1
|
Liu L, Feng L, Lu C, Zhang J, Zhao Y, Che L. A new nomogram to predict in-hospital mortality in patients with acute decompensated chronic heart failure and diabetes after 48 Hours of Intensive Care Unit. BMC Cardiovasc Disord 2024; 24:199. [PMID: 38582861 PMCID: PMC10998347 DOI: 10.1186/s12872-024-03848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The study set out to develop an accurate and clinically valuable prognostic nomogram to assess the risk of in-hospital death in patients with acute decompensated chronic heart failure (ADCHF) and diabetes. METHODS We extracted clinical data of patients diagnosed with ADCHF and diabetes from the Medical Information Mart for Intensive Care III database. Risk variables were selected utilizing least absolute shrinkage and selection operator regression analysis, and were included in multivariate logistic regression and presented in nomogram. bootstrap was used for internal validation. The discriminative power and predictive accuracy of the nomogram were estimated using the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis (DCA). RESULTS Among 867 patients with ADCHF and diabetes, In-hospital death occurred in 81 (9.3%) patients. Age, heart rate, systolic blood pressure, red blood cell distribution width, shock, β-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers, assisted ventilation, and blood urea nitrogen were brought into the nomogram model. The calibration curves suggested that the nomogram was well calibrated. The AUC of the nomogram was 0.873 (95% CI: 0.834-0.911), which was higher that of the Simplified Acute Physiology Score II [0.761 (95% CI: 0.711-0.810)] and sequential organ failure assessment score [0.699 (95% CI: 0.642-0.756)], and Guidelines-Heart Failure score [0.782 (95% CI: 0.731-0.835)], indicating that the nomogram had better ability to predict in-hospital mortality. In addition, the internally validated C-index was 0.857 (95% CI: 0.825-0.891), which again verified the validity of this model. CONCLUSIONS This study constructed a simple and accurate nomogram for predicting in-hospital mortality in patients with ADCHF and diabetes, especially in those who admitted to the intensive care unit for more than 48 hours, which contributed clinicians to assess the risk and individualize the treatment of patients, thereby reducing in-hospital mortality.
Collapse
Affiliation(s)
- Linlin Liu
- Department of Cardiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Lei Feng
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Rd, Putuo District, Shanghai, 200065, China
| | - Cheng Lu
- Department of Cardiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jiehan Zhang
- Department of Cardiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Ya Zhao
- Department of Cardiology, Kong Jiang Hospital Of Yangpu District, Shanghai, 200093, China.
| | - Lin Che
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Rd, Putuo District, Shanghai, 200065, China.
| |
Collapse
|
2
|
Kim J, Yoon Y, Kim Y, Park J, Choi K, Nam J, Lee C, Son J, Park J, Kim U. Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus. Clin Cardiol 2024; 47:e24248. [PMID: 38436204 PMCID: PMC10910463 DOI: 10.1002/clc.24248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real-world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM). HYPOTHESIS A difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes. METHODS From 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3-year period. RESULTS Propensity-score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73-2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all-cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE. CONCLUSIONS Dapagliflozin and empagliflozin showed no significant difference of real-world clinical cardiovascular outcomes in patients with DM over a 3-year period. Further large randomized clinical trials will be warranted for better evaluation.
Collapse
Affiliation(s)
- Jee‐Heon Kim
- Yeungnam University College of MedicineDaeguRepublic of Korea
| | - Young‐Chae Yoon
- Yeungnam University College of MedicineDaeguRepublic of Korea
| | - Young‐Hoon Kim
- Yeungnam University College of MedicineDaeguRepublic of Korea
| | - Jong‐Il Park
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Kang‐Un Choi
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Jong‐Ho Nam
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Chan‐Hee Lee
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Jang‐Won Son
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Jong‐Seon Park
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Ung Kim
- Yeungnam University College of MedicineDaeguRepublic of Korea
- Division of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| |
Collapse
|
3
|
Mohammed AA, El-Matty DMA, Abdel-Azeem R, Raafat K, Hussein MA, El-Ansary AR, Hafez W, Hassan HA, Nassar NA, Selim NM, Ghaith D, Kholy AAE, Abd El Salam SM, Anouti FA, Wahba AS. Allelic Discrimination of Vitamin D Receptor Polymorphisms and Risk of Type 2 Diabetes Mellitus: A Case-Controlled Study. Healthcare (Basel) 2023; 11:healthcare11040485. [PMID: 36833019 PMCID: PMC9956945 DOI: 10.3390/healthcare11040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
(1) Background: Type 2 diabetes mellitus (T2DM) is one of the rapidly growing healthcare problems, and several vitamin D receptor (VDR) polymorphisms seem to modulate the risk of T2DM. Our research was designed to investigate the allelic discrimination of VDR polymorphisms and T2DM occurrence risk. (2) Methods: This case-control research included 156 patients with T2DM and 145 healthy control subjects. Most of the study population were males 56.6% vs. 62.8% in the case and control groups, respectively. Genotyping for VDR single nucleotide polymorphisms (SNPs), rs228570 (Fok1), rs7975232 (Apa1), and rs1544410 (Bsm1) was compared between both groups. (3) Results: There was a negative link between vitamin D levels and insulin sensitivity. A significant difference was noted in the allelic discrimination of VDR polymorphism rs228570 and rs1544410 between the study groups (p < 0.001). No difference was observed in the allelic discrimination of VDR polymorphism rs7975232 between the groups (p = 0.063). Moreover, T2DM patients had significantly higher levels of fasting blood sugar (FBS), glycated hemoglobin HbA1c, 2-h post-prandial blood sugar (PP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), total cholesterol, and triglycerides (p < 0.001), while High-Density Lipoprotein (HDL) Cholesterol (HDL-C) was significantly decreased (p = 0.006). (4) Conclusions: VDR polymorphisms had a positive association with T2DM risk among the Egyptian population. Further large-scale research using deep sequencing of samples is strongly urged to investigate different vitamin D gene variants and interactions, as well as the influence of vitamin D on T2DM.
Collapse
Affiliation(s)
- Amal Ahmed Mohammed
- Department of Biochemistry and Molecular Biology, National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 11796, Egypt
| | - Dina M. Abo El-Matty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Rola Abdel-Azeem
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Khaled Raafat
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo11566, Egypt
| | - Mona A. Hussein
- Department of Internal Medicine, National Institute of Diabetes and Endocrinology, Cairo 11562, Egypt
| | - Amira R. El-Ansary
- Department of Internal Medicine, Faculty of Medicine, Misr University for Science and Technology, Giza 12577, Egypt
| | - Wael Hafez
- Department of Internal Medicine, The National Research Centre, Cairo 12622, Egypt
- Correspondence: or ; Tel.: +20-9712235000
| | - Hatem Ahmed Hassan
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Minia University, Minia 61519, Egypt
| | | | - Nora Mahmoud Selim
- Department of Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Doaa Ghaith
- Department of Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Amal A. El Kholy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Soha M. Abd El Salam
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Suez University, Suez 43512, Egypt
| | - Fatme Al Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, United Arab Emirates
| | - Alaa S. Wahba
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| |
Collapse
|
4
|
Ushakov A, Ivanchenko V, Gagarina A. Heart Failure And Type 2 Diabetes Mellitus: Neurohumoral, Histological And Molecular Interconnections. Curr Cardiol Rev 2023; 19:e170622206132. [PMID: 35718961 PMCID: PMC10201898 DOI: 10.2174/1573403x18666220617121144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure (HF) is a global healthcare burden and a leading cause of morbidity and mortality worldwide. Type 2 diabetes mellitus (T2DM) appears to be one of the major risk factors that significantly worsen HF prognosis and increase the risk of fatal cardiovascular outcomes. Despite a great knowledge of pathophysiological mechanisms involved in HF development and progression, hospitalization rates in patients with HF and concomitant T2DM remain elevated. In this review, we discuss the complex interplay between systemic neurohumoral regulation and local cardiac mechanisms participating in myocardial remodeling and HF development in T2DM with special attention to cardiomyocyte energy metabolism, mitochondrial function and calcium metabolism, cardiomyocyte hypertrophy and death, extracellular matrix remodeling.
