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Kotseva K, Jennings C, Bassett P, Adamska A, Hobbs R, Wood D. Challenge of cardiovascular prevention in primary care: achievement of lifestyle, blood pressure, lipids and diabetes targets for primary prevention in England - results from ASPIRE-3-PREVENT cross-sectional survey. Open Heart 2024; 11:e002704. [PMID: 39414309 PMCID: PMC11481111 DOI: 10.1136/openhrt-2024-002704] [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: 04/09/2024] [Accepted: 09/18/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Implementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary Prevention by Intervention to Reduce Events (ASPIRE) surveys in 1994-1995, 2008-2010 and 2017-2019. The primary care arm of ASPIRE-2-PREVENT (A-3-P) was conducted to evaluate lifestyle and medical risk factor management in people at high risk of atherosclerotic CVD in everyday clinical practice. METHODS A-3-P was a cross-sectional survey in 27 general practices and health centres across 5 English National Health Service regions. Patients with no history of atherosclerotic CVD started on blood pressure and/or lipid and/or glucose lowering treatments were identified retrospectively and interviewed at least 6 months after the initiation of medication. RESULTS 557 patients attended the interview and examination (45.8% women; mean age 61.7±10.8 years). The risk factor control was poor: 9.3% of patients were smokers, 38.1% obese (body mass index≥30 kg/m2) and 53.5% centrally obese (waist circumference≥88 cm for women, ≥102 cm for men). Only 37.8% of patients on blood pressure-lowering therapies achieved the target of<140/90 mm Hg. Among treated dyslipidaemic patients, 59.5% reached the low-density lipoprotein cholesterol target of <2.6 mmol/L. 62% of patients with self-reported diabetes mellitus attained the glycated haemoglobin target of <7.0%. CONCLUSION The results of A-3-P survey show that large proportions of people at high CVD risk have poor control of lifestiles and medical risk factors. There is considerable potential to raise the standards of preventive cardiology care by providing comprehensive, multidisciplinary prevention programmes addressing all aspects of risk factor management to reduce the total risk of future CVD.
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Affiliation(s)
- Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | | | - Agnieszka Adamska
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | | | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
- Imperial College London, London, UK
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Ferrannini G, Tuomilehto J, De Backer G, Kotseva K, Mellbin L, Schnell O, Wood D, De Bacquer D, Rydén L. Dysglycaemia screening and its prognostic impact in patients with coronary artery disease: experiences from the EUROASPIRE IV and V cohort studies. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00201-8. [PMID: 39326426 DOI: 10.1016/s2213-8587(24)00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Glucose perturbations can be detected by fasting plasma glucose (FPG), HbA1c, and the oral glucose tolerance test (OGTT). The highest yield is provided by OGTT. HbA1c is considered more practical. We compare the diagnostic and predictive performance of these glycaemic indicators based on combined data from the EUROASPIRE IV (EAIV) and V (EAV) studies. METHODS This cohort study was conducted in 79 centres in 24 European countries (EAIV) and 131 centres in 27 European countries (EAV). Eligible patients were aged 18-80 years, did not have diabetes, and were diagnosed with coronary artery disease 6-36 months (EAIV) or 6-24 months (EAV) before the investigation. Patients were investigated with OGTT (FPG and 2 h post-load glucose [2-hPG]) and HbA1c. Follow-up of subsequent cardiovascular events was done by means of a questionnaire at least 1 year after the baseline investigation. Analyses were done in patients with both OGTT and HbA1c data available. Outcome analysis in these patients was restricted to those with valid follow-up data available. FINDINGS 16 259 patients were interviewed in EAIV (2012-13) and EAV (2016-17). 8364 patients had both OGTT and HbA1C data and were included in the analysis population (3932 in EAIV and 4432 in EAV). Information on cardiovascular events was available in 7892 patients. Follow-up was for a median 1·6 years (IQR 1·2-2·0). The average patient age was 63·3 years (SD 9·8), and 6346 (75·9%) of 8364 patients were men. At baseline, 1856 (22·5%) of 8263 patients were determined to have newly detected type 2 diabetes using OGTT alone, compared with 346 (4·2%) using HbA1c alone. New dysglycaemia, defined as newly detected type 2 diabetes or impaired glucose tolerance (IGT), was present in 3896 (47·1%) of the patients according to 2hPG. 2hPG 9 mmol/L or greater (162 mg/dL, adjusted hazard ratio [aHR] 1·58; 95% CI 1·27-1·95, p<0·0001), and HbA1c 5·9% or greater (41 mmol/mol, aHR 1·48, 1·19-1·84; p=0·0010) were the strongest predictors of cardiovascular events, while FPG did not predict. A multivariable model showed that the effect of HbA1c on cardiovascular events was mainly explained by 2hPG (aHR for 1 unit increase in HbA1c 1·13, 0·98-1·30; p=0·11; and aHR for 1 unit increase in Ln[2hPG] 1·37, 1·08-1·74; p=0·0042). INTERPRETATION 2hPG appears better than HbA1c in detecting dysglycaemia and predicting its impact on future cardiovascular events in patients with coronary artery disease and should be recommended as the primary screening tool. FUNDING Swedish Heart-Lung Foundation, Region Stockholm (ALF), the Erling Persson Foundation, the Baltic Child Foundation.
