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Sasaki N, Maeda R, Ozono R, Yoshimura K, Nakano Y, Higashi Y. Differences in the impact of newly diagnosed type 2 diabetes on cardiovascular mortality between normotensive and hypertensive individuals. J Hypertens 2024; 42:610-619. [PMID: 38441184 DOI: 10.1097/hjh.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. METHODS In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. RESULTS During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. CONCLUSION The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
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Ouyang A, Hu K, Chen L. Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020. Diabetes Res Clin Pract 2024; 207:111022. [PMID: 37981123 DOI: 10.1016/j.diabres.2023.111022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
AIMS To assess the national trends in prevalence of diabetes and prediabetes and their major risk factors among adolescents in the US. METHODS We analyzed data on 6,936 adolescents aged 12 to 19 years from the National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2020. Diabetes was defined by self-reported physician-diagnosis (diagnosed) and by fasting plasma glucose and HbA1c levels (undiagnosed). Prediabetes was identified by fasting plasma glucose and HbA1c levels. Logistic regression was performed to estimate the associations of major risk factors with diabetes and prediabetes. RESULTS The prevalence of prediabetes in adolescents increased from 11.5% in 1999-2002 to 36.3% in 2015-2020. The prevalence of diabetes increased from 0.82% (0.62% of diagnosed and 0.20% of undiagnosed) in 1999-2002 to 1.14% (0.76% of diagnosed and 0.38% of undiagnosed) in 2015-2020, but the increase was not statistically significant (P value = 0.69). Obesity was significantly associated with higher odds of diabetes and prediabetes while boys and Mexican Americans had a significantly higher risk of prediabetes than their counterparts. CONCLUSIONS The prevalence of prediabetes among adolescents in the US has more than tripled from 1999 to 2020. Obese adolescents are at the greatest risk for diabetes and prediabetes.
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Affiliation(s)
- Anthony Ouyang
- Thomas S. Wootton High School, 2100 Wootton Pkwy, Rockville, MD 20850, USA
| | - Kathy Hu
- Episcopal School of Baton Rouge, 3200 Woodland Ridge Blvd, Baton Rouge, LA 70816, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA.
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3
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Poráčová J, Nagy M, Mydlárová Blaščáková M, Konečná M, Sedlák V, Zahatňanská M, Kimáková T, Vašková H, Rybárová V, Majherová M, Uher I. Diabetes mellitus and its influence on the incidence and process of diabetic retinopathy. Cent Eur J Public Health 2023; 31:S4-S9. [PMID: 38272471 DOI: 10.21101/cejph.a7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVES The main aim of the study was to show the effect of diabetes in relation to the gender of the patients, duration of the disease, and on the incidence of diabetic retinopathy. In this study, we investigated the prevalence of these two diseases, pathological ocular changes and progression of disease occurrence in relation to the duration of the disease with respect to their impact on the quality of vision of the patient. METHODS The prospective observational cross-sectional study included 3,951 patients (1,838 males, 2,113 females) with diabetes mellitus from 7 districts of eastern Slovakia. Patients with diabetes mellitus and diabetic retinopathy were identified by special screening in the number of 2,093 (1,094 females and 999 males). Subjects were divided by sex and by duration of diabetes into 5 groups: patients with diabetes under 5, 10, 15, 20, and over 20 years. We differentiated between proliferative and non-proliferative forms of diabetic retinopathy and monitored changes in visual quality. Manifestations of pathological changes were recorded using special examination methods in the eye clinic. We observed a decrease in vision by two lines, pathological changes on the retina and the occurrence of practical blindness. RESULTS Of the total number of diabetic patients examined, diabetic retinopathy was also present in more than half of the patients. The major form represented in the patients was the non-proliferative form of retinopathy. The obtained results confirmed that the representation of patients with diabetic retinopathy increases with increasing duration of diabetes. Similarly, pathological changes characteristic of this type of late complication of diabetes were also more frequent, such as deterioration of visual acuity, the appearance of aneurysms, hard exudates macular edema, and gradual loss of vision, which can result in practical blindness. CONCLUSION The percentage of people with diabetic retinopathy increases with the duration of diabetes, as well as the increased frequency of pathological late complication of diabetes, including deterioration of visual acuity, the development of aneurysms, hard exudates, macular oedema, and gradual loss of vision, which can result in practical blindness. Early diagnosis of the disease and introduction of appropriate treatment would alleviate the symptoms of the disease in more than half of the patients, so more frequent preventive check-ups with an ophthalmologist should be performed in diabetic patients to avoid detection of the disease in its late stages.
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Affiliation(s)
- Janka Poráčová
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Melinda Nagy
- Department of Biology, Faculty of Education, J. Selye University, Komarno, Slovak Republic
| | - Marta Mydlárová Blaščáková
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Mária Konečná
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Vincent Sedlák
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Mária Zahatňanská
- Institute of Pedagogy, Andragogy and Psychology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Tatiana Kimáková
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Hedviga Vašková
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Viktória Rybárová
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Mária Majherová
- Department of Physics, Mathematics and Technologies, Faculty of Humanities and Natural Sciences, University of Presov, Presov, Slovak Republic
| | - Ivan Uher
- Institute of Physical Education and Sports, Pavol Jozef Safarik University, Kosice, Slovak Republic
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Шляхто ЕВ, Сухих ГТ, Серов ВН, Дедов ИИ, Арутюнов ГП, Сучков ИА, Орлова ЯА, Андреева ЕН, Юренева СВ, Явелов ИС, Ярмолинская МИ, Виллевальде СВ, Григорян ОР, Дудинская ЕН, Илюхин ЕА, Козиолова НА, Сергиенко ИВ, Сметник АА, Тапильская НИ. [Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia]. PROBLEMY ENDOKRINOLOGII 2023; 69:115-136. [PMID: 37968959 PMCID: PMC10680541 DOI: 10.14341/probl13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.
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Affiliation(s)
- Е. В. Шляхто
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - Г. Т. Сухих
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - В. Н. Серов
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - И. И. Дедов
- Национальный медицинский исследовательский центр эндокринологии
| | - Г. П. Арутюнов
- Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
| | - И. А. Сучков
- Рязанский государственный медицинский университет им. акад. И.П. Павлова
| | - Я. А. Орлова
- Медицинский научно-образовательный центр МГУ им. М.В. Ломоносова
| | - Е. Н. Андреева
- Национальный медицинский исследовательский центр эндокринологии
| | - С. В. Юренева
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - И. С. Явелов
- Национальный медицинский исследовательский центр терапии и профилактической медицины
| | - М. И. Ярмолинская
- Научно-исследовательский институт акушерства и гинекологии и репродуктологии им. Д.О. Отта
| | | | - О. Р. Григорян
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. Н. Дудинская
- Российский геронтологический научно-клинический центр Российского национального исследовательского медицинского университета им. Н.И. Пирогова
| | | | - Н. А. Козиолова
- Пермский государственный медицинский университет им. акад. Е.А. Вагнера
| | - И. В. Сергиенко
- Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова
| | - А. А. Сметник
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - Н. И. Тапильская
- Научно-исследовательский институт акушерства и гинекологии и репродуктологии им. Д.О. Отта
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Shlyakhto EV, Sukhikh GT, Serov VN, Dedov II, Arutyunov GP, Suchkov IA, Orlova YA, Andreeva EN, Yureneva SV, Yavelov IS, Yarmolinskaya MI, Villevalde SV, Grigoryan OR, Dudinskaya EN, Ilyukhin EA, Koziolova NA, Sergienko IV, Smetnik AA, Tapilskaya NI. [Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP]. KARDIOLOGIIA 2023; 63:9-28. [PMID: 37970852 DOI: 10.18087/cardio.2023.10.n2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.
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Affiliation(s)
| | - G T Sukhikh
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology
| | - V N Serov
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology
| | - I I Dedov
- National Medical Research Center of Endocrinology
| | - G P Arutyunov
- Pirogov Russian National Research Medical University
| | | | - Ya A Orlova
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - E N Andreeva
- National Medical Research Center of Endocrinology; Evdokimov Moscow State University of Medicine and Dentistry
| | - S V Yureneva
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology
| | - I S Yavelov
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | | | - E N Dudinskaya
- Russian Gerontology Research and Clinical Center, Pirogov Russian Research Medical University
| | | | | | - I V Sergienko
- Chazov National Medical Research Center of Cardiology
| | - A A Smetnik
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology
| | - N I Tapilskaya
- Ott Research Institute of Obstetrics, Gynecology and Reproductology
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Zhang YS, Taha AT, Thompson IJB, Keenan JD, Yang D, Wu J, Stewart JM. Association of Male Sex and Microvascular Alterations on Optical Coherence Tomography Angiography in Diabetes. Transl Vis Sci Technol 2023; 12:30. [PMID: 38010281 PMCID: PMC10683768 DOI: 10.1167/tvst.12.11.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose Epidemiologically, men have a higher incidence, severity, and progression of diabetic retinopathy (DR) than women. We investigated microvascular differences between men and women with diabetes on optical coherence tomography angiography (OCTA). Methods Three × 3 mm OCTA macula scans of non-diabetic and patients with diabetes were obtained. Vascular parameters included parafoveal vessel density (VD), vessel length density (VLD), and flow index (FI) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) as well as foveal avascular zone (FAZ) area and perimeter. Multivariable linear regression was used for statistical analysis. Results There were 1809 patients with diabetes and 217 non-diabetic participants that were included in this study. Diabetic individuals included those with no DR (n = 1356), mild non-proliferative DR (NPDR; n = 286), moderate NPDR (n = 126), and severe NPDR/proliferative DR (PDR; n = 41). Male sex was significantly associated with smaller FAZ area/perimeter and lower DCP VLD in both non-diabetic subjects and patients with diabetes. Male sex in the diabetic group was additionally associated with lower SCP VD/VLD and DCP VD. Addition of an interaction between male sex and diabetes status in the interaction analysis showed that being male and diabetic conferred increased reduction in DCP VD and VLD compared to sex-based changes in non-diabetics. Larger FAZ perimeter, lower SCP VD/VLD, and lower DCP VLD were associated with poorer visual acuity in diabetics. Conclusions On OCTA, male patients with diabetes may have more severe microvascular disease especially in the DCP compared to women. Translational Evidence Sex-based alterations in diabetic microvascular disease has the potential to influence future basic and clinical studies as well as the implementation of OCTA disease markers.