Collapse
Affiliation(s)
- A. Ushakov
- Department of Internal Medicine 1, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
| | - V. Ivanchenko
- Department of Internal Medicine 1, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
| | - A. Gagarina
- Department of Internal Medicine 1, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
| |
Collapse
|
5
|
Bilovol OM, Dunaeva IP, Kravchun PP. METABOLIC AND HORMONAL FEATURES OF CHRONIC HEART FAILURE IN PERSONS WITH POST-INFARCTION CARDIOSCLEROSIS WITH TYPE 2 DIABETES MELLITUS AND OBESITY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2831-2834. [PMID: 36591775 DOI: 10.36740/wlek202211218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim: To determine the role of lipid metabolism and fractalkin and clusterin in the progression of chronic heart failure in patients with postinfarction cardiosclerosis with concomitant type 2 diabetes and obesity. PATIENTS AND METHODS Materials and methods: A retrospective analysis of a comprehensive examination of 67 patients with postinfarction cardiosclerosis with concomitant type 2 diabetes and obesity. All patients were divided into 3 groups depending on the functional class (FC) of CHF: 1 group (n = 22) - patients with CHF II FC; Group 2 (n = 23) - patients with CHF III FC; Group 3 (n = 22) - patients with CHF IV FC. All patients were examined clinically, they were instrumental, biochemical and hormonal examination. RESULTS Results: With the progression of CHF from FC II to FC III there is a deterioration of lipid metabolism: a significant increase in cholesterol levels by 5.5%, TG - by 15.7%, LDL cholesterol - by 74.4%, VLDL cholesterol - by 15 , 9%, reduction of HDL cholesterol - by 27.6% (p <0,05). An analysis of the fractal equation showing that ailing on CHF is advised by FC; rіven clusterin -decrease. CONCLUSION Conclusions: Classical changes in patients with postinfarction cardiosclerosis with CHF and concomitant type 2 diabetes mellitus and obesity , which are the formation of atherogenic lipid metabolism disorders associated with body weight, as well as changes in the latest indicators such as fractalkin and clusterin , indicating the role of these molecules in the progression of CHF.
Collapse
Affiliation(s)
- Olexandr M Bilovol
- KHARKIV NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE, KHARKIV, UKRAINE
| | - Inna P Dunaeva
- KHARKIV NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE, KHARKIV, UKRAINE
| | - Pavel P Kravchun
- KHARKIV NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE, KHARKIV, UKRAINE
| |
Collapse
|
6
|
Oyeleye SI, Ademiluyi AO, Raymond OO, Oboh G. Synergistic cardioprotective ability of co-administration of Moringa supplemented diets and acarbose in diabetic cardiomyopathy involves attenuation of cholinergic, purinergic, monoaminergic, renin-angiotensin system, and antioxidant pathways. J Food Biochem 2022; 46:e14475. [PMID: 36219759 DOI: 10.1111/jfbc.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022]
Abstract
One of the major complications of diabetes mellitus (DM) is diabetic cardiomyopathy (DCM) due to the multifaceted therapy involved. Here, we evaluated the combinatorial effect of Moringa leaf (ML) and seed (MS) supplemented diets plus acarbose (ACA) on cardiac acetylcholinesterase (AChE), adenosine triphosphatase (ATPase), adenosine deaminase (ADA), monoamine oxidase (MAO), arginase, angiotensin-I converting enzyme (ACE), and lactate dehydrogenase (LDH) activities, thiobarbituric acid reactive species (TBARS), and thiols levels. The diets and ACA (25 mg/kg) were administered for 14 days. The fasting blood glucose level (FBGL), cardiac AChE, ATPase, ADA, MAO, arginase, ACE, LDH activities, and TBARS and thiol levels were determined. Relative to the normal rats, the biomarkers were significantly increased in DM rats but were suppressed significantly in the diets plus ACA-treated rats while improving antioxidant status, with the 4% Moringa plus ACA proving outstanding compared to individual ML/MS and ACA. In addition, ML-supplemented diets with/without ACA had better effects compared to MS with/without ACA, respectively. In conclusion, the combination of ML/MS supplemented diets and ACA synergistically modulates the tested biochemicals. However, the effect on blood vessels and the nerves that control the heart, stiffness of left ventricular (LV) hypertrophy, fibrosis, cell signaling abnormalities, related gene expression, clinical trials, and echocardiology studies should be further investigated to affirm this claim. PRACTICAL APPLICATIONS: Moringa oleifera has been a vocal appetite in mitigating cardiovascular disease induced by diabetes, but the formulation of a medicinal diet as an ameliorative route of attention to the pathology is fairly addressed, not talking of its combination with the synthetic antidiabetic drug, such as ACA. Based on this experiment, it is imperative to explore such an idea. This research shows that co-administration of moringa leaf/seed formulated diets plus ACA exhibits a synergistic effect in DCM management. However, further research is needed in this field of experiment.
Collapse
Affiliation(s)
- Sunday I Oyeleye
- Department of Biomedical Technology, Federal University of Technology, Akure, Nigeria.,Functional Foods, Nutraceuticals and Phytomedicine Laboratory Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Adedayo O Ademiluyi
- Functional Foods, Nutraceuticals and Phytomedicine Laboratory Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Ojo O Raymond
- Functional Foods, Nutraceuticals and Phytomedicine Laboratory Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Ganiyu Oboh
- Functional Foods, Nutraceuticals and Phytomedicine Laboratory Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| |
Collapse
|
7
|
Bundgaard J, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study. Nutr Metab Cardiovasc Dis 2022; 32:1880-1885. [PMID: 35752540 DOI: 10.1016/j.numecd.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/01/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM Heart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM. METHODS AND RESULTS Patients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis. CONCLUSION Patients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.
Collapse
Affiliation(s)
- Johan Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| |
Collapse
|
8
|
Karamichalakis N, Kolovos V, Paraskevaidis I, Tsougos E. A New Hope: Sodium-Glucose Cotransporter-2 Inhibition to Prevent Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9080236. [PMID: 35893226 PMCID: PMC9331782 DOI: 10.3390/jcdd9080236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Atrial arrhythmias are common in patients with diabetes mellitus (DM), and despite recent advances in pharmaceutical and invasive treatments, atrial fibrillation (AF) and atrial flutter (AFl) are still associated with substantial mortality and morbidity. Clinical trial data imply a protective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2is) on the occurrence of AF and AFl. This review summarizes the state of knowledge regarding DM-mediated mechanisms responsible for AF genesis and recurrence but also discusses the recent data from experimental studies, published trials and metanalyses.
Collapse
|
9
|
Ormsbee JJ, Burden HJ, Knopp JL, Chase JG, Murphy R, Shepherd PR, Merry T. Variability in Estimated Modelled Insulin Secretion. J Diabetes Sci Technol 2022; 16:732-741. [PMID: 33588609 PMCID: PMC9294570 DOI: 10.1177/1932296821991120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ability to measure insulin secretion from pancreatic beta cells and monitor glucose-insulin physiology is vital to current health needs. C-peptide has been used successfully as a surrogate for plasma insulin concentration. Quantifying the expected variability of modelled insulin secretion will improve confidence in model estimates. METHODS Forty-three healthy adult males of Māori or Pacific peoples ancestry living in New Zealand participated in an frequently sampled, intravenous glucose tolerance test (FS-IVGTT) with an average age of 29 years and a BMI of 33 kg/m2. A 2-compartment model framework and standardized kinetic parameters were used to estimate endogenous pancreatic insulin secretion from plasma C-peptide measurements. Monte Carlo analysis (N = 10 000) was then used to independently vary parameters within ±2 standard deviations of the mean of each variable and the 5th and 95th percentiles determined the bounds of the expected range of insulin secretion. Cumulative distribution functions (CDFs) were calculated for each subject for area under the curve (AUC) total, AUC Phase 1, and AUC Phase 2. Normalizing each AUC by the participant's median value over all N = 10 000 iterations quantifies the expected model-based variability in AUC. RESULTS Larger variation is found in subjects with a BMI > 30 kg/m2, where the interquartile range is 34.3% compared to subjects with a BMI ≤ 30 kg/m2 where the interquartile range is 24.7%. CONCLUSIONS Use of C-peptide measurements using a 2-compartment model and standardized kinetic parameters, one can expect ~±15% variation in modelled insulin secretion estimates. The variation should be considered when applying this insulin secretion estimation method to clinical diagnostic thresholds and interpretation of model-based analyses such as insulin sensitivity.