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Affiliation(s)
- Giulia Ferrannini
- Södertälje hospital, Stockholm, Sweden; Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, UK; University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, Ireland
| | - Linda Mellbin
- Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Oliver Schnell
- Forschergruppe Diabetes e V, Helmholtz Center Munich, Neuherberg, Germany
| | - David Wood
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Lars Rydén
- Department for Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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He L, Lin C, Tu Y, Yang Y, Lin M, Tu H, Li J. Correlation of cardiometabolic index and sarcopenia with cardiometabolic multimorbidity in middle-aged and older adult: a prospective study. Front Endocrinol (Lausanne) 2024; 15:1387374. [PMID: 38863933 PMCID: PMC11165091 DOI: 10.3389/fendo.2024.1387374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Background Research has demonstrated that sarcopenia and visceral obesity are significant risk factors for chronic disease in middle-aged and older adults. However, the relationship between sarcopenia, the cardiac metabolic index (CMI), a novel measure of visceral obesity, and cardiometabolic multimorbidity (CMM) remains unclear. In this study, data from the China Longitudinal Study of Health and Retirement (CHARLS) were analyzed to investigate the association between sarcopenia and CMI with CMM in the middle-aged and older adult population. Methods The study included 4,959 participants aged 45 and over. Sarcopenia was defined using the criteria of the Asian Sarcopenia Working Group 2019. CMM is defined as having two or more of the following conditions: physician-diagnosed heart disease, diabetes, stroke, and/or hypertension. CMI was calculated using the formula: CMI = (TG/HDL-C) × WHtR. To explore the association between CMI and sarcopenia and CMM, cox proportional risk regression models were used. Results The median age of all participants was 57 years, with 47.1% being male. Over the 8-year follow-up, 1,362 individuals developed CMM. The incidence of CMM was 8.7/1,000 person-years in the group without sarcopenia or high CMI, 17.37/1,000 person-years in those with high CMI, 14.22/1,000 person-years in the sarcopenia group, and 22.34/1,000 person-years in the group with both conditions. After adjusting for covariates, the group with both sarcopenia and high CMI had a significantly increased risk of CMM (HR 2.48, 95% CI 1.12-5.51) and heart disease (HR 2.04, 95% CI 1.05-3.98). Among those over 65 years, sarcopenia was discovered to be associated with an increased risk of CMM [HR (95% CI: 4.83 (1.22, 19.06)]. The risk of CMM was further increased to 7.31-fold (95% CI:1.72, 31.15) when combined with high CMI. Conclusions The combination of sarcopenia and high CMI is associated with an increased risk of developing CMM. Early identification and intervention of sarcopenia and CMI not only enable the development of targeted therapeutic strategies but also provide potential opportunities to reduce the morbidity and mortality of CMM.
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Affiliation(s)
- Ling He
- The Department of Geriatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chuyang Lin
- The Department of Clinical Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yansong Tu
- The Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC, Australia
| | - Yazhi Yang
- The Department of Clinical Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ming Lin
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Huaijun Tu
- The Department of Geriatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jian Li
- The Department of Geriatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Benberin V, Karabaeva R, Kulmyrzaeva N, Bigarinova R, Vochshenkova T. Evolution of the search for a common mechanism of congenital risk of coronary heart disease and type 2 diabetes mellitus in the chromosomal locus 9p21.3. Medicine (Baltimore) 2023; 102:e35074. [PMID: 37832109 PMCID: PMC10578751 DOI: 10.1097/md.0000000000035074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 10/15/2023] Open
Abstract
9.21.3 chromosomal locus predisposes to coronary heart disease (CHD) and type 2 diabetes mellitus (DM2), but their overall pathological mechanism and clinical applicability remain unclear. The review uses publications of the study results of 9.21.3 chromosomal locus in association with CHD and DM2, which are important for changing the focus of clinical practice. The eligibility criteria are full-text articles published in the PubMed database (MEDLINE) up to December 31, 2022. A total of 56 publications were found that met the inclusion criteria. Using the examples of the progressive stages in understanding the role of the chromosomal locus 9p.21.3, scientific ideas were grouped, from a fragmentary study of independent pathological processes to a systematic study of the overall development of CHD and DM2. The presented review can become a source of new scientific hypotheses for further studies, the results of which can determine the general mechanism of the congenital risk of CHD and DM2 and change the focus of clinical practice.
