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Tian L, Yang YM, Zhu J, Zhang H, Shao XH. Gender difference in association between diabetes mellitus and all-cause mortality in atrial fibrillation patients. J Diabetes Complications 2022; 36:108265. [PMID: 35914400 DOI: 10.1016/j.jdiacomp.2022.108265] [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: 02/23/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There may be gender difference in correlation of diabetes mellitus (DM) and cardiovascular events. We attempt to investigate whether there is gender-heterogeneity in one-year outcomes of atrial fibrillation (AF) patients with DM or not. METHODS Patients who were diagnosed with AF admitted to the emergency departments in the Chinese AF Multicenter Registry study were enrolled. Basic demographics information, initial Blood Pressure and heart rate, medical histories, and treatments of each patient were collected. Follow-up was carried out with a mean duration of one year. The primary endpoint was all-cause mortality and systemic embolism. RESULTS A total of 2016 patients were selected from September 2008 and April 2011. All-cause mortality was significantly higher in male AF patients with DM than those without (21.8 % & 13.6 %, P = 0.014). Cox regression analysis showed that there was an interaction between gender and DM for one-year all-cause mortality (P = 0.049). DM was significantly associated with one-year all-cause mortality regardless of univariate analysis (HR = 1.436, 95%CI:1.079-1.911, P = 0.013) or multivariate analysis (HR = 1.418, 95%CI: 1.059-1.899, P = 0.019). For male patients with AF, DM was significantly associated with one-year all-cause mortality (P = 0.048), but not for female patients with AF (P = 0.362). CONCLUSION DM was independently associated with one-year all-cause mortality in the entire cohort of AF patients. This association was found mainly in male patients with AF, but not in female patients. DM management programs may need to reflect gender difference.
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Affiliation(s)
- Li Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yan-Min Yang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
| | - Jun Zhu
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Han Zhang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xing-Hui Shao
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
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Wang Y. Higher fasting triglyceride predicts higher risks of diabetes mortality in US adults. Lipids Health Dis 2021; 20:181. [PMID: 34930280 PMCID: PMC8686260 DOI: 10.1186/s12944-021-01614-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It is unknown whether higher triglyceride results in higher mortality from diabetes, i.e., diabetes mortality. This study aimed to investigate the association of fasting triglyceride with diabetes mortality. METHODS This study included 26,582 US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. Diabetes mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglyceride for diabetes mortality. RESULTS Higher levels of fasting triglyceride were associated with higher levels of glucose, glycated hemoglobin, insulin, and homeostatic model assessment for insulin resistance at baseline. A 1-natural-log-unit increase in triglyceride (e.g., from 70 to 190 mg/dL) was associated with a 115% higher multivariate-adjusted risk of diabetes diagnosis (odds ratio, 2.15; 95% CI, 2.00-2.33). During 319,758 person-years of follow-up with a mean follow-up of 12.0 years, 582 diabetes deaths were documented. Compared with people with triglyceride in the lowest quintile, people with triglyceride in the highest quintile had an 85% higher risk of diabetes mortality (HR, 1.85; 95% CI, 1.25-2.73). A 1-natural-log-unit increase in triglyceride was associated with a 40% higher multivariate-adjusted risk of diabetes mortality. The positive association between triglyceride and diabetes mortality was also presented in sub-cohorts of participants with or without diabetes. CONCLUSIONS This study demonstrated that higher fasting triglyceride was associated with a higher diabetes mortality risk.
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Affiliation(s)
- Yutang Wang
- Discipline of Life Sciences, School of Science, Psychology and Sport, Federation University Australia, University Drive, Mt Helen, VIC, 3350, Australia.
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Gao T, Agho KE, Piya MK, Simmons D, Osuagwu UL. Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014-2017). BMC Public Health 2021; 21:1991. [PMID: 34732173 PMCID: PMC8567571 DOI: 10.1186/s12889-021-12120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. METHODS Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014-30 June 2015 to 1 July 2016-30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. RESULTS Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3-21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5-12.1) and more in men than women (23.1, 95%CI 21.2-25.0 vs 17.9, 95%CI 16.2-19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78-4.48) and 1.79 (95%CI 0.77-2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49-35.02) but not in those with diabetes. CONCLUSIONS In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.
