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Liu J, Zhang Y. Comment on: Hypertension combined with atherosclerosis increases the risk of heart failure in patients with diabetes. Hypertens Res 2024; 47:2612-2613. [PMID: 38890523 DOI: 10.1038/s41440-024-01749-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Jintao Liu
- Department of Cardiology, Wuwei Liangzhou Hospital, Wuwei, 733000, Gansu, China
| | - Yong Zhang
- Department of Cardiology, Wuwei Liangzhou Hospital, Wuwei, 733000, Gansu, China.
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Lv L, Guo Y, Zheng Z, Li B. Blood metabolites mediate effects of breakfast skipping on heart failure via Mendelian randomization analysis. Sci Rep 2024; 14:18957. [PMID: 39147796 PMCID: PMC11327247 DOI: 10.1038/s41598-024-69874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024] Open
Abstract
Numerous observational studies have suggested a potential causal relationship between skipping breakfast and cardiovascular diseases, including heart failure (HF). However, these studies are susceptible to inherent confounders and the challenge of reverse causation, and the underlying metabolic factors are not yet clear. Therefore, our aim is to assess the causal impact of breakfast skipping on HF and the role of potential mediating metabolic products from a genetic perspective, by conducting Mendelian Randomization (MR) studies and mediation analysis. We leveraged summary data from the most extensive genome-wide association studies to date on breakfast skipping (with 193,860 participants), blood metabolites (with 118,461 participants), and HF (involving 47,309 cases and 930,014 controls). To explore the causal relationship between breakfast skipping and HF, as well as the role of 249 potential blood metabolite mediators, we conducted bidirectional MR and mediation MR analyses. We primarily employed the Inverse Variance Weighted (IVW) method, complemented by various other techniques to ensure the comprehensiveness and reliability of our analysis. Our research confirms a causal association between breakfast skipping and an increased risk of HF (odds ratio [OR]: 1.378, 95% confidence interval [CI]: 1.047-1.813; p = 0.022). Furthermore, our research findings demonstrate that breakfast skipping is positively correlated with 6 blood metabolites and negatively correlated with 2 others. Notably, our mediation MR analysis further reveals that three blood metabolites act as mediators in the relationship between breakfast skipping and the risk of HF. Specifically, the mediating effects are attributed to the ratio of docosahexaenoic acid (DHA) to total fatty acids (proportion mediated = 9.41%, 95% CI: 2.10-28.61%), glucose (proportion mediated = 6.17%, 95% CI: 0.97-28.53%), and glycoprotein acetyls (GlycA) (proportion mediated = 5.68%, 95% CI: 0.94-21.62%). The combined mediating effects of these three factors total 20.53% (95%CI: 8.59-91.06%). Our research confirms the causal relationship between genetically instrumented breakfast skipping and HF, underscoring the potential mediating roles played by three key blood metabolites: ratio of DHA to total fatty acids, glucose and GlycA. This discovery offers valuable perspectives for clinical strategies targeting HF.
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Affiliation(s)
- Luo Lv
- Department of Cardiology, The Second Hospital of Shanxi Medical University, School of Medicine, Shanxi Medical University, Taiyuan, China
| | - Yuli Guo
- Department of Cardiology, The Frist Hospital of Shanxi Medical University, School of Medicine, Shanxi Medical University, Taiyuan, China
| | - Zhongyi Zheng
- Department of Urology, The First Hospital of Shanxi Medical University, School of Medicine, Shanxi Medical University, Taiyuan, China
| | - Bao Li
- Department of Cardiology, The Second Hospital of Shanxi Medical University, School of Medicine, Shanxi Medical University, Taiyuan, China.
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3
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Shi Y, Yu C. U shape association between triglyceride glucose index and congestive heart failure in patients with diabetes and prediabetes. Nutr Metab (Lond) 2024; 21:42. [PMID: 38956581 PMCID: PMC11221084 DOI: 10.1186/s12986-024-00819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND While previous population studies have shown that higher triglyceride-glucose (TyG) index values are associated with an increased risk of congestive heart failure (CHF), the relationship between TyG and CHF in patients with abnormal glucose metabolism remains understudied. This study aimed to evaluate the association between TyG and CHF in individuals with diabetes and prediabetes. METHODS The study population was derived from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. The exposure variable, TyG, was calculated based on triglyceride and fasting blood glucose levels, while the outcome of interest was CHF. A multivariate logistic regression analysis was employed to assess the association between TyG and CHF. RESULTS A total of 13,644 patients with diabetes and prediabetes were included in this study. The results from the fitting curve analysis demonstrated a non-linear U-shaped correlation between TyG and CHF. Additionally, linear logistic regression analysis showed that each additional unit of TyG was associated with a non-significant odds ratio (OR) of 1.03 (95%CI: 0.88-1.22, P = 0.697) for the prevalence of CHF. A two-piecewise logistic regression model was used to calculate the threshold effect of the TyG. The log likelihood ratio test (p < 0.05) indicated that the two-piecewise logistic regression model was superior to the single-line logistic regression model. The TyG tangent point was observed at 8.60, and on the left side of this point, there existed a negative correlation between TyG and CHF (OR: 0.54, 95%CI: 0.36-0.81). Conversely, on the right side of the inflection point, a significant 28% increase in the prevalence of CHF was observed per unit increment in TyG (OR: 1.28, 95%CI: 1.04-1.56). CONCLUSIONS The findings from this study suggest a U-shaped correlation between TyG and CHF, indicating that both elevated and reduced levels of TyG are associated with an increased prevalence of CHF.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Nanchang of Jiangxi, Jiangxi Medical College, Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang of Jiangxi, Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Chao Yu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Nanchang of Jiangxi, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang of Jiangxi, Nanchang University, Nanchang, China.
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China.
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Ribeiro GJS, Moriguchi EH, Pinto AA. Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North. Healthcare (Basel) 2024; 12:951. [PMID: 38727508 PMCID: PMC11082983 DOI: 10.3390/healthcare12090951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach.
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Affiliation(s)
- Guilherme José Silva Ribeiro
- Graduate Program in Nutrition Science, Department of Nutrition, Federal University of Viçosa, Viçosa 36570-900, Brazil;
| | - Emilio Hideyuki Moriguchi
- Graduate Program in Cardiology and Cardiovascular Sciences, Department of Cardiology, Federal University of Rio Grande do Sul, Rio Grande do Sul 90010-150, Brazil;
| | - André Araújo Pinto
- Health Sciences Center, State University of Roraima, Roraima 69306-530, Brazil
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Yasin A, Nguyen M, Sidhu A, Majety P, Spitz J, Asgharpour A, Siddiqui MS, Sperling LS, Quyyumi AA, Mehta A. Liver and cardiovascular disease outcomes in metabolic syndrome and diabetic populations: Bi-directional opportunities to multiply preventive strategies. Diabetes Res Clin Pract 2024; 211:111650. [PMID: 38604447 DOI: 10.1016/j.diabres.2024.111650] [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: 08/09/2023] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
The incidence and prevalence of metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) are rising globally. MetS and T2DM are associated with significant morbidity and mortality, which is partly related to liver and cardiovascular disease. Insulin resistance is central to MetS and T2DM pathophysiology, and drives ectopic fat deposition in the liver, also known as metabolic dysfunction-associated steatotic liver disease (MASLD). MetS and T2DM are not only risk factors for developing MASLD but are also independently associated with disease progression to steatohepatitis, cirrhosis, and hepatocellular carcinoma. In addition to the risk of liver disease, MetS and T2DM are independent risk factors for cardiovascular disease (CVD), including coronary artery disease (CAD) and heart failure (HF). Importantly, there is a bidirectional relationship between liver and CVD due to shared disease pathophysiology in patients with MetS and T2DM. In this review, we have described studies exploring the relationship of MetS and T2DM with MASLD and CVD, independently. Following this we discuss studies evaluating the interplay between liver and cardiovascular risk as well as pragmatic risk mitigation strategies in this patient population.
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Affiliation(s)
| | | | - Angad Sidhu
- Virginia Commonwealth University, Richmond, VA, US
| | | | - Jared Spitz
- Inova Heart and Vascular Institute, Fairfax, VA, US
| | | | | | | | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Anurag Mehta
- Virginia Commonwealth University, Richmond, VA, US.
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Berezin AE, Berezina TA, Hoppe UC, Lichtenauer M, Berezin AA. Methods to predict heart failure in diabetes patients. Expert Rev Endocrinol Metab 2024; 19:241-256. [PMID: 38622891 DOI: 10.1080/17446651.2024.2342812] [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: 01/26/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is one of the leading causes of cardiovascular disease and powerful predictor for new-onset heart failure (HF). AREAS COVERED We focus on the relevant literature covering evidence of risk stratification based on imaging predictors and circulating biomarkers to optimize approaches to preventing HF in DM patients. EXPERT OPINION Multiple diagnostic algorithms based on echocardiographic parameters of cardiac remodeling including global longitudinal strain/strain rate are likely to be promising approach to justify individuals at higher risk of incident HF. Signature of cardiometabolic status may justify HF risk among T2DM individuals with low levels of natriuretic peptides, which preserve their significance in HF with clinical presentation. However, diagnostic and predictive values of conventional guideline-directed biomarker HF strategy may be non-optimal in patients with obesity and T2DM. Alternative biomarkers affecting cardiac fibrosis, inflammation, myopathy, and adipose tissue dysfunction are plausible tools for improving accuracy natriuretic peptides among T2DM patients at higher HF risk. In summary, risk identification and management of the patients with T2DM with established HF require conventional biomarkers monitoring, while the role of alternative biomarker approach among patients with multiple CV and metabolic risk factors appears to be plausible tool for improving clinical outcomes.
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Affiliation(s)
- Alexander E Berezin
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tetiana A Berezina
- VitaCenter, Department of Internal Medicine & Nephrology, Zaporozhye, Ukraine
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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Qiu S, Liu J, Chen J, Li Y, Bu T, Li Z, Zhang L, Sun W, Zhou T, Hu W, Yang G, Yuan L, Duan Y, Xing C. Targeted delivery of MerTK protein via cell membrane engineered nanoparticle enhances efferocytosis and attenuates atherosclerosis in diabetic ApoE -/- Mice. J Nanobiotechnology 2024; 22:178. [PMID: 38614985 PMCID: PMC11015613 DOI: 10.1186/s12951-024-02463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Clearance of apoptotic cells by efferocytosis is crucial for prevention of atherosclerosis progress, and impaired efferocytosis contributes to the aggravated atherosclerosis. RESULTS In this study, we found that diabetic ApoE-/- mice showed aggravated atherosclerosis as hyperglycemia damaged the efferocytosis capacity at least partially due to decreased expression of Mer tyrosine kinase (MerTK) on macrophages. To locally restore MerTK in the macrophages in the plaque, hybrid membrane nanovesicles (HMNVs) were thus developed. Briefly, cell membrane from MerTK overexpressing RAW264.7 cell and transferrin receptor (TfR) overexpressing HEK293T cell were mixed with DOPE polymers to produce nanovesicles designated as HMNVs. HMNVs could fuse with the recipient cell membrane and thus increased MerTK in diabetic macrophages, which in turn restored the efferocytosis capacity. Upon intravenous administration into diabetic ApoE-/- mice, superparamagnetic iron oxide nanoparticles (SMN) decorated HMNVs accumulated at the aorta site significantly under magnetic navigation, where the recipient macrophages cleared the apoptotic cells efficiently and thus decreased the inflammation. CONCLUSIONS Our study indicates that MerTK decrease in macrophages contributes to the aggravated atherosclerosis in diabetic ApoE-/- mice and regional restoration of MerTK in macrophages of the plaque via HMNVs could be a promising therapeutic approach.
