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Alfageme-García P, Basilio-Fernández B, Ramírez-Durán MDV, Gómez-Luque A, Jiménez-Cano VM, Fabregat-Fernández J, Alonso VR, Clavijo-Chamorro MZ, Hidalgo-Ruíz S. Risk of Type 2 Diabetes in University Students at the University of Extremadura: A Cross-Sectional Study. J Pers Med 2024; 14:146. [PMID: 38392580 PMCID: PMC10890267 DOI: 10.3390/jpm14020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The prevalence of type 2 diabetes is increasing worldwide. The aim of our study was to detect people susceptible to DM among a university population aged 18 to 45 years and analyze the existence of modifiable risk factors in order to implement prevention programs, in addition to analyzing BMI data related to the variables under study. We proposed a descriptive, cross-sectional study following the recommendations of cross-sectional studies (STROBE), with a sample of 341 subjects, students enrolled at the University of Extremadura, carried out by two researchers. The research protocol was approved by the Bioethics Committee of the University of Extremadura (165/2021). The study considered the Findrisk questionnaire in Spanish, validated by the Blackboard Study, a stadiometer to measure height, a bioimpedance meter to evaluate weight and body composition parameters, and a blood pressure monitor to measure blood pressure. The results indicated that the participants had a low risk of suffering T2DM. The highest Findrisk test scores were found in those with a BMI value above 25, lower physical activity, poor dietary intake of fruits and vegetables, and increased fat mass. Our future research will be the implementation of T2DM prevention programs, acting on modifiable factors.
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Affiliation(s)
- Pilar Alfageme-García
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Belinda Basilio-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | | | - Adela Gómez-Luque
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Víctor Manuel Jiménez-Cano
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Juan Fabregat-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Vicente Robles Alonso
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | | | - Sonia Hidalgo-Ruíz
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
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2
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Hao M, Huang X, Liu X, Fang X, Li H, Lv L, Zhou L, Guo T, Yan D. Novel model predicts diastolic cardiac dysfunction in type 2 diabetes. Ann Med 2023; 55:766-777. [PMID: 36908240 PMCID: PMC10798288 DOI: 10.1080/07853890.2023.2180154] [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: 10/07/2022] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE Diabetes mellitus complicated with heart failure has high mortality and morbidity, but no reliable diagnoses and treatments are available. This study aimed to develop and verify a new model nomogram based on clinical parameters to predict diastolic cardiac dysfunction in patients with Type 2 diabetes mellitus (T2DM). METHODS 3030 patients with T2DM underwent Doppler echocardiography at the First Affiliated Hospital of Shenzhen University between January 2014 and December 2021. The patients were divided into the training dataset (n = 1701) and the verification dataset (n = 1329). In this study, a predictive diastolic cardiac dysfunction nomogram is developed using multivariable logical regression analysis, which contains the candidates selected in a minor absolute shrinkage and selection operator regression model. Discrimination in the prediction model was assessed using the area under the receiver operating characteristic curve (AUC-ROC). The calibration curve was applied to evaluate the calibration of the alignment nomogram, and the clinical decision curve was used to determine the clinical practicability of the alignment map. The verification dataset was used to evaluate the prediction model's performance. RESULTS A multivariable model that included age, body mass index (BMI), triglyceride (TG), creatine phosphokinase isoenzyme (CK-MB), serum sodium (Na), and urinary albumin/creatinine ratio (UACR) was presented as the nomogram. We obtained the model for estimating diastolic cardiac dysfunction in patients with T2DM. The AUC-ROC of the training dataset in our model was 0.8307, with 95% CI of 0.8109-0.8505. Similar to the results obtained with the training dataset, the AUC-ROC of the verification dataset in our model was 0.8083, with 95% CI of 0.7843-0.8324, thus demonstrating robust. The function of the predictive model was as follows: Diastolic Dysfunction = -4.41303 + 0.14100*Age(year)+0.10491*BMI (kg/m2) +0.12902*TG (mmol/L) +0.03970*CK-MB (ng/mL) -0.03988*Na(mmol/L) +0.65395 * (UACR > 30 mg/g) + 1.10837 * (UACR > 300 mg/g). The calibration plot diagram of predicted probabilities against observed DCM rates indicated excellent concordance. Decision curve analysis demonstrated that the novel nomogram was clinically useful. CONCLUSION Diastolic cardiac dysfunction in patients with T2DM can be predicted by clinical parameters. Our prediction model may represent an effective tool for large-scale epidemiological study of diastolic cardiac dysfunction in T2DM patients and provide a reliable method for early screening of T2DM patients with cardiac complications.KEY MESSAGESThis study used clinical parameters to predict diastolic cardiac dysfunction in patients with T2DM. This study established a nomogram for predicting diastolic cardiac dysfunction by multivariate logical regression analysis. Our predictive model can be used as an effective tool for large-scale epidemiological study of diastolic cardiac dysfunction in patients with T2DM and provides a reliable method for early screening of cardiac complications in patients with T2DM.