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Affiliation(s)
- Valeriy Benberin
- Centre of Gerontology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Raushan Karabaeva
- Centre of Gerontology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Nazgul Kulmyrzaeva
- Centre of Gerontology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Rauza Bigarinova
- Centre of Gerontology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Tamara Vochshenkova
- Centre of Gerontology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
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Bhandari R, Armenian SH, McCormack S, Natarajan R, Mostoufi-Moab S. Diabetes in childhood cancer survivors: emerging concepts in pathophysiology and future directions. Front Med (Lausanne) 2023; 10:1206071. [PMID: 37675136 PMCID: PMC10478711 DOI: 10.3389/fmed.2023.1206071] [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: 04/14/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
With advancements in cancer treatment and supportive care, there is a growing population of childhood cancer survivors who experience a substantial burden of comorbidities related to having received cancer treatment at a young age. Despite an overall reduction in the incidence of most chronic health conditions in childhood cancer survivors over the past several decades, the cumulative incidence of certain late effects, in particular diabetes mellitus (DM), has increased. The implications are significant, because DM is a key risk factor for cardiovascular disease, a leading cause of premature death in childhood cancer survivors. The underlying pathophysiology of DM in cancer survivors is multifactorial. DM develops at younger ages in survivors compared to controls, which may reflect an "accelerated aging" phenotype in these individuals. The treatment-related exposures (i.e., chemotherapy, radiation) that increase risk for DM in childhood cancer survivors may be more than additive with established DM risk factors (e.g., older age, obesity, race, and ethnicity). Emerging research also points to parallels in cellular processes implicated in aging- and cancer treatment-related DM. Still, there remains marked inter-individual variability regarding risk of DM that is not explained by demographic and therapeutic risk factors alone. Recent studies have highlighted the role of germline genetic risk factors and epigenetic modifications that are associated with risk of DM in both the general and oncology populations. This review summarizes our current understanding of recognized risk factors for DM in childhood cancer survivors to help inform targeted approaches for disease screening, prevention, and treatment. Furthermore, it highlights the existing scientific gaps in understanding the relative contributions of individual therapeutic exposures and the mechanisms by which they exert their effects that uniquely predispose this population to DM following cancer treatment.
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Affiliation(s)
- Rusha Bhandari
- Department of Pediatrics, City of Hope, Duarte, CA, United States
- Department of Population Sciences, City of Hope, Duarte, CA, United States
| | - Saro H. Armenian
- Department of Pediatrics, City of Hope, Duarte, CA, United States
- Department of Population Sciences, City of Hope, Duarte, CA, United States
| | - Shana McCormack
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rama Natarajan
- Department of Diabetes Complications and Metabolism, Arthur Riggs Diabetes and Metabolism Research Institute, City of Hope, Duarte, CA, United States
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Overgaard KS, Andersen TR, Mohamed RA, Heinsen LJ, Binderup HG, Möller S, Auscher S, Lambrechtsen J, Egstrup K. Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients? Diab Vasc Dis Res 2023; 20:14791641231179870. [PMID: 37344962 PMCID: PMC10288424 DOI: 10.1177/14791641231179870] [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] [Indexed: 06/23/2023] Open
Abstract
We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3-3.5) for CAC >400 and 1.5 (95% CI: 1.0-2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.
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Affiliation(s)
- Katrine S Overgaard
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Thomas R Andersen
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Roda A Mohamed
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Laurits J Heinsen
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Helle G Binderup
- Odense University Hospital, Department of Clinical Biochemistry, Svendborg, Denmark
| | - Sören Möller
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
- Odense University Hospital, OPEN Research Unit–Open Patient Data Explorative Network, Odense, Denmark
| | - Søren Auscher
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jess Lambrechtsen
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
| | - Kenneth Egstrup
- Odense University Hospital Svendborg, Cardiovascular Research Unit, Svendborg, Denmark; University of Southern Denmark, Odense, Denmark
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Cosic V, Jakab J, Pravecek MK, Miskic B. The Importance of Prediabetes Screening in the Prevention of Cardiovascular Disease. Med Arch 2023; 77:97-104. [PMID: 37260805 PMCID: PMC10227840 DOI: 10.5455/medarh.2023.77.97-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/20/2023] [Indexed: 06/02/2023] Open
Abstract
Background Prediabetes is a disordered state of glucose metabolism defined by an elevated blood glucose level that is below the level required for the diagnosis of diabetes. Prediabetes is associated with an increased risk of cardiovascular disease. The onset and progression of macrovascular disease occur during the prediabetes phase. Early diagnosis and screening of prediabetes are essential steps to prevent diabetes and its associated complications. Objective To assess the prevalence of prediabetes and undiagnosed diabetes in patients with cardiovascular disease according to the ADA criteria. Methods This cross-sectional study included 2968 a high cardiovascular risk patients aged 40 to 75 years admitted to the Department of Internal Medicine. Sociodemographic variables and other relevant medical history information were collected by the researchers during the clinical interview. A fasting blood sample was obtained to determine HbA1c levels and other relevant laboratory findings. Results Of the total number of participants, 1496 participants were not diagnosed with diabetes, 485 (32.4%) of them had HbA1c values indicating prediabetes and 158 (10.6%) of them had HbA1c values indicating new diagnosed diabetes. Up to one-third of those with undiagnosed prediabetes had already been diagnosed with cardiovascular complications. Conclusion Routine screening of glycemic metabolism could be valuable in identifying high-risk individuals before a cardiovascular event occurs.
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Affiliation(s)
- Vesna Cosic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jelena Jakab
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marijana Knezevic Pravecek
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- General Hospital “Dr. Josip Benčevic” Slavonski Brod, Slavonski Brod, Croatia
| | - Blazenka Miskic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- General Hospital “Dr. Josip Benčevic” Slavonski Brod, Slavonski Brod, Croatia
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Ungethüm K, Wiedmann S, Wagner M, Leyh R, Ertl G, Frantz S, Geisler T, Karmann W, Prondzinsky R, Herdeg C, Noutsias M, Ludwig T, Käs J, Klocke B, Krapp J, Wood D, Kotseva K, Störk S, Heuschmann PU. Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys. Clin Res Cardiol 2023; 112:285-298. [PMID: 36166067 PMCID: PMC9898414 DOI: 10.1007/s00392-022-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. METHODS The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). RESULTS 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). CONCLUSION Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.
