Preventing Diabetes and Atherosclerosis in the Cardiometabolic Syndrome

Association between estimated glucose disposal rate with the all-cause and cause-specific mortality among the population with cardiometabolic syndrome

BACKGROUND

Estimated glucose disposal rate (eGDR) is considered as a reliable alternative indicator of insulin resistance. However, the relationship between eGDR levels and mortality among individuals with cardiometabolic syndrome (CMS), as well as within different glucose metabolic states in this population, remains unclear.

METHODS

We conducted a cohort study on 9928 CMS participants from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018. The relationship between eGDR levels and mortality in the CMS population was evaluated using multivariable Cox proportional hazards regression models and restricted cubic splines (RCS). Finally, stratified analysis was performed to determine the relationship between eGDR levels and mortality in different subgroups.

RESULTS

Cox regression analysis showed a significant correlation between eGDR levels and both all-cause and cause-specific mortality in the entire CMS population (all p < 0.05). RCS analysis revealed a non-linear relationship between eGDR levels and both all-cause (p for overall < 0.001, p for non-linear < 0.001) and diabetes specific mortality (p for overall < 0.001, p for non-linear = 0.004) in CMS population, while a linear relationship with cardiovascular specific mortality (p for overall < 0.001, p for non-linear = 0.091). In participants with baseline diabetes mellitus (DM), eGDR levels were significantly correlated with all-cause mortality, cardiovascular specific mortality, and diabetes specific mortality (all p < 0.05). In CMS participants with baseline pre-diabetes mellitus (Pre-DM), eGDR levels were significantly correlated with cardiovascular-specific and diabetes-specific mortality (all p < 0.05). In CMS participants with baseline normal glucose regulation (NGR), eGDR levels were only significantly related to diabetes specific mortality (p < 0.05).

CONCLUSION

There is a significant correlation between eGDR levels and both all-cause and cause-specific mortality in the entire CMS population. Furthermore, the protective effect of high eGDR levels on mortality persists across various glucose metabolic states.

Association between atherogenic index of plasma and type 2 diabetic complications: a cross-sectional study

Background

The Atherogenic Index of Plasma (AIP) was originally developed primarily as a marker for assessing atherosclerosis. Consequently, this study investigates the potential association between AIP and type 2 diabetic complications through a cross-sectional design.

Methods

The National Metabolic Management Center(MMC) serves as a comprehensive platform dedicated to the establishment of standardized protocols for the diagnosis, treatment, and long-term follow-up of metabolic diseases. Following the relevant inclusion and exclusion criteria, a total of 3,094 patients were enrolled for subsequent analysis. In this study, logistic regression, restricted cubic splines, and subgroup analyses were employed to evaluate the association between the AIP and four major complications of type 2 diabetes, namely, type 2 diabetes with carotid atherosclerosis (DA), diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN).

Results

The logistic regression results demonstrate that in the fully adjusted model, each SD increase in AIP correlates with an elevated risk of type 2 diabetic kidney disease (DKD), with the risk of kidney damage intensifying alongside higher AIP groupings. The RCS analysis and subgroup analyses similarly revealed a dose-response relationship between AIP levels and the risk of DKD. Furthermore, the AIP was not found to be statistically significantly associated with DA, DR,and DPN.

Conclusions

The AIP may serve as a valuable predictive indicator for evaluating kidney damage in patients with type 2 diabetes, and regular screening of AIP in this population could provide significant benefits in the prevention of DKD.

Comparison of adverse cardiovascular event endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques: a systematic review and meta-analysis

BACKGROUND

The classification of major adverse cardiovascular event (MACE) endpoints in patients with type 2 diabetes mellitus (T2DM) and either confirmed coronary artery disease (CAD) or high CAD risk, as well as the extent of the association between T2DM and coronary plaque characteristics, remains uncertain.

PURPOSE

This meta-analysis aims to compare MACE endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques.

METHODS

We searched studies from Web of Science, PubMed, Embase, and the Cochrane Library up until September 1, 2023. Two independent researchers evaluated the quality and bias of the included studies. We used odds ratio (OR) and standardized mean difference (SMD) with 95% confidence interval (CI) to assess the effect of individual lesion parameters and coronary artery plaque characteristics on MACE endpoints.

RESULTS

Seven studies covered 1218 patients with diabetes and 3038 patients without diabetes. The follow-up time ranged from 2 to 5.4 years. The pooled results indicated that in all CAD lesions, DM was more strongly associated with MACE, myocardial infarction (MI), revascularization, and rehospitalization for unstable or progressive angina. The pooled OR was 1.82 (95% CI: 1.42 to 2.33, I2 = 0%, P < 0.00001) for MACE, 2.36 (95% CI: 1.47 to 3.79, I2 = 0%, P = 0.0004) for MI, 1.83 (95% CI: 1.33 to 2.53, I2 = 0%, P = 0.0002) for revascularization, and 1.65 (95% CI: 1.20 to 2.27, I2 = 0%, P = 0.002) for rehospitalization respectively. Subgroup analysis of culprit lesions (CLs) revealed significant differences between DM and non-DM for MACE, MI, revascularization, and stent thrombosis. While non-culprit lesions (NCLs) showed differences for MACE, MI, revascularization, and rehospitalization between the two groups.

