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Antoniou S, Naka KK, Papadakis M, Bechlioulis A, Tsatsoulis A, Michalis LK, Tigas S. Effect of glycemic control on markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus: A review. World J Diabetes 2021; 12:1856-1874. [PMID: 34888012 PMCID: PMC8613661 DOI: 10.4239/wjd.v12.i11.1856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/29/2021] [Accepted: 10/09/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease is the predominant cause of death in type 2 diabetes mellitus (T2DM). Evidence suggests a strong association between duration and degree of hyperglycemia and vascular disease. However, large trials failed to show cardiovascular benefit after intensive glycemic control, especially in patients with longer diabetes duration. Atherosclerosis is a chronic and progressive disease, with a long asymptomatic phase. Subclinical atherosclerosis, which is impaired in T2DM, includes impaired vasodilation, increased coronary artery calcification (CAC), carotid intima media thickness, arterial stiffness, and reduced arterial elasticity. Each of these alterations is represented by a marker of subclinical atherosclerosis, offering a cost-effective alternative compared to classic cardiac imaging. Their additional use on top of traditional risk assessment strengthens the predictive risk for developing coronary artery disease (CAD). We, herein, review the existing literature on the effect of glycemic control on each of these markers separately. Effective glycemic control, especially in earlier stages of the disease, attenuates progression of structural markers like intima-media thickness and CAC. Functional markers are improved after use of newer anti-diabetic agents, such as incretin-based treatments or sodium-glucose co-transporter-2 inhibitors, especially in T2DM patients with shorter disease duration. Larger prospective trials are needed to enhance causal inferences of glycemic control on clinical endpoints of CAD.
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Affiliation(s)
- Sofia Antoniou
- Department of Endocrinology, University of Ioannina, Ioannina 45110, Greece
| | - Katerina K Naka
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina 45110, Greece
| | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
| | - Aris Bechlioulis
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina 45110, Greece
| | | | - Lampros K Michalis
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina 45110, Greece
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina 45110, Greece
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The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with coronary artery disease. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp200810126s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background / Aim. Well-organized cardiovascular rehabilitation (CVR) reduces
cardiovascular burden by influencing cardiovascular risk factors, improving
the quality of life and reducing mortality and hospital readmission.
However, its effects on hemodynamic status are largely unknown. The aim of
our study was to evaluate the influence of three-week CVR program on
hemodynamic status and to investigate if there is a correlation between
physical strain tolerance and hemodynamic parameters measured by impedance
cardiography (ICG) before and after CVR program in patients with coronary
artery disease. Methods. Fifty-two patients attended a three-week CVR
program. At the beginning and at the end of rehabilitation program
laboratory tests, exercise stress tests (EST) and ICG measurements were
taken. Results. Patients showed better strain tolerance on the second
exercise stress test (EST2) by achieving higher strain level (Z=2,315;
p=0,021) and longer duration of test (Z=2,305; p=0,021). There was a strong
positive correlation between the level of EST2 and cardiac output (CO)
(r=0,538; p<0,001) and stroke volume (SV) (r=0,380; p=0,017) on the second
ICG (ICG2). Also, there was a strong negative correlation between EST2 level
and systemic vascular resistance (SVR) (r=-0,472; p=0,002) and SVR index
(SSVRI) (r=-0,407; p=0,010) on ICG2. There was a strong positive correlation
between EST2 duration and CO (r=0.517; p=0.001) as well as between EST2
duration and SV (r=0.340; p=0.034), and a strong negative correlation
between EST2 duration and SVR (r=-0.504; p=0.001) as well as between EST2
duration and SVRI (r=-0.448; p=0.004), according to ICG2. Conclusion. Our
study showed that a well-designed CVR program can lead to better physical
strain tolerance. Furthermore, CVR led to a significant positive correlation
between EST and cardiac output as well as between EST and stroke volume
measured by ICG. On the other hand, there was a significant negative
correlation between EST and vascular related parameters according to ICG at
the end of the CVR program.