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Affiliation(s)
- Yi Stephanie Zhang
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Abu T. Taha
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Isabel J. B. Thompson
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
| | - Jeremy D. Keenan
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
| | - Daphne Yang
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Joshua Wu
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Jay M. Stewart
- University of California – San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
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Hu T, Shen Y, Xu Y, Wang Y, Bao Y, Ma X. Low total osteocalcin levels are associated with the risk of cardiovascular events among women with hyperglycaemia: a 7.6-year prospective study. Endocrine 2023; 82:47-56. [PMID: 37341923 DOI: 10.1007/s12020-023-03428-1] [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: 04/08/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To investigate the association between circulating osteocalcin and incident cardiovascular diseases in a community-based cohort, and further assess whether the association differs by different glycemic stages. METHODS This cohort study included 1428 participants (626 men and 802 women) aged 50-80 years, without baseline cardiovascular diseases, and with osteocalcin data available. Circulating total osteocalcin levels were measured by electrochemiluminescence immunoassay. Multivariate Cox proportional hazards models were used to assess the relationship between osteocalcin levels and different glycemic stages with cardiovascular events. RESULTS At baseline, 437 participants were normoglycaemia and 991 participants were hyperglycaemia. Median circulating osteocalcin levels were 16.43 (13.34-20.19) and 21.66 (17.95-26.11) ng/mL in men and women, respectively. During a mean follow-up of 7.6 years, 144 cases of cardiovascular diseases occurred (10.1%). The risk of incident cardiovascular diseases linearly increased with a decrease in baseline osteocalcin quartiles (quartile 1 versus quartile 4: hazard ratio 2.44, 95% confidence interval 1.07-5.55) in women, while not in men (Pinteraction on sex = 0.028). Subgroup analyses showed that the association was more predominant in participants with baseline hyperglycaemia. Besides, the joint effect of baseline decreased osteocalcin levels and hyperglycaemia resulted in higher risks of future cardiovascular diseases. CONCLUSIONS Low baseline osteocalcin levels were associated with high risks of cardiovascular diseases in middle-aged and elderly women, which were more predominant among those with baseline hyperglycaemia.
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Affiliation(s)
- Tingting Hu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China
| | - Yiting Xu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China.
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China.
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8
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Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia 2023; 66:986-1002. [PMID: 36897358 PMCID: PMC10163139 DOI: 10.1007/s00125-023-05891-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 03/11/2023]
Abstract
The prevalence of type 2 diabetes mellitus is increasing in both sexes, but men are usually diagnosed at a younger age and lower body fat mass than women. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus. Women appear to bear a greater risk factor burden at the time of their type 2 diabetes diagnosis, especially obesity. Moreover, psychosocial stress might play a more prominent role in diabetes risk in women. Across their lifespan, women experience greater hormone fluctuations and body changes due to reproductive factors than men. Pregnancies can unmask pre-existing metabolic abnormalities, resulting in the diagnosis of gestational diabetes, which appears to be the most prominent risk factor for progression to type 2 diabetes in women. Additionally, menopause increases women's cardiometabolic risk profile. Due to the progressive rise in obesity, there is a global increase in women with pregestational type 2 diabetes, often with inadequate preconceptual care. There are differences between men and women regarding type 2 diabetes and other cardiovascular risk factors with respect to comorbidities, the manifestation of complications and the initiation of and adherence to therapy. Women with type 2 diabetes show greater relative risk of CVD and mortality than men. Moreover, young women with type 2 diabetes are currently less likely than men to receive the treatment and CVD risk reduction recommended by guidelines. Current medical recommendations do not provide information on sex-specific or gender-sensitive prevention strategies and management. Thus, more research on sex differences, including the underlying mechanisms, is necessary to increase the evidence in the future. Nonetheless, intensified efforts to screen for glucose metabolism disorders and other cardiovascular risk factors, as well as the early establishment of prophylactic measures and aggressive risk management strategies, are still required for both men and women at increased risk of type 2 diabetes. In this narrative review we aim to summarise sex-specific clinical features and differences between women and men with type 2 diabetes into risk factors, screening, diagnosis, complications and treatment.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.
- Gender Institute, Lapura Women's Health Resort, Gars am Kamp, Austria.
| | - Michael Leutner
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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9
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Ungethüm K, Wiedmann S, Wagner M, Leyh R, Ertl G, Frantz S, Geisler T, Karmann W, Prondzinsky R, Herdeg C, Noutsias M, Ludwig T, Käs J, Klocke B, Krapp J, Wood D, Kotseva K, Störk S, Heuschmann PU. Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys. Clin Res Cardiol 2023; 112:285-298. [PMID: 36166067 PMCID: PMC9898414 DOI: 10.1007/s00392-022-02093-0] [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: 03/30/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. METHODS The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). RESULTS 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). CONCLUSION Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.
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Affiliation(s)
- K Ungethüm
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany.
| | - S Wiedmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Berlin, Germany
| | - M Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Kuratorium für Dialyse und Nierentransplantation E.V, Neu-Isenburg, Hesse, Germany
| | - R Leyh
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - G Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - S Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
| | - T Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - W Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Bavaria, Germany
| | - R Prondzinsky
- Cardiology/Intensive Care Medicine, Carl Von Basedow Klinikum Merseburg, Merseburg, Saxony-Anhalt, Germany
| | - C Herdeg
- Medius Klinik Ostfildern-Ruit, Klinik für Innere Medizin, Herz- und Kreislauferkrankungen, Ostfildern-Ruit, Baden-Württemberg, Germany
| | - M Noutsias
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
- Department of Internal Medicine A, University Hospital Ruppin-Brandenburg (UKRB) of the Medical School of Brandenburg (MHB), Neuruppin, Brandenburg, Germany
| | - T Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Käs
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - B Klocke
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Krapp
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - D Wood
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - K Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - S Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - P U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
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Wooten JS, Breden M, Hoeg T, Smith BK. Effects of weight-loss on adipokines, total and regional body composition and markers of metabolic syndrome in women who are overweight and obese. ENDOCRINE AND METABOLIC SCIENCE 2022. [DOI: 10.1016/j.endmts.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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11
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Yang T, Fan K, Cao Y, Yan J, Han Z. Stroke Type, Etiology, Clinical Features and Prognosis of Diabetic Patients in Southern China. Clin Appl Thromb Hemost 2021; 26:1076029620973090. [PMID: 33296224 PMCID: PMC7731598 DOI: 10.1177/1076029620973090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
To analyze the type, etiology, clinical features and prognosis of stroke in southern China diabetic patients. From January to August 2019, acute stroke patients were prospectively enrolled in the Wenzhou Stroke Registry within 7 days of admission to the Hospital. The differences between the 2 groups of stroke patients with or without diabetes were in the following aspects: bleeding site of hemorrhagic stroke, different ischemic stroke etiology, Oxfordshire Community Stroke Project (OCSP) classification, death and disability within 3 months. Of the 497 patients enrolled, 104 (20.9%) were diabetic patients. 114(22.9%) patients had hemorrhagic stroke. The incidence of hemorrhagic stroke in the diabetic group was 10.6%, deep hemorrhage stroke account for 90.9%.In patients with ischemic stroke, the proportions of the new Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological subtype classifications (atherothrombosis (AT), cardioembolism (CE), small artery disease (SAD), stroke of other determined etiology (SOD) and stroke of undetermined etiology (SUD)) in the diabetic (non-diabetic) group was 43% (31%), 7.5% (14.1%), 27.9% (16.9%), 1% (0.3%), and 20.4% (37.6%), respectively; the proportion of The OCSP classifications(total anterior circulation infarcts(TACI), partial anterior circulation infarcts(PACI), lacunar infarcts(LACI) and posterior circulation infarcts(POCI)) in the diabetic (non-diabetic) group was16.1% (22%), 30.1%(37.2%), 42% (31.4%), and 10.8% (9%), respectively. The 3-month poor prognosis of the diabetic and non-diabetic groups was 23.1% and 28.2%. For diabetic patients, the incidence of hemorrhagic stroke is low, deep hemorrhage is common; SAD and LACI are common in the ischemic stroke; There was no significant difference in the 3-month prognosis between the 2 groups.
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Affiliation(s)
- Ting Yang
- Department of Emergency, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Kai Fan
- Department of Neurology, Zhoukou Central Hospital, Henan Province, China
| | - Yungang Cao
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jueyue Yan
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhao Han
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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12
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Increasing glycaemia is associated with a significant decline in HDL cholesterol in women with prediabetes in two national populations. Sci Rep 2021; 11:12194. [PMID: 34108497 PMCID: PMC8190299 DOI: 10.1038/s41598-021-91075-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Internationally, studies have shown associations between lipids and glycemia; however, whether the link varies by gender and population has been rarely examined. We investigated relationships between glycemia and HDL- and Non-HDL-cholesterol and their modification by gender. We undertook a cross-sectional analysis from the National Health Examination Survey for Thailand (NHES-Thailand) and the Health Survey for England (HS-England) in adults aged 18–75 year. Glycaemia was assessed by FPG in Thailand and by HbA1c in the UK. In population- and gender-stratified analyses, the relationships between glycemia and lipids were explored. A total of 15,145 Thai and 3484 UK adults with blood measurement were included. The prevalences of prediabetes were: in NHES-Thailand, 16% (SE = 0.004), based on FPG (5.6 to < 7.0 mmol/L) and in HS-England, 19% (0.007) based on HbA1c (39 to < 48 mmol/mol). Increasingly abnormal glucose homeostasis was associated with increasing age, adiposity, SBP, proportion of antihypertensive and lipid-lowering agent use and with decreasing HDL-cholesterol. Independent of age, adiposity, smoking, alcohol, physical activity, and lipid and BP lowering drug use, increasing glycemia was associated with decreasing HDL-cholesterol specifically in women with prediabetes (NHES-Thailand, beta-coefficient − 0.07 (95% CI − 0.15, − 0.001) p = 0.04 and HS-England, − 0.03 (− 0.04, − 0.006) p = 0.01). In both populations, among those with prediabetes, increasing glycaemia is associated with an adverse, significant decline in HDL cholesterol, specifically in women. These adverse effects are apparent in widely-differing international populations.
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Succurro E, Miceli S, Fiorentino TV, Sciacqua A, Perticone M, Andreozzi F, Sesti G. Sex-specific differences in left ventricular mass and myocardial energetic efficiency in non-diabetic, pre-diabetic and newly diagnosed type 2 diabetic subjects. Cardiovasc Diabetol 2021; 20:60. [PMID: 33676510 PMCID: PMC7937311 DOI: 10.1186/s12933-021-01248-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background Women with type 2 diabetes (T2DM) have a higher excess risk for cardiovascular disease (CVD) than their male counterparts. However, whether the risk for CVD is higher in prediabetic women than men is still debated. We aimed to determine whether sex-related differences exist in left ventricular mass index (LVMI), and myocardial mechano-energetic efficiency (MEEi) in with normal glucose tolerant (NGT), pre-diabetic and newly diagnosed type 2 diabetic subjects. Methods Sex-related differences in LVMI and myocardial MEEi, assessed by validated echocardiography-derived measures, were examined among 1562 adults with NGT, prediabetes, and newly diagnosed T2DM, defined according to fasting glucose, 2-h post-load glucose, or HbA1c. Results Worsening of glucose tolerance in both men and women was associated with an increase in age-adjusted LVMI and myocardial MEEi. Women with newly diagnosed T2DM exhibited greater relative differences in LVMI and myocardial MEEi than diabetic men when compared with their NGT counterparts. Prediabetic women exhibited greater relative differences in myocardial MEEi, but not in LVMI, than prediabetic men when compared with their NGT counterparts. The statistical test for interaction between sex and glucose tolerance on both LVMI (P < 0.0001), and myocardial MEEi (P < 0.0001) was significant suggesting a sex-specific association. Conclusions Left ventricle is subject to maladaptive changes with worsening of glucose tolerance, especially in women with newly diagnosed T2DM. The sex-specific increase in LVM and decrease in MEEi, both being predictors of CVD, may have a role in explaining the stronger impact of T2DM on the excess risk of CVD in women than in men.
