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The Impact of Selenium Deficiency on Cardiovascular Function. Int J Mol Sci 2021; 22:ijms221910713. [PMID: 34639053 PMCID: PMC8509311 DOI: 10.3390/ijms221910713] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/04/2023] Open
Abstract
Selenium (Se) is an essential trace element that is necessary for various metabolic processes, including protection against oxidative stress, and proper cardiovascular function. The role of Se in cardiovascular health is generally agreed upon to be essential yet not much has been defined in terms of specific functions. Se deficiency was first associated with Keshan’s Disease, an endemic disease characterized by cardiomyopathy and heart failure. Since then, Se deficiency has been associated with multiple cardiovascular diseases, including myocardial infarction, heart failure, coronary heart disease, and atherosclerosis. Se, through its incorporation into selenoproteins, is vital to maintain optimal cardiovascular health, as selenoproteins are involved in numerous crucial processes, including oxidative stress, redox regulation, thyroid hormone metabolism, and calcium flux, and inadequate Se may disrupt these processes. The present review aims to highlight the importance of Se in cardiovascular health, provide updated information on specific selenoproteins that are prominent for proper cardiovascular function, including how these proteins interact with microRNAs, and discuss the possibility of Se as a potential complemental therapy for prevention or treatment of cardiovascular disease.
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Wang L, Xing Y, Yu X, Ming J, Liu X, Li X, Fu J, Zhou J, Gao B, Hu D, Pan C, Ji L, Ji Q. Greater macrovascular and microvascular morbidity from type 2 diabetes in northern compared with southern China: A cross-sectional study. J Diabetes Investig 2020; 11:1285-1294. [PMID: 32227466 PMCID: PMC7477533 DOI: 10.1111/jdi.13262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 03/15/2020] [Accepted: 03/23/2020] [Indexed: 01/19/2023] Open
Abstract
AIMS/INTRODUCTION There are substantial differences in genes, diet, culture and environment between the northern and southern Chinese populations, which might influence treatment strategy and screening policy. We studied the differences in type 2 diabetes and diabetic complications between northern and southern China. MATERIALS AND METHODS We carried out a cross-sectional survey using data from the China Cardiometabolic Registries on blood pressure, blood lipids and blood glucose in 25,398 Chinese type 2 diabetes patients. Macrovascular, microvascular and other complications were collected by self-report or medical records, and then divided into the northern and southern groups by the boundary of the Yangtze River. RESULTS Northern patients were younger, and had heavier weight, greater body mass index and waist circumference, higher blood pressure, higher total cholesterol, higher low-density lipoprotein cholesterol, and higher hemoglobin A1C. The prevalence of cardiovascular, cerebrovascular and macrovascular complications were 1.76-fold, 1.24-fold and 1.47-fold more in northern than that in southern Chinese patients. In addition, the prevalence of diabetic nephropathy, retinopathy, neuropathy and microvascular complications in northern Chinese patients also increased. When stratified by age, the difference in both cardiovascular disease and ischemic stroke morbidity became significant, even in the 35-44 years age group. CONCLUSIONS More macrovascular and microvascular complications were found in northern compared with southern patients, and the largest difference also appeared in the younger age groups <55 years, which might be meaningful to a screening and treatment strategy according to geographic differences.