Collapse
Affiliation(s)
- Jennifer J. Ormsbee
- Department of Mechanical Engineering,
Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
- Jennifer J. Ormsbee, MSc, University of
Canterbury, Level 5 Civil/Mechanical Building, Private Bag 4800, Christchurch,
Canterbury 8140, New Zealand.
| | - Hannah J. Burden
- Discipline of Nutrition, Faculty of
Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jennifer L. Knopp
- Department of Mechanical Engineering,
Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering,
Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Rinki Murphy
- Discipline of Nutrition, Faculty of
Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Peter R. Shepherd
- Discipline of Nutrition, Faculty of
Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular
Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Troy Merry
- Discipline of Nutrition, Faculty of
Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular
Biodiscovery, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
10
|
Gerbaud E, Bouchard de La Poterie A, Baudinet T, Montaudon M, Beauvieux MC, Lemaître AI, Cetran L, Seguy B, Picard F, Vélayoudom FL, Ouattara A, Kabore R, Coste P, Domingues-Dos-Santos P, Catargi B. Glycaemic Variability and Hyperglycaemia as Prognostic Markers of Major Cardiovascular Events in Diabetic Patients Hospitalised in Cardiology Intensive Care Unit for Acute Heart Failure. J Clin Med 2022; 11:jcm11061549. [PMID: 35329874 PMCID: PMC8951492 DOI: 10.3390/jcm11061549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Hyperglycaemia and hypoglycaemia are both emerging risk factors for cardiovascular disease. Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients presenting with acute heart failure (AHF) remains unclear. This study investigates the prognostic value of GV in diabetic patients presenting with acute heart failure (AHF). (2) Methods: this was an observational study including consecutive patients with diabetes and AHF between January 2015 and November 2016. GV was calculated using standard deviation of glycaemia values during initial hospitalisation in the intensive cardiac care unit. MACE, including recurrent AHF, new-onset myocardial infarction, ischaemic stroke and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analysed with respect to baseline characteristics and cardiac status. (3) Results: In total, 392 patients with diabetes and AHF were enrolled. During follow-up (median (interquartile range) 29 (6−51) months), MACE occurred in 227 patients (57.9%). In total, 92 patients died of cardiac causes (23.5%), 107 were hospitalised for heart failure (27.3%), 19 had new-onset myocardial infarction (4.8%) and 9 (2.3%) had an ischaemic stroke. Multivariable logistic regression analysis showed that GV > 50 mg/dL (2.70 mmol/L), age > 75 years, reduced left ventricular ejection fraction (LVEF < 30%) and female gender were independent predictors of MACE: hazard ratios (HR) of 3.16 (2.25−4.43; p < 0.001), 1.54 (1.14−2.08; p = 0.005), 1.47 (1.06−2.07; p = 0.02) and 1.43 (1.05−1.94; p = 0.03), respectively. (4) Conclusions: among other well-known factors of HF, a GV cut-off value of >50 mg/dL was the strongest independent predictive factor for mid-term MACE in patients with diabetes and AHF.
Collapse
Affiliation(s)
- Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France; (M.M.); (P.D.-D.-S.)
- Correspondence: ; Tel.: +33-524-549-188; Fax: +33-557-636-316
| | - Ambroise Bouchard de La Poterie
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
| | - Thomas Baudinet
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
| | - Michel Montaudon
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France; (M.M.); (P.D.-D.-S.)
| | - Marie-Christine Beauvieux
- Biochemistry Laboratory, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University, 33600 Pessac, France;
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Bordeaux University, 33076 Bordeaux, France
| | - Anne-Iris Lemaître
- Advanced Heart Failure Unit, Department of Cardiovascular Medicine, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University, 33604 Pessac, France; (A.-I.L.); (F.P.)
| | - Laura Cetran
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
| | - Benjamin Seguy
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
| | - François Picard
- Advanced Heart Failure Unit, Department of Cardiovascular Medicine, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University, 33604 Pessac, France; (A.-I.L.); (F.P.)
| | - Fritz-Line Vélayoudom
- Department of Diabetology-Endocrinology, University Hospital of Guadeloupe, 97159 Pointe-à-Pitre, France;
- Inserm UMR 1283, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, 59000 Lille, France
| | - Alexandre Ouattara
- Department of Anesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux University, 33600 Pessac, France;
- Biology of Cardiovascular Diseases Centre, U1034, Bordeaux University, 33600 Pessac, France
| | - Rémi Kabore
- Institut de Santé Publique, d’Épidémiologie et de Développement (ISPED), Bordeaux Population Health Research, U1219, Bordeaux University, 33000 Bordeaux, France;
| | - Pierre Coste
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; (A.B.d.L.P.); (T.B.); (L.C.); (B.S.); (P.C.)
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France; (M.M.); (P.D.-D.-S.)
| | - Pierre Domingues-Dos-Santos
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France; (M.M.); (P.D.-D.-S.)
- Advanced Heart Failure Unit, Department of Cardiovascular Medicine, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University, 33604 Pessac, France; (A.-I.L.); (F.P.)
- Institut de Rythmologie et Modélisation Cardiaque (IHU Liryc), Fondation Bordeaux Université, 33600 Pessac, France
| | - Bogdan Catargi
- Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, 33000 Bordeaux, France;
| |
Collapse
|
11
|
Yuan J, Yin X, Jiang H. Inhibition of Toll-like Receptor-4 expression for amelioration of myocardial injury in diabetes: A meta-analysis. Clinics (Sao Paulo) 2022; 77:100137. [PMID: 36434877 PMCID: PMC9700273 DOI: 10.1016/j.clinsp.2022.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To understand the relationship between the inhibition of Toll-Like Receptor-4 (TLR4) expression levels and diabetic myocardial injury, studies on TLR4 and diabetic myocardial injury in the China National Knowledge Internet (CNKI), WanFang database, VIP Database, PubMed, The Cochrane Library, Web of Science, and other databases were explored (retrieval details: November 2020). A meta-analysis of the selected literature was performed using the RevMan 5.4 software to detect publication bias using funnel plots and conduct a sensitivity analysis. Nine publications were finally included in this study, of which six included data on Heart Weight/Body Weight (HW/BW) indexes, and five included data on Left Ventricular Systolic Pressure (LVSP) and Left Ventricular End-Diastolic Pressure (LVEDP) indices. The meta-analysis showed that HW/BW was significantly reduced after the suppression of TLR4 expression (Standardized Mean Difference [SMD = 1.9], 95% CI between 0.59 and 3.21, p = 0.004), LVSP was significantly improved (SMD = -2.39, 95% CI between -4.32 and -0.46, p = 0.02), and LVEDP was significantly reduced (SMD = 2.88, 95% CI between 1.05 and 4.71, p = 0.002). The TLR4 signaling pathway plays an essential role in the pathogenesis of Diabetic Cardiomyopathy (DCM). Inhibition of TLR4 expression can improve the degree of cardiac impairment. TLR4 may become a new target for the treatment of DCM, and the use of TLR4 inhibitors may prove to be a novel strategy for therapeutic research.
Collapse
Affiliation(s)
- Jinxin Yuan
- The Second Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Xingwen Yin
- The Second Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Hua Jiang
- The Second Affiliated Hospital of Dalian Medical University, Liaoning, China.
| |
Collapse
|
12
|
Biegus J, Niewinski P, Josiak K, Kulej K, Ponikowska B, Nowak K, Zymlinski R, Ponikowski P. Pathophysiology of Advanced Heart Failure: What Knowledge Is Needed for Clinical Management? Heart Fail Clin 2021; 17:519-531. [PMID: 34511202 DOI: 10.1016/j.hfc.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Understanding of heart failure (HF) has evolved from a simple hemodynamic problem through a neurohormonally and proinflammatory-driven syndrome to a complex multiorgan dysfunction accompanied by inadequate energy handling. This article discusses the most important clinical aspects of advanced HF pathophysiology. It presents the concept of neurohormonal activation and its deleterious effect on cardiovascular system and reflex control. The current theories regarding the role of inflammation, cytokine activation, and myocardial remodeling in HF progression are presented. Advanced HF is a multiorgan syndrome with interplay between cardiovascular system and other organs. The role of iron deficiency is also discussed.