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Affiliation(s)
- Shuo Qiu
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Jiahan Liu
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Jianmei Chen
- Department of Health Medicine, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yangni Li
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Te Bu
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Zhelong Li
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Liang Zhang
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Wenqi Sun
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Tian Zhou
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Wei Hu
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China
| | - Guodong Yang
- The State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
| | - Lijun Yuan
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China.
| | - Yunyou Duan
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China.
| | - Changyang Xing
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, No.569, Xinsi Road, Xi'an, 710038, China.
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Accorsi TAD, dos Santos GGR, Nemoto RP, Moreira FT, De Amicis K, Köhler KF, Cordioli E, Pedrotti CHS. Telemedicine and patients with heart failure: evidence and unresolved issues. EINSTEIN-SAO PAULO 2024; 22:eRW0393. [PMID: 38451690 PMCID: PMC10948100 DOI: 10.31744/einstein_journal/2024rw0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
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Affiliation(s)
| | | | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Patel R, Peesay T, Krishnan V, Wilcox J, Wilsbacher L, Khan SS. Prioritizing the primary prevention of heart failure: Measuring, modifying and monitoring risk. Prog Cardiovasc Dis 2024; 82:2-14. [PMID: 38272339 PMCID: PMC10947831 DOI: 10.1016/j.pcad.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/27/2024]
Abstract
With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.
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Affiliation(s)
- Ruchi Patel
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tejasvi Peesay
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vaishnavi Krishnan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Wilcox
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Wilsbacher
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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10
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Panchal K, Lawson C, Chandramouli C, Lam C, Khunti K, Zaccardi F. Diabetes and risk of heart failure in people with and without cardiovascular disease: systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 207:111054. [PMID: 38104900 DOI: 10.1016/j.diabres.2023.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND People with diabetes have an increased risk of heart failure (HF), compared to those without diabetes. However, no comprehensive systematic review and meta-analysis has explored whether these associations could differ in relation to prevalent cardiovascular disease (CVD). AIMS To estimate the association between diabetes and incident heart failure (HF), compared to without diabetes, in individuals with and without CVD. METHODS PubMed, Scopus, and Web of Science were searched for observational cohort studies from the earliest dates to 22nd March 2023. A random-effects model calculated the pooled relative risk (RR). RESULTS Of 11,609 articles, 31 and 6 studies reported data in people with type 2 diabetes (T2D) and type 1 diabetes (T1D) respectively. Individuals with T2D had an increased risk of HF irrespective of CVD prevalence: 1.61 (95% CI: 1.35-1.92) in those with CVD; 1.78 (1.60-1.99) without CVD; and 2.02 (1.75-2.33) with unspecified CVD prevalence. Meta-regression did not identify a significant difference comparing HF risk in T2D individuals with vs. without CVD (p = 0.232). CONCLUSION Peoplewith T2D, compared to those without diabetes, have similar increased risk of HF, regardless of CVD prevalence. Strategiesproven to lower HF risk in T2D individuals should be prioritized for those with and without CVD.
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Affiliation(s)
- Kajal Panchal
- University of Leicester, Leicester Diabetes Centre, UK.
| | - Claire Lawson
- University of Leicester, Department of Cardiovascular Sciences, UK.
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Upadhya B, Hegde S, Tannu M, Stacey RB, Kalogeropoulos A, Schocken DD. Preventing new-onset heart failure: Intervening at stage A. Am J Prev Cardiol 2023; 16:100609. [PMID: 37876857 PMCID: PMC10590769 DOI: 10.1016/j.ajpc.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023] Open
Abstract
Heart failure (HF) prevention is an urgent public health need with national and global implications. Stage A HF patients do not show HF symptoms or structural heart disease but are at risk of HF development. There are no unique recommendations on detecting Stage A patients. Patients in Stage A are heterogeneous; many patients have different combinations of risk factors and, therefore, have markedly different absolute risks for HF. Comprehensive strategies to prevent HF at Stage A include intensive blood pressure lowering, adequate glycemic and lipid management, and heart-healthy behaviors (adopting Life's Essential 8). First and foremost, it is imperative to improve public awareness of HF risk factors and implement healthy lifestyle choices very early. In addition, recognize the HF risk-enhancing factors, which are nontraditional cardiovascular (CV) risk factors that identify individuals at high risk for HF (genetic susceptibility for HF, atrial fibrillation, chronic kidney disease, chronic liver disease, chronic inflammatory disease, sleep-disordered breathing, adverse pregnancy outcomes, radiation therapy, a history of cardiotoxic chemotherapy exposure, and COVID-19). Early use of biomarkers, imaging markers, and echocardiography (noninvasive measures of subclinical systolic and diastolic dysfunction) may enhance risk prediction among individuals without established CV disease and prevent chemotherapy-induced cardiomyopathy. Efforts are needed to address social determinants of HF risk for primordial HF prevention.Central illustrationPolicies developed by organizations such as the American Heart Association, American College of Cardiology, and the American Diabetes Association to reduce CV disease events must go beyond secondary prevention and encompass primordial and primary prevention.
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Affiliation(s)
- Bharathi Upadhya
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Manasi Tannu
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - R. Brandon Stacey
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andreas Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Long Island, NY, USA
| | - Douglas D. Schocken
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Duan Y, Ye L, Shu Q, Huang Y, Zhang H, Zhang Q, Ding G, Deng Y, Li C, Yin L, Wang Y. Abnormal left ventricular systolic reserve function detected by treadmill exercise stress echocardiography in asymptomatic type 2 diabetes. Front Cardiovasc Med 2023; 10:1253440. [PMID: 37928757 PMCID: PMC10622805 DOI: 10.3389/fcvm.2023.1253440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Aims Subclinical left ventricular (LV) dysfunction may occur in T2DM patients at the early asymptomatic stage, and LV reserve function is a sensitive index to detect subtle LV dysfunction. The purpose of our study is (1) to assess the LV reserve function using treadmill exercise stress echocardiography (ESE) in asymptomatic type 2 diabetes mellitus (T2DM) patients; (2) to explore the link of serum biological parameters and LV reserve function. Methods This study included 84 patients with asymptomatic T2DM from September 2021 to July 2022 and 41 sex- and age-matched healthy controls during the corresponding period. All subjects completed treadmill ESE, LV systolic function-related parameters such as global longitudinal strain (GLS) and systolic strain rate (SRs), as well as diastolic function-related parameters such as E wave (E), early diastolic velocity (e'), E/e' ratio, early diastolic SR (SRe), and late diastolic SR (SRa) were compared at rest and immediately after exercise. The difference between LV functional parameters after treadmill exercise and its corresponding resting value was used to compute LV reserve function. In addition, the associations of LV reserve function and serum biological parameters were analyzed. Results Patients with T2DM did not significantly vary from the controls in terms of alterations in LV diastolic reserve measures, the changes of LVGLS and SRs (ΔGLS: 2.19 ± 2.72% vs. 4.13 ± 2.79%, P < 0.001 and ΔSRs:0.78 ± 0.33 s-1 vs. 1.02 ± 0.28 s-1, P < 0.001) in the T2DM group were both lower than those in the control group. Glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NTproBNP), waist circumference, and high-sensitive C-reactive protein (hsCRP) were identified as independent predictors of LV systolic reserve by stepwise multiple linear regression analysis. Conclusion LV systolic reserve function, as measured by pre- and post-exercise differences in GLS and SRs were significantly impaired in patients with asymptomatic T2DM, whereas diastolic reserve remained normal during exercise and was comparable to that of the control group. This was different from previous findings. High levels of HbA1c, NTproBNP, hsCRP, and increasing waist circumference were independent predictors of LV systolic reserve.
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Affiliation(s)
- Yuyou Duan
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Luwei Ye
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinglan Shu
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Huang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongmei Zhang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qingfeng Zhang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Geqi Ding
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Deng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Li
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Wang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Isiozor NM, Kunutsor SK, Laukkanen JA. A sour note: sweetened beverages linked to incident heart failure. Eur J Prev Cardiol 2023; 30:1359-1360. [PMID: 37279579 DOI: 10.1093/eurjpc/zwad190] [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] [Received: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Nzechukwu M Isiozor
- Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, Kuopio, 70211 Kuopio, Finland
| | - Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK
| | - Jari A Laukkanen
- Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, Kuopio, 70211 Kuopio, Finland
- Department of Internal Medicine, Wellbeing Services County of Central Finland, Jyvaskyla, Finland
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14
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Zhang W, Zhang R, Ling J, Tian T, Liu T, Dong J, Ruan Y. Time Series Analysis of the Acute Effect of Atmospheric Fine Particulate Matter on Hospitalization for Heart Failure in Lanzhou, China. J Occup Environ Med 2023; 65:711-716. [PMID: 37167930 DOI: 10.1097/jom.0000000000002878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the correlation between environmental PM 2.5 and heart failure (HF) hospitalization in Lanzhou, China. METHOD The correlation between atmospheric PM 2.5 and HF hospitalization was evaluated using a distributed lag nonlinear model. RESULT During the study period, 16,122 HF patients were hospitalized. The average concentration of PM 2.5 is 45.24 μg/m 3 . PM 2.5 was positively correlated with HF hospitalization with single lag (lag0) and cumulative lag (lag01, lag02, lag03). The maximum lag effect is estimated to occur in lag03, and with the PM 2.5 concentration increasing by 10 μg/m 3 , HF hospitalization risk increased by 1.023 (95% confidence interval, 1.006-1.039). The risk of hospitalization for HF in the male group, the age group 65 years or older, and the cold season was statistically significant and more positively correlated. CONCLUSION PM 2.5 exposure increases the risk of HF admission in Lanzhou.