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Affiliation(s)
- Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189, Rome, Italy
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14
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Succurro E, Fiorentino TV, Miceli S, Perticone M, Sciacqua A, Andreozzi F, Sesti G. Relative Risk of Cardiovascular Disease Is Higher in Women With Type 2 Diabetes, but Not in Those With Prediabetes, as Compared With Men. Diabetes Care 2020; 43:3070-3078. [PMID: 32998991 DOI: 10.2337/dc20-1401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Most but not all studies suggest that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in women with prediabetes compared with men with prediabetes. RESEARCH DESIGN AND METHODS In a cross-sectional study, in 3,540 adults with normal glucose tolerance (NGT), prediabetes, and diabetes, we compared the RR for prevalent nonfatal CVD between men and women. In a longitudinal study including 1,658 adults with NGT, prediabetes, and diabetes, we compared the RR for incidences of major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events, after 5.6 years of follow-up. RESULTS Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, hs-CRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in women with diabetes (RR 9.29; 95% CI 4.73-18.25; P < 0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P < 0.0001), but no difference in RR for CVD was observed comparing women and men with prediabetes. In the longitudinal study, we found that women with diabetes, but not those with prediabetes, have higher RR (RR 5.25; 95% CI 3.22-8.56; P < 0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P < 0.0001). CONCLUSIONS This study suggests that women with diabetes, but not those with prediabetes, have higher RR for prevalent and incident major adverse outcomes than men.
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Affiliation(s)
- Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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Ye L, Xu J, Zhang T, Lin X, Pan X, Zeng W, Ren Y, Shan P. Global burden of noncommunicable diseases attributable to high fasting plasma glucose. J Diabetes 2020; 12:807-818. [PMID: 32472661 DOI: 10.1111/1753-0407.13072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperglycemia is a major public health concern. An understanding of the latest trends of the global burden of noncommunicable diseases (NCDs) by high fasting plasma glucose (HFPG) is critical for determining research priorities and planning health policy. METHODS This is a comparative burden-of-disease study. We obtained global, regional, and national data on deaths and disability-adjusted life years (DALYs) of NCDs attributable to HFPG from the Global Burden of Disease Study 2017, performed a secondary analysis of deaths and DALYs by time, age, gender, location, and specific causes, and analyzed their associations. RESULTS In 2017, 6.39 million deaths and 166.36 million DALYs from NCDs were attributable to HFPG, accounting for 15.6% and 10.7% of all deaths and DALYs, respectively. The burden's rate decreased with time, increased with age and was significantly higher in males. A negative association was found between the sociodemographic index (SDI) and disease burden, and a positive association was found between SDI and male superiority by gender difference and gender ratio. CONCLUSIONS The burden of NCDs attributable to HFPG has increased significantly since 1990 and varied widely across regions. Greater efforts are needed to prevent and control hyperglycemia, especially in less developed countries and among males.
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Affiliation(s)
- Lingxia Ye
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingya Xu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianyue Zhang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiling Lin
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenheng Zeng
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuezhong Ren
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pengfei Shan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Diabetic retinopathy (DR) is one of the main causes of visual loss in individuals aged 20–64 years old. The aim of this study was to investigate, in a multicenter retrospective cross-sectional study, sex-gender difference in DR in a large sample of type 2 diabetic patients (T2DM). 20,611 T2DM regularly attending the units for the last three years were classified as having: (a) No DR (NDR), (b) nonproliferative DR (NPDR), or (c) preproliferative/proliferative DR (PPDR). DR of all grades was present in 4294 T2DM (20.8%), with a significant higher prevalence in men as compared to women (22.0% vs. 19.3% p < 0.0001). Among DR patients, both NPDR and PPDR were significantly more prevalent in men vs. women (p = 0.001 and p = 0.0016, respectively). Women had similar age and BMI, but longer diabetes duration, worse glycemic metabolic control, and more prevalence of hypertension and chronic renal failure (CRF) of any grade vs. men. No significant differences between sexes were evident in term of drug therapy for diabetes and associate pathologies. Conclusions: In this large sample of T2DM, men show higher prevalence of DR vs. women, in spite of less represented risk factors, suggesting that male sex per se might be a risk factor for DR development.
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Mesenteric arterial dysfunction in the UC Davis Type 2 Diabetes Mellitus rat model is dependent on pre-diabetic versus diabetic status and is sexually dimorphic. Eur J Pharmacol 2020; 879:173089. [PMID: 32320701 DOI: 10.1016/j.ejphar.2020.173089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/27/2023]
Abstract
Previous reports suggest that diabetes may differentially affect the vascular beds of females and males. However, there is insufficient evidence to establish the timeline of the vascular dysfunction in diabetes, specifically in relation to sex. Here, we determined whether mesenteric arterial function is altered in UC Davis Type-2 Diabetes Mellitus (UCD-T2DM) rats and if this occurs as early as the pre-diabetic stage of the disease. Specifically, we investigated whether vascular dysfunction differs between pre-diabetic or diabetic status and if this varies by sex. We measured the responses to endothelium-dependent and -independent vasorelaxant as well as vasoconstrictor agents and explored the potential mechanisms involved in sex-specific development of arterial dysfunction in UCD-T2DM rats. In addition, indices of insulin sensitivity were assessed. We report the reduced insulin sensitivity in pre-diabetic males and diabetic females. Vascular relaxation to acetylcholine was impaired to a greater extent in mesenteric artery from males in the pre-diabetic stage than in their female counterparts. In contrast, the arteries from females with diabetes exhibited a greater impairment to acetylcholine compared with diabetic males. Additionally, the sensitivity of mesenteric artery to contractile agents in females, but not in males, after the onset of diabetes was increased. Our data suggest that the reduced insulin sensitivity through AKT may predispose vessels to injury in the pre-diabetic stage in males. On the other hand, reduced insulin sensitivity as well as enhanced responsiveness to contractile agents may predispose arteries to injury in the diabetic stage in females.
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18
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Shen Y, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Yin P, Bazzano AN, Nigam S, Hu G. Race and sex differences in rates of diabetic complications. J Diabetes 2019; 11:449-456. [PMID: 30315628 PMCID: PMC6462252 DOI: 10.1111/1753-0407.12869] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies on racial differences in diabetic complications are very limited. The aim of this study was to investigate the race and sex differences in diabetic complications between African Americans and Whites with type 2 diabetes (T2D) in Louisiana. METHODS A prospective cohort study was performed of 27 113 African Americans and 40 431 Whites with T2D who were 35 to 95 years of age from three healthcare systems located in south Louisiana. Four major diabetic complications were assessed: coronary heart disease (CHD), heart failure, stroke, and end-stage renal disease (ESRD). RESULTS The age- and sex-adjusted incident rates per 1000 person-years and 95% confidence intervals (CI) for CHD, heart failure, stroke, and ESRD for African Americans with diabetes were 43.1 (95% CI 41.6-44.6), 36.6 (95% CI 35.2-37.9), 29.6 (95% CI 28.4-30.8), and 38.3 (95% CI 36.9-39.7), respectively. Cox regression models showed that African American women had a higher risk than White women for heart failure (hazard ratio (HR) 1.26; 95% CI 1.18-1.34), stroke (HR 1.15; 95% CI 1.08-1.22), and ESRD (HR 1.32; 95% CI 1.24-1.40), whereas African American men had higher risks than White men for heart failure (HR 1.33; 95% CI 1.25-1.43) and ESRD (HR 1.47; 95% CI 1.37-1.57) but a lower risk of CHD (HR 0.88; 95% CI 0.83-0.94). CONCLUSIONS The incidence of major diabetic complications varied among difference race and sex groups. More race- or sex-specific studies on complications in patients with diabetes are needed to see whether incident rates are changing over time.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Eboni G Price-Haywood
- Ochsner Health System Center for Applied Health Services Research, New Orleans, Louisiana, USA
| | - Ping Yin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Rollmann MF, Herath SC, Braun BJ, Holstein JH, Pohlemann T, Menger MD, Histing T. In-hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study. Geriatr Gerontol Int 2018; 19:24-29. [PMID: 30586683 DOI: 10.1111/ggi.13558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/25/2018] [Accepted: 10/08/2018] [Indexed: 12/20/2022]
Abstract
AIM With the predicted demographic change, the treatment of geriatric patients will become a major issue for health systems worldwide. The majority of pelvic ring fractures occur in older adults, and their treatment might be associated with a distinct mortality. Herein, we analyzed the data of 5665 patients with pelvic ring fractures aged ≥60 years included in the German Pelvic Trauma Registry from 1991 to 2013. METHODS The data were collected prospectively, multicentrically in hospitals participating in the German Pelvic Trauma Registry. Demographic data were retrospectively analyzed, stratified for age, sex, type of injury, mode of therapy, injury severity score (ISS) and mortality. RESULTS The overall mortality decreased over the 22-year study period from 9.3% to 3.8% (P < 0.05), whereas the median ISS significantly increased. During the observation period, mortality was higher in patients with type B and, particularly, type C fractures when compared with patients with type A fractures. Mortality rates of patients aged >80 years did not significantly differ from those aged >60 or >70 years. Male patients showed a significantly higher mortality compared with female patients, as well as a significantly higher median ISS. The mortality rate of patients with surgically-treated type C fractures decreased over the study period from 35.7% to 6.9% (P < 0.05). CONCLUSIONS Over the past two decades, the mortality of older patients after pelvic ring fractures has significantly decreased. The higher overall mortality rate of male patients might mainly be accounted for by the relatively higher fraction of type C fractures and a higher ISS. Geriatr Gerontol Int 2019; 19: 24-29.
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Affiliation(s)
- Mika F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Joerg H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
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20
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Bakshi S, Schmidt HM, Baskin AE, Croniger CM, Thompson CL, Bonfield T, Fletcher D, Berger NA. Sexual dimorphism in developmental and diet-dependent circulating retinol binding protein 4. Obes Sci Pract 2018; 4:526-534. [PMID: 30574346 PMCID: PMC6298211 DOI: 10.1002/osp4.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Retinol binding protein 4 (RBP4) transports vitamin A (Retinol) in the blood and contributes mechanistically to the linkage between obesity, insulin resistance and associated comorbidities including type 2 diabetes mellitus, coronary artery and neoplastic diseases. Circulating RBP4 levels have variably been associated with body mass and gender differences. Many of these differences have been demonstrated after limited dietary interventions, and/or at single unique time points. This study investigated the impact of sex and age as biologic variables as well as high versus low fat diets on development of obesity, RBP4 levels and insulin resistance in C57BL/6J mice. METHODS Male and female C57BL/6J mice were fed for 400 days with either low or high fat diets. Female mice were also evaluated on same diets after ovariectomy or sham ovariectomy. Mice were monitored for changes in weight, circulating levels RBP4, glucose and insulin at 100-day intervals and also by 2-hour glucose tolerance tests. RESULTS All mice on low or high fat diets gained weight. Mice on high fat diets showed significantly greater weight gain than those on low fat. Male mice showed significantly greater weight gain compared with females on corresponding diet. Male mice compared with females already showed significantly higher RBP4 levels even before starting diets. Sex differences were maintained for more than 1 year. Gender differences in RBP4 were associated with significant differences in development of glucose intolerance and insulin resistance. CONCLUSIONS Male compared with female C57BL/6J mice show significant gender differences in circulating RBP4 levels from 6 weeks of age, extending more than 1 year. Gender differences in RBP4 may be mechanistically associated with protection against glucose intolerance and insulin resistance. Targeting RBP4 pathways could be useful to disrupt gender differences in insulin resistance and disparities in comorbidities.
