Considerable disturbances of cardiovascular risk factors in women with diabetes and myocardial infarction

Impaired Adipogenesis and Dysfunctional Adipose Tissue in Human Hypertrophic Obesity

The subcutaneous adipose tissue (SAT) is the largest and best storage site for excess lipids. However, it has a limited ability to expand by recruiting and/or differentiating available precursor cells. When inadequate, this leads to a hypertrophic expansion of the cells with increased inflammation, insulin resistance, and a dysfunctional prolipolytic tissue. Epi-/genetic factors regulate SAT adipogenesis and genetic predisposition for type 2 diabetes is associated with markers of an impaired SAT adipogenesis and development of hypertrophic obesity also in nonobese individuals. We here review mechanisms for the adipose precursor cells to enter adipogenesis, emphasizing the role of bone morphogenetic protein-4 (BMP-4) and its endogenous antagonist gremlin-1, which is increased in hypertrophic SAT in humans. Gremlin-1 is a secreted and a likely important mechanism for the impaired SAT adipogenesis in hypertrophic obesity. Transiently increasing BMP-4 enhances adipogenic commitment of the precursor cells while maintained BMP-4 signaling during differentiation induces a beige/brown oxidative phenotype in both human and murine adipose cells. Adipose tissue growth and development also requires increased angiogenesis, and BMP-4, as a proangiogenic molecule, may also be an important feedback regulator of this. Hypertrophic obesity is also associated with increased lipolysis. Reduced lipid storage and increased release of FFA by hypertrophic SAT are important mechanisms for the accumulation of ectopic fat in the liver and other places promoting insulin resistance. Taken together, the limited expansion and storage capacity of SAT is a major driver of the obesity-associated metabolic complications.

High serum phosphate and triglyceride levels in smoking women and men with CVD risk and type 2 diabetes

BACKGROUND

Both low and high serum phosphate levels may be associated with morbidity and mortality from cardiovascular disease. As smoking increases risk for type 2 diabetes (as shown by dyslipidemia and hyperglycemia), we wanted to study whether smoking and type 2 diabetes were associated with serum phosphate and triglyceride levels independently from other CVD risk factors.

METHODS

Upon admittance to the Vindeln Health Education Centre (VHE-centre) for a four-week comprehensive lifestyle intervention, the participants (1408 women and 1096 men) completed a questionnaire that included their smoking habits - current smoker or non-smoker. We used multiple linear regression analyses to investigate the association between smoking and other CVD risk factors with S-P and S-TG levels.

RESULTS

In the non-type 2 diabetes populations, the smokers, compared to the non-smokers, had higher S-P and higher serum triglycerides (S-TG). In women, serum-TG in smokers with type 2 diabetes was higher than in smokers with non-type 2 diabetes. Non-type 2 diabetes patients exhibited an inverse relation between S-Glucose (S-Glu) and S-P and a positive association with S-TG. For men only, an association was seen between age (-) and S-Crea (-) and S-P. For women only, an association was seen between BMI (-) and S-Cholesterol (+) (S-Chol) and S-P.

CONCLUSIONS

Compared to non-smokers, smoking women with non-type 2 diabetes and smoking men with type 2 diabetes had a higher level of S-P and S-TG. The association between smoking and S-P and S-TG levels still existed after adjusting for age and CVD risk factors in the multiple linear regression analyses.

TRIAL REGISTRATION

The study has been registered as a sub-study to the Lifestyle Intervention Trial no. ISRCTN79355192.

Type 2 diabetes and cardiovascular disease in women

Cardiovascular disease is the leading cause of death in both men and women. This is also true for patients with diabetes. In general, differences between the sexes are present in several areas, such as epidemiology, pathophysiology, diagnostics, treatment response and prognosis, as well as the way in which disease is experienced and expressed. Cardiovascular disease presents later in life in women, who are therefore more likely to suffer from comorbidities. However, this age-related difference is attenuated in women with diabetes, who suffer their first myocardial infarction at about the same age as men with diabetes. Diabetes mellitus increases the risk of cardiovascular disease by three to four times in women and two to three times in men, after adjusting for other risk factors. This paper describes the differences in cardiovascular disease in men and women and the special situation of women with type 2 diabetes when it comes to risk factors, symptoms and the setting of acute coronary syndromes. Furthermore, it highlights the importance of sex-specific analyses in clinical research to improve our knowledge of cardiovascular disease in women in general and in women with diabetes in particular. The importance of taking sex into account when treating women and men at risk of cardiovascular disease is discussed.

Anthropometric features and cardiovascular risk in young Latin Americans with type 2 diabetes mellitus

OBJECTIVE

The purpose of this study is to compare score systems used to estimate the risk for cardiovascular disease (CVD) in young patients with poorly controlled type 2 diabetes.

METHODS

Fifty-seven Latin American patients with type 2 diabetes, between the ages 18 and 45 years, were screened to participate in a clinical research study evaluating the effects of intensive insulin therapy on both traditional and nontraditional CVD risk factors. All women were premenopausal and had regular menstrual periods. Baseline reviews of cardiovascular (CV) risk scores, personal history, physical examination, and laboratory screening were performed. The Framingham Study Score system and the presence of features of the metabolic syndrome (MSyn) were recorded and compared.

RESULTS

Both genders had a comparable number of features of the MSyn, whereas according to the Framingham Score System, men had a slightly higher risk of CVD.

CONCLUSIONS

The Framingham Score system is not an accurate device to estimate risk of CVD in premenopausal women with type 2 diabetes mellitus, who otherwise have a multiple features of the MSyn. If used to estimate risk of CVD, the Framingham score system could underestimate the risk of CVD in both young men and women with type 2 diabetes mellitus.