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Affiliation(s)
- Wancheng Zhang
- From the School of Public Health, Lanzhou University, Lanzhou, PR China
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15
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Signori LU, Rubin Neto LJ, Jaenisch RB, Puntel GO, Nunes GS, Paulitsch FS, Hauck M, Silva AMVD. Effects of therapeutic ultrasound on the endothelial function of patients with type 2 diabetes mellitus. Braz J Med Biol Res 2023; 56:e12576. [PMID: 37377306 DOI: 10.1590/1414-431x2023e12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/01/2023] [Indexed: 06/29/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction that causes micro- and macrovascular complications. Low intensity therapeutic ultrasound (LITUS) may improve endothelial function, but its effects have not been investigated in these patients. The aim of our study was to compare the effects of pulsed (PUT) and continuous (CUT) waveforms of LITUS on the endothelium-dependent vasodilation of T2DM patients. The present randomized crossover trial had a sample of twenty-three patients (7 men) diagnosed with T2DM, 55.6 (±9.1) years old, with a body mass index of 28.6 (±3.3) kg/m2. All patients were randomized and submitted to different waveforms (Placebo, CUT, and PUT) of LITUS and the arterial endothelial function was evaluated. The LITUS of 1 MHz was applied in pulsed (PUT: 20% duty cycle, 0.08 W/cm2 SATA), continuous (CUT: 0.4 W/cm2 SPTA), and Placebo (equipment off) types of waves during 5 min on the brachial artery. Endothelial function was evaluated using the flow-mediated dilation (FMD) technique. PUT (mean difference 2.08%, 95% confidence interval 0.65 to 3.51) and CUT (mean difference 2.32%, 95% confidence interval 0.89 to 3.74) increased the %FMD compared to Placebo. In the effect size analysis, PUT (d=0.65) and CUT (d=0.65) waveforms presented moderate effects in the %FMD compared to Placebo. The vasodilator effect was similar in the different types of waves. Pulsed and continuous waveforms of LITUS of 1 MHz improved the arterial endothelial function in T2DM patients.
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Affiliation(s)
- L U Signori
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - L J Rubin Neto
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - R B Jaenisch
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - G O Puntel
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - G S Nunes
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - F S Paulitsch
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - M Hauck
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - A M V da Silva
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
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Qiu W, Cai A, Xiao X, Gao Z, Feng Y, Li L. Diabetes mellitus status modifies the association between N-terminal B-type natriuretic peptide and all-cause mortality risk in ischemic heart failure: a prospective cohort study. Diabetol Metab Syndr 2023; 15:72. [PMID: 37041629 PMCID: PMC10088130 DOI: 10.1186/s13098-023-01046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND N-terminal B-type natriuretic peptide (NT-proBNP) discriminates mortality risk in diabetes mellitus (DM) and in heart failure (HF) populations. Whether DM status modifies the association between NT-proBNP and all-cause mortality risk in ischemic HF is unknown. METHODS This was a single-center, prospective cohort study conducted with 2287 ischemic HF patients. Subjects were divided into with DM group and without DM group. Multivariate Cox proportional-hazards models were conducted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). The product of DM status and NT-proBNP were used to assess the interaction. Propensity score matching analysis was used to verify the robustness of the results. RESULTS Of 2287 ischemic HF participants, 1172 (51.2%) had DM. After a median follow-up of 3.19 years (7287 person-years), 479 (20.9%) of the participants died. After adjusting for the covariates, continuous NT-proBNP was more prominently associated with risk of mortality in HF patients with DM (HR: 1.65, 95% CI: 1.43-1.91) than those without (HR: 1.28, 95% CI: 1.09-1.50). A significant interaction of DM status and NT-proBNP was observed (P-interaction = 0.016). The relationships were consistent when NT-proBNP was considered as a categorical variable and in the propensity matching analysis. CONCLUSIONS DM status modified the association between NT-proBNP and all-cause mortality in ischemic HF patients, suggesting that NT-proBNP was more prominently associated with risk of mortality in patients with DM than those without. Future studies to clarify the mechanisms underlying these observations are needed.
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Affiliation(s)
- Weida Qiu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xiaoju Xiao
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhiping Gao
- Concord medical center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Guangdong Provincial People's Hospital, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Liwen Li
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Guangdong Provincial People's Hospital, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Arshadipour A, Thorand B, Linkohr B, Ladwig KH, Heier M, Peters A. Multimorbidity patterns and mortality in older adults: Results from the KORA-Age study. Front Nutr 2023; 10:1146442. [PMID: 37051131 PMCID: PMC10083328 DOI: 10.3389/fnut.2023.1146442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
The coexistence of several chronic diseases is very common in older adults, making it crucial to understand multimorbidity (MM) patterns and associated mortality. We aimed to determine the prevalence of MM and common chronic disease combinations, as well as their impact on mortality in men and women aged 65 years and older using the population-based KORA-Age study, based in South of Germany. The chronic disease status of the participants was determined in 2008/9, and mortality status was followed up until 2016. MM was defined as having at least two chronic diseases. We used Cox proportional hazard models to calculate the hazard ratios (HRs) and the 95% confidence intervals (CIs) for associations between MM and all-cause mortality. During the study period 495 men (24.6%) and 368 women (17.4%) died. Although the MM prevalence was almost the same in men (57.7%) and women (60.0%), the overall effect of MM on mortality was higher in men (HR: 1.81, 95% CI: 1.47–2.24) than in women (HR: 1.28, 95% CI: 1.01–1.64; p-value for interaction <0.001). The type of disease included in the MM patterns had a significant impact on mortality risk. For example, when both heart disease and diabetes were included in the combinations of two and three diseases, the mortality risk was highest. The risk of premature death does not only depend on the number of diseases but also on the specific disease combinations. In this study, life expectancy depended strongly on a few diseases, such as diabetes, hypertension, and heart disease.
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Affiliation(s)
- Ava Arshadipour
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Medical Information Processing Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
- *Correspondence: Ava Arshadipour, ;
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Karl-Heinz Ladwig
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, Technical University of München, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Medical Information Processing Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich, Germany
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The Impact of SGLT2 Inhibitor Dapagliflozin on Adropin Serum Levels in Men and Women with Type 2 Diabetes Mellitus and Chronic Heart Failure. Biomedicines 2023; 11:biomedicines11020457. [PMID: 36830993 PMCID: PMC9953100 DOI: 10.3390/biomedicines11020457] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND adropin plays a protective role in cardiac remodeling through supporting energy metabolism and water homeostasis and suppressing inflammation. Low circulating levels of adropin were positively associated with the risk of cardiovascular diseases and type 2 diabetes mellitus (T2DM). We hypothesized that sodium-glucose linked transporter 2 (SGLT2) inhibitor dapagliflosin might represent cardiac protective effects in T2DM patients with known chronic HF through the modulation of adropin levels. METHODS we prospectively enrolled 417 patients with T2DM and HF from an entire cohort of 612 T2DM patients. All eligible patients were treated with the recommended guided HF therapy according to their HF phenotypes, including SGLT2 inhibitor dapagliflozin 10 mg, daily, orally. Anthropometry, clinical data, echocardiography/Doppler examinations, and measurements of biomarkers were performed at the baseline and over a 6-month interval of SGLT2 inhibitor administration. RESULTS in the entire group, dapagliflozin led to an increase in adropin levels by up to 26.6% over 6 months. In the female subgroup, the relative growth (Δ%) of adropin concentrations was sufficiently higher (Δ% = 35.6%) than that in the male subgroup (Δ% = 22.7%). A multivariate linear regression analysis of the entire group showed that the relative changes (Δ) in the left ventricular (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and E/e' were significantly associated with increased adropin levels. In the female subgroup, but not in the male subgroup, ΔLVEF (p = 0.046), ΔLAVI (p = 0.001), and ΔE/e' (p = 0.001) were independent predictive values for adropin changes. CONCLUSION the levels of adropin seem to be a predictor for the favorable modification of hemodynamic performances during SGLT2 inhibition, independent ofN-terminal brain natriuretic pro-peptide levels.
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Liu J, Liu S, Yu Z, Qiu X, Jiang R, Li W. Uncovering the gene regulatory network of type 2 diabetes through multi-omic data integration. J Transl Med 2022; 20:604. [PMID: 36527108 PMCID: PMC9756634 DOI: 10.1186/s12967-022-03826-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) onset is a complex, organized biological process with multilevel regulation, and its physiopathological mechanisms are yet to be elucidated. This study aims to find out the key drivers and pathways involved in the pathogenesis of T2D through multi-omics analysis. METHODS The datasets used in the experiments comprise three groups: (1) genomic (2) transcriptomic, and (3) epigenomic categories. Then, a series of bioinformatics technologies including Marker set enrichment analysis (MSEA), weighted key driver analysis (wKDA) was performed to identify key drivers. The hub genes were further verified by the Receiver Operator Characteristic (ROC) Curve analysis, proteomic analysis, and Real-time quantitative polymerase chain reaction (RT-qPCR). The multi-omics network was applied to the Pharmomics pipeline in Mergeomics to identify drug candidates for T2D treatment. Then, we used the drug-gene interaction network to conduct network pharmacological analysis. Besides, molecular docking was performed using AutoDock/Vina, a computational docking program. RESULTS Module-gene interaction network was constructed using MSEA, which revealed a significant enrichment of immune-related activities and glucose metabolism. Top 10 key drivers (PSMB9, COL1A1, COL4A1, HLA-DQB1, COL3A1, IRF7, COL5A1, CD74, HLA-DQA1, and HLA-DRB1) were selected by wKDA analysis. Among these, COL5A1, IRF7, CD74, and HLA-DRB1 were verified to have the capability to diagnose T2D, and expression levels of PSMB9 and CD74 had significantly higher in T2D patients. We further predict the co-expression network and transcription factor (TF) binding specificity of the key driver. Besides, based on module interaction networks and key driver networks, 17 compounds are considered to possess T2D-control potential, such as sunitinib. CONCLUSIONS We identified signature genes, biomolecular processes, and pathways using multi-omics networks. Moreover, our computational network analysis revealed potential novel strategies for pharmacologic interventions of T2D.
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Affiliation(s)
- Jiachen Liu
- Department of General Surgery, Third Xiangya Hospital Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
- Xiangya Medical College, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
- The Center of Systems Biology and Data science, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Shenghua Liu
- Department of General Surgery, Third Xiangya Hospital Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
- Xiangya Medical College, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
| | - Zhaomei Yu
- Department of Thyroid and Breast Surgery, The Frist Afflicted Hospital of Fujian Medical University, No. 20 Chayzhong Road, Taijiang District, Fuzhou, 350005, Fujian, People's Republic of China
| | - Xiaorui Qiu
- Xiangya Medical College, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
| | - Rundong Jiang
- Department of General Surgery, Third Xiangya Hospital Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital Central South University, No. 138 Tongzipo Road Yuelu District, Changsha, 410013, Hunan, People's Republic of China.
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Debik J, Isaksen SH, Strømmen M, Spraul M, Schäfer H, Bathen TF, Giskeødegård GF. Effect of Delayed Centrifugation on the Levels of NMR-Measured Lipoproteins and Metabolites in Plasma and Serum Samples. Anal Chem 2022; 94:17003-17010. [PMID: 36454175 DOI: 10.1021/acs.analchem.2c02167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Metabolic profiling is widely used for large-scale association studies, based on biobank material. The main obstacle to the translation of metabolomic findings into clinical application is the lack of standardization, making validation in independent cohorts challenging. One reason for this is sensitivity of metabolites to preanalytical conditions. We present a systematic investigation of the effect of delayed centrifugation on the levels of NMR-measured metabolites and lipoproteins in serum and plasma samples. Blood was collected from 20 anonymous donors, of which 10 were recruited from an obesity clinic. Samples were stored at room temperature until centrifugation after 30 min, 1, 2, 4, or 8 h, which is within a realistic time scenario in clinical practice. The effect of delaying centrifugation on plasma and serum metabolic concentrations, and on concentrations of lipoprotein subfractions, was investigated. Our results show that lipoproteins are only minimally affected by a delay in centrifugation while metabolite levels are more sensitive to a delay. Metabolites significantly increased or decreased in concentration depending on delay duration. Further, we describe differences in the stability of serum and plasma, showing that plasma is more stable for metabolites, while lipoprotein subfractions are equally stable for both types of matrices.