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Affiliation(s)
- K Ungethüm
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany.
| | - S Wiedmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Berlin, Germany
| | - M Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Kuratorium für Dialyse und Nierentransplantation E.V, Neu-Isenburg, Hesse, Germany
| | - R Leyh
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - G Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - S Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
| | - T Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - W Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Bavaria, Germany
| | - R Prondzinsky
- Cardiology/Intensive Care Medicine, Carl Von Basedow Klinikum Merseburg, Merseburg, Saxony-Anhalt, Germany
| | - C Herdeg
- Medius Klinik Ostfildern-Ruit, Klinik für Innere Medizin, Herz- und Kreislauferkrankungen, Ostfildern-Ruit, Baden-Württemberg, Germany
| | - M Noutsias
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
- Department of Internal Medicine A, University Hospital Ruppin-Brandenburg (UKRB) of the Medical School of Brandenburg (MHB), Neuruppin, Brandenburg, Germany
| | - T Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Käs
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - B Klocke
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Krapp
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - D Wood
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - K Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - S Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - P U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
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10
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Inzucchi SE, Claggett BL, Vaduganathan M, Desai AS, Jhund PS, de Boer RA, Hernandez AF, Kosiborod MN, Lam CSP, Martinez F, Shah SJ, Verma S, Han Y, Kerr Saraiva JF, Bengtsson O, Petersson M, Langkilde AM, McMurray JJV, Solomon SD. Efficacy and safety of dapagliflozin in patients with heart failure with mildly reduced or preserved ejection fraction by baseline glycaemic status (DELIVER): a subgroup analysis from an international, multicentre, double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2022; 10:869-881. [PMID: 36372069 DOI: 10.1016/s2213-8587(22)00308-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Type 2 diabetes and prediabetes are risk factors for heart failure and adverse heart failure outcomes. The Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial showed that dapagliflozin was associated with a reduction in the primary outcome of worsening heart failure or cardiovascular mortality in patients with heart failure with mildly reduced or preserved ejection fraction. We aimed to assess the efficacy and safety of oral dapagliflozin in these patients by their baseline glycaemia categories. METHODS DELIVER was an international, multicentre, double-blind, randomised, placebo-controlled trial done in 350 health-care centres and hospitals across 20 countries. Patients aged 40 years or older with New York Heart Association class II-IV, left ventricular ejection fraction of more than 40%, elevated natriuretic peptides (N-terminal pro B-type natriuretic peptide ≥300 pg/mL or ≥600 pg/mL for patients in atrial fibrillation or flutter), and evidence of structural heart disease were randomly assigned (1:1) to 10 mg dapagliflozin or placebo, administered orally, and followed up for a median of 2·3 years (IQR 1·7-2·8). The primary outcome, a composite of time from randomisation to first worsening heart failure events (defined as an unplanned hospitalisation or urgent heart failure visit requiring intravenous therapy) or cardiovascular death, in participants with type 2 diabetes (history of or identified by HbA1c ≥6·5% [48 mmol/mol] at baseline) or prediabetes (HbA1c 5·7 to <6·5% [39 mmol/mol to <48 mmol/mol] at baseline) was compared with those with normoglycaemia (HbA1c <5·7% [39 mmol/mol]). Efficacy of dapagliflozin versus placebo was assessed according to glycaemic status and based on HbA1c as a continuous measure. The full-analysis set comprised all patients who were randomly assigned to study treatment, with patients analysed according to their randomised treatment assignment, irrespective of the treatment received (ie, intention to treat). The safety analysis set comprised patients who were randomly assigned to study treatment and who took at least one dose of investigational product, with patients analysed according to the treatment actually received. This trial is registered with ClinicalTrials.gov, NCT03619213. FINDINGS Between Sept 1, 2018, and Jan 18, 2021, 6263 patients were randomly assigned to oral dapagliflozin (n=3131) or placebo (n=3132). Of these patients, 1175 had normoglycaemia, 1934 had prediabetes, and 3150 had type 2 diabetes and were included in the glycaemia subgroup analysis (3515 [56·2%] of 6263 patients were men and 4435 [70·9%] were White). The incidence rate of the primary outcome was 6·9 per 100 patient-years in the normoglycaemia subgroup (reference), increasing to 7·6 per 100 patient-years in the prediabetes subgroup (hazard ratio 1·09 [95% CI 0·90-1·31]) and 10·1 per 100 patient-years in the type 2 diabetes subgroup (1·46 [1·24-1·73]; p<0·0001 for trend). Dapagliflozin reduced the risk of the primary outcome versus placebo in each subgroup (hazard ratio 0·77 [95% CI 0·57-1·04], log-rank p=0·088, for patients with normoglycaemia, 0·87 [0·69-1·08], log-rank p=0·21, for patients with prediabetes, and 0·81 [0·69-0·95], log-rank p=0·0077, for patients with type 2 diabetes; pinteraction=0·82) and across the continuous HbA1c range (pinteraction=0·85). Volume-related or renal serious adverse events or adverse events leading to discontinuation of the study drug, hypoglycaemia, and amputations were not differentially affected by treatment in any of the glycaemia categories. INTERPRETATION In patients with heart failure with mildly reduced or preserved ejection fraction, oral dapagliflozin improved heart failure outcomes to a similar extent in three glycaemia subgroups: normoglycaemia, prediabetes, and type 2 diabetes. Moreover, the heart failure benefits of dapagliflozin seem to be consistent across a continuous glycaemic range. FUNDING AstraZeneca.