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Souza RRD, Santos SMD, Maifrino LBM, Gama EF, Caperuto EC, Maldonado DC. Resistance training attenuates the effects of aging in the aorta of Wistar rats. MOTRIZ: REVISTA DE EDUCACAO FISICA 2015. [DOI: 10.1590/s1980-65742015000400012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract The objective of the present study was to follow the structural modifications of the aortic wall in middle-aged rats submitted to a resistance training protocol for a period of four months. Three groups of 8 animals per group were considered: middle-aged group (MA), old control group (OC) and old trained group (OT). Training consisted in to climb a 1.1-m vertical (80° incline) ladder with weights tied to their tail. Aortic wall structural modifications were studied through light and electron microscopy and morphometry. The mean arterial blood pressure at rest was similar in the three experimental groups (p = .07). At the beginning of the experiment, the OC and OT groups had similar repetition maximums, ranging from 1.6-fold to 1.9-fold the body weight. At the end of the experiment, the repetition maximum of the OT group was 5-fold greater than the body weight (p = .03). The LV weight was 15% larger in the OT group than in the MA group and 12% larger than in the OC group (p = .02). The LV wall thickness of the OT group was significantly larger than that of both, the MA group and the OC group (p = .03). The LV internal diameter in the OT group was significantly smaller than that observed in the MA and OC groups (p = .02). Resistance training diminished the alterations associated with aging improving aortic wall structure by reducing the thickness, normalising the elastic material, the collagen and the smooth muscle cells. Resistance training seems to be a potential treatment for reducing the deleterious effects of aging on the aortic wall.
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Effect of early exercise engagement on arterial stiffness in patients diagnosed with a transient ischaemic attack. J Hum Hypertens 2014; 29:87-91. [DOI: 10.1038/jhh.2014.56] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 11/09/2022]
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Badavi M, Abedi HA, Dianat M, Sarkaki AR. Exercise Training and Grape Seed Extract Co-Administration Improves Lipid Profile, Weight Loss, Bradycardia, and Hypotension of STZ-Induced Diabetic Rats. Int Cardiovasc Res J 2013; 7:111-7. [PMID: 24757634 PMCID: PMC3987445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Exercise Training (ET) and Grape Seed Extract (GSE) as an antioxidant have many positive effects on controlling diabetes mellitus and its complications. OBJECTIVES This study aimed to determine the effects of GSE alone or combined with ET on body weight, plasma lipid profile, blood pressure, and heart rate in STZ-induced diabetic rats. METHODS IN THIS STUDY, MALE WISTAR RATS WERE RANDOMLY ASSIGNED TO FIVE GROUPS: sedentary control, sedentary diabetic, trained diabetic, GSE treated sedentary diabetic, and GSE treated trained diabetic. ET was conducted on the treadmill daily for 8 weeks. One way ANOVA followed by LSD test was used for statistical analysis. RESULTS Reduction of body weight, high density lipoproteins, heart rate, and systolic blood pressure and increment of total cholesterol, triglyceride, low density lipoprotein, and very low density lipoproteins were observed after STZ injection. Co-administration of GSE and ET had more positive effects on lipid profile compared to each method alone. In addition, GSE and ET modified heart rate partially, while their combination was more effective in improvement of heart rat in conscious rats. On the other hand, administration of ET or GSE alone did not affect systolic blood pressure and body weight, while their combination restored systolic blood pressure completely and improved body weight partially. CONCLUSIONS The study findings indicated that ET combined with GSE had more beneficial effects compared to each one alone on the complications of STZ induced diabetes. This may constitute a convenient and inexpensive therapeutic approach to diabetic complications.