CONCLUSION

The rates of MACE, MI, and revascularization are greater in DM than in non-DM patients in terms of all lesions, CLs, and NCLs. Except for CLs, the readmission rate is greater for unstable or progressive angina. Plaque characteristics are similar between patients with and without diabetes. Prospero registration number CRD42023474226.

Effect of Cognitive Behavioural Therapy in Improving Sleep and Health Status in Patients with Cardiometabolic Syndrome: a Meta-Analysis

The aim of this study was to assess the effect of cognitive behavioural therapy intervention on sleep and health improvement in patients with cardiometabolic syndrome and sleep problems. This study also aimed to assess the effect of different study designs to explain the overall intervention effect through subgroup analysis. Relevant randomized controlled trial studies were searched through six online databases. The PEDro scale was used to assess the quality of the included studies. The random effects model was used to assess the mean difference, effect size, and standard deviation of the outcome variables. The heterogeneity of the included studies was assessed using I2 and Q tests. Publication bias was assessed by the Egger test. Cognitive behavioural therapy intervention provided a significant effect in improving the Pittsburgh Sleep Quality Index, Insomnia Severity Index, total sleep time, sleep efficiency, depression, fatigue, and HbA1c. The effect of cognitive behavioural therapy is more significant when relaxation training and education components are included. Cognitive behavioural therapy is suitable for the treatment of sleep problems in patients with cardiometabolic syndrome. Cognitive behavioural therapy is also effective on depression and fatigue but has a limited effect on blood pressure and biomedical indicators related to cardiometabolic syndrome.

High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on "residual cardiovascular disease risk". During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual's CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.

Epigenetically altered macrophages promote development of diabetes-associated atherosclerosis

Background

Atherosclerosis (AS) risk is elevated in diabetic patients, but the underlying mechanism such as involvement of epigenetic control of foam macrophages remains unclear. We have previously shown the importance of immune regulation on endothelial cells to AS development in diabetes. In this study, we examined the hypothesis that diabetes may promote AS through modification of the epigenetic status of macrophages.

Methods

We employed the Laser Capture Microdissection (LCM) method to evaluate the expression levels of key epigenetic regulators in both endothelial cells and macrophages at the AS lesions of patients. We then assessed the correlation between the significantly altered epigenetic regulator and serum levels of low-density Lipoprotein (LDL), triglycerides (TRIG) and high-density Lipoprotein (HDL) in patients. In vitro, the effects of high glucose on glucose utilization, lactate production, succinate levels, oxygen consumption and polarization in either undifferentiated or differentiated bone marrow-derived macrophages (BMDMs) were analyzed. The effects of depleting this significantly altered epigenetic regulator in macrophages on AS development were assessed in AS-prone diabetic mice.

Results

Histone deacetylase 3 (HDAC3) was identified as the most significantly altered epigenetic regulator in macrophages from the AS lesions in human diabetic patients. The levels of HDAC3 positively correlated with high serum LDL and TRIG, as well as low serum HDL. High glucose significantly increased glucose utilization, lactate production, succinate levels and oxygen consumption in cultured macrophages, and induced proinflammatory M1-like polarization. Macrophage depletion of HDAC3 significantly attenuated AS severity in AS-prone diabetic mice.

Conclusion

Epigenetically altered macrophages promote development of diabetes-associated AS, which could be prevented through HDAC3 depletion.

The Influence of Abdominal Adiposity and Physical Fitness on Obesity Status of Portuguese Adolescents

The aim of this study was to verify the relationship between abdominal adiposity and physical fitness in the obesity status of Portuguese adolescents. BMI, abdominal adiposity, and physical fitness tests from the FITescola^® were evaluated in a total of 654 Portuguese adolescents, aged 10-19 years old-male: n = 334 (51%), female: n = 320 (49%). For the final model, BMI was positively related with age (β = 0.25), abdominal adiposity (β = 0.313), horizontal jump (β = -0.100), 40 m maximal velocity (β = 0.274), and aerobic fitness (β = -0.250, R² = 0.75, F = 382.2, and p = 0.0001). We conclude that higher age and abdominal adiposity are positively related with a higher adolescent BMI. Furthermore, lower horizontal jump distances and worse times on the 40 m maximal velocity were inversely related with a higher adolescent BMI, and lower aerobic fitness was inversely related with a higher adolescent BMI.

The critical roles of histone deacetylase 3 in the pathogenesis of solid organ injury

Histone deacetylase 3 (HDAC3) plays a crucial role in chromatin remodeling, which, in turn, regulates gene transcription. Hence, HDAC3 has been implicated in various diseases, including ischemic injury, fibrosis, neurodegeneration, infections, and inflammatory conditions. In addition, HDAC3 plays vital roles under physiological conditions by regulating circadian rhythms, metabolism, and development. In this review, we summarize the current knowledge of the physiological functions of HDAC3 and its role in organ injury. We also discuss the therapeutic value of HDAC3 in various diseases.