is a common complication in patients with type 2 diabetes and it is closely associated with high morbidity and mortality rate. The incidence of cardiovascular events in patients with diabetes is related to high levels of glycemia, expressed by increase of HbA1c levels. However, there is little evidence to indicate that glycemic control can reduce the incidence of HF events in this population. Recently, several new antidiabetic drugs have been proposed although the exact clinical impact on heart failure occurrence and deterioration is under debate. Most common oral antidiabetic medication such as SGLT2, GLP-1 receptor agonist, metformin, and DPP4 inhibitor revealed peculiar metabolic and biomolecular signal effects. Moreover, the negative effects of thiazolidinediones on HF prognosis, on cardiac function, and exercise tolerance is of great interest. Conversely, several studies on GLP-1RA have highlighted many positive effects on cardiac myocytes, reducing apoptosis through cAMP/PKA/CRCB-mediated pathways protecting against oxidative stress. DPP-4 inhibitors have a controversial effect: saxagliptin and alogliptin may increase the risk of HF as opposed to vildagliptin and sitagliptin. Metformin increases myocardial ATP levels due to activation of 5-AMPK and this could explain the positive link between the drug and events rate reduction in diabetic patients with HF. The more interesting class of new drugs is SGLT2 inhibitors, that seems to have a positive effect on cardiac function by 38% reduction of HF incidence and mortality with empagliflozin treatment. In this review, we would analyze the specific effects of each class so as to better elucidate the clinical impact of antidiabetic drug on HF for guiding the clinicians in the choice of a best individualized therapy.
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Aune D, Schlesinger S, Neuenschwander M, Feng T, Janszky I, Norat T, Riboli E. Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2018; 28:1081-1091. [PMID: 30318112 DOI: 10.1016/j.numecd.2018.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM The strength of the association between diabetes and risk of heart failure has differed between previous studies and the available studies have not been summarized in a meta-analysis. We therefore quantified the association between diabetes and blood glucose and heart failure in a systematic review and meta-analysis. METHODS AND RESULTS PubMed and Embase databases were searched up to May 3rd 2018. Prospective studies on diabetes mellitus or blood glucose and heart failure risk were included. A random effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). Seventy seven studies were included. Among the population-based prospective studies, the summary RR for individuals with diabetes vs. no diabetes was 2.06 (95% CIs: 1.73-2.46, I2 = 99.8%, n = 30 studies, 401495 cases, 21416780 participants). The summary RR was 1.23 (95% CI: 1.15-1.32, I2 = 78.2%, n = 10, 5344 cases, 91758 participants) per 20 mg/dl increase in blood glucose and there was evidence of a J-shaped association with nadir around 90 mg/dl and increased risk even within the pre-diabetic blood glucose range. Among the patient-based studies the summary RR was 1.69 (95% CI: 1.57-1.81, I2 = 85.5%, pheterogeneity<0.0001) for diabetes vs. no diabetes (n = 41, 100284 cases and >613925 participants) and 1.25 (95% CI: 0.89-1.75, I2 = 95.6%, pheterogeneity<0.0001) per 20 mg/dl increase in blood glucose (1016 cases, 34309 participants, n = 2). In the analyses of diabetes and heart failure there was low or no heterogeneity among the population-based studies that adjusted for alcohol intake and physical activity and among the patient-based studies there was no heterogeneity among studies with ≥10 years follow-up. CONCLUSIONS These results suggest that individuals with diabetes are at an increased risk of developing heart failure and there is evidence of increased risk even within the pre-diabetic range of blood glucose.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Nutrition, Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - S Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - M Neuenschwander
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - T Feng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - I Janszky
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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18