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Affiliation(s)
- S. Bakshi
- Departments of Biochemistry, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - H. M. Schmidt
- Departments of Genetics and Genome Sciences, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - A. E. Baskin
- Departments of Genetics and Genome Sciences, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - C. M. Croniger
- Departments of Nutrition, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - C. L. Thompson
- Departments of Nutrition, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - T. Bonfield
- Departments of Pediatrics, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - D. Fletcher
- Departments of Pediatrics, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - N. A. Berger
- Departments of Biochemistry, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
- Departments of Genetics and Genome Sciences, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
- Departments of Medicine, Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
- Center for Science, Health and SocietyCase Western Reserve University School of MedicineClevelandOHUSA
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Sartoretto SM, Santos FF, Costa BP, Ceravolo GS, Santos-Eichler R, Carvalho MHC, Fortes ZB, Akamine EH. Involvement of inducible nitric oxide synthase and estrogen receptor ESR2 (ERβ) in the vascular dysfunction in female type 1 diabetic rats. Life Sci 2018; 216:279-286. [PMID: 30447304 DOI: 10.1016/j.lfs.2018.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
AIMS Inflammation is involved in diabetes-related vascular dysfunction. Estrogen receptor ESR2/ERβ induces the expression of inducible nitric oxide (NO) synthase (iNOS) and inflammation. The present study investigated the effect of alloxan-induced type 1 diabetes on the iNOS and ESR2 expression and the effect of the chronic iNOS inhibition on the vascular smooth muscle dysfunction in diabetic female rats. In addition, we evaluated the involvement of ESR2 in iNOS expression. MAIN METHODS Alloxan-induced diabetic female rats were treated or not with iNOS inhibitor (L-NIL). iNOS and ESR2 immunostaining, S-nitrosylated proteins and IL-1β protein expression in aorta and plasmatic NO levels were analyzed. Contractile response to noradrenaline was analyzed in endothelium-denuded aorta. iNOS mRNA expression was analyzed in isolated aortic smooth muscle cells (ASMCs) of female rats, incubated with 22 mM glucose and an ESR2 antagonist. KEY FINDINGS Aortic iNOS and ESR2 immunostaining, S-nitrosylated proteins, IL-1β protein expression and plasmatic NO levels were all increased, whereas noradrenaline-induced contraction was reduced in aorta of diabetic female rats. With the exception of iNOS and ESR2 immunostaining, all these parameters were corrected by L-NIL treatment. High glucose increased iNOS mRNA expression in ASMCs, which was reduced by an ESR2 antagonist. SIGNIFICANCE We demonstrated that increased iNOS-NO contributed to the impairment of the contractile response of aortic smooth muscle cells in female type 1 diabetic rats and that increased expression of iNOS may involve the participation of ESR2/ERβ.
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Affiliation(s)
- Simone Marcieli Sartoretto
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Fernanda Fernandes Santos
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Beatriz Pereira Costa
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Graziela Scalianti Ceravolo
- Department of Physiological Sciences, Biological Sciences Center, State University of Londrina, Paraná, Brazil
| | - Rosângela Santos-Eichler
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Zuleica Bruno Fortes
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Eliana Hiromi Akamine
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
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Familial hypercholesterolemia and atherosclerotic cardiovascular mortality among Korean adults with low levels of serum cholesterol. Atherosclerosis 2018; 278:103-109. [DOI: 10.1016/j.atherosclerosis.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/22/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The following is a review of the current concepts on the relationship between hypertension (HTN) and diabetes mellitus with a focus on the epidemiology and cardiovascular prognostic implications of coexistent HTN and diabetes mellitus, shared mechanisms underlying both conditions and pathophysiology of increased risk of cardiovascular disease, treatment of HTN in individuals with diabetes mellitus, and effects of anti-diabetic medications on blood pressure (BP). RECENT FINDINGS Diabetes mellitus and HTN often coexist in the same individual. They share numerous risk factors and underlying pathophysiologic mechanisms, most important of which are insulin resistance and inappropriate activation of the rennin-angiotensin-aldosterone system. Recently updated guidelines recommend a BP goal of 140/90 mmHg in most individuals with diabetes mellitus. A new class of anti-diabetic medications, sodium-glucose co-transporter 2 inhibitors, has shown favorable effects on BP. SUMMARY HTN affects the majority of individuals with diabetes mellitus. Coexistence of diabetes mellitus and HTN, especially if BP is not well controlled, dramatically increases the risk of morbidity and mortality from cardiovascular disease. BP control is an essential part of management of patients with diabetes mellitus, because it is one of the most effective ways to prevent vascular complications and death.
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Imano H, Iso H, Kitamura A, Yamagishi K, Hayama-Terada M, Muraki I, Okada T, Umesawa M, Ohira T, Sankai T, Cui R, Tanigawa T, Kiyama M. Nonfasting Glucose and Incident Stroke and Its Types - The Circulatory Risk in Communities Study (CIRCS). Circ J 2018; 82:1598-1604. [PMID: 29445058 DOI: 10.1253/circj.cj-17-0950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of postprandial glucose on the risk of cardiovascular disease has been emphasized, but it is controversial whether nonfasting glucose is related to incident stroke and its types.Methods and Results:We investigated the associations of nonfasting glucose with incident stroke and its types among 7,198 participants aged 40-74 years from the Circulatory Risk in Communities Study, enrolled in 1995-2000. We estimated multivariable hazard ratios (HR) using Cox proportional hazard models. Over a median follow-up of 14.1 years, 291 cases of total stroke (ischemic strokes: 191 including 109 lacunar infarctions) were identified. Nonfasting glucose concentration was associated with greater risk of incident total stroke, ischemic stroke and lacunar infarction when modeled categorically (for prediabetic type: 7.8-11.0 mmol/L vs. normal type: <7.8 mmol/L among all subjects, HR for lacunar infarction was 2.02, 95% confidence interval (CI): 1.19, 3.43) or continuously (per one standard deviation increment among all subjects, HR for lacunar infarction was 1.29, 95% CI: 1.15, 1.45). Diabetic type showed similar results. Population attributable fractions of nonfasting hyperglycemia were 13.2% for ischemic stroke and 17.4% for lacunar infarction. CONCLUSIONS Nonfasting glucose concentration, either as a diagnosis of prediabetic and diabetic types or as a continuous variable, proved to be an independent predictor significantly attributed to incident total stroke, especially ischemic stroke and lacunar infarction, in the general population.
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Affiliation(s)
- Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Akihiko Kitamura
- Osaka Center for Cancer and Cardiovascular Disease Prevention.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
| | | | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Mitsumasa Umesawa
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University
| | - Tomoko Sankai
- Department of Community Health, Faculty of Medicine, University of Tsukuba
| | - Renzhe Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University School of Medicine
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention
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Hoare E, Dash SR, Varsamis P, Jennings GL, Kingwell BA. Fasting Plasma Glucose, Self-Appraised Diet Quality and Depressive Symptoms: A US-Representative Cross-Sectional Study. Nutrients 2017; 9:nu9121330. [PMID: 29215576 PMCID: PMC5748780 DOI: 10.3390/nu9121330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022] Open
Abstract
Depression and type 2 diabetes (T2D) contribute significantly to global burden of disease and often co-occur. Underpinning type 2 diabetes is poor glycaemic control and glucose is also an obligatory substrate for brain metabolism, with potential implications for cognition, motivation and mood. This research aimed to examine the relationships between fasting plasma glucose and depressive symptoms in a large, population representative sample of US adults, controlling for other demographic and lifestyle behavioural risk factors. Using the 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, this study first investigated the relationship between fasting plasma glucose and mental disorders at a population-level, accounting for demographic, health behavioural and weight-related factors known to co-occur with both type 2 diabetes and mental disorders. Depressive symptoms were derived from the 9-item Patient Health Questionnaire. Fasting plasma glucose was obtained through medical examination and demographic (age, household income, sex) and health characteristics (perceived diet quality, daily time sedentary) were self-reported. Body mass index was calculated from objectively measured height and weight. In the univariate model, higher fasting plasma glucose was associated with greater depressive symptoms among females (b = 0.24, 95% CI = 0.05, 0.43, p < 0.05), but not males. In the final fully adjusted model, the relationship between fasting plasma glucose and depressive symptoms was non-significant for both males and females. Of all independent variables, self-appraised diet quality was strongly and significantly associated with depressive symptoms and this remained significant when individuals with diabetes were excluded. Although diet quality was self-reported based on individuals’ perceptions, these findings are consistent with a role for poor diet in the relationship between fasting plasma glucose and depressive symptoms.
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Affiliation(s)
- Erin Hoare
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Sarah R Dash
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Pia Varsamis
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Garry L Jennings
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
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Sex difference in the effect of the fasting serum glucose level on the risk of coronary heart disease. J Cardiol 2017; 71:149-154. [PMID: 28882397 DOI: 10.1016/j.jjcc.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Diabetic women have a greater relative risk of coronary heart disease than diabetic men. However, the sex difference in the effect of fasting serum glucose levels below the diabetic range on the risk of coronary heart disease is unclear. We investigated whether the association between nondiabetic blood glucose levels and the incident risk of coronary heart disease is different between men and women. METHODS The fasting serum glucose levels and other cardiovascular risk factors at baseline were measured in 159,702 subjects (100,144 men and 59,558 women). Primary outcomes were hospital admission and death due to coronary heart disease during the 11-year follow-up. RESULTS The risk for coronary heart disease in women significantly increased with impaired fasting glucose levels (≥110mg/dL) compared to normal glucose levels (<100mg/dL), whereas the risk for coronary heart disease in men was significantly increased at a diabetic glucose range (≥126mg/dL). Women had a higher hazard ratio of coronary heart disease associated with the fasting serum glucose level than men (p for interaction with sex=0.021). CONCLUSIONS The stronger effect of the fasting serum glucose levels on the risk of coronary heart disease in women than in men was significant from a prediabetic range (≥110mg/dL).