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology and Metabolism, Yale School of Medicine, and Yale New Haven Hospital, New Haven, CT, USA.
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Felipe Martinez
- Department of Cardiology, University of Cordoba, Cordoba, Argentina
| | - Sanjiv J Shah
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Yaling Han
- Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | | | | | | | | | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population. Diabetes Care 2022; 45:2111-2117. [PMID: 35771773 DOI: 10.2337/dc22-0272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Göran's Hospital, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Terhi Vihervaara
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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12
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Wei W, Liang Y, Guo D, Xu X, Xu Q, Li S, Li Y, Liu J, Liu Y, Tu M, Chen K, Chen H, Chen S. Hyperglycemia newly detected by glycated hemoglobin affects all-cause mortality in coronary artery disease patients: a retrospective cohort study. Diabetes Res Clin Pract 2022; 191:110053. [PMID: 36038089 DOI: 10.1016/j.diabres.2022.110053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
AIMS We aim to assess the relationship between hyperglycemia and long-term prognosis in CAD patients without known diabetes. METHODS In this retrospective observational study, we enrolled 11,384 CAD patients without known diabetes. Newly detected diabetes was defined as HbA1c ≥ 6.5 %, and prediabetes was defined as HbA1c ranging from 5.7 to 6.4 %.The association between hyperglycemia and long-term all-cause mortality was examined using Cox proportional hazards regression analysis. RESULTS According to HbA1c level, 8207 (72.1 %) patients had hyperglycemia, including 13.0 % with diabetes and 59.1 % with prediabetes. During a median follow-up of 4.9 years, 1157(10.2 %) patients died. Compared with normoglycemia, hyperglycemia was associated with increased risk for long-term mortality (adjusted hazard ratio for diabetes and prediabetes: 1.23 [95 % confidence interval (CI): 1.00 to 1.51] and 1.17 [95 % CI: 1.01 to 1.36], respectively). CONCLUSIONS Hyperglycemia detected by HbA1c was common in CAD patients without known diabetes and was associated with increased long-term mortality. It is necessary to routinely use HbA1c to assess glucose metabolic status in CAD patients and treat hyperglycemia as early as possible to reduce the risk of adverse outcomes.
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Affiliation(s)
- Wen Wei
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Dachuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Xinghao Xu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Qingbo Xu
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Shanggang Li
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yuqi Li
- Department of Cardiology, Zhong Shan City People's Hospital, Zhong Shan 528403, China
| | - Jin Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510100, China
| | - Mei Tu
- Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China.
| | - Hong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
| | - Shiqun Chen
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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13
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Zywicki V, Capozza P, Caravelli P, Del Prato S, De Caterina R. Glucose tolerance and markers of myocardial injury after an acute coronary syndrome: predictive role of the 1-h plus 2-h plasma glucose at the oral glucose tolerance test. Cardiovasc Diabetol 2022; 21:152. [PMID: 35941590 PMCID: PMC9358640 DOI: 10.1186/s12933-022-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/16/2022] [Indexed: 01/08/2023] Open
Abstract
Objective Impaired glucose tolerance (IGT) has been related to adverse cardiovascular outcomes. We investigated the added value of 1-h plasma glucose (PG) at the oral glucose tolerance test (OGTT) in predicting admission and peak cardiac high-sensitivity troponin T (hs-TnT) and NT-proBNP values in IGT patients admitted for an acute coronary syndrome (ACS). Research design and methods Among 192 consecutive ACS patients, 109 had Hb1Ac and fasting plasma glucose negative for newly diagnosed diabetes. Upon OGTT performed > 96 h after admission, 88, conventionally diagnosed as IGT, were divided into: “full glucose tolerance” (1-h PG-OGTT < 155 mg/dL and 2-h PG-OGTT < 140 mg/dL, N = 12);”early IGT” (1 h-PG-OGTT ≥ 155 mg/dL and 2-h PG-OGTT < 140 mg/dL, N = 33);”late IGT” (1-h PG-OGTT < 155 mg/dL and 2-h PG-OGTT ≥ 140 mg/dL, N = 8); and “full IGT” (1-h PG-OGTT ≥ 155 mg/dL and 2-h PG-OGTT ≥ 140 mg/dL, N = 35). The 4 groups were compared for cardiac markers. Results The first three groups had similar cardiac marker values, but only full IGT patients had significantly higher admission hs-TnT compared with the 3 other groups [median (interquartile range): 911 (245-2976) vs 292 (46-1131), P < 0.001]. Full IGT patients also had higher hs-TnT peak compared with fully glucose tolerant and early IGT patients. Only full IGT patients had longer hospitalization and higher NT-proBNP vs fully glucose tolerant patients (P = 0.005). Conclusions Among non-diabetic ACS patients, only those with both 1-h PG ≥ 155 mg/dL and 2-h PG ≥ 140 mg/dL had more severe myocardial injury and longer hospitalization. One-h PG-OGTT importantly contributes to assessing post-ACS cardiac risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01590-w.