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Affiliation(s)
- Julia Debik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway.,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Sylvia Hetlelid Isaksen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim 7030, Norway.,The Clinical Research Ward, Department for Research and Development, St. Olavs Hospital, Trondheim University Hospital, Trondheim 7030, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Manfred Spraul
- Bruker BioSpin AIC Division, Ettlingen, Rheinstetten 76287, Germany
| | - Hartmut Schäfer
- Bruker BioSpin AIC Division, Ettlingen, Rheinstetten 76287, Germany
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim 7030, Norway
| | - Guro F Giskeødegård
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim 7491, Norway.,Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim 7030, Norway
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Li FR, Hukportie DN, Yang J, Yang HH, Chen GC, Wu XB. Microvascular Burden and Incident Heart Failure Among Middle-Aged and Older Adults With Type 1 or Type 2 Diabetes. Diabetes Care 2022; 45:2999-3006. [PMID: 35944243 DOI: 10.2337/dc22-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between microvascular disease (MVD) and risk of heart failure (HF) among individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We included 1,713 and 28,624 participants with T1DM and T2DM, respectively, from the UK Biobank who were free of HF during enrollment. MVD burden reflected by the presence of retinopathy, peripheral neuropathy, and chronic kidney disease (CKD) at baseline was prospectively evaluated for the association with incidence of HF. Hazard ratios (HRs) and 95% CIs of HF were estimated by Cox regression models adjusted for multiple traditional risk factors. RESULTS There were 145 and 2,515 incident cases of HF recorded among participants with T1DM and T2DM, respectively, during a median follow-up of 11.5 years. The association between the number of MVD and HF was stronger among participants with T1DM than among those with T2DM (P for interaction <0.001). Compared with participants with no MVD, those with all three MVD had an adjusted HR (95% CI) of 11.37 (5.62, 22.99) in T1DM and 3.66 (2.74, 4.88) in T2DM. In T1DM, HRs (CIs) were 2.69 (1.75, 4.14) for retinopathy, 2.11 (1.38, 3.23) for peripheral neuropathy, and 2.21 (1.53, 3.18) for CKD. The corresponding estimates in T2DM were 1.24 (1.13, 1.36), 1.63 (1.36, 1.96), and 1.73 (1.59, 1.89), respectively. CONCLUSIONS While a heavier burden of MVD was associated with excess risk of HF both in T1DM and T2DM, the association was evidently more pronounced in T1DM.
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Affiliation(s)
- Fu-Rong Li
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China.,Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.,School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jing Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.,Department of Clinical Nutrition, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huan-Huan Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
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22
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Sugar-Sweetened Coffee Intake and Blood Glucose Management in Korean Patients with Diabetes Mellitus. Metabolites 2022; 12:metabo12121177. [PMID: 36557215 PMCID: PMC9782232 DOI: 10.3390/metabo12121177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
One of the most frequently consumed beverages by Korean adults is 3-in-1 coffee (mixed coffee) with sugar and creamer. Hence, understanding the effect of sugar-sweetened coffee (SSC) consumption on blood sugar levels in patients with diabetes mellitus (DM) is important. This study was conducted using the Korea National Health and Nutrition Examination Survey data from 2008 to 2020. In total, 5671 patients with DM were included in the analysis. Coffee consumption patterns were assessed using a 24 h recall. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were used to evaluate whether patients reached the glycemic control targets defined by the Korean Diabetes Association. In total, 46.57% of patients with DM included in this analysis consumed SSC. Patients who frequently consumed SSC had significantly higher FBG and HbA1c levels than those who did not (both p for trend <0.01). In a multivariate logistic regression model, the odds ratios of not achieving the target FBG and HbA1c levels were 1.24 (95% confidence interval [CI]: 1.03−1.48, p for trend = 0.01) and 1.29 (95% CI: 1.05−1.58, p for trend = 0.009), respectively. Frequent consumption of SSC can cause difficulty in FBG and HbA1c management in patients with DM.
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23
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Echouffo Tcheugui JB, Guan J, Fu L, Retnakaran R, Shah BR. Association of Concomitant Gestational Hypertensive Disorders and Gestational Diabetes With Cardiovascular Disease. JAMA Netw Open 2022; 5:e2243618. [PMID: 36416822 PMCID: PMC9685489 DOI: 10.1001/jamanetworkopen.2022.43618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Accruing evidence suggests that gestational hypertensive disorders (GHTD) and gestational diabetes (GD) are each associated with an increased risk of cardiovascular disease (CVD). However, the extent to which the co-occurrence of GHTD and GD is associated with the risk of CVD remains largely unknown. OBJECTIVE To estimate the individual and joint associations of GHTD and GD with incident CVD. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. All women in Ontario with a GHTD and/or GD diagnosis, and a live-birth singleton delivery between July 1, 2007, and March 31, 2018, were considered for inclusion. Women with pregravid diabetes, hypertension, or cardiovascular disease were excluded. Statistical analysis was performed from November 2021 to September 2022. EXPOSURES GD and/or GHTD, defined using diagnosis coding. MAIN OUTCOMES AND MEASURES Individual and joint associations of GHTD and GD with incident CVD (including a composite of myocardial infarction, acute coronary syndrome, stroke, coronary artery bypass grafting, percutaneous coronary intervention, or carotid endarterectomy), estimated using Cox regression models, adjusting for relevant cardiometabolic risk factors. The follow-up extended from the index pregnancy until March 31, 2020. RESULTS Among 886 295 eligible women (mean [SD] age, 30 [5.6] years; 43 861 [4.9%] with isolated GHTD, 54 061 [6.1%] with isolated GD, and 4975 [0.6%] with GHTD and GD), there were 1999 CVD events over 12 years of follow-up. In the early postpartum phase (first 5 years post partum), there was no association of co-occurrence of GTHD and GD (adjusted hazard ratio [aHR], 1.42, 95% CI, 0.78-2.58) or GD alone (aHR, 0.80; 95% CI, 0.60-1.06) with CVD; there was an association between isolated GTHD and incident CVD compared with no GTHD and no GD (aHR, 1.90; 95% CI, 1.51-2.35). In the late postpartum period (after the initial 5 years post partum), compared with no GD and no GHTD, isolated GHTD (aHR, 1.41, 95% CI, 1.12-1.76) and co-occurrence of GHTD and GD (aHR, 2.43, 95% CI, 1.60-3.67) were each associated with a higher risk of incident CVD. There was no association between isolated GD and incident CVD. CONCLUSIONS AND RELEVANCE In this cohort study, GHTD was associated with a high risk of CVD post partum, and the co-occurrence of GD and GHTD was associated with a much greater postpartum CVD risk. These findings suggest that CVD preventive care is particularly needed in the aftermath of combined GD and GHTD.
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Affiliation(s)
- Justin B. Echouffo Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R. Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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24
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Echouffo-Tcheugui JB, Ogunmoroti O, Golden SH, Bertoni AG, Mongraw-Chaffin M, Pandey A, Ndumele CE, Michos ED. Glycemic Markers and Heart Failure Subtypes: The Multi-Ethnic Study of Atherosclerosis (MESA). J Card Fail 2022; 28:1593-1603. [PMID: 35114382 PMCID: PMC9339035 DOI: 10.1016/j.cardfail.2022.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although diabetes increases heart failure (HF) risk, it is unclear how various dysglycemia markers (hemoglobin A1C [HbA1C], fasting plasma glucose [FPG], homeostasis model assessment of insulin resistance, and fasting insulin) are associated with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]). We assessed the relation of markers of dysglycemia and risks of HFpEF and HFrEF. METHODS AND RESULTS We included 6688 adults without prevalent cardiovascular disease who attended the first MESA visit (2000-2002) and were followed for incident hospitalized HF (HFpEF or HFrEF). Association of glycemic markers and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF were evaluated using adjusted Cox models. Over a median follow-up of 14.9 years, there were 356 HF events (145 HFpEF, 173 HFrEF, and 38 indeterminate HF events). Diabetes status conferred higher risks of HFpEF (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.57-2.68) and HFrEF (HR 2.02, 95% CI 1.38-2.97) compared with normoglycemia. Higher levels of FPG (≥126 mg/dL) and HbA1C (≥6.5%) were associated with similarly higher risks of HFpEF (HR for FPG 1.96, 95% CI 1.21-3.17; HR for HbA1C 2.00, 95% CI 1.20-3.31) and HFrEF (HR for FPG 1.84, 95% CI 1.18-2.88; HR for HbA1C 1.99, 95% CI 1.28-3.09) compared with reference values. Prediabetic range HbA1C (5.7%-6.4%) or FPG (100%-125 mg/dL), homeostasis model assessment of insulin resistance, and fasting insulin were not significantly associated with HFpEF or HFrEF. CONCLUSIONS Among community-dwelling individuals, HbA1C and FPG in the diabetes range were each associated with higher risks of HFpEF and HFrEF, with similar magnitudes of their associations. LAY ABSTRACT Heart failure (HF) has 2 major subtypes (the heart's inability to pump or to fill up). Diabetes is known to increase HF risk, but its effects and that of markers of high glucose levels (fasting blood glucose and hemoglobin A1C) on the occurrence of HF subtypes remains unknown. Among 6688 adults without known cardiovascular disease followed for nearly 15 years, diabetes conferred significantly higher risks of both HF types, compared with those with normal blood glucose levels. Higher levels of fasting blood glucose and hemoglobin A1C were similarly associated with higher risks of both types of HF.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- From the Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Oluseye Ogunmoroti
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sherita H Golden
- From the Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alain G Bertoni
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ambarish Pandey
- The Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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25
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Heart Failure and Diabetes Mellitus: Dangerous Liaisons. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:163-174. [PMID: 36381018 PMCID: PMC9634025 DOI: 10.36628/ijhf.2022.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 01/25/2023]
Abstract
Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40% of HF patients have DM, having poorer outcomes than those without DM. Myocardial ischemia caused by endothelial dysfunction, renal dysfunction, obesity, and impaired myocardial energetics is pathophysiology of DM-induced HF (DM-HF). Also, patients with HF show an increased risk for the onset of DM due to several mechanisms including insulin resistance. This review is focused on the epidemiology, pathogenic mechanism and treatment strategy of DM-HF.