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Rossello X, Ferreira JP, McMurray JJV, Aguilar D, Pfeffer MA, Pitt B, Dickstein K, Girerd N, Rossignol P, Zannad F. Editor’s Choice- Impact of insulin-treated diabetes on cardiovascular outcomes following high-risk myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:231-241. [DOI: 10.1177/2048872618803701] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Diabetes is associated with poor cardiovascular outcomes, and insulin-treated patients usually have a worse prognosis than non-insulin-treated subjects. The relationship between insulin treatment and outcomes in high-risk myocardial infarction patients has not been described in a large dataset. Methods: To investigate the association between insulin-treated diabetes and long-term cardiovascular outcomes in patients with high-risk myocardial infarction, we used adjusted Cox models to compare cardiovascular mortality and hospitalisation among 28,771 patients grouped by diabetes status and insulin treatment from four randomised clinical trials (VALIANT, EPHESUS, OPTIMAAL, CAPRICORN) of acute myocardial infarction complicated by heart failure and/or left ventricular systolic dysfunction. Results: After an approximately 2-year follow-up, patients with no diabetes (21,386 subjects, 74.3%), non-insulin-treated diabetes (4977 patients, 17.3%) and insulin-treated diabetes (2409 subjects, 8.4%) had an incremental yearly mortality risk (15.8%, 21.3% and 28.1%, respectively). Insulin-treated diabetes patients presented with a higher cardiovascular burden and comorbidities. After adjustment for 18 baseline covariates, patients with non-insulin-treated and insulin-treated diabetes were at higher risk of cardiovascular death (hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.13–1.38 and HR 1.49, 95% CI 1.31–1.69, respectively; P for comparison of non-insulin-treated vs. insulin-treated diabetes =0.016) and cardiovascular hospitalisation (HR 1.33, 95% CI 1.25–1.41 and HR 1.16, 95% CI 1.11–1.22, respectively) compared to patients without diabetes. These results remained consistent after further adjustment for medications and left ventricular ejection fraction. Conclusions: Insulin-treated diabetes patients had higher event rates than diabetes patients taking oral treatments and patients without diabetes. However, insulin-treated diabetes patients had more comorbidities and atherosclerotic disease, precluding any causality suggestion between insulin treatment and outcomes. This high-risk population may require specific and/or more intense cardiovascular protective therapies.
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Affiliation(s)
- Xavier Rossello
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Spain
- CIBER de Enfermedades CardioVasculares, Spain
| | - João Pedro Ferreira
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
- Department of Physiology and Cardiothoracic Surgery, University of Porto, Portugal
| | | | - David Aguilar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, USA
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, USA
| | | | - Nicolas Girerd
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
| | - Faiez Zannad
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
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19
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Coutinho AD, Raju AD, Wang W, Stafkey-Mailey D, Shetty S, Sander SD. Incremental burden of type 2 diabetes in patients experiencing cardiovascular hospitalizations. Curr Med Res Opin 2018; 34:1005-1012. [PMID: 29378486 DOI: 10.1080/03007995.2018.1434497] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the incremental economic burden of type 2 diabetes in patients experiencing cardiovascular (CV) hospitalizations. RESEARCH DESIGN AND METHODS Adults with ≥1 CV hospitalization were identified using a US-based healthcare claims database from 1 July 2011 to 30 June 2014. Outcomes for patients surviving the index hospitalization were compared between patients with vs. without type 2 diabetes (cohorts were identified in the pre-index period). Subsequent CV hospitalizations were evaluated using Cox proportional hazards models. All-cause and CV-related healthcare resource utilization (HCRU) and costs captured on a per-patient per-month (PPPM) basis during a variable follow-up period were evaluated using appropriate multivariable regression models. RESULTS Of 316,207 patients with ≥1 CV hospitalization, 23% had comorbid type 2 diabetes. The mean age ± SD was 62.6 ± 12.3 years and 64.4% were male. During follow-up, the type 2 diabetes cohort had a 19% higher risk of subsequent CV hospitalizations compared to the non-type-2-diabetes cohort (p < .001). This difference in risk was highest in patients aged 35-44 years. Subsequent all-cause hospitalizations for the type 2 diabetes cohort were longer (mean length of stay, 6.7 vs. 6.3 days; p < .001), with higher total bed-days PPPM (mean, 0.52 vs. 0.43; p < .001), compared to the non-type-2-diabetes cohort. The type 2 diabetes cohort had a significantly higher incremental cost for both the index CV hospitalization (mean cost difference, $1046; p < .001) and all-cause costs PPPM following discharge (mean cost difference, $749; p < .001). CONCLUSIONS Comorbid type 2 diabetes was associated with an increased risk of subsequent CV hospitalizations and higher costs and HCRU during the follow-up period.