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Affiliation(s)
- Li Wang
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Ying Xing
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Xinwen Yu
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Jie Ming
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Xiangyang Liu
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Xiaomiao Li
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Jianfang Fu
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Jie Zhou
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Bin Gao
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
| | - Dayi Hu
- Department of CardiologyPeking University People’s HospitalBeijingChina
| | - Changyu Pan
- Department of EndocrinologyBeijing 301 Military General HospitalBeijingChina
| | - Linong Ji
- Department of Endocrinology and MetabolismPeking University People’s HospitalBeijingChina
| | - Qiuhe Ji
- Department of Endocrinology and MetabolismXijing HospitalXi’an, ShaanxiChina
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Kumar S, Talwalkar PG, Das S, Goswami S. Cardiovascular Effects of Sodium Glucose Co-transporter-2 Inhibitors in Patients with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2019; 23:150-158. [PMID: 31016170 PMCID: PMC6446691 DOI: 10.4103/ijem.ijem_161_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM), the leading type of diabetes, has a typical association with coronary heart disease. In India, patients with diabetes are at an increased risk of developing coronary disease as compared to people without diabetes and this suggests the requirement of intensive treatment of cardiovascular (CV) risk factors. Consequently, there is a need for an intervention that could target CV risk factors in multiple paths beyond hyperglycemic control alone. Although metformin is the mainstay of treatment in most of the patients with T2DM, a second line of treatment with anti-hyperglycemic agent is warranted in patients with T2DM in the management of CV risk factors beyond glycemic control. Sodium glucose co-transporter-2 (SGLT-2) inhibitors, the oral hypoglycemic drug, that act independent of insulin secretion are associated with a reduced risk of hypoglycemia which is associated with the increased risk of CV events. Moreover, it has been observed that the use of SGLT-2 inhibitors in patients with T2DM is associated with reductions in blood pressure and body weight beyond improved glycemic control. In this article, the clinical efficacy, safety, and tolerability of SGLT-2 inhibitors on glycemic, nonglycemic parameters, and CV outcome including data from the EMPA-REG OUTCOME study are discussed. The EMPA-REG OUTCOME study is the first CV outcome study that demonstrated the association of a glucose lowering agent with the reduced CV mortality and all-cause mortality, and reduced hospitalization for heart failure in patients with T2DM at high risk of CV events. Although the mode of action associated with the CV benefits remains unknown, data from ongoing trials including DECLARE-TIMI (Dapagliflozin Effect on CV Events) and CANVAS (Canagliflozin CV Assessment Study) trials potentially can validate the class-effect for SGLT-2 inhibitors regarding the CV outcomes.
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Affiliation(s)
- Surender Kumar
- Department Endocrinology, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sambit Das
- Department Endocrinology, Apollo Hospital, Bhubaneswar, Orissa, India
| | - Soumik Goswami
- Department Endocrinology, NRS Medical College, Kolkata, West Bengal, India
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Davies MJ, Merton K, Vijapurkar U, Yee J, Qiu R. Efficacy and safety of canagliflozin in patients with type 2 diabetes based on history of cardiovascular disease or cardiovascular risk factors: a post hoc analysis of pooled data. Cardiovasc Diabetol 2017; 16:40. [PMID: 28327140 PMCID: PMC5361783 DOI: 10.1186/s12933-017-0517-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/02/2017] [Indexed: 02/08/2023] Open
Abstract
Background Treatment of patients with type 2 diabetes mellitus (T2DM) and a history of cardiovascular (CV) disease or CV risk factors may present clinical challenges due to the presence of comorbid conditions and the use of concomitant medications. The sodium glucose co-transporter 2 inhibitor, canagliflozin, has been shown to improve glycaemic control and reduce body weight and blood pressure (BP) with a favourable tolerability profile in a broad range of patients with T2DM. This post hoc analysis assessed the efficacy and safety of canagliflozin in patients with T2DM based on CV disease history or CV risk factors. Methods Analyses were based on pooled data from four 26-week, placebo-controlled, Phase 3 studies that evaluated canagliflozin 100 and 300 mg in patients with T2DM (N = 2313; mean HbA1c, 8.0%; body weight, 89 kg; systolic BP, 128 mmHg). Changes from baseline to week 26 in HbA1c, body weight, and systolic BP were assessed based on history of CV disease, history of hypertension, baseline statin use, and number of CV risk factors. Safety was assessed based on adverse event (AE) reports. Results At week 26, both canagliflozin doses lowered HbA1c, body weight, and systolic BP compared with placebo in patients