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Zucker I, Shohat T, Dankner R, Chodick G. New onset diabetes in adulthood is associated with a substantial risk for mortality at all ages: a population based historical cohort study with a decade-long follow-up. Cardiovasc Diabetol 2017; 16:105. [PMID: 28810857 PMCID: PMC5558697 DOI: 10.1186/s12933-017-0583-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/29/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes has been reported to be associated with an increased relative risk for mortality, with estimates ranging from 1.1 to 2.1. Findings are inconsistent regarding modification of the risk by gender and by age. The aim of this study was to estimate the mortality risk associated with new-onset diabetes in adulthood, by age group and gender. METHODS From the database of a large health care provider, we identified 31,987 individuals diagnosed with diabetes during 2003-2005; and 162,656 individuals without diabetes, group-matched by age. We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for overall mortality adjusted for age, gender, socioeconomic (SE) level, obesity, smoking and comorbidities at baseline. RESULTS During a median follow-up of 9.5 years, 4464 (14%) of persons with diabetes and 13,327 (8.2%) of those without died. Among persons with incident diabetes, the proportion of men, smokers, obese and patients of low SE level was higher, as was the prevalence of cardiovascular disease and renal impairment at baseline. Incident diabetes was associated with an adjusted HR for mortality of 1.38 (95% CI 1.32-1.43). Mortality HR for DM was comparable with hypertension (1.42; 1.37-1.46), smoking (1.65; 1.58-1.71) and atherosclerosis (1.40; 1.35-1.46). Diabetes associated mortality HR was somewhat higher among women 1.78 (95% CI 1.58-2.08) as compared with men 1.51 (95% CI 1.41-1.62). CONCLUSIONS Incident diabetes in adults is associated with a substantial risk for mortality, especially in younger adults. Further efforts should be allocated to diabetes primary prevention.
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Affiliation(s)
- Inbar Zucker
- Israel Center for Disease Control (ICDC) Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tamy Shohat
- Israel Center for Disease Control (ICDC) Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rachel Dankner
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
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Desrois M, Lan C, Movassat J, Bernard M. Reduced up-regulation of the nitric oxide pathway and impaired endothelial and smooth muscle functions in the female type 2 diabetic goto-kakizaki rat heart. Nutr Metab (Lond) 2017; 14:6. [PMID: 28101124 PMCID: PMC5237314 DOI: 10.1186/s12986-016-0157-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/25/2016] [Indexed: 02/07/2023] Open
Abstract
Background Type 2 diabetes is associated with greater relative risk of cardiovascular diseases in women than in men, which is not well understood. Consequently, we have investigated if male and female displayed differences in cardiac function, energy metabolism, and endothelial function which could contribute to increased cardiovascular complications in type 2 diabetic female. Methods Male and female Control and type 2 diabetic Goto-Kakizaki (GK) isolated rat hearts were perfused during 28 min with a physiological buffer before freeze-clamping for biochemical assays. High energy phosphate compounds and intracellular pH were followed using 31P magnetic resonance spectroscopy with simultaneous measurement of contractile function. Nitric oxide (NO) pathway and endothelium-dependent and independent vasodilatations were measured as indexes of endothelial function. Results were analyzed via two-way ANOVA, p < 0.05 was considered as statistically significant. Results Myocardial function was impaired in male and female diabetic versus Control groups (p < 0.05) without modification of energy metabolism. Coronary flow was decreased in both diabetic versus Control groups but to a higher extent in female GK versus male GK rat hearts (p < 0.05). NO production was up-regulated in diabetic groups but to a less extent in female GK rat hearts (p < 0.05). Endothelium-dependent and independent vasodilatations were impaired in female GK rat compared with male GK (p < 0.05) and female Control (p < 0.05) rat hearts. Conclusions We reported here an endothelial damage characterized by a reduced up-regulation of the NO pathway and impaired endothelial and smooth muscle functions, and coronary flow rates in the female GK rat hearts while energy metabolism was normal. Whether these results are related to the higher risk of cardiovascular complications among type 2 diabetic female needs to be further elicited in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0157-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martine Desrois
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France ; Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR n°7339, Aix-Marseille Université, CNRS, Faculté de Medecine, 27 Bd Jean Moulin, Marseille Cedex 05, 13385 France
| | - Carole Lan
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | - Jamileh Movassat
- Université Paris-Diderot, CNRS, UMR 8251, Laboratoire de Biologie et Pathologie du Pancréas Endocrine (B2PE), Unité BFA, Paris, France
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Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ 2016; 355:i5953. [PMID: 27881363 PMCID: PMC5121106 DOI: 10.1136/bmj.i5953] [Citation(s) in RCA: 570] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality. DESIGN Meta-analysis of prospective cohort studies. DATA SOURCES Electronic databases (PubMed, Embase, and Google Scholar). SELECTION CRITERIA Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes. REVIEW METHODS Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c (HbA1c) of 39-47 mmol/mol : (5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals. RESULTS 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality. CONCLUSIONS Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol.
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Affiliation(s)
- Yuli Huang
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
| | - Xiaoyan Cai
- Clinical Medicine Research Centre, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China
| | - Weiyi Mai
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meijun Li
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
- Department of Cardiology, Graduate College, Guangdong medical university, Zhanjiang, China
| | - Yunzhao Hu
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
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Baena-Díez JM, Peñafiel J, Subirana I, Ramos R, Elosua R, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, García-Lareo M, Gómez de la Cámara A, Lapetra J, Quesada M, Marrugat J, Medrano MJ, Berjón J, Frontera G, Gavrila D, Barricarte A, Basora J, García JM, Pavone NC, Lora-Pablos D, Mayoral E, Franch J, Mata M, Castell C, Frances A, Grau M. Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis. Diabetes Care 2016; 39:1987-1995. [PMID: 27493134 DOI: 10.2337/dc16-0614] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/27/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
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Affiliation(s)
- Jose Miguel Baena-Díez
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Judit Peñafiel
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Isaac Subirana
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Rafel Ramos
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Univeristy of Girona, Girona, Spain
| | - Roberto Elosua
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - María Jesús Guembe
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain
| | - Fernando Rigo
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - María José Tormo-Díaz
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Murcian Health Departament, Murcia, Spain.,University of Murcia, Murcia, Spain.,Murcian Institute of Biomedical Research, Murcia, Spain
| | - Conchi Moreno-Iribas
- Navarre Public Health Institute, Pamplona, Spain.,Research Network for Health Services in Chronic Disease, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Joan Josep Cabré
- Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Antonio Segura
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Manel García-Lareo
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Agustín Gómez de la Cámara
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - José Lapetra
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Primary Care Division, Department of Family Medicine, Primary Care Center San Pablo, Sevilla, Spain
| | - Miquel Quesada
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain
| | - Jaume Marrugat
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Jesús Berjón
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Guiem Frontera
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Health and Consumers Department, Murcia Government, Murcia, Spain
| | - Aurelio Barricarte
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Navarre Public Health Institute, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Josep Basora
- Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Jose María García
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Natalia C Pavone
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - David Lora-Pablos
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - Eduardo Mayoral
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Diabetes Strategy, Andalusia Health Service, Seville, Spain
| | - Josep Franch
- Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Diabetes and Associated Metabolic Diseases, Madrid, Spain
| | - Manel Mata
- Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Conxa Castell
- Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Albert Frances
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - María Grau
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain .,University of Barcelona, Barcelona, Spain
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O'Higgins AC, O'Dwyer V, O'Connor C, Daly SF, Kinsley BT, Turner MJ. Postpartum dyslipidaemia in women diagnosed with gestational diabetes mellitus. Ir J Med Sci 2016; 186:403-407. [PMID: 27401735 DOI: 10.1007/s11845-016-1474-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetes mellitus is a known risk factor for cardiovascular disease which should prompt screening for other cardiovascular risk factors, including dyslipidaemia. Women diagnosed with gestational diabetes mellitus (GDM) are not routinely screened for cardiovascular risk factors. AIMS The objective of this study was to determine the prevalence of dyslipidaemia postpartum in women with GDM. METHODS The study was performed in a large university hospital. Women with GDM had a fasting lipid profile performed 6 weeks postnatally. Clinical details were obtained from the medical records. Lipid results in our cohort were compared with healthy women of the same age. RESULTS The overall prevalence of postpartum dyslipidaemia was 52 % (n = 51). Total cholesterol was raised in 44 % (n = 43), low-density lipoprotein was raised in 33 % (n = 32) and triglycerides were raised in 16 % (n = 16). Of the 51 women with dyslipidaemia, 73 % (n = 37) had more than one abnormality in their lipid profile. Four of the five women with an abnormal postpartum GTT had an abnormal lipid profile. Compared with healthy women of the same age, women with GDM had higher total cholesterol (p = 0.04), higher LDL (p = 0.003), higher triglycerides (p < 0.001) and lower HDL (p < 0.04). CONCLUSIONS Women with GDM should be screened for dyslipidaemia postpartum and protective cardiovascular interventions offered where appropriate.
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Affiliation(s)
- A C O'Higgins
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - Vicky O'Dwyer
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Clare O'Connor
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Sean F Daly
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Brendan T Kinsley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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Leutner M, Göbl C, Wielandner A, Howorka E, Prünner M, Bozkurt L, Harreiter J, Prosch H, Schlager O, Charwat-Resl S, Kautzky-Willer A. Cardiometabolic Risk in Hyperlipidemic Men and Women. Int J Endocrinol 2016; 2016:2647865. [PMID: 27895666 PMCID: PMC5118507 DOI: 10.1155/2016/2647865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 12/30/2022] Open
Abstract
Objective. The aim of this study was to evaluate sex specific differences of metabolic and clinical characteristics of treated hyperlipidemic men and women (HL-men and HL-women). Methods. In this study vascular and metabolic characteristics of 35 HL-women and 64 HL-men were assessed. In addition a sex specific analysis of metabolic and nutritional habits of HL-patients with prediabetes (HL-IGR) was done. Results. HL-women were older and had favourable concentrations of high density lipoprotein cholesterol (HDL-cholesterol), triglycerides (TG), and triglyceride/HDL-cholesterol ratio (TG/HDL-ratio) but were also shown to have higher concentrations of lipoprotein-a compared to HL-men. HL-men were characterized as having higher levels of liver-specific parameters and body weight as well as being more physically active compared to HL-women. Brain natriuretic peptide (pro-BNP) was higher in HL-women than HL-men, while no differences in metabolic syndrome and glycemic parameters were shown. HL-IGR-women were also older and still had a better profile of sex specific lipid parameters, as well as a lower body weight compared to HL-IGR-men. No differences were seen in vascular parameters such as the intima media thickness (IMT). Conclusion. HL-women were older and had overall more favourable concentrations of lipid parameters and liver enzymes but did not differ regarding vascular morphology and insulin sensitivity compared to HL-men of comparable body mass index (BMI).