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Affiliation(s)
- Viola Zywicki
- Cardiology, University of Pisa, and Cardiovascular Division - Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paola Capozza
- Cardiology, University of Pisa, and Cardiovascular Division - Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paolo Caravelli
- Cardiology, University of Pisa, and Cardiovascular Division - Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Stefano Del Prato
- Diabetology Divisions, Pisa University Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Caterina
- Cardiology, University of Pisa, and Cardiovascular Division - Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy. .,Fondazione VillaSerena Per La Ricerca, Città Sant'Angelo, Pescara, Italy.
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14
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Rosén A, Otten J, Stomby A, Vallin S, Wennberg P, Brunström M. Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden. BMJ Open 2022; 12:e062172. [PMID: 35676014 PMCID: PMC9185658 DOI: 10.1136/bmjopen-2022-062172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance (IGT). DESIGN Retrospective analysis of serial cross-sectional screening study. SETTING Population-based health examinations within primary care in Västerbotten County, Sweden. PARTICIPANTS Individuals aged 40- 50 and 60 years with participation from 1985 to 2017. Those with previously diagnosed diabetes and FPG≥7 mmol/L were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of hyperglycaemia on the OGTT (IGT and T2D defined as 2-hour postload capillary plasma glucose of 8.9-12.1 mmol/L and ≥12.2 mmol/L, respectively). Analyses were further stratified by age, sex and risk factor burden to identify groups at high or low risk of IGT and T2D on testing. The numbers needed to screen (NNS) to prevent one case of T2D through detection and treatment of IGT was estimated, combining prevalence numbers with average progression rates and intervention effects from previous meta-analyses. RESULTS The prevalence of IGT ranged from 0.9% (95% CI 0.7% to 1.1%) to 29.6% (95% CI 27.4% to 31.7%), and the prevalence of T2D ranged from 0.06% (95% CI 0.02% to 0.11%) to 7.0% (95% CI 5.9% to 8.3%), depending strongly on age, sex and risk factor burden. The estimated NNS to prevent one case of T2D through detection and lifestyle treatment of IGT ranged from 1332 among 40-year-old men without risk factors, to 39 among 60-year-old women with all risk factors combined. CONCLUSIONS The prevalence of hyperglycaemia on OGTT is highly dependent on age, sex and risk factor burden; OGTT should be applied selectively to high-risk groups to avoid unnecessary testing in the general population.
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Affiliation(s)
- Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Andreas Stomby
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Simon Vallin
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
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15
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Zhang L, Zhang J, Qin Z, Liu N, Zhang Z, Lu Y, Xu Y, Zhang J, Tang J. Diagnostic and Predictive Values of Circulating Extracellular Vesicle-Carried microRNAs in Ischemic Heart Disease Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2022; 9:813310. [PMID: 35295267 PMCID: PMC8918773 DOI: 10.3389/fcvm.2022.813310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/05/2022] [Indexed: 12/14/2022] Open
Abstract
Ischemic heart disease patients with diabetes mellitus (IHD-DM) have a higher risk of cardiovascular events than those without DM. Rapid identification of IHD-DM can enable early access to medical treatment and reduce the occurrence of cardiovascular adverse events. In the present study, we identified and examined extracellular vesicle (EV)-carried microRNAs (miRNAs) as the possible diagnostic biomarkers of IHD-DM. Small RNA sequencing was performed to analyze the EV-carried miRNAs spectrum, and differentially expressed miRNAs were further confirmed by quantitative real-time polymerase chain reaction (qRT-PCR). Through small RNA sequencing, we identified 138 differentially expressed EV-carried miRNAs between IHD-DM patients and healthy controls. Furthermore, we identified that five EV-carried miRNAs (miR-15a-3p, miR-18a-5p, miR-133a-3p, miR-155-5p, and miR-210-3p) were significantly down-regulated and one (miR-19a-3p) was significantly up-regulated in the IHD-DM patients compared to healthy controls. The receiver–operating characteristic curve analysis showed that the above six EV-carried miRNAs have excellent diagnostic efficacy of IHD-DM. Our findings indicated that the circulating EV-miRNAs might be promising biomarkers for the convenient and rapid diagnosis of IHD-DM.
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Affiliation(s)
- Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jianchao Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Zhen Qin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Na Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zenglei Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Yongzheng Lu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Yanyan Xu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jinying Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
- Jinying Zhang
| | - Junnan Tang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, China
- Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, China
- *Correspondence: Junnan Tang
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16
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Changes in type 2 diabetes incidence and mortality associated with introduction of HbA1c as diagnostic option: A Danish 24-year population-based study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100291. [PMID: 35024680 PMCID: PMC8733171 DOI: 10.1016/j.lanepe.2021.100291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background In 2011, the World Health Organization began recommending glycated haemoglobin (HbA1c) as a measure for diagnosing type 2 diabetes (T2D). This initiative may have changed basic T2D epidemiology. Consequently, we examined time changes in T2D incidence and mortality during 1995-2018. Methods In this population-based cohort study, we included 415,553 individuals with incident T2D. We calculated annual age-standardized incidence rates of T2D. We examined HbA1c testing and used Poisson-regression to investigate all-cause mortality among the T2D patients and a matched comparison cohort from the general population over successive 3-year periods. Findings From 1995 to the 2012 introduction of HbA1c testing as a diagnostic option in Denmark, the annual standardized incidence rate (SIR) of T2D doubled, from 193 to 396 per 100,000 persons (4.1% increase annually). From 2012 onwards, the T2D incidence declined by 36%, reaching 253 per 100,000 persons in 2018 (5.7% decrease annually). This was driven by fewer patients starting treatment with an HbA1c measurement of <6·5% or without prior HbA1c testing. Mortality per 1,000 person-years following a T2D diagnosis decreased by 44% between 1995-1997 and 2010-2012, from 69 deaths to 38 deaths (adjusted mortality rate ratio: 0·55 (95% CI: 0·54-0·56)). After the low level during 2010-2012, mortality increased again by 27% to 48 per 1,000 person-years (95% CI: 46-50) by 2016-2018. Interpretation Our findings suggest that introducing HbA1c as a diagnostic option may have changed basic T2D epidemiology by leaving patients undiagnosed, that previously would have been diagnosed and treated. Funding Aarhus University funded the study and had no further involvement.