with and without CV disease history or risk factors. Placebo-subtracted HbA1c reductions with canagliflozin 100 and 300 mg were similar in patients with a history of CV disease (−0.95 and −1.07%) versus no history of CV disease (−0.71 and −0.90%), history of hypertension (−0.72 and −0.89%) versus no history of hypertension (−0.73 and −0.95%), baseline statin use (−0.77 and −0.99%) versus no statin use (−0.69 and −0.85%), and 0–1 CV risk factor (−0.72 and −0.87%) versus ≥2 CV risk factors (−0.74 and −1.02%). Similar body weight and systolic BP reductions were seen with canagliflozin versus placebo across subgroups. The incidence of AEs, AEs leading to discontinuation, and serious AEs was similar across subgroups. Conclusions The efficacy and safety of canagliflozin were generally consistent across subgroups of patients with T2DM and varying degrees of CV disease history or risk factors. Trial registration numbers and dates ClinicalTrials.gov: NCT01081834, 4 March 2010; NCT01106625, 1 April 2010; NCT01106677, 1 April 2010; NCT01106690, 1 April 2010 Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0517-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael J Davies
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Katherine Merton
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Ujjwala Vijapurkar
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
| | - Jacqueline Yee
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
| | - Rong Qiu
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
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Johansen OE. Interpretation of cardiovascular outcome trials in type 2 diabetes needs a multiaxial approach. World J Diabetes 2015; 6:1092-6. [PMID: 26265995 PMCID: PMC4530322 DOI: 10.4239/wjd.v6.i9.1092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/25/2015] [Accepted: 07/21/2015] [Indexed: 02/05/2023] Open
Abstract
In cardiovascular (CV) diabetology a "one-size fits-all" approach needs caution as vasculopathy and CV manifestations in patients with type 2 diabetes (T2D) with short disease duration are different as compared to those with longer duration. This is of relevance when interpreting results of CV outcome trials as responses to any intervention aimed to reduce CV risk might be different in patients with established vasculopathy as compared to those without, where also the duration of the intervention may play a role. Additionally, the mode-of-action of the intervention and its assumed time to peak CV risk modulation need to be taken into account: an intervention with possibly immediate effects, like on blood pressure or other direct functional dynamic parameters such as endothelial function or renal hemodynamics, could likely provide a meaningful impact on CV outcomes over a shorter time span than interventions that primarily target pathways that work on atherosclerotic processes, organ-remodelling, or vessel integrity. We are now faced with CV outcome results to interpret from a plethora of outcomes trials in T2D, some of which are testing the CV risk modulation predominantly beyond glucose lowering, e.g., as is the case for several trials testing the newer therapy classes di-peptidyl peptidase-4 inhibitors, glucagon-like protein-1 receptor analogues and sodium glucose co-transporter-2 inhibitors, and this paper reviews the data that support a call for a multiaxial approach to interpret these results.
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Inzucchi SE, Zinman B, Wanner C, Ferrari R, Fitchett D, Hantel S, Espadero RM, Woerle HJ, Broedl UC, Johansen OE. SGLT-2 inhibitors and cardiovascular risk: proposed pathways and review of ongoing outcome trials. Diab Vasc Dis Res 2015; 12:90-100. [PMID: 25589482 PMCID: PMC4361459 DOI: 10.1177/1479164114559852] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Given the multi-faceted pathogenesis of atherosclerosis in type 2 diabetes mellitus (T2DM), it is likely that interventions to mitigate this risk must address cardiovascular (CV) risk factors beyond glucose itself. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are newer antihyperglycaemic agents with apparent multiple effects. Inherent in their mode of action to decrease glucose reabsorption by the kidneys by increasing urinary glucose excretion, these agents improve glycaemic control independent of insulin secretion with a low risk of hypoglycaemia. In this review, we outline those CV risk factors that this class appears to influence and provide the design features and trial characteristics of six ongoing outcome trials involving more than 41,000 individuals with T2DM. Those risk factors beyond glucose that can potentially be modulated positively with SGLT-2 inhibitors include blood pressure, weight, visceral adiposity, hyperinsulinaemia, arterial stiffness, albuminuria, circulating uric acid levels and oxidative stress. On the other hand, small increases in low-density lipoprotein (LDL)-cholesterol levels have also been observed for the class, which theoretically might offset some of these benefits. The potential translational impact of these effects is being tested with outcome trials, also reviewed in this article, powered to assess both macrovascular as well as certain microvascular outcomes in T2DM. These are expected to begin to report in late 2015.