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Göbl
- Department of Gynecology and Obstetrics, Division of Feto-Maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alice Wielandner
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Eleonora Howorka
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marlies Prünner
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Latife Bozkurt
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Giertel 18-20, 1090 Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Oliver Schlager
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Silvia Charwat-Resl
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- *Alexandra Kautzky-Willer:
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Bosevski M, Stojanovska L. Progression of carotid-artery disease in type 2 diabetic patients: a cohort prospective study. Vasc Health Risk Manag 2015; 11:549-53. [PMID: 26527880 PMCID: PMC4621201 DOI: 10.2147/vhrm.s79079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In order to assess the progression of carotid-artery disease in type 2 diabetic cohort (n=207 patients), the dynamic change in carotid intima-media thickness (CIMT) and the occurrence of plaques were followed for a period of 31.35±10.59 months. The mean CIMT at the beginning of the study was 0.9178±0.1447 mm, with a maximal value of 1.1210±0.2366 mm. The maximal value of CIMT changed by 0.07 mm/year. Progression of CIMT was noted in 86.8% and its regression in 7.8% of patients. The occurrence of carotid plaques was detected in 41.8% of patients. Multiple regression analysis revealed the maximal value of CIMT to be associated with diastolic blood pressure, despite mean CIMT being predicted by body mass index. The presence of peripheral arterial disease and hypo-high-density lipoproteinemia were found to be predictors for the occurrence of carotid plaques. Our data have clinical implications in predicting risk factors for the progression of carotid-artery disease in type 2 diabetic patients for their appropriate management.
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Affiliation(s)
- Marijan Bosevski
- Faculty of Medicine, University Cardiology Clinic, Skopje, Macedonia
| | - Lily Stojanovska
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
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Goulopoulou S, Hannan JL, Matsumoto T, Ogbi S, Ergul A, Webb RC. Reduced vascular responses to soluble guanylyl cyclase but increased sensitivity to sildenafil in female rats with type 2 diabetes. Am J Physiol Heart Circ Physiol 2015; 309:H297-304. [PMID: 25957216 DOI: 10.1152/ajpheart.00079.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/04/2015] [Indexed: 01/25/2023]
Abstract
Impaired nitric oxide (NO), soluble guanylyl cyclase (sGC), and cyclic guanosine monophosphate (cGMP) signaling (NO-sGC-cGMP) has been implicated in the pathogenesis of diabetic vascular dysfunction. Efforts to directly target this signaling have led to the development of sGC agonists that activate the heme group of sGC (stimulators) or preferentially activate sGC when the heme is oxidized (activators). In this study, we hypothesized that resistance arteries from female rats with spontaneous type 2 diabetes (Goto-Kakizaki rats, GK) would have reduced vasodilatory responses to heme-dependent sGC activation and increased responses to heme-independent sGC activation compared with control rats (Wistar). Endothelium-dependent and -independent relaxation was assessed in isolated segments from mesenteric resistance arteries (MA) mounted in a wire myograph. GK MA had reduced responses to acetylcholine (pEC50: 7.96 ± 0.06 vs. 7.66 ± 0.05, P < 0.05) and sodium nitroprusside (pEC50: 8.34 ± 0.05 vs. 7.77 ± 0.04, P < 0.05). There were no group differences in 8-bromoguanosine cGMP-induced relaxation and protein kinase G1 expression (P > 0.05). GK MA had attenuated responses to BAY 41-2272 (heme-dependent sGC stimulator; pEC50: 7.56 ± 0.05 vs. 6.93 ± 0.06, P < 0.05) and BAY 58-2667 (heme-independent sGC activator; pEC50: 10.82 ± 0.07 vs. 10.27 ± 0.08, P < 0.05) and increased sensitivity to sildenafil [phosphodiesterase 5 (PDE5) inhibitor; pEC50: 7.89 ± 0.14 vs. 8.25 ± 0.13, P < 0.05]. Isolated resistance arteries from female rats of reproductive age that spontaneously develop type 2 diabetes have increased sensitivity to PDE5 inhibition and reduced responsiveness to sGC activators and stimulators.
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Affiliation(s)
| | - Johanna L Hannan
- Department of Physiology, Georgia Regents University, Augusta, Georgia
| | - Takayuki Matsumoto
- Department of Physiology and Morphology, Institute of Medicinal Chemistry, Hoshi University, Shinagawa-ku, Tokyo, Japan
| | - Safia Ogbi
- Department of Physiology, Georgia Regents University, Augusta, Georgia
| | - Adviye Ergul
- Department of Physiology, Georgia Regents University, Augusta, Georgia
| | - R Clinton Webb
- Department of Physiology, Georgia Regents University, Augusta, Georgia
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35
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Li N, Katzmarzyk PT, Horswell R, Zhang Y, Li W, Zhao W, Wang Y, Johnson J, Hu G. BMI and coronary heart disease risk among low-income and underinsured diabetic patients. Diabetes Care 2014; 37:3204-12. [PMID: 25249653 PMCID: PMC4237979 DOI: 10.2337/dc14-1091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The association between obesity and coronary heart disease (CHD) risk remains debatable, and no studies have assessed this association among diabetic patients. The aim of our study was to investigate the association between BMI and CHD risk among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS The sample included 30,434 diabetic patients (10,955 men and 19,479 women) 30-95 years of age without a history of CHD or stroke in the Louisiana State University Hospital-Based Longitudinal Study. RESULTS During a mean follow-up period of 7.3 years, 7,414 subjects developed CHD. The multivariable-adjusted hazard ratios for CHD across levels of BMI at baseline (18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and ≥40 kg/m(2)) were 1.00, 1.14 (95% CI 1.00-1.29), 1.27 (1.12-1.45), 1.54 (1.34-1.78), and 1.42 (1.23-1.64) (Ptrend < 0.001) in men and 1.00, 0.95 (0.85-1.07), 0.95 (0.84-1.06), 1.06 (0.94-1.20), and 1.09 (1.00-1.22) (Ptrend < 0.001) in women, respectively. When we used an updated mean or last visit value of BMI, the positive association between BMI and CHD risk did not change in men. However, the positive association of BMI with CHD changed to a U-shaped association in women when we used the last visit value of BMI. CONCLUSIONS Our study suggests that there is a positive association between BMI at baseline and during follow-up with the risk of CHD among patients with type 2 diabetes. We indicate a U-shaped association between BMI at the last visit and the risk of CHD among women with type 2 diabetes.
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Affiliation(s)
- Nan Li
- Pennington Biomedical Research Center, Baton Rouge, LA Tianjin Women's and Children's Health Center, Tianjin, China
| | | | | | | | - Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA Tianjin Women's and Children's Health Center, Tianjin, China
| | - Wenhui Zhao
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA
| | | | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA
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Huang Y, Cai X, Chen P, Mai W, Tang H, Huang Y, Hu Y. Associations of prediabetes with all-cause and cardiovascular mortality: a meta-analysis. Ann Med 2014; 46:684-92. [PMID: 25230915 DOI: 10.3109/07853890.2014.955051] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reports on the association of prediabetes with all-cause mortality and cardiovascular mortality are inconsistent. Objective. To evaluate the risk of all-cause and cardiovascular mortality in association with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS Prospective cohort studies with data on prediabetes and mortality were included. The relative risks (RRs) of all-cause and cardiovascular mortality were calculated and reported with 95% confidence intervals (95% CIs). RESULTS Twenty-six studies were included. The risks of all-cause and cardiovascular mortality were increased in participants with prediabetes defined as IFG of 110-125 mg/dL (IFG 110) (RR 1.12, 95% CI 1.05-1.20; and RR 1.19, 95% CI 1.05-1.35, respectively), IGT (RR 1.33, 95% CI 1.24-1.42; RR 1.23, 95% CI 1.11-1.36, respectively), or combined IFG 110 and/or IGT (RR 1.21, 95% CI 1.11-1.32; RR 1.21, 95% CI 1.07-1.36, respectively), but not when IFG was defined as 100-125 mg/dL (RR 1.07, 95% CI 0.92-1.26; and RR 1.16, 95% CI 0.94-1.42, respectively). CONCLUSIONS Prediabetes, defined as IFG 110, IGT, or combined IFG 110 and/or IGT, was associated with increased all-cause and cardiovascular mortality.
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Affiliation(s)
- Yi Huang
- Clinical Medicine Research Institute, the Affiliated Hospital at Shunde, Southern Medical University , Foshan , PR China
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37
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Anagnostis P, Majeed A, Johnston DG, Godsland IF. Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men? Eur J Endocrinol 2014; 171:R245-55. [PMID: 25117464 DOI: 10.1530/eje-14-0401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The relative risk for cardiovascular disease (CVD) events and mortality in diabetic women (in comparison with non-diabetic women) is believed to be greater than that in diabetic men. However, the absolute risk for CVD mortality and morbidity does not appear to be higher in women. In general, there is heterogeneity between studies, and whether there is any definite difference in the CVD risk between sexes at any level of glycaemia is not known. The same arguments also apply when comparing the CVD risk factors, such as lipid profiles and systemic inflammation indices, which seem to be worse in women than in men with diabetes mellitus (DM). The same questions emerge at any given glycaemic state: are women at worse risk and do they have a worse risk factor profile than men? These issues have yet to be resolved. Similar, though less extensive, data have been reported for prediabetes. Furthermore, women with DM are suboptimally treated compared with men regarding lipid and blood pressure targets. Large prospective studies representative of the general population are therefore needed to define the differences between sexes regarding CVD events and mortality at a given glucose level and after adjusting for any other confounders.
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Affiliation(s)
- Panagiotis Anagnostis
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Azeem Majeed
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Desmond G Johnston
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Ian F Godsland
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
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Piniés JA, González-Carril F, Arteagoitia JM, Irigoien I, Altzibar JM, Rodriguez-Murua JL, Echevarriarteun L. Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: the Basque Country Prospective Complications and Mortality Study risk engine (BASCORE). Diabetologia 2014; 57:2324-33. [PMID: 25212259 DOI: 10.1007/s00125-014-3370-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/14/2014] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed. METHODS We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed. RESULTS The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno's C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk. CONCLUSIONS/INTERPRETATION This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.
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Affiliation(s)
- José A Piniés
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza-Basque Country Health Service, Baracaldo, Bizkaia, Spain
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Song X, Tabák AG, Zethelius B, Yudkin JS, Söderberg S, Laatikainen T, Stehouwer CDA, Dankner R, Jousilahti P, Onat A, Nilsson PM, Satman I, Vaccaro O, Tuomilehto J, Qiao Q. Obesity attenuates gender differences in cardiovascular mortality. Cardiovasc Diabetol 2014; 13:144. [PMID: 25928355 PMCID: PMC4212094 DOI: 10.1186/s12933-014-0144-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/06/2014] [Indexed: 01/15/2023] Open
Abstract
Background To estimate cardiovascular disease (CVD) mortality in relation to obesity and gender. Methods Data from 11 prospective cohorts from four European countries including 23 629 men and 21 965 women, aged 24 to 99 years, with a median follow-up of 7.9 years were analyzed. Hazards ratios (HR) for CVD mortality in relation to baseline body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were estimated using Cox proportional hazards models with age as the timescale. Results Men had higher CVD mortality than women in all four BMI categories (<25.0, 25.0-29.9, 30.0-34.9 and ≥35.0 kg/m2). Compared with the lowest BMI category in women, multivariable adjusted HRs (95% confidence intervals) for higher BMI categories are 1.0 (0.8-1.4), 1.6 (1.1-2.1) and 2.8 (2.0-3.8) in women and 2.8 (2.2-3.6), 3.1 (2.5-3.9), 3.8 (2.9-4.9) and 5.4 (3.8-7.7) in men, respectively. Similar findings were observed for abdominal obesity defined by WC, WHR or WHtR. The gender difference was slightly smaller in obese than in non-obese individuals; but the interaction was statistically significant only between gender and WC (p = 0.02), and WHtR (p = 0.01). None of the interaction terms was significant among non-diabetic individuals. Conclusions Men had higher CVD mortality than women across categories of anthropometric measures of obesity. The gender difference was attenuated in obese individuals, which warrants further investigation. Electronic supplementary material The online version of this article (doi:10.1186/s12933-014-0144-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Song
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland. .,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, UK. .,1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden. .,Medical Products Agency, Uppsala, Sweden.
| | - John S Yudkin
- Department of Medicine, University College London, London, UK.