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17
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Mak KH, Vidal-Petiot E, Young R, Sorbets E, Greenlaw N, Ford I, Tendera M, Ferrari R, Tardif JC, Udell JA, Escobedo J, Fox KM, Steg PG. Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities. Eur J Prev Cardiol 2022; 28:1795-1806. [DOI: 10.1093/eurjpc/zwab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/20/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
Abstract
Background
In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.
Methods and results
CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.
Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest.
Conclusion
In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.
ClinicalTrials identifier
ISRCTN43070564
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Affiliation(s)
- Koon-Hou Mak
- Mak Heart Clinic, Gleneagles Medical Centre, 6 Napier Road, # 08-13, 258499, Singapore
| | - Emmanuelle Vidal-Petiot
- Physiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat and INSERM U1149, Centre for Research in Inflammation, 46 rue Henri Huchard, Paris 75018, France
- Université de Paris, 16 rue Henri Huchard, 75018 Paris, France
| | - Robin Young
- Robertson Centre for Biostatistics, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow G12 8QQ, UK
| | - Emmanuel Sorbets
- Université de Paris, 16 rue Henri Huchard, 75018 Paris, France
- Centre de Diagnostic et de Thérapeutique, Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel Dieu, 1, place du Parvis Notre Dame, Paris 75004, France
- FACT (French Alliance for Cardiovascular Trials) and INSERM U1148, Laboratory for Vascular Translational Science, 46, rue Henri Huchard, Paris 75018, France
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow G12 8QQ, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow G12 8QQ, UK
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziolowa Str. 45/47, 40-635 Katowice, Poland
| | - Roberto Ferrari
- Cardiovascular Centre, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1 48033 Cotignola (RA), Italy
| | - Jean-Claude Tardif
- Department of Medicine, Montreal Heart Institute, Université de Montreal, 5000 Belanger Street, Montreal, PQ H1T1C8, Canada
| | - Jacob A Udell
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, 76 Grenville St, Toronto, ON M5S 1B1, Canada
| | - Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional 1, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Kim M Fox
- NHLI Imperial College, Dovehouse Street, London SW3 6LP ICMS, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Philippe Gabriel Steg
- Université de Paris, 16 rue Henri Huchard, 75018 Paris, France
- FACT (French Alliance for Cardiovascular Trials) and INSERM U1148, Laboratory for Vascular Translational Science, 46, rue Henri Huchard, Paris 75018, France
- NHLI Imperial College, Dovehouse Street, London SW3 6LP ICMS, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hopital Bichat, Paris 75018, France
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18
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Ferrannini G, De Bacquer D, Gyberg V, De Backer G, Kotseva K, Mellbin LG, Risebrink R, Tuomilehto J, Wood D, Rydén L. Saving time by replacing the standardised two-hour oral glucose tolerance test with a one-hour test: Validation of a new screening algorithm in patients with coronary artery disease from the ESC-EORP EUROASPIRE V registry. Diabetes Res Clin Pract 2022; 183:109156. [PMID: 34843858 DOI: 10.1016/j.diabres.2021.109156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS An oral glucose tolerance test (OGTT) combining fasting (FPG) and 2-hour plasma glucose (2hPG) is the most sensitive method for detecting type 2 diabetes (T2DM). Since it is considered time-consuming, we aim at validating a previously proposed screening algorithm based on a 1-hour plasma glucose (1hPG) with a 12 mmol/L threshold. METHODS Nine-hundred-eighteen patients with coronary artery disease (CAD) without known T2DM from the EUROASPIRE V cross-sectional survey underwent an OGTT. The reference for T2DM was 2hPG ≥ 11.1 mmol/L. T2DM diagnosis by HbA1c ≥ 6.5%(48 mmol/mol), FPG ≥ 7.0 mmol/L, and 1hPG ≥ 12 mmol/L were compared with the outcome of 2hPG. RESULTS Mean FPG, HbA1c and 2hPG were 6.1 mmol/L, 5.6%(38 mmol/mol) and 7.8 mmol/L respectively. Ninety-six patients (10%) were diagnosed with T2DM according to 2hPG. Using this definition, in the group with FPG < 6.5 mmol/L and 1hPG < 12 only 5 (1%) were misdiagnosed as false negatives. All patients with a FPG > 8.0 mmol/L and 1hPG > 15.0 mmol/L were identified as having T2DM. According to the algorithm, in 79% of patients T2DM could be excluded by combining FPG < 6.5 mmol/L and 1hPG < 12 mmol/L. CONCLUSIONS T2DM Screening by means of an algorithm combining FPG and 1hPG limits the demand of a 2hOGTT in 79% of CAD patients without known T2DM. HbA1c did not add to the information derived from this algorithm.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Viveca Gyberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, UK; St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Risebrink
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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19
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Sun K, Xiao X, You L, Hong X, Lin D, Liu Y, Huang C, Wang G, Li F, Sun C, Chen C, Lu J, Qi Y, Wang C, Li Y, Xu M, Ren M, Yang C, Wang G, Yan L. Development and validation of a nomogram for assessing risk of isolated high 2-hour plasma glucose. Front Endocrinol (Lausanne) 2022; 13:943750. [PMID: 36157464 PMCID: PMC9492843 DOI: 10.3389/fendo.2022.943750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