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Christoph Wanner
- Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy
| | - David Fitchett
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stefan Hantel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | | | - Uli C Broedl
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
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Lucke-Wold BP, DiPasquale K, Logsdon AF, Nguyen L, Lucke-Wold AN, Turner RC, Huber JD, Rosen CL. Metabolic Syndrome and its Profound Effect on Prevalence of Ischemic Stroke. AMERICAN MEDICAL STUDENT RESEARCH JOURNAL 2014; 1:29-38. [PMID: 27284575 PMCID: PMC4896644 DOI: 10.15422/amsrj.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ischemic stroke represents a leading cause of death worldwide and the leading cause of disability in the United States. Greater than 8% of all deaths are attributed to ischemic stroke. This rate is consistent with the heightened burden of cardiovascular disease deaths. Treatments for acute ischemic stroke remain limited to tissue plasminogen activator and mechanical thrombolysis, both of which require significant medical expertise and can only be applied to a select number of patients based on time of presentation, imaging, and absence of contraindications. Over 1,000 compounds that were successful in treating ischemic stroke in animal models have failed to correlate to success in clinical trials. The search for alternative treatments is ongoing, drawing greater attention to the importance of preclinical models that more accurately represent the clinical population through incorporation of common risk factors. This work reviews the contribution of these commonly observed risk factors in the clinical population highlighting both the pathophysiology as well as current clinical diagnosis and treatment standards. We also highlight future potential therapeutic targets, areas requiring further investigation, and recent changes in best-practice clinical care.
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Affiliation(s)
- Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
| | - Kenneth DiPasquale
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Aric F Logsdon
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - A Noelle Lucke-Wold
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; West Virginia University, School of Nursing, Morgantown, West Virginia
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
| | - Jason D Huber
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
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NF-kappaB binding activity and pro-inflammatory cytokines expression correlate with body mass index but not glycosylated hemoglobin in Chinese population. Diabetes Res Clin Pract 2010; 90:73-80. [PMID: 20630610 DOI: 10.1016/j.diabres.2010.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/30/2010] [Accepted: 06/14/2010] [Indexed: 01/18/2023]
Abstract
AIMS Chronic inflammation is linked to type 2 diabetes (T2DM), so we investigated correlations between obesity, blood glucose levels, and inflammation in T2DM patients. METHODS Peripheral blood mononuclear cells (PBMCs) were collected from 40 T2DM patients (27 men, 13 women; mean age 49.63 years), and 10 non-diabetic controls (all men; mean age 38.60 years). Inflammation was measured as DNA-binding activity of nuclear factor kappaB (NF-kappaB), a key transcription factor in inflammation. Protein levels of NF-kappaB subunit p65, and NF-kappaB inhibitor IkappaBalpha were assessed by Western blot. Transcript levels for p65, IkappaBalpha, and the NF-kappaB target genes TNF-alpha, MMP-9, IL-6, IL-8, and IL-18 were measured by real-time PCR. Body mass index (BMI) and glycohemoglobin were measured for all the subjects. RESULTS NF-kappaB DNA-binding activity, p65 and IkappaBalpha protein levels, and expression of IL-6, TNFalpha and MMP-9 were significantly higher in PBMCs from T2DM patients, than from non-diabetic controls. NF-kappaB binding was significantly positively associated with both BMI and homeostasis model assessment of insulin resistance (HOMA-IR). CONCLUSIONS Inflammation was observed in PBMCs in T2DM patients in a Chinese population, and correlated independently with obesity and blood glucose levels. Lack of correlation with glycohemoglobin suggested that moderate-term blood glucose control did not mitigate inflammation.
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Rubin MF, Townsend RR. Aldosterone blockade in diabetic nephropathy: relative risks and potential promise. J Am Soc Nephrol 2009; 20:2487-9. [PMID: 19875814 DOI: 10.1681/asn.2009101036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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KUROKAWA M, HIDESHIMA M, ISHII Y, KYUWA S, YOSHIKAWA Y. Aortic ER Stress in Streptozotocin-Induced Diabetes Mellitus in APA Hamsters. Exp Anim 2009; 58:113-21. [DOI: 10.1538/expanim.58.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Masaki KUROKAWA
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Makoto HIDESHIMA
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Yoshiyuki ISHII
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Shigeru KYUWA
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Yasuhiro YOSHIKAWA
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo
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