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Affiliation(s)
| | | | - Weijia Wang
- b Boehringer Ingelheim Pharmaceuticals Inc. , Ridgefield , CT , USA
| | | | - Sharash Shetty
- b Boehringer Ingelheim Pharmaceuticals Inc. , Ridgefield , CT , USA
| | - Stephen D Sander
- b Boehringer Ingelheim Pharmaceuticals Inc. , Ridgefield , CT , USA
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20
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Metra M. May 2018 at a glance: the central role of co-morbidities. Eur J Heart Fail 2018; 20:833-834. [DOI: 10.1002/ejhf.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
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21
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Metra M. January 2018 at a glance: biomarkers, co-morbidities and mechanical circulatory support. Eur J Heart Fail 2018; 20:1-2. [PMID: 29388339 DOI: 10.1002/ejhf.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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22
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Vacante F, Senesi P, Montesano A, Frigerio A, Luzi L, Terruzzi I. L-Carnitine: An Antioxidant Remedy for the Survival of Cardiomyocytes under Hyperglycemic Condition. J Diabetes Res 2018; 2018:4028297. [PMID: 30622968 PMCID: PMC6304876 DOI: 10.1155/2018/4028297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Metabolic alterations as hyperglycemia and inflammation induce myocardial molecular events enhancing oxidative stress and mitochondrial dysfunction. Those alterations are responsible for a progressive loss of cardiomyocytes, cardiac stem cells, and consequent cardiovascular complications. Currently, there are no effective pharmacological measures to protect the heart from these metabolic modifications, and the development of new therapeutic approaches, focused on improvement of the oxidative stress condition, is pivotal. The protective effects of levocarnitine (LC) in patients with ischemic heart disease are related to the attenuation of oxidative stress, but LC mechanisms have yet to be fully understood. OBJECTIVE The aim of this work was to investigate LC's role in oxidative stress condition, on ROS production and mitochondrial detoxifying function in H9c2 rat cardiomyocytes during hyperglycemia. METHODS H9c2 cells in the hyperglycemic state (25 mmol/L glucose) were exposed to 0.5 or 5 mM LC for 48 and 72 h: LC effects on signaling pathways involved in oxidative stress condition were studied by Western blot and immunofluorescence analysis. To evaluate ROS production, H9c2 cells were exposed to H2O2 after LC pretreatment. RESULTS Our in vitro study indicates how LC supplementation might protect cardiomyocytes from oxidative stress-related damage, preventing ROS formation and activating antioxidant signaling pathways in hyperglycemic conditions. In particular, LC promotes STAT3 activation and significantly increases the expression of antioxidant protein SOD2. Hyperglycemic cardiac cells are characterized by impairment in mitochondrial dysfunction and the CaMKII signal: LC promotes CaMKII expression and activation and enhancement of AMPK protein synthesis. Our results suggest that LC might ameliorate metabolic aspects of hyperglycemic cardiac cells. Finally, LC doses herein used did not modify H9c2 growth rate and viability. CONCLUSIONS Our novel study demonstrates that LC improves the microenvironment damaged by oxidative stress (induced by hyperglycemia), thus proposing this nutraceutical compound as an adjuvant in diabetic cardiac regenerative medicine.