Collapse
Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Niewinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Josiak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Katarzyna Kulej
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Ponikowska
- Student Scientific Organization, Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krzysztof Nowak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Robert Zymlinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland.
| |
Collapse
|
13
|
Evangelista LS, Jose MM, Sallam H, Serag H, Golovko G, Khanipov K, Hamilton MA, Fonarow GC. High-protein vs. standard-protein diets in overweight and obese patients with heart failure and diabetes mellitus: findings of the Pro-HEART trial. ESC Heart Fail 2021; 8:1342-1348. [PMID: 33502122 PMCID: PMC8006643 DOI: 10.1002/ehf2.13213] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 01/02/2021] [Indexed: 01/11/2023] Open
Abstract
AIMS The intermediate-term effects of dietary protein on cardiometabolic risk factors in overweight and obese patients with heart failure and diabetes mellitus are unknown. We compared the effect of two calorie-restricted diets on cardiometabolic risk factors in this population. METHODS AND RESULTS In this randomized controlled study, 76 overweight and obese (mean weight, 107.8 ± 20.8 kg) patients aged 57.7 ± 9.7 years, 72.4% male, were randomized to a high-protein (30% protein, 40% carbohydrates, and 30% fat) or standard-protein diet (15% protein, 55% carbohydrates, and 30% fat) for 3 months. Reductions in weight and cardiometabolic risks were evaluated at 3 months. Both diets were equally effective in reducing weight (3.6 vs. 2.9 kg) and waist circumference (1.9 vs. 1.3 cm), but the high-protein diet decreased to a greater extent glycosylated haemoglobin levels (0.7% vs. 0.1%, P = 0.002), cholesterol (16.8 vs. 0.9 mg/dL, P = 0.031), and triglyceride (25.7 vs. 5.7 mg/dL, P = 0.032), when compared with the standard-protein diet. The high-protein diet also significantly improved both systolic and diastolic blood pressure than the standard-protein diet (P < 0.001 and P = 0.040, respectively). CONCLUSIONS Both energy-restricted diets reduced weight and visceral fat. However, the high-protein diet resulted in greater reductions in cardiometabolic risks relative to a standard-protein diet. These results suggest that a high-protein diet may be more effective in reducing cardiometabolic risk in this population, but further trials of longer duration are needed.
Collapse
Affiliation(s)
| | - Mini M. Jose
- School of NursingUniversity of Texas Medical BranchGalvestonTX77555‐1132USA
| | - Hanaa Sallam
- Diabetes Prevention and Care ProgramUniversity of Texas Medical BranchGalvestonTXUSA
| | - Hani Serag
- Diabetes Prevention and Care ProgramUniversity of Texas Medical BranchGalvestonTXUSA
| | - George Golovko
- Department of Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTXUSA
| | - Kamil Khanipov
- Department of Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTXUSA
| | - Michele A. Hamilton
- Department of Medicine/CardiologyUniversity of California, Los AngelesLos AngelesCAUSA
- Heart Failure ProgramCedars‐Sinai Heart InstituteLos AngelesCAUSA
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy Center and CardiologyUniversity of California, Los AngelesLos AngelesCAUSA
| |
Collapse
|
14
|
McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZI, Dagogo-Jack S, Pratley R, Greenberg M, Wang S, Huyck S, Gantz I, Terra SG, Masiukiewicz U, Cannon CP. Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes: A Meta-analysis. JAMA Cardiol 2021; 6:148-158. [PMID: 33031522 PMCID: PMC7542529 DOI: 10.1001/jamacardio.2020.4511] [Citation(s) in RCA: 597] [Impact Index Per Article: 199.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Sodium-glucose cotransporter 2 (SGLT2) inhibitors favorably affect cardiovascular (CV) and kidney outcomes; however, the consistency of outcomes across the class remains uncertain. Objective To perform meta-analyses that assess the CV and kidney outcomes of all 4 available SGLT2 inhibitors in patients with type 2 diabetes. Data Sources A systematic literature search was conducted in PubMed from January 1, 2015, to January 31, 2020. Study Selection One hundred forty-five records were initially identified; 137 were excluded because of study design or topic of interest. As a result, a total of 6 randomized, placebo-controlled CV and kidney outcomes trials of SGLT2 inhibitors in patients with type 2 diabetes were identified, with contributory data from 9 publications. All analyses were conducted on the total patient population of these trials. Data Extraction and Synthesis Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were analyzed using a fixed-effect model. Main Outcomes and Measures Outcomes included time to the first event of (1) the composite of major adverse CV events of myocardial infarction, stroke, or CV death, and each component, (2) the composite of hospitalization for heart failure (HHF) or CV death (HHF/CV death) and each component, and (3) kidney composite outcomes. For outcomes in the overall trial populations and in selected subgroups, hazard ratios (HRs) and 95% CIs were pooled and meta-analyzed across trials. Results Data from 6 trials comprised 46 969 unique patients with type 2 diabetes, including 31 116 (66.2%) with atherosclerotic CV disease. The mean (SD) age of all trial participants was 63.7 (7.9) years; 30 939 (65.9%) were men, and 36 849 (78.5%) were White. The median number of participants per trial was 8246 (range, 4401-17 160). Overall, SGLT2 inhibitors were associated with a reduced risk of major adverse CV events (HR, 0.90; 95% CI, 0.85-0.95; Q statistic, P = .27), HHF/CV death (HR, 0.78; 95% CI, 0.73-0.84; Q statistic, P = .09), and kidney outcomes (HR, 0.62; 95% CI, 0.56-0.70; Q statistic, P = .09), with no significant heterogeneity of associations with outcome. Associated risk reduction for HHF was consistent across the trials (HR, 0.68; 95% CI, 0.61-0.76; I2 = 0.0%), whereas significant heterogeneity of associations with outcome was observed for CV death (HR, 0.85; 95% CI, 0.78-0.93; Q statistic, P = .02; I2 = 64.3%). The presence or absence of atherosclerotic CV disease did not modify the association with outcomes for major adverse CV events (HR, 0.89; 95% CI, 0.84-0.95 and HR, 0.94; 95% CI, 0.83-1.07, respectively; P = .63 for interaction), with similar absence of associations with outcome modification by prevalent atherosclerotic CV disease for HHF/CV death (P = .62 for interaction), HHF (P = .26 for interaction), or kidney outcomes (P = .73 for interaction). Conclusions and Relevance In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of major adverse CV events; in addition, results suggest significant heterogeneity in associations with CV death. The largest benefit across the class was for an associated reduction in risk for HHF and kidney outcomes, with benefits for HHF risk being the most consistent observation across the trials.
Collapse
Affiliation(s)
- Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas
| | - Weichung J Shih
- Rutgers School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Dagogo-Jack
- Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Richard Pratley
- AdventHealth Translational Research Institute, Orlando, Florida
| | | | | | | | - Ira Gantz
- Merck & Co Inc, Kenilworth, New Jersey
| | | | | | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Vitamin D Receptor gene polymorphisms and susceptibility to type 2 diabetes: evidence from a meta-regression and meta-analysis based on 47 studies. J Diabetes Metab Disord 2021; 20:845-867. [PMID: 34222093 DOI: 10.1007/s40200-020-00704-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
Background Evidence from various studies suggest that vitamin D receptor (VDR) gene polymorphisms are associated with type 2 diabetes (T2D); However, these results have been disputable. Here we conducted a meta-analysis to comprehensively evaluate the effect of VDR gene polymorphisms and susceptibility to T2D. Methods All relevant studies reporting the association between VDR gene polymorphisms and susceptibility to T2D published up to August 2020 were identified by comprehensive systematic database search in web of science, Scopus, and Medline. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to measure strength of association. The methodological quality of each study was assessed according to the Newcastle-Ottawa Scale. Subgroup and meta-regression analysis were also performed. Results A total of 47 case-control studies were included in this meta-analysis. The overall population results revealed a significant association between FokI, and BsmI (heterozygote model) polymorphisms and T2D in the overall analysis. However, no association was found with the TaqI and ApaI polymorphisms. Moreover, the pooled results of subgroup analysis by ethnicity suggested significant association between FokI, TaqI, and BsmI polymorphisms and T2D in some subgroups. Meta-regression analyses indicated that none of the publication year, ethnicity, and genotyping method were the source of heterogenicity in all four polymorphisms. Conclusions This meta-analysis suggested a significant association between VDR gene FokI, and BsmI (heterozygote model) polymorphisms and T2D susceptibility in overall population and ethnic-specific analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-020-00704-z.
