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Lin FJ, Tseng WK, Yin WH, Yeh HI, Chen JW, Wu CC. Residual Risk Factors to Predict Major Adverse Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes Mellitus. Sci Rep 2017; 7:9179. [PMID: 28835613 PMCID: PMC5569020 DOI: 10.1038/s41598-017-08741-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 12/19/2022] Open
Abstract
A prospective observational study was conducted to investigate the residual risk factors to predict recurrence of major adverse cardiovascular events (MACE) in atherosclerotic cardiovascular disease (ASCVD) patients with a high prevalence under lipid-lowering therapy, particularly in the subpopulations of diabetic and nondiabetic individuals. A total of 5,483 adults (with a mean age of 66.4 and 73.3% male) with established coronary heart disease, cerebrovascular disease, or peripheral artery disease were identified from the T-SPARCLE multi-center registry. Of them, 38.6% had diabetes. The residual risk factors for MACE are divergent in these atherosclerotic patients with and without diabetes. In diabetic subpopulation, the risk of MACE was significantly increased with heart failure (HF), chronic kidney disease (CKD) stage 4-5 (vs. stage 1-2), without beta blocker use, and higher non-HDL-C, after controlling for covariates including statin use and the intensity of therapy. Increased LDL-C and TG levels were also associated with increased risk, but to a much less extent. Among nondiabetic individuals, HF, CKD stage 4-5, and history of myocardial infarction were the significant independent predictors of MACE. It is suggested that ASCVD patients with concomitant diabetes need stricter control of lipid, particularly non-HDL-C levels, to reduce cardiovascular risk when on statin therapy.
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Affiliation(s)
- Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan.,Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chau-Chung Wu
- Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei, Taiwan. .,Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Musabayane CT. The effects of medicinal plants on renal function and blood pressure in diabetes mellitus. Cardiovasc J Afr 2013; 23:462-8. [PMID: 23044503 PMCID: PMC3721953 DOI: 10.5830/cvja-2012-025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/03/2012] [Indexed: 11/12/2022] Open
Abstract
Abstract Diabetes mellitus is one of the most common chronic global diseases affecting children and adolescents in both the developed and developing nations. The major types of diabetes mellitus are type 1 and type 2, the former arising from inadequate production of insulin due to pancreatic β-cell dysfunction, and the latter from reduced sensitivity to insulin in the target tissues and/or inadequate insulin secretion. Sustained hyperglycaemia is a common result of uncontrolled diabetes and, over time, can damage the heart, eyes, kidneys and nerves, mainly through deteriorating blood vessels supplying the organs. Microvascular (retinopathy and nephropathy) and macrovascular (atherosclerotic) disorders are the leading causes of morbidity and mortality in diabetic patients. Therefore, emphasis on diabetes care and management is on optimal blood glucose control to avert these adverse outcomes. Studies have demonstrated that diabetic nephropathy is associated with increased cardiovascular mortality. In general, about one in three patients with diabetes develops end-stage renal disease (ESRD) which proceeds to diabetic nephropathy (DN), the principal cause of significant morbidity and mortality in diabetes. Hypertension, a well-established major risk factor for cardiovascular disease contributes to ESRD in diabetes. Clinical evidence suggests that there is no effective treatment for diabetic nephropathy and prevention of the progression of diabetic nephropathy. However, biomedical evidence indicates that some plant extracts have beneficial effects on certain processes associated with reduced renal function in diabetes mellitus. On the other hand, other plant extracts may be hazardous in diabetes, as reports indicate impairment of renal function. This article outlines therapeutic and pharmacological evidence supporting the potential of some medicinal plants to control or compensate for diabetes-associated complications, with particular emphasis on kidney function and hypertension.
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Affiliation(s)
- C T Musabayane
- Department of Human Physiology, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Walldius G, Jungner I. Apolipoprotein A-I versus HDL cholesterol in the prediction of risk for myocardial infarction and stroke. Curr Opin Cardiol 2008; 22:359-67. [PMID: 17556890 DOI: 10.1097/hco.0b013e3281bd8849] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To compare the potential of high-density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-I, the major protein in HDL particles, in predicting cardiovascular risk. Pros and cons for using these risk markers are discussed. RECENT FINDINGS Both HDL cholesterol and apoA-I are in most clinical conditions antiatherogenic - the higher the values, the lower the cardiovascular risk. Methodological and physiological factors speak in favour of using apoA-I rather than HDL cholesterol as a marker of risk. In prospective risk studies and in lipid-lowering trials it has been shown that the apoB/A-I ratio, which reflects the cholesterol balance between all potentially atherogenic (apoB) and antiatherogenic lipoproteins (apoA-I), is a better risk marker than low-density lipoprotein cholesterol, HDL cholesterol and lipid ratios in predicting cardiovascular risk and response to lipid lowering induced by statins. Practical advantages speak in favour of using apoB and apoA-I - fasting is not needed to analyze and interpret the values of apoB and apoA-I. SUMMARY New guidelines should be developed in which target values for apoB and apoA-I are defined to enable the use of these new strong risk markers/factors in clinical practice.
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Affiliation(s)
- Göran Walldius
- King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden.
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