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26
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Hamo CE, Echouffo-Tcheugui JB, Zhang S, Florido R, Pankow JS, Michos ED, Goldberg R, Nambi V, Gerstenblith G, Post WS, Blumenthal RS, Ballantyne C, Selvin E, Coresh J, Ndumele CE. Diabetes Duration and Subclinical Myocardial Injury: The Atherosclerosis Risk in Communities Study (ARIC). Clin Chem 2022; 68:1272-1280. [PMID: 35904048 PMCID: PMC9766881 DOI: 10.1093/clinchem/hvac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Diabetes exerts adverse effects on the heart, and a longer diabetes duration is associated with greater heart failure risk. We studied diabetes duration and subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin (hs-cTnT). METHODS We analyzed 9052 participants without heart failure or coronary heart disease (mean age 63 years, 58% female, 21% Black, 15% with diabetes) at The Atherosclerosis Risk in Communities Study (ARIC) Visit 4 (1996 to 1998). Diabetes duration was calculated based on diabetes status at Visits 1 (1987 to 1989) through 4, or using self-reported age of diabetes diagnosis prior to Visit 1. We used multinomial logistic regression to determine the association of diabetes duration with increased (≥14 ng/L) or detectable (≥6 ng/L) Visit 4 hs-cTnT, relative to undetectable hs-cTnT, adjusted for demographics and cardiovascular risk factors. RESULTS The prevalence of increased Visit 4 hs-cTnT was higher in persons with longer diabetes duration, from 12% for those with diabetes 0 to <5 years up to 31% among those with diabetes for ≥15 years (P for trend <0.0001). New onset diabetes at Visit 4 was associated with 1.92× higher relative risk (95% CI, 1.27-2.91) of increased hs-cTnT than no diabetes. Longer diabetes duration was associated with greater myocardial injury, with duration ≥15 years associated with 9.29× higher risk (95% CI, 5.65-15.29) for increased hs-cTnT and 2.07× (95% CI, 1.24-3.16) for detectable hs-cTnT, compared to no diabetes. CONCLUSIONS Longer diabetes duration is strongly associated with subclinical myocardial injury. Interventional studies are needed to assess whether the prevention and delay of diabetes onset can mitigate early myocardial damage.
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Affiliation(s)
- Carine E. Hamo
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sui Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roberta Florido
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronald Goldberg
- Division of Endocrinology, University of Miami, Miami, FL, USA
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital, Houston TX, USA
- Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Gary Gerstenblith
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Christie Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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27
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Hu P, Zheng M, Duan X, Zhou H, Huang J, Lao L, Zhao Y, Li Y, Xue M, Zhao W, Deng H, Liu X. Association of healthy lifestyles on the risk of hypertension, type 2 diabetes mellitus, and their comorbidity among subjects with dyslipidemia. Front Nutr 2022; 9:1006379. [PMID: 36225875 PMCID: PMC9550234 DOI: 10.3389/fnut.2022.1006379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to a healthy lifestyle could reduce the risk of hypertension and diabetes in general populations; however, whether the associations exist in subjects with dyslipidemia remains unclear. This study aimed to investigate the integrated effect of lifestyle factors on the risk of hypertension, type 2 diabetes mellitus (T2DM), and their comorbidity among subjects with dyslipidemia. Methods In total of 9,339 subjects with dyslipidemia were recruited from the baseline survey of the Guangzhou Heart Study. A questionnaire survey and medical examination were performed. The healthy lifestyle score (HLS) was derived from five factors: smoking, alcohol drinking, diet, body mass index, and leisure-time physical activity. Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated by using the logistic regression model and the multinomial logistic regression after adjusting for confounders. Results The prevalence of hypertension, T2DM, and their comorbidity was 47.65, 16.02, and 10.10%, respectively. Subjects with a higher HLS were associated with a lower risk of hypertension, T2DM, and their comorbidity. In comparison to the subjects with 0–2 HLS, the adjusted ORs for subjects with five HLS was 0.48 (95% CI: 0.40–0.57) and 0.67 (95% CI: 0.54–0.84) for hypertension and T2DM. Compared with subjects with 0-2 HLS and neither hypertension nor T2DM, those with five HLS had a lower risk of suffering from only one disease (OR: 0.48, 95% CI: 0.40–0.57) and their comorbidity (OR: 0.35, 95% CI: 0.26–0.47). Conclusions The results suggest that the more kinds of healthy lifestyle, the lower the risk of hypertension, T2DM, and their comorbidity among subjects with dyslipidemia. Preventive strategies incorporating lifestyle factors may provide a more feasible approach for the prevention of main chronic diseases.
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Affiliation(s)
- Peng Hu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Murui Zheng
- Department of Community Health, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xueru Duan
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Huanning Zhou
- Department of Chronic Disease, Guangzhou Yuexiu District Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Huang
- Department of Geriatrics, Institute of Geriatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Lixian Lao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yue Zhao
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yi Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meng Xue
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
- *Correspondence: Wenjing Zhao
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
- Hai Deng
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Xudong Liu
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28
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Yasmin F, Aamir M, Moeed A, Iqbal K, Iqbal A, Asghar MS, Ullah W, Rajapreyar I, Brailovsky Y. Causes and Predictors of Heart Failure Hospitalizations Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2022; 48:101428. [DOI: 10.1016/j.cpcardiol.2022.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
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29
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Chang YK, Fan HC, Lin CC, Wang YH, Tsai WN, Lim PS. Association between atrial fibrillation and risk of end-stage renal disease among adults with diabetes mellitus. PLoS One 2022; 17:e0273646. [PMID: 36026496 PMCID: PMC9417190 DOI: 10.1371/journal.pone.0273646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes mellitus (DM) is an important risk factor in patients with end-stage renal disease (ESRD). DM is associated with the development of cardiovascular diseases, such as atrial fibrillation (AF), due to poor glycemic control. However, few studies have focused on the risk of developing ESRD among DM patients with and without AF. This study evaluated ESRD risk among DM patients with and without AF in Taiwan. Data were retrieved from one million patients randomly sampled from Taiwan’s National Health Insurance Research Database, including 6,105 DM patients with AF propensity score–matched with 6,105 DM patients without AF. Both groups were followed until death, any dialysis treatment, or December 31, 2013, whichever occurred first. AF was diagnosed by a qualified physician according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), using the diagnostic code 427.31. Patients aged <20 years or diagnosed with ESRD before the index date were excluded. A Cox proportional hazard regression model was used to calculate the relative ESRD risk. Among DM patients, those with AF have more comorbidities than those without AF. We also found a 1.18-fold (95% confidence interval [CI]: 1.01–1.46) increase in ESRD risk among patients with AF compared with those without AF. In addition, DM patients with hypertension, chronic kidney disease (CKD), or higher Charlson Comorbidity Index scores also have significantly increased ESRD risks than those without these complications. A 1.39-fold (95% CI: 1.04–1.86) increase in risk was observed for patients with AF among the non-CKD group. Our findings suggest that patients with DM should be closely monitored for irregular or rapid heart rates.
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Affiliation(s)
- Yu-Kang Chang
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
- Department of Rehabilitation, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chi-Chien Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Science, iEGG and Animal Biotechnology Center, National Chung-Hsing University, Taichung, Taiwan
| | - Yuan-Hung Wang
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New City, Taiwan
| | - Wan-Ni Tsai
- Department of Endocrinology and Metabolism, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Paik-Seong Lim
- Division of Renal Medicine, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
- * E-mail:
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30
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Bundgaard J, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study. Nutr Metab Cardiovasc Dis 2022; 32:1880-1885. [PMID: 35752540 DOI: 10.1016/j.numecd.2022.05.003] [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: 08/19/2021] [Revised: 05/01/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM Heart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM. METHODS AND RESULTS Patients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis. CONCLUSION Patients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.
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Affiliation(s)
- Johan Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
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31
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Kilpatrick ES. Cardiac Troponin as a Marker of Heart Failure Risk in Diabetes. Clin Chem 2022; 68:1232-1234. [PMID: 35897125 DOI: 10.1093/clinchem/hvac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Eric S Kilpatrick
- Department of Clinical Biochemistry, Manchester Royal Infirmary, Manchester, UK
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The Effect of SGLT2 Inhibitor Dapagliflozin on Serum Levels of Apelin in T2DM Patients with Heart Failure. Biomedicines 2022; 10:biomedicines10071751. [PMID: 35885056 PMCID: PMC9313111 DOI: 10.3390/biomedicines10071751] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Apelin is a multifunctional peptide that plays a pivotal role in cardiac remodeling and HF manifestation because of counteracting angiotensin-II. We hypothesized that positive influence of sodium-glucose co-transporter-2 (SGLT2) inhibitor on cardiac function in T2DM patients with HF might be mediated by apelin and that its levels seem to be a target of management. A total of 153 type 2 diabetes mellitus (T2DM) patients with II/III HF NYHA class and average left ventricular (LV) ejection fraction (EF) of 46% have been enrolled and treated with dapagliflosin. The serum levels of apelin and N-terminal brain natriuretic pro-peptide (NT-proBNP) were measured at baseline and over a 6-month period of dapagliflosin administration. We noticed that administration of dapagliflozin was associated with a significant increase in apelin levels of up to 18.3% and a decrease in NT-proBNP of up to 41.0%. Multivariate logistic regression showed that relative changes of LVEF, LA volume index, and early diastolic blood filling to longitudinal strain ratio were strongly associated with the levels of apelin, whereas NT-proBNP exhibited a borderline significance in this matter. In conclusion, dapagiflosin exerted a positive impact on echocardiographic parameters in close association with an increase in serum apelin levels, which could be a surrogate target for HF management.
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Seferović P, Farmakis D, Bayes-Genis A, Ben Gal T, Böhm M, Chioncel O, Ferrari R, Filippatos G, Hill L, Jankowska E, Lainscak M, Lopatin Y, Lund LH, Mebazaa A, Metra M, Moura B, Rosano G, Thum T, Voors A, Coats AJS. Biomarkers for the prediction of heart failure and cardiovascular events in patients with type 2 diabetes: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:1162-1170. [PMID: 35703329 DOI: 10.1002/ejhf.2575] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
Knowledge on risk predictors of incident heart failure (HF) in patients with type 2 diabetes (T2D) is crucial given the frequent coexistence of the two conditions and the fact that T2D doubles the risk of incident HF. In addition, HF is increasingly being recognized as an important endpoint in trials in T2D. On the other hand, the diagnostic and prognostic performance of established cardiovascular biomarkers may be modified by the presence of T2D. The present position paper, derived by an expert panel workshop organized by the Heart Failure Association of the European Society of Cardiology, summarizes the current knowledge and gaps in evidence regarding the use of a series of different biomarkers, reflecting various pathogenic pathways, for the prediction of incident HF and cardiovascular events in patients with T2D and in those with established HF and T2D.