Collapse
|
16
|
Randhawa VK, Dhanvantari S, Connelly KA. How Diabetes and Heart Failure Modulate Each Other and Condition Management. Can J Cardiol 2020; 37:595-608. [PMID: 33276047 DOI: 10.1016/j.cjca.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
Heart failure (HF) and diabetes mellitus (DM) confer considerable burden on the health care system. Although these often occur together, DM can increase risk of HF, whereas HF can accelerate complications of DM. HF is a clinical syndrome resulting from systolic or diastolic impairment caused by ischemic, nonischemic (eg, DM), or other etiologies. HF exists along a spectrum from stage A (ie, persons at risk of DM) to stage D (ie, refractory HF from end-stage DM cardiomyopathy [DMCM]). HF is further categorized by reduced, midrange, and preserved ejection fraction (EF). In type 2 DM, the most prevalent form of DM, several pathophysiological mechanisms (eg, insulin resistance and hyperglycemia) can contribute to myocardial damage, leading to DMCM. Management of HF and DM and patient outcomes are guided by EF and drug efficacy. In this review, we focus on the interplay between HF and DM on disease pathophysiology, management, and patient outcomes. Specifically, we highlight the role of novel antihyperglycemic (eg, sodium glucose cotransporter 2 inhibitors) and HF therapies (eg, renin-angiotensin-aldosterone system inhibitors) on HF outcomes in patients with DM and HF.
Collapse
Affiliation(s)
- Varinder Kaur Randhawa
- Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Savita Dhanvantari
- Metabolism and Diabetes, Imaging Program, Lawson Health Research Institute and Medical Biophysics, Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada.
| |
Collapse
|
17
|
Thiazole-based and thiazolidine-based protein tyrosine phosphatase 1B inhibitors as potential anti-diabetes agents. Med Chem Res 2020. [DOI: 10.1007/s00044-020-02668-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
18
|
Sohrabi C, Saberwal B, Lim WY, Tousoulis D, Ahsan S, Papageorgiou N. Heart Failure in Diabetes Mellitus: An Updated Review. Curr Pharm Des 2020; 26:5933-5952. [PMID: 33213313 DOI: 10.2174/1381612826666201118091659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM) and heart failure (HF) are comorbid conditions associated with significant morbidity and mortality worldwide. Despite the availability of novel and effective therapeutic options and intensive glycaemic control strategies, mortality and hospitalisation rates continue to remain high and the incidence of HF persists. In this review, we described the impact of currently available glucose-lowering therapies in DM with a focus on HF clinical outcomes. Non-conventional modes of management and alternative pathophysiological mechanisms with the potential for therapeutic targeting are also discussed.
Collapse
Affiliation(s)
- Catrin Sohrabi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Bunny Saberwal
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Wei-Yao Lim
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Dimitris Tousoulis
- First Cardiology Department, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
| |
Collapse
|
19
|
Wingard MC, Frasier CR, Singh M, Singh K. Heart failure and diabetes: role of ATM. Curr Opin Pharmacol 2020; 54:27-35. [PMID: 32745970 PMCID: PMC7769978 DOI: 10.1016/j.coph.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022]
Abstract
Heart failure is a leading cause of death in the United States. Diabetes, also known as diabetes mellitus (DM), exponentially increases the risk of heart failure. The increase in oxidative stress and metabolic dysfunction caused by DM can lead to DNA damage and the development of diabetic cardiomyopathy. Ataxia telangiectasia mutated kinase (ATM) is a DNA damage response protein with a primary nuclear function to regulate cell cycle progression in response to double-strand DNA breaks, acts as a redox sensor, and facilitates DNA repair. ATM deficiency associates with the development of insulin resistance and DM. Consequently, patients with Ataxia telangiectasia, a rare autosomal recessive disorder, have an increased risk of developing heart failure. The main objective of this review is to summarize the shared metabolic and cardiac abnormalities associated with DM and ATM deficiency, with a focus on the development of heart failure.
Collapse
Affiliation(s)
- Mary C Wingard
- Department of Biomedical Sciences, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Chad R Frasier
- Department of Biomedical Sciences, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Mahipal Singh
- Department of Biomedical Sciences, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Krishna Singh
- Department of Biomedical Sciences, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; Center of Excellence for Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN 37614, USA; James H Quillen Veterans Affairs Medical Center, Mountain Home, TN 37684, USA.
| |
Collapse
|
20
|
Brito D, Bettencourt P, Carvalho D, Ferreira J, Fontes-Carvalho R, Franco F, Moura B, Silva-Cardoso JC, de Melo RT, Fonseca C. Sodium-Glucose Co-transporter 2 Inhibitors in the Failing Heart: a Growing Potential. Cardiovasc Drugs Ther 2020; 34:419-436. [PMID: 32350793 PMCID: PMC7242490 DOI: 10.1007/s10557-020-06973-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new drug class designed to treat patients with type 2 diabetes (T2D). However, cardiovascular outcome trials showed that SGLT2i also offer protection against heart failure (HF)-related events and cardiovascular mortality. These benefits appear to be independent of glycaemic control and have recently been demonstrated in the HF population with reduced ejection fraction (HFrEF), with or without T2D. This comprehensive, evidence-based review focuses on the published studies concerning HF outcomes with SGLT2i, discussing issues that may underlie the different results, along with the impact of these new drugs in clinical practice. The potential translational mechanisms behind SGLT2i cardio-renal benefits and the information that ongoing studies may add to the already existing body of evidence are also reviewed. Finally, we focus on practical management issues regarding SGLT2i use in association with other T2D and HFrEF common pharmacological therapies. Safety considerations are also highlighted. Considering the paradigm shift in T2D management, from a focus on glycaemic control to a broader approach on cardiovascular protection and event reduction, including the potential for wide SGLT2i implementation in HF patients, with or without T2D, we are facing a promising time for major changes in the global management of cardiovascular disease.
Collapse
Affiliation(s)
- Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal. .,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal.
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital CUF Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar, Universitário de São João, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Espinho, Portugal.,Department of Surgery and Physiology, Cardiovascular Investigation Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Fátima Franco
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Brenda Moura
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Department of Cardiology, Hospital das Forças Armadas-Pólo do Porto, Porto, Portugal.,CINTESIS-Cardiocare, Center for Health Technology and Services Research, Porto, Portugal
| | - José Carlos Silva-Cardoso
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,CINTESIS-Cardiocare, Center for Health Technology and Services Research, Porto, Portugal.,Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Cândida Fonseca
- Heart Failure Clinic, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
21
|
Kaul U, Ray S, Prabhakar D, Kochar A, Sharma K, Hazra PK, Chandra S, Solanki DRB, Dutta AL, Kumar V, Rao MS, Oomman A, Dani S, Pinto B, Raghu TR. Consensus document: management of heart failure in type 2 diabetes mellitus. Heart Fail Rev 2020; 26:1037-1062. [PMID: 32447488 DOI: 10.1007/s10741-020-09955-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a known predisposing factor for heart failure (HF). The growing burden of these two conditions and their impact on health of the individual and on society in general needs urgent attention from the health care professionals. Availability of multiple treatment choices for managing T2DM and HF may make therapeutic decisions more complex for clinicians. Recent cardiovascular outcome trials of antidiabetic drugs have added very robust evidence to effectively manage subjects with this dual condition. This consensus statement provides the prevalence trends and the impact of this dual burden on patients. In addition, it concisely narrates the types of HF, the different treatment algorithms, and recommendations for physicians to comprehensively manage such patients.