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Affiliation(s)
- Mingyu Hao
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiaohong Huang
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
- Guangzhou Medical University, Guangzhou, China
| | - Xueting Liu
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Xiaokang Fang
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Haiyan Li
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Lingbo Lv
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Liming Zhou
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Tiecheng Guo
- Chiwan Community Health Service Centre, Shenzhen, China
| | - Dewen Yan
- Department of Endocrinology, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
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Povar-Echeverría M, Méndez-Bailón M, Martín-Sánchez FJ, Montero-Pérez-Barquero M, Trullàs JC, Miró Ò. Prognostic impact of metformin in patients with type 2 diabetes mellitus and acute heart failure: Combined analysis of the EAHFE and RICA registries. Rev Clin Esp 2023; 223:542-551. [PMID: 37717921 DOI: 10.1016/j.rceng.2023.09.007] [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: 06/02/2023] [Accepted: 07/29/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients with diabetes mellitus (DM) and heart failure (HF) have a worse prognosis despite therapeutic advances in both diseases. Sodium-glucose co-transporter type 2 and GLP-1 receptor agonists have shown cardiovascular benefits and they have been positioned as the first step in the treatment of DM in patients with HF or high cardiovascular risk. However, in the pivotal trials the majority of patients receive concomitant treatment with metformin. Randomized clinical trials have not yet been developed to assess the prognostic impact of metformin at the cardiovascular level. Our objective has been centered in analyzing whether patients with DM and acute HF who receive treatment with metformin at the time of discharge may have a better prognosis at one year of follow-up. METHODS Prospective cohort trial using the combined analysis of the two main Spanish HF registries, the EAHFE Registry (Epidemiology of Acute Heart Failure in Emergency Departments) and the RICA (National Registry of Patients with Heart Failure). RESULTS 33% (1453) of a total of 4403 patients with DM type 2 received treatment with metformin. This group presents significantly lower mortality after one year of treatment (22 versus 32%; Log Rank test P < 0.001). In the adjusted analysis of mortality, patients receiving treatment with metformin have lower mortality at one year of follow-up regardless of the rest of the variables (RR 0,814; 95%IC 0,712-0,930; P < 0.01). CONCLUSIONS Patients with DM type 2 and acute HF who receive metformin have a better prognosis after one year of follow-up, so we believe that this drug should continue to be a fundamental pillar in the treatment of these patients.
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Affiliation(s)
- M Povar-Echeverría
- Internal Medicine Service, Hospital Comarcal de Barbastro, Barbastro, Huesca, Spain.