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Affiliation(s)
- Peter Seferović
- Faculty of Medicine, University of Belgrade Belgrade, Serbia and Serbian Academy of Sciences and Arts, Belgrade, Serbia.,University of Belgrade Belgrade, Belgrade, Serbia
| | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari German Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud, Madrid, Spain
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, and University of Medicine Carol Davila, Bucharest, Romania
| | - Roberto Ferrari
- Maria Cecilia Hospital, GVM Care & Research, Ravenna, Italy.,Laboratory for Technologies of Advanced Therapies (LTTA), Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gerasimos Filippatos
- Second Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrina University of Athens Medical School, Athens, Greece
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Ewa Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd, Volgograd, Russian Federation
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Paris, France; Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Brenda Moura
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas - Pólo do Porto, Porto, Portugal
| | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Adriaan Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Echouffo-Tcheugui JB, Ndumele CE, Zhang S, Florido R, Matsushita K, Coresh J, Skali H, Shah AM, Selvin E. Diabetes and Progression of Heart Failure: The Atherosclerosis Risk In Communities (ARIC) Study. J Am Coll Cardiol 2022; 79:2285-2293. [PMID: 35680178 PMCID: PMC10125541 DOI: 10.1016/j.jacc.2022.03.378] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The influence of diabetes on progression from preclinical heart failure (HF) stages to overt HF is poorly understood. OBJECTIVES The purpose of this study was to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF. METHODS We included 4,774 adults with preclinical HF (stage A [n = 1,551] or B [n = 3,223]) who attended the ARIC (Atherosclerosis Risk In Communities) study Visit 5 (2011-2013). Within each stage (A or B), we assessed the associations of diabetes and glycemic control (hemoglobin A1C [HbA1C] <7% vs ≥7%) with progression to HF, and of cross-categories of HF stages (A vs B), diabetes, and glycemic control with incident HF. RESULTS Among the participants (mean age 75.4 years, 58% women, 20% Black), there were 470 HF events during 8.6 years of follow-up. Stage B participants with HbA1C ≥7% experienced clinical HF at a younger age than those with controlled diabetes or without diabetes (mean age 80 years vs 83 years vs 82 years; P < 0.001). HbA1C ≥7% was more strongly associated with HF in stage B (HR: 1.83; 95% CI: 1.33-2.51) compared with stage A (HR: 1.52; 95% CI: 0.53-4.38). In cross-categories of preclinical HF stage and HbA1C, participants with stage B and HbA1C ≥7% had increased risk of HF progression compared with stage A without diabetes (HR: 7.56; 95% CI: 4.68-12.20). CONCLUSIONS Among older adults with preclinical HF stages, uncontrolled diabetes was associated with substantial risk of HF progression. Our results suggest that targeting diabetes early in the HF process is critical.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roberta Florido
- Division of Cardiology, Department of Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Division of Cardiology, Department of Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lind V, Hammar N, Lundman P, Friberg L, Talbäck M, Walldius G, Norhammar A. Impaired fasting glucose: a risk factor for atrial fibrillation and heart failure. Cardiovasc Diabetol 2021. [PMID: 34819087 DOI: 10.1186/s12933-021-01422-3/figures/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Dysglycaemia is associated with overall cardiovascular disease even at prediabetes levels. The aim of this study was to explore the association between glucose levels and future risk of developing atrial fibrillation and heart failure, respectively. METHODS In this prospective cohort study subjects from the Swedish AMORIS-cohort with fasting glucose from health examinations 1985-1996 without previous cardiovascular disease (N = 294,057) were followed to 31 December 2011 for incident atrial fibrillation or heart failure. Cox proportional hazard models with attained age as timescale and adjustments for sex, cholesterol, triglycerides, and socioeconomic status were used to estimate hazard ratios by glucose categorized groups (normal glucose 3.9-6.0 mmol/L, impaired fasting glucose; 6.1-6.9 mmol/L, undiagnosed diabetes ≥ 7.0 mmol/L, and diagnosed diabetes). RESULTS During a mean follow-up time of 19.1 years 28,233 individuals developed atrial fibrillation and 25,604 developed heart failure. The HR for atrial fibrillation was 1.19 (95% confidence interval 1.13-1.26) for impaired fasting glucose, 1.23 (1.15-1.32) for undiagnosed diabetes and 1.30 (1.21-1.41) for diagnosed diabetes. Corresponding figures for heart failure were; 1.40 (1.33-1.48), 2.11 (1.99-2.23), 2.22 (2.08-2.36) respectively. In a subset with BMI data (19%), these associations were attenuated and for atrial fibrillation only remained statistically significant among subjects with diagnosed diabetes (HR 1.25; 1.02-1.53). CONCLUSIONS Fasting glucose at prediabetes levels is associated with development of atrial fibrillation and heart failure. To some extent increased BMI may drive this association.
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Affiliation(s)
- Viktor Lind
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.,Capio S:T Görans Hospital, Stockholm, Sweden
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36
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Lind V, Hammar N, Lundman P, Friberg L, Talbäck M, Walldius G, Norhammar A. Impaired fasting glucose: a risk factor for atrial fibrillation and heart failure. Cardiovasc Diabetol 2021; 20:227. [PMID: 34819087 PMCID: PMC8614025 DOI: 10.1186/s12933-021-01422-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dysglycaemia is associated with overall cardiovascular disease even at prediabetes levels. The aim of this study was to explore the association between glucose levels and future risk of developing atrial fibrillation and heart failure, respectively. METHODS In this prospective cohort study subjects from the Swedish AMORIS-cohort with fasting glucose from health examinations 1985-1996 without previous cardiovascular disease (N = 294,057) were followed to 31 December 2011 for incident atrial fibrillation or heart failure. Cox proportional hazard models with attained age as timescale and adjustments for sex, cholesterol, triglycerides, and socioeconomic status were used to estimate hazard ratios by glucose categorized groups (normal glucose 3.9-6.0 mmol/L, impaired fasting glucose; 6.1-6.9 mmol/L, undiagnosed diabetes ≥ 7.0 mmol/L, and diagnosed diabetes). RESULTS During a mean follow-up time of 19.1 years 28,233 individuals developed atrial fibrillation and 25,604 developed heart failure. The HR for atrial fibrillation was 1.19 (95% confidence interval 1.13-1.26) for impaired fasting glucose, 1.23 (1.15-1.32) for undiagnosed diabetes and 1.30 (1.21-1.41) for diagnosed diabetes. Corresponding figures for heart failure were; 1.40 (1.33-1.48), 2.11 (1.99-2.23), 2.22 (2.08-2.36) respectively. In a subset with BMI data (19%), these associations were attenuated and for atrial fibrillation only remained statistically significant among subjects with diagnosed diabetes (HR 1.25; 1.02-1.53). CONCLUSIONS Fasting glucose at prediabetes levels is associated with development of atrial fibrillation and heart failure. To some extent increased BMI may drive this association.
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Affiliation(s)
- Viktor Lind
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.,Capio S:T Görans Hospital, Stockholm, Sweden
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37
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Ghio S, Mercurio V, Attanasio A, Asile G, Tocchetti CG, Paolillo S. Prognostic impact of diabetes in chronic and acute heart failure. Heart Fail Rev 2021; 28:577-583. [PMID: 34811630 DOI: 10.1007/s10741-021-10193-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
A strong, bidirectional relationship exists between diabetes mellitus (DM) and heart failure (HF) and DM is responsible of the activation of several molecular and pathophysiological mechanisms that may, on the long term, damage the heart. However, the prognostic role of DM in the context of chronic and acute HF is still not yet defined and there are several gaps of evidence in the literature on this topic. These gaps are related to the wide phenotypic heterogeneity of patients with chronic and acute HF and to the concept that not all diabetic patients are the same, but there is the necessity to better characterize the disease and each single patient, also considering the role of other possible comorbidities. The aim of the present review is to summarize the pathophysiological mechanisms subtending the negative effect of DM in HF and analyze the available data exploring the prognostic impact of such comorbidity in both chronic and acute HF.
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Affiliation(s)
- Stefano Ghio
- Divisione Di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, 27100, Pavia, Italy.
| | - Valentina Mercurio
- Dipartimento Di Scienze Mediche Traslazionali, Università Degli Studi Di Napoli Federico II, Napoli, Italy
| | - Andrea Attanasio
- Divisione Di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, 27100, Pavia, Italy.,Dipartimento Di Medicina Molecolare, Università Di Pavia, Pavia, Italy
| | - Gaetano Asile
- Dipartimento Di Scienze Biomediche Avanzate, Università Degli Studi Di Napoli Federico II, Napoli, Italy
| | - Carlo Gabriele Tocchetti
- Dipartimento Di Scienze Mediche Traslazionali, Università Degli Studi Di Napoli Federico II, Napoli, Italy
| | - Stefania Paolillo
- Dipartimento Di Scienze Biomediche Avanzate, Università Degli Studi Di Napoli Federico II, Napoli, Italy.,Mediterranea Cardiocentro, Napoli, Italy
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38
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Mohan M, Dihoum A, Mordi IR, Choy AM, Rena G, Lang CC. Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. Front Cardiovasc Med 2021; 8:746382. [PMID: 34660744 PMCID: PMC8513785 DOI: 10.3389/fcvm.2021.746382] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.
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Affiliation(s)
- Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Adel Dihoum
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.,UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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39
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Vuori MA, Reinikainen J, Söderberg S, Bergdahl E, Jousilahti P, Tunstall-Pedoe H, Zeller T, Westermann D, Sans S, Linneberg A, Iacoviello L, Costanzo S, Salomaa V, Blankenberg S, Kuulasmaa K, Niiranen TJ. Diabetes status-related differences in risk factors and mediators of heart failure in the general population: results from the MORGAM/BiomarCaRE consortium. Cardiovasc Diabetol 2021; 20:195. [PMID: 34583686 PMCID: PMC8479921 DOI: 10.1186/s12933-021-01378-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background The risk of heart failure among diabetic individuals is high, even under tight glycemic control. The correlates and mediators of heart failure risk in individuals with diabetes need more elucidation in large population-based cohorts with long follow-up times and a wide panel of biologically relevant biomarkers. Methods In a population-based sample of 3834 diabetic and 90,177 non-diabetic individuals, proportional hazards models and mediation analysis were used to assess the relation of conventional heart failure risk factors and biomarkers with incident heart failure. Results Over a median follow-up of 13.8 years, a total of 652 (17.0%) and 5524 (6.1%) cases of incident heart failure were observed in participants with and without diabetes, respectively. 51.4% were women and the mean age at baseline was 48.7 (standard deviation [SD] 12.5) years. The multivariable-adjusted hazard ratio (HR) for heart failure among diabetic individuals was 2.70 (95% confidence interval, 2.49–2.93) compared to non-diabetic participants. In the multivariable-adjusted Cox models, conventional cardiovascular disease risk factors, such as smoking (diabetes: HR 2.07 [1.59–2.69]; non-diabetes: HR 1.85 [1.68–2.02]), BMI (diabetes: HR 1.30 [1.18–1.42]; non-diabetes: HR 1.40 [1.35–1.47]), baseline myocardial infarction (diabetes: HR 2.06 [1.55–2.75]; non-diabetes: HR 2.86 [2.50–3.28]), and baseline atrial fibrillation (diabetes: HR 1.51 [0.82–2.80]; non-diabetes: HR 2.97 [2.21–4.00]) had the strongest associations with incident heart failure. In addition, biomarkers for cardiac strain (represented by nT-proBNP, diabetes: HR 1.26 [1.19–1.34]; non-diabetes: HR 1.43 [1.39–1.47]), myocardial injury (hs-TnI, diabetes: HR 1.10 [1.04–1.16]; non-diabetes: HR 1.13 [1.10–1.16]), and inflammation (hs-CRP, diabetes: HR 1.13 [1.03–1.24]; non-diabetes: HR 1.29 [1.25–1.34]) were also associated with incident heart failure. In general, all these associations were equally strong in non-diabetic and diabetic individuals. However, the strongest mediators of heart failure in diabetes were the direct effect of diabetes status itself (relative effect share 43.1% [33.9–52.3] and indirect effects (effect share 56.9% [47.7-66.1]) mediated by obesity (BMI, 13.2% [10.3–16.2]), cardiac strain/volume overload (nT-proBNP, 8.4% [-0.7–17.4]), and hyperglycemia (glucose, 12.0% [4.2–19.9]). Conclusions The findings suggest that the main mediators of heart failure in diabetes are obesity, hyperglycemia, and cardiac strain/volume overload. Conventional cardiovascular risk factors are strongly related to incident heart failure, but these associations are not stronger in diabetic than in non-diabetic individuals. Active measurement of relevant biomarkers could potentially be used to improve prevention and prediction of heart failure in high-risk diabetic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01378-4.