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. .,Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
| | - Tiina Laatikainen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. .,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland. .,Hospital District of North Karelia, Joensuu, Finland.
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel. .,Division of Epidemiology and Prevention, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Pekka Jousilahti
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
| | - Altan Onat
- Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden. .,Center of Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Ilhan Satman
- Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Jaakko Tuomilehto
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. .,Center for Vascular Prevention, Danube University Krems, Krems, Austria. .,King Abdulaziz University, Jeddah, Saudi Arabia. .,Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain.
| | - Qing Qiao
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland. .,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. .,R&D AstraZeneca AB, Mölndal, Sweden.
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Baviera M, Santalucia P, Cortesi L, Marzona I, Tettamanti M, Avanzini F, Nobili A, Riva E, Caso V, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Sex differences in cardiovascular outcomes, pharmacological treatments and indicators of care in patients with newly diagnosed diabetes: Analyses on administrative database. Eur J Intern Med 2014; 25:270-5. [PMID: 24556165 DOI: 10.1016/j.ejim.2014.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of diabetes on cardiovascular disease in both sexes is known, but the specifics have not been fully clarified. We investigated whether sex-related differences exist in terms of management and hospitalization in patients with newly diagnosed diabetes. METHODS We examined the rates of hospitalization for cardiovascular causes, mortality, treatments and management of patients with diabetes compared to subjects without, from administrative database. Interaction between sex and diabetes on clinical outcomes were calculated using a Cox regression model. Pharmacological treatments and recommended examinations by sex were calculated using logistic regression. RESULTS From 2002 to 2006, 158,426 patients with diabetes and 314,115 subjects without were identified and followed up for a mean of 33 months (± 17.5). Diabetes confers a higher risk for all clinical outcomes. Females with diabetes have a risk profile for hospitalization for coronary heart disease comparable to males without (4.6% and 5.3%). Interaction between sex and diabetes shows that females with diabetes had an added 19% higher risk of total death (95% CI 1.13-1.24). No differences were observed in hospitalizations, although females with diabetes were less likely to undergo revascularization after myocardial infarction. Females received cardiovascular prevention drugs less frequently than males and had a slight tendency to get fewer examinations. CONCLUSION Diabetes is linked to a higher increase of mortality in females relative to males. This might reflect sex differences in the use of revascularization procedures or therapeutic regimens. Closer attention and implementation of standard care for females are necessary from the onset of diabetes.
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Affiliation(s)
- Marta Baviera
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
| | - Paola Santalucia
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Scientific Direction and Emergency Medicine Dept, Milan, Italy
| | - Laura Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Irene Marzona
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Geriatric Neuropsychiatry, Milan, Italy
| | - Fausto Avanzini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory for Quality Assessment of Geriatric Therapies and Services, Milan, Italy
| | - Emma Riva
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Geriatric Neuropsychiatry, Milan, Italy
| | - Valeria Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Maria Carla Roncaglioni
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
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Lastra G, Syed S, Kurukulasuriya LR, Manrique C, Sowers JR. Type 2 diabetes mellitus and hypertension: an update. Endocrinol Metab Clin North Am 2014; 43:103-22. [PMID: 24582094 PMCID: PMC3942662 DOI: 10.1016/j.ecl.2013.09.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with hypertension and type 2 diabetes are at increased risk of cardiovascular and chronic renal disease. Factors involved in the pathogenesis of both hypertension and type 2 diabetes include inappropriate activation of the renin-angiotensin-aldosterone system, oxidative stress, inflammation, impaired insulin-mediated vasodilatation, augmented sympathetic nervous system activation, altered innate and adaptive immunity, and abnormal sodium processing by the kidney. The renin-angiotensin-aldosterone system blockade is a key therapeutic strategy in the treatment of hypertension in type 2 diabetes. Emerging therapies for resistant hypertension as often exists in patients with diabetes, include renal denervation and carotid body denervation.
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Affiliation(s)
- Guido Lastra
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA
| | - Sofia Syed
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA
| | - L Romayne Kurukulasuriya
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA
| | - Camila Manrique
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA
| | - James R Sowers
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA; Department of Medical Physiology and Pharmacology, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
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Arnetz L, Ekberg NR, Alvarsson M. Sex differences in type 2 diabetes: focus on disease course and outcomes. Diabetes Metab Syndr Obes 2014; 7:409-20. [PMID: 25258546 PMCID: PMC4172102 DOI: 10.2147/dmso.s51301] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women with type 2 diabetes (T2D) are less likely to reach the goals for hemoglobin A1c compared with men, and have higher all-cause mortality. The risk of cardiovascular disease is elevated among both men and women with T2D, however, the risk has declined among men over recent years while it remains stationary in women. Reasons for these sex differences remain unclear, and guidelines for diabetes treatment do not differentiate between sexes. Possible causes for varying outcome include differences in physiology, treatment response, and psychological factors. This review briefly outlines sex differences in hormonal pathophysiology, and thereafter summarizes the literature to date on sex differences in disease course and outcome. METHODS Systematic searches were performed on PubMed using "sex", "gender", and various glucose-lowering therapies as keywords. Earlier reviews are summarized and results from individual studies are reported. Reference lists from studies were used to augment the search. RESULTS There is an increased risk of missing the diagnosis of T2D when screening women with only fasting plasma glucose instead of with an oral glucose tolerance test. The impact of various risk factors for complications may differ by sex. Efficacy and side effects of some glucose-lowering drugs differ between men and women. Men with T2D appear to suffer more microvascular complications, while women have higher morbidity and mortality in cardiovascular disease and also fare worse psychologically. CONCLUSION Few studies to date have focused on sex differences in T2D. Several questions demand further study, such as whether risk factors and treatment guidelines should be sex-specific. There is a need for clinical trials designed specifically to evaluate sex differences in efficacy and outcome of the available treatments.
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Affiliation(s)
- Lisa Arnetz
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Stockholm, Sweden
| | - Neda Rajamand Ekberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Stockholm, Sweden
| | - Michael Alvarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Stockholm, Sweden
- Correspondence: Michael Alvarsson, Department of Endocrinology, Diabetes and Metabolism, D2:04, Karolinska University Hospital Solna, 17176 Stockholm, Sweden, Tel +46 8 5177 2862, Fax +46 8 5177 3096, Email
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43
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Sartoretto SM, Santos-Eichler R, de Cássia A Tostes R, Carvalho MHC, Akamine EH, Fortes ZB. Role of nitric oxide and endothelin in endothelial maintenance of vasoconstrictor responses in aortas of diabetic female rats. J Diabetes 2013; 5:197-206. [PMID: 23061464 DOI: 10.1111/1753-0407.12011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 09/11/2012] [Accepted: 10/07/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetes differentially affects the vascular system in males and females. Although various results have been reported, very few studies have focused on responses in females. In the present study, we investigated contractile responses to norepinephrine in aortas of alloxan-diabetic female rats and evaluated endothelial modulation of these responses. METHODS Concentration-response curves were constructed to norepinephrine in the absence or presence of N(G) -nitro-l-arginine methyl ester (l-NAME), indomethacin, losartan, tezosentan, and calphostin C; pre-pro-endothelin mRNA expression was evaluated; and norepinephrine-stimulated expression of phosphorylated (p-) Akt Ser(473) , p-endothelial nitric oxide synthase (eNOS) Ser(1177) , and p-eNOS Ser(633) was determined in endothelial cells incubated in the presence of low (5 mmol/L) or high (25 mmol/L) glucose concentrations. RESULTS Similar maximal responses (Rmax ) to norepinephrine were seen in control and diabetic endothelium-intact aortas; however, Rmax was reduced in diabetic endothelium-denuded aortas. Incubation of endothelium-intact aortas with 100 μmol/L l-NAME increased Rmax in the control group only. Inhibition of cyclo-oxygenase (10 μmol/L indomethacin) and blockade of angiotensin II receptors (10 μmol/L losartan) reduced Rmax in endothelium-intact aortas in both the control and diabetic groups. Blockade of endothelin receptors (0.1 μmol/L tezosentan) and inhibition of protein kinase C (PKC; 0.1 μmol/L calphostin C) reduced Rmax only in endothelium-intact aortas from diabetic rats. Pre-pro-endothelin mRNA expression was increased in aortas from diabetic female rats. Finally, p-Akt Ser(473) , p-eNOS Ser(1177) , and p-eNOS Ser(633) levels were enhanced after norepinephrine stimulation only in low glucose-treated endothelial cells. CONCLUSIONS In aortas of diabetic female rats, reductions in smooth muscle contractile responses to norepinephrine are counterbalanced by the endothelium via reduced eNOS activation and increased endothelin release and PKC activation.
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MESH Headings
- Animals
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/physiopathology
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/physiopathology
- Endothelins/metabolism
- Endothelium, Vascular/metabolism
- Female
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/physiopathology
- Nitric Oxide/metabolism
- RNA, Messenger/metabolism
- Rats
- Rats, Wistar
- Vasoconstriction
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Affiliation(s)
- Simone M Sartoretto
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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44
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Kovrigina MN, Mamedov MN. EARLY DISTURBANCES OF CARBOHYDRATE METABOLISM — A TARGET FOR PRIMARY CARDIOVASCULAR PREVENTION. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-2-89-93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The paper discusses the social and economic costs associated with diabetes mellitus (DM) and its complications. Cardiovascular disease (CVD) is the leading cause of disability and complications in DM patients. The diagnostics and correction of the early disturbances of carbohydrate metabolism are important components of the primary prevention of Type 2 DM (DM-2). The DM-2 development is preceded by the abnormalities typically overlooked by the busy practitioners, such as impaired fasting glucose and impaired glucose tolerance. The authors present the evidence from international clinical trials confirming that the early disturbances of carbohydrate metabolism are an independent risk factor of CVD. Therefore, recently, the importance of the combined primary prevention of DM-2 and diabetes-associated CVD has been extensively discussed.