Collapse
Affiliation(s)
- Upendra Kaul
- Batra Heart Centre and Dean Academics and Research of BHMRC, Batra Hospital & Medical Research Centre, 1, Tughlakabad Institutional Area, Mehrauli Badarpur Road, New Delhi, 110 062, India.
| | - Saumitra Ray
- Heart Clinic, Kolkata, West Bengal, 700019, India
| | - D Prabhakar
- Apollo First Med Hospitals, Chennai, 600 010, India
| | - Arun Kochar
- Fortis Hospital, Mohali, Punjab, 160062, India
| | - Kamal Sharma
- SAL Hospital & Medical Institute, Ahmedabad, Gujarat, 380054, India
| | | | - Subhash Chandra
- BLK Super Speciality Hospital, Pusa Road, Karol Bagh, New Delhi, 110005, India
| | | | - Anjan Lal Dutta
- Peerless Hospital, Pancha Sayar Rd, Sahid Smirity Colony, Pancha Sayar, 700094, Kolkata, West Bengal, India
| | - Viveka Kumar
- Cath Labs MSSH (East) Saket, Max Super Speciality Hospital, New Delhi, 110017, India
| | - M Srinivas Rao
- Care Hospitals, Road No 1, Banjara Hills, Hyderabad, 500034, India
| | - Abraham Oomman
- Apollo Hospitals Greams Road Chennai, Apollo Hospitals 21, Greams Lane, Off Greams Road, Chennai, 600 006, India
| | - Sameer Dani
- Apollo Hospitals, Plot No.1 A, Bhat GIDC Estate, Gandhinagar, Gujarat, 382428, India
| | - Brian Pinto
- Holy Family Hospital, Mumbai, 400 050, India
| | - T R Raghu
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560 069, India
| |
Collapse
|
22
|
Lee KA, Kim YJ, Park TS, Lee JH, Jin HY. The association between cardiac autonomic neuropathy and heart function in type 2 diabetic patients. Somatosens Mot Res 2020; 37:149-156. [PMID: 32323604 DOI: 10.1080/08990220.2020.1756245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Cardiac autonomic neuropathy (CAN) is a common and important chronic complication in diabetic patients. Heart failure resulting from cardiomyopathy is also a lethal complication in diabetic patients. However, data showing the exact association between CAN and heart failure in diabetic patients are relatively scarce. Therefore, our study aimed to determine the association between the parameters assessing CAN and heart function in diabetic patients.Method: The medical records of type 2 diabetic patients who underwent an autonomic function test with heart rate variability (HRV) and echocardiography were reviewed from January 2018 to December 2018. A total of 100 type 2 diabetic patients were included, and the association between the parameters assessing CAN and heart function was analysed.Results: Among the 100 analysed patients, 65 were diagnosed with CAN and 26 showed diastolic dysfunction. Moreover, 19 (73.1%) diabetic patients with diastolic dysfunction were complicated with CAN. The occurrence of diastolic dysfunction was higher in diabetic patients with CAN than in diabetic patients without CAN (29.2% vs 20.0%, p < 0.05), and the occurrence of CAN was higher in diabetic patients with diastolic dysfunction than in patients without diastolic dysfunction (73.1% vs 62.2%, p < 0.05). However, there were no significant associations between HRV parameters and heart function.Conclusion: We demonstrated that diastolic dysfunction is more common in diabetic patients complicated with CAN than in diabetic patients without CAN, although several diabetic patients without diastolic dysfunction are also diagnosed with CAN. Moreover, further studies about the long-term serial monitoring of heart function according to the progression of CAN are required to confirm the exact association between CAN and heart function.
Collapse
Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Ju Hyung Lee
- Department of Preventive Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| |
Collapse
|
23
|
Wang N, Tan AWK, Jahn LA, Hartline L, Patrie JT, Lin S, Barrett EJ, Aylor KW, Liu Z. Vasodilatory Actions of Glucagon-Like Peptide 1 Are Preserved in Skeletal and Cardiac Muscle Microvasculature but Not in Conduit Artery in Obese Humans With Vascular Insulin Resistance. Diabetes Care 2020; 43:634-642. [PMID: 31888883 PMCID: PMC7035589 DOI: 10.2337/dc19-1465] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Obesity is associated with microvascular insulin resistance, which is characterized by impaired insulin-mediated microvascular recruitment. Glucagon-like peptide 1 (GLP-1) recruits skeletal and cardiac muscle microvasculature, and this action is preserved in insulin-resistant rodents. We aimed to examine whether GLP-1 recruits microvasculature and improves the action of insulin in obese humans. RESEARCH DESIGN AND METHODS Fifteen obese adults received intravenous infusion of either saline or GLP-1 (1.2 pmol/kg/min) for 150 min with or without a euglycemic insulin clamp (1 mU/kg/min) superimposed over the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow velocity and blood flow, brachial artery diameter and blood flow, and pulse wave velocity (PWV) were determined. RESULTS Insulin failed to change MBV or flow in either skeletal or cardiac muscle, confirming the presence of microvascular insulin resistance. GLP-1 infusion alone increased MBV by ∼30% and ∼40% in skeletal and cardiac muscle, respectively, with no change in flow velocity, leading to a significant increase in microvascular blood flow in both skeletal and cardiac muscle. Superimposition of insulin to GLP-1 infusion did not further increase MBV or flow in either skeletal or cardiac muscle but raised the steady-state glucose infusion rate by ∼20%. Insulin, GLP-1, and GLP-1 + insulin infusion did not alter brachial artery diameter and blood flow or PWV. The vasodilatory actions of GLP-1 are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes. CONCLUSIONS In obese humans with microvascular insulin resistance, GLP-1's vasodilatory actions are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.
Collapse
Affiliation(s)
- Nasui Wang
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
- Department of Endocrinology and Metabolism, Shantou University First Hospital, Guangdong, China
| | - Alvin W K Tan
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Linda A Jahn
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Lee Hartline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA
| | - Shaoda Lin
- Department of Endocrinology and Metabolism, Shantou University First Hospital, Guangdong, China
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Kevin W Aylor
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
24
|
Nana M, Morgan H, Bondugulapati LNR. Sodium-glucose co-transporter 2 inhibitors and heart failure-the present and the future. Heart Fail Rev 2020; 26:953-960. [PMID: 32020487 DOI: 10.1007/s10741-020-09925-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 diabetes mellitus is associated with an increased risk of heart failure. The prevalence of type 2 diabetes mellitus is on an upward trend. Heart failure represents one of the major causes for hospitalisation and mortality despite advances in management. Recent cardiovascular outcome trials have demonstrated that sodium-glucose co-transporter 2 inhibitors, which were introduced to the market in 2013, can incur a clinically significant risk reduction in heart failure outcomes in such patients. In this review, we discuss the epidemiology and pathophysiology of heart failure in diabetes and explore the landmark trials, the potential mechanisms of benefit of SGLT-2 inhibitors in heart failure, how the trials have led to major changes in treatment guidelines, and future potential directions for use of these drugs, including in those without diabetes.
Collapse
Affiliation(s)
- Melanie Nana
- Diabetes and Endocrinology Department, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Wales, LL13 7TD, UK.
| | - Holly Morgan
- Cardiology Department, Royal Glamorgan Hospital, Llantrisant, Wales, CF72 8XR, UK
| | - L N Rao Bondugulapati
- Diabetes and Endocrinology Department, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Wales, LL13 7TD, UK
| |
Collapse
|
25
|
Scheen AJ. Series: Implications of the recent CVOTs in type 2 diabetes: Impact on guidelines: The endocrinologist point of view. Diabetes Res Clin Pract 2020; 159:107726. [PMID: 31108136 DOI: 10.1016/j.diabres.2019.05.005] [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: 05/02/2019] [Accepted: 05/08/2019] [Indexed: 12/11/2022]
Abstract
The management of type 2 diabetes mellitus (T2DM) essentially consists in controlling hyperglycaemia, together with other vascular risk factors, in order to reduce the incidence and severity of diabetic complications. Whereas glucose control using classical glucose-lowering agents (except perhaps metformin) largely fails to reduce cardiovascular disease (CVD), two new pharmacological classes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is), have proven their ability to reduce major cardiovascular events in patients with established CVD. Furthermore, SGLT2is reduced the risk of hospitalisation for heart failure and the progression of renal disease. According to the 2018 ADA-EASD consensus report, the choice of a second agent to be added to metformin should now be driven by the presence or not of atherosclerotic CVD, heart failure or renal disease, all conditions that should promote the use of a SGLT2i or a GLP-1 RA with proven efficacy. Thus endocrinologists have to face a new paradigm in the management of T2DM, with a shift from a primary objective of glucose control without inducing hypoglycaemia and weight gain to a goal of cardiovascular and renal protection, largely independent of glucose control. Of note, however, the latter remains crucial to reduce the risk of microangiopathy.
