Diabetes mellitus: biological determinants of atherosclerosis and restenosis

Neutrophil-to-Lymphocyte Ratio Predicts Restenosis After Drug-Coated Balloon Therapy for Femoropopliteal Artery Lesions: A Retrospective Study

Background

Peripheral artery disease (PAD) is a common atherosclerotic vascular disease. The use of drug-coated balloon (DCB) for the treatment of femoropopliteal artery disease has gradually increased. A certain percentage of patients developed target lesion restenosis after DCB treatment of the femoral popliteal artery. The neutrophil-to-lymphocyte ratio (NLR) is closely related to the level of inflammatory activity and has predictive value for atherosclerotic vascular disease. This study aimed to analyze the relationship between NLR and 1-year restenosis after DCB for femoropopliteal artery disease.

Methods

Patients with femoropopliteal artery disease who were treated with DCBs at our hospital from May 2016 to December 2020 were retrospectively included. Baseline data during the patient’s first hospital stay and data during follow-up were collected. Demographic data, laboratory test results, lesion examination results, and major adverse events during the follow-up period were collected. Logistic regression was used to analyze the factors associated with restenosis after DCB.

Results

A total of 117 patients were included. During 1-year follow-up, 19 cases (16.2%) of restenosis were detected. Five of these patients (4.3% of total included patients) were readmitted for symptomatic ischemia. No deaths or amputations occurred. Baseline NLR in patients with restenosis was higher than that in patients without restenosis (2.4 (2.1, 3.4) vs. 1.8 (1.3, 2.3), P < 0.001). Logistic univariate and multivariate analysis showed that baseline hs-CRP level (OR = 1.10, 95%CI: 1.05–1.34), lesion length (OR = 1.04, 95%CI: 1.02–1.27), use of rivaroxaban (OR = 1.08, 95%CI: 1.05–1.39), NLR (OR = 1.47, 95%CI: 1.13–2.48), LDL-C level (OR = 1.25, 95%CI: 1.05–1.52), and diabetes (OR = 1.25, 95%CI: 1.05–1.52) = 1.18, 95%CI: 1.06–1.66) were predictors of restenosis.

Conclusion

Baseline NLR before DCB can predict the risk of restenosis after surgery.

Prognostic Value of Hemoglobin A1c Levels in Postmenopausal Diabetic Patients Undergoing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome

Background

The purpose of our study was to analyze the clinical value of glycosylated hemoglobin Alc (HbA1c) levels in postmenopausal women with acute coronary syndrome (ACS) and diabetes following percutaneous coronary intervention (PCI).

Material/Methods

A total of 173 consecutive postmenopausal patients with comorbid diabetes underwent PCI for primary ACS were enrolled in this study. Serum HbA1c levels were measured prior to PCI, and baseline clinical characteristics of all patients were collected. All patients were followed up at regular intervals for major adverse cardiovascular events (MACEs) during the first year after PCI. MACEs included cardiac death, non-fatal myocardial infarction, and target vessel revascularization (TVR).

Results

At the endpoint of this study, 29 (16.8%) patients out of all 173 patients had MACEs. According to the effect of glycemic control (as indicated by HbA1c levels), all patients were stratified into a well-controlled group (HbA1c ≤7.0%, N=72) and a poorly-controlled group (HbA1c >7.0%, N=101). The incidence rate of MACEs and TVR in poorly-controlled diabetics was prominently higher than that in well-controlled diabetics (10.8% vs. 21.8%, p=0.04). In multivariable COX regression analysis, after adjustment for potential confounders, HbA1c ≥7.0% remained an independent risk predictor of MACE (HR, 2.17; 95%CI, 1.13–5.65; p<0.01).

Conclusions

In postmenopausal ACS patients with comorbid diabetes, a high level of HbA1c is associated with a higher MACE rate after PCI, which is mainly driven by a higher rate of TVR.

Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting

Background

Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.

Methods

We evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126 mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6 months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).

Results

The adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).

Conclusions

Our data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI.

Mitigating micro-and macro-vascular complications of diabetes beginning in adolescence

Diabetes is a chronic disorder, which manifests when insulin levels or resistance to insulin action becomes insufficient to control systemic glucose levels. Although the number of available agents to manage diabetes continues to expand rapidly, the maintenance of euglycemia by individuals with diabetes remains a substantial challenge. Unfortunately, many patients with type 1 and type 2 diabetes will ultimately experience diabetes complications. These complications result from the toxic effects of chronic hyperglycemia combined with other metabolic derangements that afflict persons with diabetes. This review will present a comprehensive look at the complications of diabetes, the risk factors for their progression, the mechanistic basis for their development, and the clinical approach to screening for, preventing, and treating these sequelae. In addition, since diabetes is commonly diagnosed in childhood, we will provide a special focus on the care of the adolescent patient.