| | - M Méndez-Bailón
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - F J Martín-Sánchez
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - M Montero-Pérez-Barquero
- Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J C Trullàs
- Internal Medicine Service, Hospital d'Olot i Comarcal de la Garrotxa, Olot, Girona, Spain; Grupo de Investigación en Reparación y Regeneración Q2 Tisular (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central, Barcelona, Spain
| | - Ò Miró
- Emergencies Service, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Puig-Jové C, Julve J, Castelblanco E, Julián MT, Amigó N, Andersen HU, Ahluwalia TS, Rossing P, Mauricio D, Jensen MT, Alonso N. The novel inflammatory biomarker GlycA and triglyceride-rich lipoproteins are associated with the presence of subclinical myocardial dysfunction in subjects with type 1 diabetes mellitus. Cardiovasc Diabetol 2022; 21:257. [PMID: 36434633 PMCID: PMC9700974 DOI: 10.1186/s12933-022-01652-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subjects with Type 1 diabetes mellitus (T1DM) have an increased incidence of heart failure (HF). Several pathophysiological mechanisms have been involved in its development. The aim of this study was to analyze the potential contribution of the advanced lipoprotein profile and plasma glycosylation (GlycA) to the presence of subclinical myocardial dysfunction in subjects with T1DM. METHODS We included subjects from a Danish cohort of T1DM subjects (Thousand & 1 study) with either diastolic and/or systolic subclinical myocardial dysfunction, and a control group without myocardial dysfunction, matched by age, sex and HbA1c. All underwent a transthoracic echocardiogram and an advanced lipoprotein profile obtained by using the NMR-based Liposcale® test. GlycA NMR signal was also analyzed. Systolic dysfunction was defined as left ventricular ejection fraction ≤ 45% and diastolic dysfunction was considered as E/e'≥12 or E/e' 8-12 + volume of the left atrium > 34 ml/m2. To identify a metabolic profile associated with the presence of subclinical myocardial dysfunction, a multivariate supervised model of classification based on least squares regression (PLS-DA regression) was performed. RESULTS One-hundred forty-six subjects had diastolic dysfunction and 18 systolic dysfunction. Compared to the control group, patients with myocardial dysfunction had longer duration of diabetes (p = 0.005), and higher BMI (p = 0.013), serum NTproBNP concentration (p = 0.001), systolic blood pressure (p < 0.001), albuminuria (p < 0.001), and incidence of advanced retinopathy (p < 0.001). The supervised classification model identified a specific pattern associated with myocardial dysfunction, with a capacity to discriminate patients with myocardial dysfunction from controls. PLS-DA showed that triglyceride-rich lipoproteins (TGRLs), such as VLDL (total VLDL particles, large VLDL subclass and VLDL-TG content) and IDL (IDL cholesterol content), as well as the plasma concentration of GlycA, were associated with the presence of subclinical myocardial dysfunction. CONCLUSION Proatherogenic TGRLs and the proinflammatory biomarker Glyc A are strongly associated to myocardial dysfunction in T1DM. These findings suggest a pivotal role of TGRLs and systemic inflammation in the development of subclinical myocardial dysfunction in T1DM.
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Affiliation(s)
- Carlos Puig-Jové
- grid.414875.b0000 0004 1794 4956Department of Endocrinology & Nutrition, University Hospital Mútua de Terrassa, Terrassa, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Josep Julve
- grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Esmeralda Castelblanco
- grid.4367.60000 0001 2355 7002Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St Louis, MO USA
| | - M Teresa Julián
- grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain ,Department of Endocrinology & Nutrition, University Hospital and Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | - Núria Amigó
- grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain ,Biosfer Teslab SL, Reus, Spain ,grid.410367.70000 0001 2284 9230Department of Basic Medical Sciences, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Henrik U Andersen
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Tarunveer S Ahluwalia
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Herlev, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Herlev, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dídac Mauricio
- grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain ,grid.440820.aFaculty of Medicine, University of Vic - Central University of Catalonia (UVic/UCC), Vic, Spain ,grid.413396.a0000 0004 1768 8905Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Magnus T Jensen
- grid.413660.60000 0004 0646 7437Department of Cardiology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Núria Alonso
- grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain ,Department of Endocrinology & Nutrition, University Hospital and Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
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Ramírez-Durán MDV, Basilio-Fernández B, Gómez-Luque A, Alfageme-García P, Clavijo-Chamorro MZ, Jiménez-Cano VM, Fabregat-Fernández J, Robles-Alonso V, Hidalgo-Ruiz S. Efficacy of an Online Educational Intervention in Reducing Body Weight in the Pre-Diabetic Population of 18-45 Years Old, a Randomized Trial Protocol. J Pers Med 2022; 12:1669. [PMID: 36294808 PMCID: PMC9604779 DOI: 10.3390/jpm12101669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Aim: to analyze the efficacy of an educational online intervention focused on lifestyle changes in reducing body weight from baseline to 6 months in the pre-diabetic population of 18−45 years old in Extremadura (Spain). Methods: a single-blind, multicenter randomized parallel-comparison trial with two intervention groups in a 1:1 ratio will be carried out. Participants will be randomly assigned to intervention A or B with 37 cases in each group according to inclusion criteria of being enrolled or working at Extremadura University, scoring >7 points on the Findrisc test and not having diagnosed diabetes mellitus or physical disabilities. Intervention-A group will have access to online information about healthy diet and exercise. Intervention-B group will have access to a six-session educational program regarding behavioral changes in diet and exercise habits. They will complete follow-up activities and have a personal trainer and motivation. The primary outcome will be identifying changes in body weight from baseline to 1 and 6 months and between groups. The secondary outcomes will be accomplishing regular physical activity (>30 min/day or >4 h/week), decreasing sugary food intake or avoiding it altogether, increasing vegetable/fruit intake and lowering HbA1c levels to non-diabetic status when necessary.