Collapse
Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium; Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
| |
Collapse
|
26
|
Li S, Zheng Z, Tang X, Zhong J, Liu X, Zhao Y, Chen L, Zhu J, Liu J, Chen Y. Impact of HbA1c variability on subclinical left ventricular remodeling and dysfunction in patients with type 2 diabetes mellitus. Clin Chim Acta 2019; 502:159-166. [PMID: 31866332 DOI: 10.1016/j.cca.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Glycemic instability confers a risk of poor prognosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate whether HbA1c variability provided additional value over mean HbA1c for predicting subclinical left ventricular remodeling and dysfunction in T2DM patients. METHODS A total of 466 T2DM patients with normal cardiac structure and function were recruited and prospectively followed up for a median of 4.7 y. HbA1c was measured quarterly. The intrapersonal mean and standard deviation (SD) of HbA1c measurements were calculated, and SD-HbA1c was considered as a measure of HbA1c variability. All participants underwent transthoracic echocardiography at baseline and after follow-up. RESULTS In multivariable regression analyses, SD-HbA1c was independently associated with annualized changes in left ventricular end diastolic diameter, interventricular septum, left ventricular posterior wall, left ventricular mass index, left ventricular ejection fraction, E/e' ratio, and E/A ratio (P < 0.001). Subgroup analysis based on mean HbA1c levels (<7.0%, 7.0-7.5%, and ≥7.5%) further confirmed that SD-HbA1c was associated with most of the above parameters regardless of mean HbA1c levels. CONCLUSION This study indicates that HbA1c variability adds to the mean value in predicting subclinical left ventricular remodeling and dysfunction in T2DM patients.
Collapse
Affiliation(s)
- Suhua Li
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Zhenda Zheng
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xixiang Tang
- Department of Endocrinology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China; Advanced Medical Center, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Junlin Zhong
- Department of Ultrasonography, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xing Liu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yunyue Zhao
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Lin Chen
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Jieming Zhu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| | - Jinlai Liu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| | - Yanming Chen
- Department of Endocrinology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| |
Collapse
|
27
|
Cunha FM, Pereira J, Marques P, Ribeiro A, Bettencourt P, Lourenço P. Diabetic patients need higher furosemide doses: a report on acute and chronic heart failure patients. J Cardiovasc Med (Hagerstown) 2019; 21:21-26. [PMID: 31714331 DOI: 10.2459/jcm.0000000000000896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Diuretics are first-line drugs in symptomatic heart failure treatment. Diabetes mellitus has been suggested as a determinant of diuretic resistance. Studies comparing the dose and efficacy of diuretics in patients with and without diabetes are lacking. We aimed to study if furosemide dose differed according to diabetes status. METHODS We studied two cohorts of heart failure patients: a cohort of acute heart failure patients consecutively hospitalized with the primary diagnosis of heart failure and another of stable and optimized patients followed in a heart failure clinic. Data on comorbidities and medication were abstracted from patients' files. Use and doses of furosemide were compared between diabetic and nondiabetic patients. Regression analysis was used to determine the association of variables with diuretic dose. The independent association of diabetes with furosemide dose was assessed using multivariate models. RESULTS We studied 865 heart failure patients: 601 acute heart failure patients and 264 chronic stable heart failure patients. Acute heart failure patients with diabetes were more likely to need intravenous diuretic therapy and they were also more often discharged under higher doses of furosemide. They needed extra 6-mg furosemide at discharge in comparison with their nondiabetics counterparts and had an independent 26% higher odds of being discharged with at least 80-mg furosemide. Chronic patients were also more frequently prescribed with furosemide and on higher doses, although, diabetes was not independently associated with the use of higher furosemide doses. CONCLUSION Diabetic patients are more intensively treated with the loop diuretic furosemide. In acute heart failure, diabetes is an independent predictor of furosemide dose.
Collapse
Affiliation(s)
- Filipe M Cunha
- Endocrinology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel
| | - Joana Pereira
- Internal Medicine Department, Centro Hospitalar de São João
| | - Pedro Marques
- Internal Medicine Department, Centro Hospitalar de São João
| | - Ana Ribeiro
- Internal Medicine Department, Centro Hospitalar de São João
| | - Paulo Bettencourt
- Internal Medicine Department, Hospital CUF Porto.,Porto Cardiovascular I&D Unit (UnIC), Faculdade de Medicina da Universidade do Porto
| | - Patrícia Lourenço
- Internal Medicine Department, Centro Hospitalar de São João.,Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
| |
Collapse
|
28
|
Bashier A, Bin Hussain A, Abdelgadir E, Alawadi F, Sabbour H, Chilton R. Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases. Diabetol Metab Syndr 2019; 11:80. [PMID: 31572499 PMCID: PMC6761728 DOI: 10.1186/s13098-019-0476-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 02/12/2023] Open
Abstract
The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium-glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.
Collapse
Affiliation(s)
- Alaaeldin Bashier
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Azza Bin Hussain
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Elamin Abdelgadir
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, Abu Dhabi, UAE
| | - Robert Chilton
- Division of Cardiology, University of Texas Health Science Center, Audie L Murphy VA Hospital, San Antonio, TX USA
| |
Collapse
|
29
|
|
30
|
Kobalava ZD, Yeshniyazov NV, Medovchshikov VV, Khasanova ER. [Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis]. KARDIOLOGIYA 2019; 59:76-87. [PMID: 31002044 DOI: 10.18087/cardio.2019.4.10253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Abstract
Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24-40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium - glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF.
Collapse
Affiliation(s)
- Zh D Kobalava
- Peoples Friendship University of Russia (RUDN University) Vinogradov City Hospital, Moscow
| | | | | | - E R Khasanova
- Peoples Friendship University of Russia (RUDN University)
| |
Collapse
|
31
|
McGuire DK, Alexander JH, Johansen OE, Perkovic V, Rosenstock J, Cooper ME, Wanner C, Kahn SE, Toto RD, Zinman B, Baanstra D, Pfarr E, Schnaidt S, Meinicke T, George JT, von Eynatten M, Marx N. Linagliptin Effects on Heart Failure and Related Outcomes in Individuals With Type 2 Diabetes Mellitus at High Cardiovascular and Renal Risk in CARMELINA. Circulation 2019; 139:351-361. [PMID: 30586723 DOI: 10.1161/circulationaha.118.038352] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Individuals with type 2 diabetes mellitus are at increased risk for heart failure (HF), particularly those with coexisting atherosclerotic cardiovascular disease and/or kidney disease. Some but not all dipeptidyl peptidase-4 inhibitors have been associated with increased HF risk. We performed secondary analyses of HF and related outcomes with the dipeptidyl peptidase-4 inhibitor linagliptin versus placebo in CARMELINA (The Cardiovascular and Renal Microvascular Outcome Study With Linagliptin), a cardiovascular outcomes trial that enrolled participants with type 2 diabetes mellitus and atherosclerotic cardiovascular disease and/or kidney disease. METHODS Participants in 27 countries with type 2 diabetes mellitus and concomitant atherosclerotic cardiovascular disease and/or kidney disease were randomized 1:1 to receive once daily oral linagliptin 5 mg or placebo, on top of standard of care. All hospitalization for HF (hHF), cardiovascular outcomes, and deaths were prospectively captured and centrally adjudicated. In prespecified and post hoc analyses of HF and related events, Cox proportional hazards models adjusting for region and baseline history of HF were used. Recurrent hHF events were analyzed using a negative binomial model. In a subset of participants with left ventricular ejection fraction captured within the year before randomization, HF-related outcomes were assessed in subgroups stratified by left ventricular ejection fraction > or ≤50%. RESULTS CARMELINA enrolled 6979 participants (mean age, 65.9 years; estimated glomerular filtration rate, mL/min per 1.73m2; hemoglobin A1c, 8.0%; 62.9% men; diabetes mellitus duration, 14.8 years), including 1873 (26.8%) with a history of HF at baseline. Median follow-up was 2.2 years. Linagliptin versus placebo did not affect the incidence of hHF (209/3494 [6.0%] versus 226/3485 [6.5%], respectively; hazard ratio [HR], 0.90; 95% CI, 0.74-1.08), the composite of cardiovascular death/hHF (HR, 0.94; 95% CI, 0.82-1.08), or risk for recurrent hHF events (326 versus 359 events, respectively; rate ratio, 0.94; 95% CI, 0.75-1.20). There was no heterogeneity of linagliptin effects on hHF by history of HF at baseline, baseline estimated glomerular filtration rate or urine albumin-creatinine ratio, or prerandomization left ventricular ejection fraction. CONCLUSIONS In a large, international cardiovascular outcome trial in participants with type 2 diabetes mellitus and concomitant atherosclerotic cardiovascular disease and/or kidney disease, linagliptin did not affect the risk of hHF or other selected HF-related outcomes, including among participants with and without a history of HF, across the spectrum of kidney disease, and independent of previous left ventricular ejection fraction. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01897532.