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Affiliation(s)
- Tina Gao
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Milan K Piya
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
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Kang P, Wang J, Fang D, Fang T, Yu Y, Zhang W, Shen L, Li Z, Wang H, Ye H, Gao Q. Activation of ALDH2 attenuates high glucose induced rat cardiomyocyte fibrosis and necroptosis. Free Radic Biol Med 2020; 146:198-210. [PMID: 31689484 DOI: 10.1016/j.freeradbiomed.2019.10.416] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/03/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
Necroptosis is one of a regulated programmed death mode, fibrosis is closely related with cell death. It has been reported that inhibition of necroptosis can play the protective role in cardiac ischemia and reperfusion injury, stroke and other diseases, but the mechanisms of aldehyde dehydrogenases 2 (ALDH2) against high glucose induced neonatal rat ventricular primary cardiomyocytes fibrosis and necroptosis had not been elucidated clearly. This study was to observe the effect of ALDH2 on high glucose (HG) induced myocardial fibrosis and necroptosis in primary rat cardiomyocytes model. In contrast to normal glucose group, in HG group, with the decreases of ALDH2 activity, mRNA and protein levels, the cardiomyocytes viability was decreased, reactive oxygen species (ROS), the inflammation factors - tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) levels, collagen I (col I) and col III mRNA expressions and tissue inhibitors of matrix metalloproteinase 4 (TIMP4) protein expression were increased, while matrix metalloproteinase 14 (MMP14) protein level, the ratio of MMP14/TIMP4 were decreased, and the necroptosis key factors - the receptor interacting protein 1 (RIP1), RIP3 and mixed lineage kinase domain-like protein (MLKL) at mRNA and protein expressions were increased, the inflammasome core proteins - NLRP3 and ASC protein expressions were also increased, the apoptosis rate and necrosis rate were also increased. When the cardiomyocytes were treated with Alda-1 (the ALDH2 agonist) in HG intervention, the cell viability, ALDH2 activity, mRNA and protein levels, MMP14 protein level, the ratio of MMP14/TIMP4 were higher, ROS and TNF-α, IL-6, IL-1β levels, RIP1, RIP3, MLKL, NLRP3 and ASC expressions, col I and col III, TIMP4 expressions, the apoptosis rate and necrosis rate were lower than in HG group. Daidzin, the antagonist of ALDH2 abolished the role of Alda-1. In summary, ALDH2 maybe is a key regulator in high glucose induced cardiomyocytes injury. Activation of ALDH2 prevented the happening of fibrosis, apoptosis and necroptosis in high glucose induced primary cardiomyocytes injury model, the protective effects were related to the inhibiting of oxidative stress and inflammation, changing of MMP14 and TIMP4, then inhibiting the happening of fibrosis, apoptosis and necroptosis. These findings advance our understanding of the intensive mechanisms of ALDH2's cardioprotection, and provide the targeted basis for clinical diabetes treatment.
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Affiliation(s)
- Pinfang Kang
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Jiahui Wang
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Dian Fang
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Tingting Fang
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Ying Yu
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Weiping Zhang
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Lin Shen
- Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Zhenghong Li
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China
| | - Hongju Wang
- Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, PR China
| | - Hongwei Ye
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China.
| | - Qin Gao
- Department of Physiology, Bengbu Medical College, Bengbu, Anhui, 233030, PR China; Cardiovascular Research Center, Bengbu Medical College, Bengbu, Anhui, 233030, PR China.