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Affiliation(s)
| | - Belinda Basilio-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Adela Gómez-Luque
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Pilar Alfageme-García
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | | | - Víctor Manuel Jiménez-Cano
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Juan Fabregat-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Vicente Robles-Alonso
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Sonia Hidalgo-Ruiz
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
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Carrasco-Sánchez F, Páez-Rubio M, Arévalo-Lorido J, Carretero-Gómez J, Conde-Martel A, Epelde F, Álvarez-Rocha P, Salamanca-Bautista M, Cepeda-Rodrigo J, Montero-Pérez-Barquero M. Evolución de la asociación de diabetes y eventos posalta en pacientes con insuficiencia cardíaca crónica descompensada: hallazgos del registro RICA. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro MG, Delgado JF, Díez J, Formiga F, Manito N. Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review. Front Cardiovasc Med 2021; 8:754499. [PMID: 34859070 PMCID: PMC8631913 DOI: 10.3389/fcvm.2021.754499] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| | | | - Pedro Caravaca-Pérez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maria G. Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - Juan F. Delgado
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiovascular Diseases Programme, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain
- Departments of Nephrology, Cardiology, and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Heart Failure and Heart Transplantation Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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8
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Carrasco-Sánchez FJ, Páez-Rubio MI, Arévalo-Lorido JC, Carretero-Gómez J, Conde-Martel A, Epelde F, Álvarez-Rocha P, Salamanca-Bautista MP, Cepeda-Rodrigo JM, Montero-Pérez-Barquero M. Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry. Rev Clin Esp 2021; 222:63-72. [PMID: 34629306 DOI: 10.1016/j.rceng.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
AIMS Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods. METHODS This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods. RESULTS A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p < .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p < .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort. CONCLUSIONS In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.
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Affiliation(s)
- F J Carrasco-Sánchez
- Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
| | - M I Páez-Rubio
- Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - J Carretero-Gómez
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - F Epelde
- Unidad de Estancia Corta, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - P Álvarez-Rocha
- Unidad Multidisciplinaria de Insuficiencia Cardíaca, Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | | | - J M Cepeda-Rodrigo
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Alarco W. [Diabetes and Heart Failure]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:6-14. [PMID: 38571972 PMCID: PMC10986355 DOI: 10.47487/apcyccv.v1i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 04/05/2024]
Abstract
Diabetes Mellitus (DM) is a chronic non-communicable cardio-metabolic disease that causes macro-vascular complications such as atherosclerosis, coronary disease and heart failure (HF). There is a bidirectional relationship between HF and DM, HF being the second most frequent initial cardiovascular event in patients with diabetes. It may even be the first cardiovascular complication, before acute myocardial infarction. DM can lead to HF through mechanisms mediated by atherosclerosis and non mediated by it. In the first case, cholesterol is deposited in coronary arteries, favored by the presence of other risk factors. In the second case, the myocardium is directly affected leading to structural and functional changes through non-atherogenic mechanisms (called Diabetic Cardiomyopathy). The treatment of HF with reduced ejection fraction in the diabetic patient does not differ from that of the non-diabetic population, the triple neurohumoral block must be achieved. In the case of patients with HF with ejection fraction preserved to date, we do not have specific therapy to reduce cardiovascular morbidity and mortality. In the diabetes treatment of the patient with HF, sodium-glucose type 2 cotransporter inhibitors (SGLT2i) clearly stand out. In addition to their glucosuric and natriuretic effect, they have pleiotropic effects that produce metabolic, hemodynamic and cellular viability effects preventing apoptosis and cell death. Finally, the clinical benefits of SGLT2 inhibitors in HF go beyond glycemic control, as demonstrated by the DAPA-HF study; initiating a new era in the treatment of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Walter Alarco
- Unidad de Insuficiencia Cardiaca, Trasplante Cardiaco e Hipertensión Pulmonar Instituto Nacional Cardiovascular INCOR. Lima, Perú.
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