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Affiliation(s)
- Matti A Vuori
- Division of Medicine, University of Turku and Turku University Hospital, Kiinanmyllynkatu 2, 20521, Turku, Finland. .,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Jaakko Reinikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ellinor Bergdahl
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Tanja Zeller
- University Heart Center Hamburg, Hamburg, Germany
| | | | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.,Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Simona Costanzo
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Kari Kuulasmaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Teemu J Niiranen
- Division of Medicine, University of Turku and Turku University Hospital, Kiinanmyllynkatu 2, 20521, Turku, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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40
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Thyagaturu HS, Bolton AR, Li S, Kumar A, Shah KR, Katz D. Effect of Diabetes Mellitus on 30 and 90-Day Readmissions of Patients With Heart Failure. Am J Cardiol 2021; 155:78-85. [PMID: 34275590 DOI: 10.1016/j.amjcard.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
The prevalence of diabetes mellitus (DM) in hospitalized heart failure (HF) patients is increasing over time. However, the effect of DM on short-term readmissions for HF is not well established. We investigated the effects of DM on readmissions of HF patients. All adult hospitalizations with a primary diagnosis of HF were identified in the National Readmission Database (NRD) for 2018 and were categorized into those with and without a secondary diagnosis of DM. The primary outcome was to assess risk difference in 30 and 90-day all-cause readmissions. Multivariate Cox survival analysis and multivariate Cox regression were performed to estimate the readmission risk difference in HF patients with and without DM. Of 925,637 HF hospitalizations that met the inclusion criteria, 441,295 (47.6%) had concomitant DM. Diabetics hospitalized for HF had higher prevalence of obesity (37.3% vs 19.5%), kidney disease (58.4% vs 29.2%) and coronary disease (61.1% vs 51.0%), compared to HF hospitalizations without DM. In adjusted analyses, DM was associated with higher hazards for all-cause [hazards ratio (HR), 30 days: 1.04 (1.02-1.06); 90 days: 1.07 (1.05-1.09)], HF [HR, 30 days: 1.05 (1.02-1.07); 90 days: 1.08 (1.05-1.10)] and myocardial infarction (MI) [HR, 30 days: 1.26 (1.12-1.41); 90 days: 1.38 (1.25-1.52)] readmissions. In conclusion, in patients with HF-related hospitalizations, the presence of DM was associated with a higher risk of 30 and 90-day all-cause, HF and MI readmissions.
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Affiliation(s)
- Harshith S Thyagaturu
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York.
| | | | - Si Li
- Department of Internal Medicine, Wright Medical Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kashyap R Shah
- Department of Internal Medicine, St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Daniel Katz
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York
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Echouffo-Tcheugui JB, Guan J, Retnakaran R, Shah BR. Gestational Diabetes and Incident Heart Failure: A Cohort Study. Diabetes Care 2021; 44:dc210552. [PMID: 34385145 PMCID: PMC8929190 DOI: 10.2337/dc21-0552] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether gestational diabetes mellitus (GDM) is associated with an increased risk of heart failure (HF). RESEARCH DESIGN AND METHODS We conducted a population-based cohort study using information from the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. We identified all women in Ontario with a GDM diagnosis with a live birth singleton delivery between 1 July 2007 and 31 March 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization over a period extending from the index pregnancy until 31 March 2019. The secondary outcome was prevalent peripartum cardiomyopathy at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors. RESULTS Among 906,319 eligible women (mean age 30 years [SD 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median follow-up period of 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR] 1.62 [95% CI 1.28, 2.05]) compared with no GDM. This association remained significant after accounting for chronic kidney disease, postpartum diabetes, hypertension, and coronary artery disease (aHR 1.39 [95% CI 1.09, 1.79]). GDM increased the odds of peripartum cardiomyopathy (adjusted odds ratio 1.83 [95% CI 1.45, 2.33]). CONCLUSIONS In a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk for HF.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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42
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Echouffo-Tcheugui JB, Zhang S, Florido R, Hamo C, Pankow JS, Michos ED, Goldberg RB, Nambi V, Gerstenblith G, Post WS, Blumenthal RS, Ballantyne CM, Coresh J, Selvin E, Ndumele CE. Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study. JACC. HEART FAILURE 2021; 9:594-603. [PMID: 34325890 PMCID: PMC8629143 DOI: 10.1016/j.jchf.2021.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study assessed the association of diabetes duration with incident heart failure (HF). BACKGROUND Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown. METHODS We included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A1C [HbA1C] consistently <7%, vs HbA1C ≥7%), with tests for interaction. RESULTS Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA1C ≥7%, those with a body mass index ≥30 kg/m2, women, and Blacks (all P interactions <0.05). CONCLUSIONS Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roberta Florido
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carine Hamo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James S Pankow
- Department of Epidemiology at the University of Minnesota, Minneapolis, Minnesota, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald B Goldberg
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, Florida, USA
| | - Vijay Nambi
- Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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43
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Cai X, Liu X, Sun L, He Y, Zheng S, Zhang Y, Huang Y. Prediabetes and the risk of heart failure: A meta-analysis. Diabetes Obes Metab 2021; 23:1746-1753. [PMID: 33769672 DOI: 10.1111/dom.14388] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
AIM To determine the role of prediabetes in the incidence of heart failure (HF). MATERIALS AND METHODS We searched electronic databases (PubMed, Embase, Google Scholar and OpenGrey) for studies up to 31 December 2020. Studies were included for meta-analysis if they reported adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the risk of HF for prediabetes compared with normoglycaemia. Prediabetes was defined as impaired fasting glucose (IFG) according to the World Health Organization (WHO) criteria (IFG-WHO), or according to the American Diabetes Association (ADA) definition (IFG-ADA), impaired glucose tolerance (IGT), raised HbA1c according to the ADA criteria (HbA1c-ADA), or according to the International Expert Committee (IEC) recommendation (HbA1c-IEC). RESULTS A total of 15 studies comprising 9,827,430 individuals provided data for this analysis. The median follow-up duration of the included studies was 8.0 years. Compared with normoglycaemia, prediabetes was associated with an increased risk for HF: IFG-ADA (RR: 1.09, 95% CI: 1.05-1.13), IFG-WHO (RR: 1.18, 95% CI: 1.07-1.30), IGT (RR 1.58, 95% CI 1.04-2.39), HbA1c-ADA (RR 1.28, 95% CI 1.16-1.41) or HbA1c-IEC (RR 1.40, 95% CI 1.09-1.79), respectively. CONCLUSIONS Prediabetes is associated with an increased risk of HF. Future studies are needed to evaluate effective treatments for prediabetes to prevent the development and progression of HF.
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Affiliation(s)
- Xiaoyan Cai
- Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiong Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Lichang Sun
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yiting He
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Sulin Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yang Zhang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangdong, China
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44
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Kawabe A, Yasu T, Morimoto T, Tokushige A, Momomura SI, Sakakura K, Node K, Inoue T, Ueda S. WBC count predicts heart failure in diabetes and coronary artery disease patients: a retrospective cohort study. ESC Heart Fail 2021; 8:3748-3759. [PMID: 34268904 PMCID: PMC8497382 DOI: 10.1002/ehf2.13513] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/14/2021] [Accepted: 07/04/2021] [Indexed: 01/04/2023] Open
Abstract
Aims White blood cell (WBC) count in healthy people is associated with the risk of coronary artery disease (CAD) and mortality. This study aimed to determine whether WBC count predicts heart failure (HF) requiring hospitalization as well as all‐cause death, acute myocardial infarction (AMI) and stroke in patients with Type 2 diabetes mellitus and established CAD. Methods We conducted this retrospective registry study that enrolled consecutive patients with Type 2 diabetes mellitus and CAD based on coronary arteriography records and medical charts at 70 teaching hospitals in Japan from 2005 to 2015. A total of 7608 participants (28.2% women, mean age 68 ± 10 years) were eligible. In the cohort, the median (interquartile range) and mean follow‐up durations were 39 (16.5–66.1 months) and 44.3 ± 32.7 months, respectively. The primary outcome was HF requiring hospitalization. The secondary outcomes were AMI, stroke, all‐cause death, 3‐point major adverse cardiovascular events (MACE) (AMI/stroke/death) and 4‐point MACE (AMI/stroke/death/HF requiring hospitalization). Outcomes were reported as cumulative incidences (proportion of patients experiencing an event) and incidence rates (events/100 person‐years). The primary and secondary outcomes were assessed using the Kaplan–Meier method and were compared using the log‐rank test stratified by the baseline WBC count. The association between the WBC count at baseline and each MACE was assessed using the Cox proportional hazard model and expressed as the hazard ratio (HR) and 95% confidence interval (CI) after adjusting for other well‐known risk factors for MACE. Results During the follow‐up, 880 patients were hospitalized owing to HF. The WBC Quartile 4 (≥7700 cells/μL) had significantly lower HF event‐free survival rate (log‐rank test, P < 0.001). The HRs for HF events requiring hospitalization with each WBC quartile compared with the lowest in the first WBC quartile were 1 for Quartile 1 (WBC < 5300 cells/μL), 1.20 (95% CI, 0.96–1.5; P = 0.1) for Quartile 2 (5300 ≤ WBC < 6400), 1.34 (95% CI, 1.08–1.67; P = 0.009) for Quartile 3 (6400 ≤ WBC < 7700) and 1.62 (95% CI, 1.31–2.00; P < 0.001) for Quartile 4 after adjusting for covariates. Similar findings were observed for the risk of AMI and death; however, no significant difference was found for stroke. WBC Quartile 4 patients had a significantly lower 3‐ or 4‐point MACE‐free survival rate (log‐rank test, P < 0.0001). Conclusions A higher WBC count is a predictor of hospitalization for HF, all‐cause death and AMI but not for stroke in patients with concurrent Type 2 diabetes mellitus and established CAD.