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Affiliation(s)
- Mohammad Badavi
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahwaz Jundishapour University of Medical Sciences, Ahwaz, IR Iran
| | - Hassan Ali Abedi
- Physiology Department, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, IR Iran,Corresponding author: Hassan Ali Abedi, Physiology Department, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, IR Iran, Cellphone: +98-9177825116, Fax: +98-7914440072, E-mail:
| | - Mahin Dianat
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahwaz Jundishapour University of Medical Sciences, Ahwaz, IR Iran
| | - Ali Reza Sarkaki
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahwaz Jundishapour University of Medical Sciences, Ahwaz, IR Iran
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Oliveira NL, Ribeiro F, Alves AJ, Campos L, Oliveira J. The effects of exercise training on arterial stiffness in coronary artery disease patients: a state-of-the-art review. Clin Physiol Funct Imaging 2013; 34:254-62. [PMID: 24138480 DOI: 10.1111/cpf.12093] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/17/2013] [Indexed: 12/23/2022]
Abstract
The purpose of this state-of-the-art review was to examine the effects of exercise training on arterial stiffness (AS) in patients with coronary artery disease (CAD). A PubMed and SCOPUS literature search was conducted up to March of 2013. Two authors performed the selection of the studies and the subsequent data extraction (e.g. information on study design, exercise programme characteristics and outcome measures). Of 34 papers identified, only five studies met the inclusion criteria, with no one being a randomized controlled trial. Within the selected studies, the sample size varied between 28 and 119 patients, with mean ages ranging from 48 to 67 years old in patients with CAD after an acute myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Although all studies utilized the aerobic exercise mode, the other characteristics of the exercise programmes varied largely between the studies: programme length (from 6 to 20 weeks), exercise duration (15-20 to 50 min) and exercise intensity, which was based on heart rate reserve (40 to 85%) or heart rate at anaerobic threshold or ventilatory threshold. All the three studies evaluating pulse wave velocity, as well as one of two studies that assessed the augmentation index, reported significant reductions on those variables after exercise training. Results indicated that the majority of the AS and related measures improved after the different exercise training programmes. However, these results need to be confirmed in future randomized clinical studies controlling potential confounders.
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Affiliation(s)
- Norton Luis Oliveira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
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Badavi M, Abedi HA, Sarkaki AR, Dianat M. Co-administration of Grape Seed Extract and Exercise Training Improves Endothelial Dysfunction of Coronary Vascular Bed of STZ-Induced Diabetic Rats. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e7624. [PMID: 24693368 PMCID: PMC3950780 DOI: 10.5812/ircmj.7624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 02/02/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
Background One of the known complications of diabetes mellitus is vascular dysfunction. Inability of the coronary vascular response to cardiac hyperactivity might cause a higher incidence of ischemic heart disease in diabetic subjects. It has been indicated that regular exercise training and antioxidants could prevent diabetic cardiovascular problems enhanced by vascular damage. Objectives The aim of this study was to determine the effects of grape seed extract (as antioxidant), with and without exercise training on coronary vascular function in streptozotocin induced diabetic rats. Materials and Methods Fifty male Wistar rats weighing 200 – 232 grams were randomly divided into five groups of 10 rats each: sedentary control, sedentary diabetic, trained diabetic, grape seed extract (200 mg/kg) treated sedentary diabetic and, grape seed extract treated trained diabetic. Diabetes was induced by one intraperitoneal injection of streptozotocin. After eight weeks, coronary vascular responses to vasoactive agents were determined. Results The endothelium dependent vasorelaxation to acetylcholine was reduced significantly in diabetic animals; exercise training or grape seed extract administration partially improves this response. However, exercise training in combination with grape seed extract restores endothelial function completely. The endothelium independent vasorelaxation to sodium nitroprusside was improved by combination of exercise training and grape seed extract. On the other hand, the basal perfusion pressure and vasoconstrictive response to phenylephrine did not change significantly. Conclusions The data indicated that co-administration of grape seed extract and exercise training had more significant effects than exercise training or grape seed extract alone; this may constitute a convenient and inexpensive therapeutic approach to diabetic vascular complications.
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Affiliation(s)
- Mohammad Badavi
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Hassan Ali Abedi
- Physiology Department, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, IR Iran
- Corresponding Author: Hassan Ali Abedi, Physiology Department, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, IR Iran. Tel: +98-7913340405, Fax: +98-7914440072, E-mail:
| | - Ali Reza Sarkaki
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mahin Dianat
- Physiology Research Center, Physiology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Intermittent versus constant aerobic exercise: effects on arterial stiffness. Eur J Appl Physiol 2009; 108:801-9. [DOI: 10.1007/s00421-009-1285-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-x. [PMID: 19790194 DOI: 10.1002/dmrr.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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