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Affiliation(s)
| | - M. N. Mamedov
- State Research Centre for Preventive Medicine, Moscow
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45
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Franzini L, Ardigò D, Cavalot F, Miccoli R, Rivellese AA, Trovati M, Zavaroni I, Vaccaro O. Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: results from the MIND.IT Study Group of the Italian Society of Diabetology. Nutr Metab Cardiovasc Dis 2013; 23:235-241. [PMID: 22397873 DOI: 10.1016/j.numecd.2011.12.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS The study explores the degree of control of hyperglycaemia and cardiovascular (CV) disease risk factors in men and women with type 2 diabetes and the impact thereon of obesity, central adiposity, age and use of medications. METHODS AND RESULTS A cross-sectional survey was conducted at 10 hospital-based outpatients diabetes clinics. 1297 men and 1168 women with no previous CV events were studied. Women were slightly (only one year) older and more obese than men: average BMI was respectively 30.7 ± 5.7 vs 28.6 ± 4.1 kg/m(2) (p < 0.001), and prevalence of abdominal obesity was 86% vs 44% (p < 0.001). Women smoked less, but had higher HbA1c, LDL cholesterol, non-HDL cholesterol, systolic blood pressure and serum fibrinogen than men. Accordingly optimal targets for HbA1c (<7%), LDL cholesterol (<100 mg/dL), HDL cholesterol (>40 for men, >50 for women, mg/dL), and systolic blood pressure (<130 mmHg) were less frequently achieved by women than men (respectively 33.8% vs 40.2%; 14.6% vs 19.2%; 34.1% vs 44.5%; 68.8% vs 72%; p < 0.05 for all). Findings were confirmed after stratification for waist circumference (< or ≥ 88 cm for women; < or ≥ 102 cm for men), BMI (< or ≥ 25 kg/m(2)) or age (< or ≥ 65 years). As for treatment, women were more likely than men to take insulin, alone or in combination with oral hypoglycaemic drugs, to be under anti-hypertensive treatment, whereas the use of lipid lowering drugs was similar in men and women. CONCLUSIONS Control of hyperglycaemia and major CVD risk factors is less satisfactory in women than men. The gender disparities are not fully explained by the higher prevalence of total and central obesity in women; or by a less intensive medical management in women.
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Affiliation(s)
- L Franzini
- Department of Internal Medicine and Biomedical Sciences, University of Parma, via Gramsci 14, Parma, Italy.
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Barregard L, Bergström G, Fagerberg B. Cadmium exposure in relation to insulin production, insulin sensitivity and type 2 diabetes: a cross-sectional and prospective study in women. ENVIRONMENTAL RESEARCH 2013; 121:104-9. [PMID: 23261793 DOI: 10.1016/j.envres.2012.11.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cadmium is a wide-spread pollutant. Observational studies suggest associations between cadmium and prevalence of type 2 diabetes. Experimental studies indicate that cadmium may cause impaired insulin production. OBJECTIVES To examine whether cadmium exposure is associated with impaired glucose tolerance and type 2 diabetes and impaired pancreatic beta-cell function. METHODS Oral glucose tolerance tests were used in a screening examination of 64-year old women (n=2595) to identify all with diabetes, impaired (IGT) and normal (NGT) glucose tolerance. Random samples of women with type 2 diabetes (n=215), IGT (n=207) and NGT (n=194) were recruited in a cross-sectional examination including measurement of pancreatic insulin production (acute insulin response) and insulin sensitivity (homeostasis model assessment). Cadmium concentrations were measured in blood and urine. A follow-up examination was performed after 5.4 years with assessment of new cases with diabetes or impaired glucose tolerance. RESULTS At baseline, neither blood nor urinary cadmium concentrations showed any statistically significant differences between women with type 2 diabetes, IGT or NGT. The prospective analysis included 68 cases with incident diabetes, 58 with IGT and 118 women with NGT and no associations with cadmium levels at baseline were observed. Blood and urinary cadmium at baseline were not associated with insulin production, blood glucose, HbA1c, or changes in HbA1c during follow-up. CONCLUSIONS This is the first study of cadmium and diabetes with detailed data on pancreatic beta-cell function, insulin sensitivity and glucose tolerance. Cadmium exposure was not associated with increased risk of type 2 diabetes or IGT.
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Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE-413 45 Gothenburg, Sweden.
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Fagerberg B, Bergström G, Borén J, Barregard L. Cadmium exposure is accompanied by increased prevalence and future growth of atherosclerotic plaques in 64-year-old women. J Intern Med 2012; 272:601-10. [PMID: 22812670 DOI: 10.1111/j.1365-2796.2012.02578.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES There is currently widespread exposure to the toxic metal cadmium through the diet as well as through smoking, and it has been suggested that cadmium exposure may increase the risk of cardiovascular disease. Here we examined whether cadmium exposure is associated with prevalence and growth of atherosclerotic plaques in the carotid arteries. DESIGN AND SUBJECTS The analyses were performed in a screening-based cohort of 64-year-old Caucasian women with stratified, random selection to groups with normal glucose tolerance, impaired glucose tolerance and diabetes (n = 599). We measured cadmium concentrations in blood and urine at baseline. In addition, we performed ultrasound examination to determine the prevalence and area of atherosclerotic plaques in the carotid arteries and assessed smoking history and other cardiovascular risk factors at baseline and at a follow-up examination after a mean of 5.4 years. RESULTS At baseline, blood cadmium levels were associated with increased risk of plaque and a large plaque area after adjustment for confounders. In women who had never smoked, blood cadmium levels correlated positively with plaque area at baseline. The occurrence of large plaques and the change in plaque area at follow-up were associated with blood and creatinine-corrected urinary cadmium concentrations at baseline after adjustment for confounders. Blood and urine cadmium levels added information to established cardiovascular risk factors in predicting progress of atherosclerosis. CONCLUSIONS We have shown that cadmium levels in blood and urine are independent factors associated with the development of atherosclerotic plaques at baseline as well as prospectively. This novel observation emphasizes the need to consider cadmium as a pro-atherogenic pollutant.
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Affiliation(s)
- Björn Fagerberg
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.
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48
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Poddubskaya EA, Mamedov MN. Evidence-based principles of early diagnostics of carbohydrate metabolism disturbances in the internal disease practice. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-5-83-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This review presents the World Health Organization (WHO) data on diabetes mellitus (DM) epidemiology, medical and social consequences, and economic losses due to DM complications. It is demonstrated that the diagnostics of early carbohydrate metabolism disturbances (ECMD) is an important component of Type 2 DM (DM-2) prevention. At the same time, it is known that ECMD are an independent risk factor of cardiovascular disease (CVD). At early stages of DM-2, metabolic disturbances precede first clinical manifestations of diabetes. The importance of early (preclinical) diagnostics of ECMD is emphasised. The authors present the results of meta-analyses and large studies on DM and prediabetes, which have clearly demonstrated that pathological hyperglycemia cannot be diagnosed based only on fasting glucose levels, as this would underestimate the actual prevalence of prediabetes. Relevant methods of early ECMD diagnostics are described.
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Affiliation(s)
- E. A. Poddubskaya
- State Research Centre for Preventive Medicine; I. M. Sechenov First Moscow State Medical University, Moscow
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49
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Kautzky-Willer A, Brazzale AR, Moro E, Vrbíková J, Bendlova B, Sbrignadello S, Tura A, Pacini G. Influence of increasing BMI on insulin sensitivity and secretion in normotolerant men and women of a wide age span. Obesity (Silver Spring) 2012; 20:1966-73. [PMID: 22282046 DOI: 10.1038/oby.2011.384] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The impact of sex and age on glucose metabolism in the development of overweight/obesity is a matter of debate. We hypothesized that insulin sensitivity (IS) and β-cell function (BF) in a normal white population will differ between males and females and aimed to evaluate the possible effects of BMI and age on metabolic parameters of both sexes. This study is a cross-sectional analysis of the general community. IS was measured with quantitative insulin sensitivity check index (QUICKI) and oral glucose insulin sensitivity (OGIS) and BF with the insulinogenic index during 75-g 2-h oral glucose-tolerance tests (OGTTs). We studied 611 females and 361 males with normal glycemia according to both fasting and 2-h glucose (85 ± 0.3 mg/dl (means ± SE) in females and 89 ± 0.4 in males (P < 0.0001), and 93 ± 1 in females and 89 ± 1 in males (P = 0.005), respectively). Females were younger (37 ± 1 years) than males (40 ± 1, P < 0.0001), but no difference was found in mean BMI (BMI = 25.8 ± 0.2 kg/m(2) in both). Student's two-sample t-test was used for simple comparison between and within genders, multiple linear regressions to account for covariates. During the OGTT, females had lower glucose (area under the curve (AUC) 133 ± 1 mg/ml·2 h vs. 148 ± 2; P < 0.00001), while insulinemia was comparable (AUC 5.3 ± 0.1 mU/ml·2 h vs. 5.7 ± 0.2, P = 0.15). IS remained higher in females (473 ± 3 ml/min/m(2) vs. 454 ± 3, P < 0.0001) also after having accounted for age and BMI (P = 0.015). No difference was observed in fasting insulin or BF. However, BF increased by 46% with BMI and when accounting for age and BMI, BF of females was significantly higher (P < 0.0001). Because IS and BF are higher in females than in males, sex should be considered in metabolic studies and overweight/obese populations.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Heald AH, Knapman H, Nair S, Chambers T, Radford D, Rushton T, Anderson SG. A primary care register for impaired glucose handling (IGH): impact on cardiometabolic profile. Prim Care Diabetes 2012; 6:213-219. [PMID: 22560663 DOI: 10.1016/j.pcd.2012.02.002] [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: 09/28/2009] [Revised: 12/16/2011] [Accepted: 02/07/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diet and exercise reduce the incidence of diabetes in high-risk individuals as does metformin, although less dramatically. Here we evaluated if lifestyle and pharmacological intervention, for people at risk of diabetes, resulted in an improvement in their cardiometabolic risk profile. RESEARCH DESIGN/METHODS In a primary care based study, 92 individuals screened opportunistically and identified to have impaired glucose handling were offered detailed lifestyle advice, at 6 monthly intervals, with targeting of cardiovascular risk factors. Duration of follow-up was 4 years. The relation between fasting and 2h glucose with different cardio-metabolic risk factors over time was assessed using multi-level modeling. RESULTS There was no significant weight reduction. At 24 months, mean fasting glucose level (6.4 mmol/L (95% CI 6.0-6.8)) was slightly lower than at baseline (6.6 mM (95% CI: 6.4-6.9), F=3.67; p<0.001). For men and women combined, systolic blood pressure (mean difference=-6 mmHg, p=0.013), total cholesterol (-0.66 mmol/L, p<0.0001) and triglycerides (-0.13 mmol/L, p=0.133) fell, whilst HDL-cholesterol (0.12 mmol/L, p=0.047) rose. Diabetes developed in 18/92 participants during follow-up (up to 4 years). Five per cent of participants were started on metformin, 88.5% on lipid lowering agents and 85.4% on anti-hypertensive agents. After adjusting for age, sex and BMI, 2 h glucose was independently and negatively associated with HDL-cholesterol (β=-2.17, p=0.041), and positively with systolic BP (β=0.24, p=0.004, per 5 mmHg). CONCLUSIONS Targeted intervention had an effective role in improving lipid and BP profile in individuals with impaired glucose handling, with limited impact on glycaemia and no impact on weight. More work needs be done to evaluate the potential benefit of insulin sensitizing agents in this setting.
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