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Liu L, Klein L, Eaton C, Panjrath G, Martin LW, Chae CU, Greenland P, Lloyd-Jones DM, Wactawski-Wende J, Manson JE. Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women's Health Initiative Randomized Trials. J Card Fail 2020; 26:2-12. [DOI: 10.1016/j.cardfail.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
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Iizuka T, Oki K, Hayashida K, Minami K, Izawa Y, Takahashi S, Shimizu H, Fukuda K, Nakahara J. Cerebral Infarction after Transcatheter Aortic Valve Implantation in Japan: Retrospective Analysis at a Single High-Volume Center. J Stroke Cerebrovasc Dis 2019; 28:104455. [PMID: 31680032 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Perioperative cerebral infarction is one of the concerning complications after transcatheter aortic valve implantation in patients with aortic stenosis. Several studies have reported on this complication; however, those included only Caucasians and analyzed a small number of cases. Here, we report on the characteristics and risk factors of symptomatic cerebral infarction after transcatheter aortic valve implantation in a single, high-volume center in Japan. METHODS We included 308 consecutive patients who underwent transcatheter aortic valve implantation in our facility between 2013 and 2016. We retrospectively analyzed the occurrence, characteristics, and prognoses of symptomatic cerebral infarction within 7 days after the procedure and statistically compared the risk factors between patients with or without cerebral infarction. RESULTS Five patients (1.6%) suffered from symptomatic cerebral infarction, which was usually recognized just after the procedure, with mild symptoms. Long-term prognoses tended to be good unless other factors influenced disability. Comorbidities, such as carotid artery stenosis and peripheral artery disease, were significantly higher in patients with cerebral infarction (P = .036 and .002, respectively); in addition, coronary artery disease and longer anesthesia duration (indicating challenging catheter procedures) tended to be associated with cerebral infarction (P = .080 and .069, respectively). CONCLUSIONS Symptomatic cerebral infarction occurred in 1.6% of patients after transcatheter aortic valve implantation in a single, high-volume center in Japan; the infarctions were of mild severity tending toward good long-term prognoses. We speculate arterial embolism from atherosclerotic large arteries, especially from the aortic arch, during catheter procedures might be the mechanistic basis of cerebral infarction.
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Affiliation(s)
- Takashi Iizuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Oki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology, Saiseikai Central Hospital, Tokyo, Japan.
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazushi Minami
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikane Izawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology and Stroke, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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Kotani K, Yamada S, Takahashi H, Iwazu Y, Yamada T. The Ratio of Oxidized Lipoprotein(a) to Native Lipoprotein(a) and the Endothelial Function in Patients with Type 2 Diabetes Mellitus. Int J Mol Sci 2019; 20:ijms20194909. [PMID: 31623352 PMCID: PMC6801959 DOI: 10.3390/ijms20194909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/16/2022] Open
Abstract
The ratio of oxidized lipoprotein(a) to native lipoprotein(a) (oxLp(a)/Lp(a)) may be a reasonable index for assessing endothelial dysfunction in type 2 diabetes mellitus (T2DM). The present study investigated whether the oxLp(a)/Lp(a) level is correlated with the endothelial function using the Endo-PATTM, a newly developed device, in patients with T2DM. A total of 63 patients with T2DM (mean age: 59 years old) were enrolled in the study. The patients’ serum Lp(a) and oxLp(a) levels were measured using an enzyme-linked immunosorbent assay. The reactive hyperemia index (RHI) level was measured using an Endo-PATTM 2000. A correlation analysis between the measured variables was conducted. Among the patients, the mean hemoglobin A1c was 7.8%. The median level of oxLp(a)/Lp(a) was 0.28 (interquartile range: 0.07–0.54), and the mean RHI was 1.8 (standard deviation: 0.4). In a multiple linear regression analysis, the oxLp(a)/Lp(a) level was an independent, significant, and inverse variable for the RHI level (β = −0.26, p < 0.05), along with male gender. A high oxLp(a)/Lp(a) level may reflect endothelial dysfunction, as assessed by the Endo-PATTM, in patients with T2DM. Further studies are warranted to confirm the observed findings.
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Affiliation(s)
- Kazuhiko Kotani
- Division of Community and Family Medicine, Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan.
- Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan.
| | - Shingo Yamada
- Central Laboratory, Shino-Test, Sagamihara-City, Kanagawa 252-0331, Japan.
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga-City, Saga 849-8501, Japan.
| | - Yoshitaka Iwazu
- Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan.
| | - Toshiyuki Yamada
- Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan.
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