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Affiliation(s)
- Fernanda Vacante
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pamela Senesi
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anna Montesano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Frigerio
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Livio Luzi
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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23
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de Paula DRM, Capuano V, Filho DM, Carneiro ACDM, de Oliveira Crema V, de Oliveira LF, Rodrigues ARA, Montano N, da Silva VJD. Biological properties of cardiac mesenchymal stem cells in rats with diabetic cardiomyopathy. Life Sci 2017; 188:45-52. [PMID: 28867577 DOI: 10.1016/j.lfs.2017.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/20/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Abstract
Cardiomyopathy is a major outcome in patients with diabetes mellitus (DM) and contributes to the high morbidity/mortality observed in this disease. AIMS To evaluate several biological properties of cardiac mesenchymal stem cells (cMSCs) in a rat model of streptozotocin-induced DM with concomitant diabetic cardiomyopathy. MAIN METHODS After 10weeks of DM induction, diabetic and control rats were assessed using ECG and ventricular hemodynamics monitoring. Then, the hearts were excised and processed for histology and for extracting non-cardiomyocytic cells. A pool of these cells was plated for a colony forming units-fibroblasts (CFU-F) assay in order to estimate the number of cMSCs. The remaining cells were expanded to assess their proliferation rate as well as their osteogenic and adipogenic differentiation ability. KEY FINDINGS DM rats presented intense hyperglycemia and changes in ECG, LV hemodynamic, cardiac mass index and fibrosis, indicating presence of DCM. The CFU-F assay revealed a higher number of cardiac CFU-Fs in DM rats (10.4±1.1CFU-F/105 total cells versus 7.6±0.7CFU-F/105 total cells in control rats, p<0.05), which was associated with a significantly higher proliferative rate of cMSCs in DM rats. In contrast, cMSCs from DM rats presented a lower capacity to differentiate into both osteogenic (20.8±4.2% versus 10.1±1.0% in control rats, p<0.05) and adipogenic lineages (4.6±1.0% versus 1.3±0.5% in control rats, p<0.05). SIGNIFICANCE The findings suggest, for the first time, that in chronic DM rats with overt DCM, cMSCs increase in number and exhibit changes in several functional properties, which could be implicated in the pathogenesis of diabetic cardiomyopathy.
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Affiliation(s)
| | - Vanessa Capuano
- Department of Physiology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Daniel Mendes Filho
- Department of Physiology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Anna Cecília Dias Maciel Carneiro
- Department of Structural Biology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Virgínia de Oliveira Crema
- Department of Structural Biology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Lucas Felipe de Oliveira
- Department of Physiology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil
| | - Aldo Rogélis Aquiles Rodrigues
- Department of Physiology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil
| | - Nicola Montano
- Department of Clinical Sciences and Health Community, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Valdo José Dias da Silva
- Department of Physiology, Biological and Natural Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil.
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24
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Satthenapalli VR, Lamberts RR, Katare RG. Concise Review: Challenges in Regenerating the Diabetic Heart: A Comprehensive Review. Stem Cells 2017. [PMID: 28639375 DOI: 10.1002/stem.2661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stem cell therapy is one of the promising regenerative strategies developed to improve cardiac function in patients with ischemic heart diseases (IHD). However, this approach is limited in IHD patients with diabetes due to a progressive decline in the regenerative capacity of stem cells. This decline is mainly attributed to the metabolic memory incurred by diabetes on stem cell niche and their systemic cues. Understanding the molecular pathways involved in the diabetes-induced deterioration of stem cell function will be critical for developing new cardiac regeneration therapies. In this review, we first discuss the most common molecular alterations occurring in the diabetic stem cells/progenitor cells. Next, we highlight the key signaling pathways that can be dysregulated in a diabetic environment and impair the mobilization of stem/progenitor cells, which is essential for the transplanted/endogenous stem cells to reach the site of injury. We further discuss the possible methods of preconditioning the diabetic cardiac progenitor cell (CPC) with an aim to enrich the availability of efficient stem cells to regenerate the diseased diabetic heart. Finally, we propose new modalities for enriching the diabetic CPC through genetic or tissue engineering that would aid in developing autologous therapeutic strategies, improving the proliferative, angiogenic, and cardiogenic properties of diabetic stem/progenitor cells. Stem Cells 2017;35:2009-2026.
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Affiliation(s)
- Venkata R Satthenapalli
- Department of Physiology, School of Biomedical Sciences, HeartOtago, University of Otago, Dunedin, New Zealand
| | - Regis R Lamberts
- Department of Physiology, School of Biomedical Sciences, HeartOtago, University of Otago, Dunedin, New Zealand
| | - Rajesh G Katare
- Department of Physiology, School of Biomedical Sciences, HeartOtago, University of Otago, Dunedin, New Zealand
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