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Affiliation(s)
- Atsuhiko Kawabe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical College, Nishinomiya, Japan
| | - Akihiro Tokushige
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Node
- Department of Cardiology and Renal Medicine, Saga University School of Medicine, Saga, Japan
| | - Taku Inoue
- Department of Cardiology, Yuaikai Nanbu Hospital, Itoman, Okinawa, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Nishihara, Okinawa, Japan
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- The CHD Collaborative Investigators are mentioned in the appendix
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45
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Mordi IR, Lumbers RT, Palmer CNA, Pearson ER, Sattar N, Holmes MV, Lang CC. Type 2 Diabetes, Metabolic Traits, and Risk of Heart Failure: A Mendelian Randomization Study. Diabetes Care 2021; 44:1699-1705. [PMID: 34088700 PMCID: PMC8323186 DOI: 10.2337/dc20-2518] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to use Mendelian randomization (MR) techniques to estimate the causal relationships between genetic liability to type 2 diabetes (T2D), glycemic traits, and risk of heart failure (HF). RESEARCH DESIGN AND METHODS Summary-level data were obtained from genome-wide association studies of T2D, insulin resistance (IR), glycated hemoglobin, fasting insulin and glucose, and HF. MR was conducted using the inverse-variance weighted method. Sensitivity analyses included the MR-Egger method, weighted median and mode methods, and multivariable MR conditioning on potential mediators. RESULTS Genetic liability to T2D was causally related to higher risk of HF (odds ratio [OR] 1.13 per 1-log unit higher risk of T2D; 95% CI 1.11-1.14; P < 0.001); however, sensitivity analysis revealed evidence of directional pleiotropy. The relationship between T2D and HF was attenuated when adjusted for coronary disease, BMI, LDL cholesterol, and blood pressure in multivariable MR. Genetically instrumented higher IR was associated with higher risk of HF (OR 1.19 per 1-log unit higher risk of IR; 95% CI 1.00-1.41; P = 0.041). There were no notable associations identified between fasting insulin, glucose, or glycated hemoglobin and risk of HF. Genetic liability to HF was causally linked to higher risk of T2D (OR 1.49; 95% CI 1.01-2.19; P = 0.042), although again with evidence of pleiotropy. CONCLUSIONS These findings suggest a possible causal role of T2D and IR in HF etiology, although the presence of both bidirectional effects and directional pleiotropy highlights potential sources of bias that must be considered.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K.
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, U.K
- Health Data Research UK London, University College London, U.K
- UCL British Heart Foundation Research Accelerator, London, U.K
| | - Colin N A Palmer
- Division of Population Health and Genomics, University of Dundee, Dundee, U.K
| | - Ewan R Pearson
- Division of Population Health and Genomics, University of Dundee, Dundee, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, U.K
- Clinical Trial Service and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
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46
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Kaze AD, Santhanam P, Erqou S, Ahima RS, Bertoni A, Echouffo-Tcheugui JB. Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus. J Am Heart Assoc 2021; 10:e018998. [PMID: 34107742 PMCID: PMC8477890 DOI: 10.1161/jaha.120.018998] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus-related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus. Methods and Results A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus-related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5-fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73-3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64-3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51-3.27), 1.30 (95% CI, 0.72-2.36), and 1.33 (95% CI, 0.86-2.07) for nephropathy, retinopathy, and neuropathy, respectively. CONCLUSIONS MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus-related HF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine University of Maryland Medical Center Baltimore MD
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MD
| | - Sebhat Erqou
- Department of Medicine Providence VA Medical Center and Alpert Medical School of Brown University Providence RI
| | - Rexford S Ahima
- Division of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MD
| | - Alain Bertoni
- Department of Epidemiology and Prevention Wake Forest University School of Medicine Winston-Salem NC
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MD.,Welch Prevention Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Baltimore MD
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47
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Kaze AD, Santhanam P, Erqou S, Bertoni AG, Ahima RS, Echouffo-Tcheugui JB. Long-term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes. ESC Heart Fail 2021; 8:2959-2967. [PMID: 34032375 PMCID: PMC8318432 DOI: 10.1002/ehf2.13385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Data on the association of long-term variability of blood pressure (BP) with incident heart failure (HF) in individuals with Type 2 diabetes are scarce. We evaluated this association in a large community-based sample of adults with Type 2 diabetes. METHODS AND RESULTS A total of 4200 participants with Type 2 diabetes who had available BP measurements at four visits (baseline and 12, 24, and 36 months) in the Look AHEAD (Action for Health in Diabetes) study were included. Variability of systolic BP (SBP) and diastolic BP (DBP) across the four visits was assessed using four metrics. Participants free of HF during the first 36 months were followed for HF events. Cox regression was used to generate hazard ratios (HRs) and 95% confidence intervals (CIs) for HF. Of the 4200 participants, the average age was 59 years [standard deviation (SD): 6.8]; 58.5% were women. Over a median follow-up of 6.7 years, 129 developed HF events. After adjusting for relevant confounders, the HR of incident HF for the highest vs. lowest quartile of SD of SBP was 1.77 (95% CI 1.01-3.09); the HR for the highest (vs. lowest) quartile of variability independent of the mean of SBP was 1.29 (95% CI 0.78-2.14). The adjusted HR for participants in the highest (compared with the lowest) quartile of SD of DBP was 1.61 (95% CI 1.01-2.59), and the adjusted HR for variability independent of the mean of DBP was 1.65 (95% CI 1.03-2.65). CONCLUSIONS A greater variability in SBP and DBP is independently associated with greater risk of incident HF in individuals with Type 2 diabetes.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Prasanna Santhanam
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Sebhat Erqou
- Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rexford S Ahima
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
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48
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Astell-Burt T, Navakatikyan MA, Walsan R, Davis W, Figtree G, Arnolda L, Feng X. Green space and cardiovascular health in people with type 2 diabetes. Health Place 2021; 69:102554. [PMID: 33857869 DOI: 10.1016/j.healthplace.2021.102554] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/07/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14.67%, 7.23%, 47.36%, and 4.51%, respectively. After full adjustment, more tree canopy was associated with lower CVD mortality, lower fatal or non-fatal CVD events, and lower AMI risk. More open grass was associated with lower all-cause mortality, lower CVD mortality and lower fatal or non-fatal CVD events, but higher AMI risk.
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Affiliation(s)
- Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Humanities and Social Sciences, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI) and University of Wollongong, Wollongong, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, Australia; National Institute of Environmental Health, China CDC, Beijing, China; School of Population Medicine and Public Health, Peking Union Medical College and the Chinese Academy of Medical Sciences, China.
| | - Michael A Navakatikyan
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Humanities and Social Sciences, University of Wollongong, Wollongong, Australia
| | - Ramya Walsan
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Humanities and Social Sciences, University of Wollongong, Wollongong, Australia; School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Walt Davis
- Australian Health Services Research Institute, Sydney Business School, Faculty of Business and Law, University of Wollongong, Australia
| | - Gemma Figtree
- Kolling Institute, University of Sydney and Royal North Shore Hospital, Sydney, Australia
| | - Leonard Arnolda
- Illawarra Health and Medical Research Institute (IHMRI) and University of Wollongong, Wollongong, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Humanities and Social Sciences, University of Wollongong, Wollongong, Australia; School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, Australia; National Institute of Environmental Health, China CDC, Beijing, China
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49
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Cordola Hsu AR, Xie B, Peterson DV, LaMonte MJ, Garcia L, Eaton CB, Going SB, Phillips LS, Manson JE, Anton-Culver H, Wong ND. Metabolically Healthy/Unhealthy Overweight/Obesity Associations With Incident Heart Failure in Postmenopausal Women: The Women's Health Initiative. Circ Heart Fail 2021; 14:e007297. [PMID: 33775111 DOI: 10.1161/circheartfailure.120.007297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is associated with an increased risk of heart failure (HF); however, how metabolic weight groups relate to HF risk, especially in postmenopausal women, has not been demonstrated. METHODS We included 19 412 postmenopausal women ages 50 to 79 without cardiovascular disease from the Women's Health Initiative. Normal weight was defined as a body mass index ≥18.5 and <25 kg/m2 and waist circumference <88 cm and overweight/obesity as a body mass index ≥25 kg/m2 or waist circumference ≥88 cm. Metabolically healthy was based on <2 and unhealthy ≥2 cardiometabolic traits: triglycerides ≥150 mg/dL, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg or blood pressure medication, fasting glucose ≥100 mg/dL or diabetes medication, and HDL-C (high-density lipoprotein cholesterol) <50 mg/dL. Risk factor-adjusted Cox regression examined the hazard ratios (HRs) for incident hospitalized HF among metabolically healthy normal weight (reference), metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese. RESULTS Among our sample, 455 (2.34%) participants experienced HF hospitalizations over a mean follow-up time of 11.3±1.1 years. Compared with metabolically healthy normal weight individuals, HF risk was greater in metabolically unhealthy normal weight (HR, 1.66 [95% CI, 1.01-2.72], P=0.045) and metabolically unhealthy overweight/obese individuals (HR, 1.95 [95% CI, 1.35-2.80], P=0.0004), but not metabolically healthy overweight/obese individuals (HR, 1.15 [95% CI, 0.78-1.71], P=0.48). Subdividing the overweight/obese into separate groups showed HRs for metabolically unhealthy obese of 2.62 (95% CI, 1.80-3.83; P<0.0001) and metabolically healthy obese of 1.52 (95% CI, 0.98-2.35; P=0.06). CONCLUSIONS Metabolically unhealthy overweight/obese and metabolically unhealthy normal weight are associated with an increased risk of HF in postmenopausal women.
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Affiliation(s)
- Amber R Cordola Hsu
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine (A.R.C.H., N.D.W.), UC Irvine School of Medicine, University of California.,School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Darleen V Peterson
- School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Michael J LaMonte
- School of Public Health and Health Professions, University of Buffalo, NY (M.J.L.)
| | - Lorena Garcia
- Division of Epidemiology, Department of Public Health Sciences, UC Davis School of Medicine, CA (L.G.)
| | - Charles B Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School and School of Public Health, Brown University, Pawtucket, RI (C.B.E.)
| | - Scott B Going
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson (S.B.G.)
| | - Lawrence S Phillips
- Atlanta VA Medical Center and Division of Endocrinology, Department of Medicine, Emory University, GA (L.S.P.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Hoda Anton-Culver
- Department of Medicine (H.A.-C.), UC Irvine School of Medicine, University of California
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine (A.R.C.H., N.D.W.), UC Irvine School of Medicine, University of California
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50
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Akashi N, Tsukui T, Yamamoto K, Seguchi M, Taniguchi Y, Sakakura K, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus. Heart Vessels 2021; 36:1445-1456. [PMID: 33715109 PMCID: PMC8379135 DOI: 10.1007/s00380-021-01827-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Abstract
Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304–963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20–6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19–11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03–5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15–12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
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