Collapse
Affiliation(s)
- Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas (D.K.M., R.D.T.)
| | - John H Alexander
- Duke Clinical Research Institute, Duke Health, Durham, NC (J.H.A.)
| | | | - Vlado Perkovic
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (V.P.)
| | | | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia (M.E.C.)
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, Würzburg University Clinic, Germany (C.W.)
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, Veterans' Administration Puget Sound Health Care System and University of Washington, Seattle (S.E.K.)
| | - Robert D Toto
- University of Texas Southwestern Medical Center, Dallas (D.K.M., R.D.T.)
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Division of Endocrinology, University of Toronto, Canada (B.Z.)
| | | | - Egon Pfarr
- Boehringer Ingelheim Pharma GmbH & Co. Ingelheim, Germany (E.P., S.S.)
| | - Sven Schnaidt
- Boehringer Ingelheim Pharma GmbH & Co. Ingelheim, Germany (E.P., S.S.)
| | - Thomas Meinicke
- Boehringer Ingelheim International GmbH, Biberach, Germany (T.M.)
| | - Jyothis T George
- Boehringer Ingelheim International, Ingelheim, Germany (J.T.G., M.v.E.)
| | | | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, Rheinisch-Westfälische Technische Hochschule Aachen University, Germany (N.M.)
| |
Collapse
|
32
|
Zhang X, Zhang Z, Yang Y, Suo Y, Liu R, Qiu J, Zhao Y, Jiang N, Liu C, Tse G, Li G, Liu T. Alogliptin prevents diastolic dysfunction and preserves left ventricular mitochondrial function in diabetic rabbits. Cardiovasc Diabetol 2018; 17:160. [PMID: 30591063 PMCID: PMC6307280 DOI: 10.1186/s12933-018-0803-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/15/2018] [Indexed: 12/27/2022] Open
Abstract
Background There are increasing evidence that left ventricle diastolic dysfunction is the initial functional alteration in the diabetic myocardium. In this study, we hypothesized that alogliptin prevents diastolic dysfunction and preserves left ventricular mitochondrial function and structure in diabetic rabbits. Methods A total of 30 rabbits were randomized into control group (CON, n = 10), alloxan-induced diabetic group (DM, n = 10) and alogliptin-treated (12.5 mg/kd/day for 12 weeks) diabetic group (DM-A, n = 10). Echocardiographic and hemodynamic studies were performed in vivo. Mitochondrial morphology, respiratory function, membrane potential and reactive oxygen species (ROS) generation rate of left ventricular tissue were assessed. The serum concentrations of glucagon-like peptide-1, insulin, inflammatory and oxidative stress markers were measured. Protein expression of TGF-β1, NF-κB p65 and mitochondrial biogenesis related proteins were determined by Western blotting. Results DM rabbits exhibited left ventricular hypertrophy, left atrial dilation, increased E/e′ ratio and normal left ventricular ejection fraction. Elevated left ventricular end diastolic pressure combined with decreased maximal decreasing rate of left intraventricular pressure (− dp/dtmax) were observed. Alogliptin alleviated ventricular hypertrophy, interstitial fibrosis and diastolic dysfunction in diabetic rabbits. These changes were associated with decreased mitochondrial ROS production rate, prevented mitochondrial membrane depolarization and improved mitochondrial swelling. It also improved mitochondrial biogenesis by PGC-1α/NRF1/Tfam signaling pathway. Conclusions The DPP-4 inhibitor alogliptin prevents cardiac diastolic dysfunction by inhibiting ventricular remodeling, explicable by improved mitochondrial function and increased mitochondrial biogenesis.
Collapse
Affiliation(s)
- Xiaowei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Yajuan Yang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Ruimeng Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Jiuchun Qiu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Yungang Zhao
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Department of Health & Exercise Science, Tianjin University of Sport, Tianjin, 300381, People's Republic of China
| | - Ning Jiang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Department of Health & Exercise Science, Tianjin University of Sport, Tianjin, 300381, People's Republic of China
| | - Changle Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, China.,Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
| |
Collapse
|
33
|
Dandel M, Wallukat G, Hetzer R. Letter to the Editor regarding the article "The heart failure burden of type 2 diabetes mellitus-a review of pathophysiology and interventions". Heart Fail Rev 2018; 23:817-818. [PMID: 29982970 DOI: 10.1007/s10741-018-9725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), Partner site Berlin, Berlin, Germany. .,Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Cardio Centrum Berlin, Berlin, Germany
| |
Collapse
|
34
|
Dimitriadis K, Tsioufis C, Tousoulis D. Do we need biomarkers for diabetics progressing to heart failure? Hellenic J Cardiol 2018; 59:98-99. [PMID: 29940223 DOI: 10.1016/j.hjc.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular changes produce unfavorable outcomes including arterial hypertension and diabetes, which are related to the increased risk of heart failure (HF). The latter is highly prevalent in the setting of glucose metabolism dysregulation and high hemodynamic load, and identifying predictors of the incidence of HF with preserved ejection fraction (HFpEF) requires a research and is a clinical need. Toward this end, the variability in glucose regulation represents a novel dynamic way to comprehend and study the impact of glycemia. The results of the published study highlight the independent association of glycated hemoglobin A1c variability with the development of HFpEF in hypertensive diabetic patients. Based on the above, the effect of diverse antidiabetic therapies on glycemic control variability and overall management of these patients to reduce the risk of HFpEF remain essential for the modern cardiologist.
Collapse
Affiliation(s)
- Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| |
Collapse
|
35
|
Vacante F, Senesi P, Montesano A, Frigerio A, Luzi L, Terruzzi I. L-Carnitine: An Antioxidant Remedy for the Survival of Cardiomyocytes under Hyperglycemic Condition. J Diabetes Res 2018; 2018:4028297. [PMID: 30622968 PMCID: PMC6304876 DOI: 10.1155/2018/4028297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Metabolic alterations as hyperglycemia and inflammation induce myocardial molecular events enhancing oxidative stress and mitochondrial dysfunction. Those alterations are responsible for a progressive loss of cardiomyocytes, cardiac stem cells, and consequent cardiovascular complications. Currently, there are no effective pharmacological measures to protect the heart from these metabolic modifications, and the development of new therapeutic approaches, focused on improvement of the oxidative stress condition, is pivotal. The protective effects of levocarnitine (LC) in patients with ischemic heart disease are related to the attenuation of oxidative stress, but LC mechanisms have yet to be fully understood. OBJECTIVE The aim of this work was to investigate LC's role in oxidative stress condition, on ROS production and mitochondrial detoxifying function in H9c2 rat cardiomyocytes during hyperglycemia. METHODS H9c2 cells in the hyperglycemic state (25 mmol/L glucose) were exposed to 0.5 or 5 mM LC for 48 and 72 h: LC effects on signaling pathways involved in oxidative stress condition were studied by Western blot and immunofluorescence analysis. To evaluate ROS production, H9c2 cells were exposed to H2O2 after LC pretreatment. RESULTS Our in vitro study indicates how LC supplementation might protect cardiomyocytes from oxidative stress-related damage, preventing ROS formation and activating antioxidant signaling pathways in hyperglycemic conditions. In particular, LC promotes STAT3 activation and significantly increases the expression of antioxidant protein SOD2. Hyperglycemic cardiac cells are characterized by impairment in mitochondrial dysfunction and the CaMKII signal: LC promotes CaMKII expression and activation and enhancement of AMPK protein synthesis. Our results suggest that LC might ameliorate metabolic aspects of hyperglycemic cardiac cells. Finally, LC doses herein used did not modify H9c2 growth rate and viability. CONCLUSIONS Our novel study demonstrates that LC improves the microenvironment damaged by oxidative stress (induced by hyperglycemia), thus proposing this nutraceutical compound as an adjuvant in diabetic cardiac regenerative medicine.
Collapse
Affiliation(s)
- Fernanda Vacante
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pamela Senesi
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anna Montesano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Frigerio
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Livio Luzi
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|