A tool was constructed to assess need of an oral glucose tolerance test (OGTT) in patients whose fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are normal. Data was collected from the longitudinal REACTION study conducted from June to November 2011 (14,686 subjects, aged ≥ 40 y). In people without a prior history of diabetes, isolated high 2-hour plasma glucose was defined as 2-hour plasma glucose ≥ 11.1 mmol/L, FPG < 7.0 mmol/L, and HbA1c < 6.5%. A predictive nomogram for high 2-hour plasma glucose was developed via stepwise logistic regression. Discrimination and calibration of the nomogram were evaluated by the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test; performance was externally validated in Northeast China. Parameters in the model included gender, age, drinking status, marriage status, history of hypertension and hyperlipidemia, waist-to-hip ratio, FPG, and HbA1c. All variables were noninvasive, except FPG and HbA1c. The AUC of the nomogram for isolated high 2-hour plasma glucose was 0.759 (0.727-0.791) in the development dataset. The AUCs of the internal and externally validation datasets were 0.781 (0.712-0.833) and 0.803 (0.778-0.829), respectively. Application of the nomogram during the validation study showed good calibration, and the decision curve analysis indicated that the nomogram was clinically useful. This practical nomogram model may be a reliable screening tool to detect isolated high 2-hour plasma glucose for individualized assessment in patients with normal FPG and HbA1c. It should simplify clinical practice, and help clinicians in decision-making.
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Affiliation(s)
- Kan Sun
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianchao Xiao
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaosi Hong
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Diaozhu Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yujia Liu
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, China
| | - Chulin Huang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Wang
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, China
| | - Feng Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Sun
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, China
| | - Chaogang Chen
- Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiahui Lu
- Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiqin Qi
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Wang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingtong Xu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meng Ren
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guixia Wang
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Li Yan, ; Guixia Wang,
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Yan, ; Guixia Wang,
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20
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Lim S, Kong APS, Tuomilehto J. Influence of COVID-19 pandemic and related quarantine procedures on metabolic risk. Prim Care Diabetes 2021; 15:745-750. [PMID: 34312109 PMCID: PMC8286866 DOI: 10.1016/j.pcd.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the lives of many people across the globe. In addition to the effect of the virus on the biological functions in those infected individuals, many countries have launched government policy with additional impact of these quarantine procedures on the metabolic health of many people worldwide. This mini-review aimed to highlight current evidence regarding the influence of metabolic health due to these quarantine procedures including decrease in physical activity, changes in unhealthy eating habits, increase in stress, and provide recommendations of healthy lifestyle during COVID-19 pandemic.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
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21
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Józwa R, Bryśkiewicz M, Safranow K, Majkowska L. HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall? J Clin Med 2021; 10:jcm10194334. [PMID: 34640351 PMCID: PMC8509534 DOI: 10.3390/jcm10194334] [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: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT). Methods: The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge. Results: OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%). Conclusions: Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.
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Affiliation(s)
- Robert Józwa
- Department of Cardiology and Invasive Cardiology, Provincial Hospital, ul. Arkońska 4, 71-455 Szczecin, Poland;
| | - Marta Bryśkiewicz
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, ul. Siedlecka 2, Police, 72-010 Szczecin, Poland;
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Av. 72, 70-111 Szczecin, Poland;
| | - Liliana Majkowska
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, ul. Siedlecka 2, Police, 72-010 Szczecin, Poland;
- Correspondence:
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22
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Johansson I, Norhammar A. Diabetes and heart failure notions from epidemiology including patterns in low-, middle- and high-income countries. Diabetes Res Clin Pract 2021; 177:108822. [PMID: 33872631 DOI: 10.1016/j.diabres.2021.108822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
About 463 million people are currently living with diabetes and 64 million with heart failure and in addition, substantial proportions of both diseases are undiagnosed. At ages above 65 years prevalence of diabetes is estimated to be around 19% and heart failure at least 10%. In the western world, incidence of both diabetes and heart failure are slightly decreasing while prevalent cases are increasing in high as well as middle and low-income countries due to a general increased longevity and successful prevention and treatment of cardiac disease and of diabetes complications. Therefore, we will see an increase of epidemic proportions of both diabetes and heart failure if novel preventive strategies are not appropriately introduced. Type 1 and type 2 diabetes are both major contributors to the development of heart failure and the combination of diabetes and heart failure severely affects prognosis. In addition, the changing faces of diabetes complications have resulted in heart failure more often being the first manifestation of cardiac complications. An updated scenario on diabetes and heart failure epidemiology to health care providers is important in order to direct resources towards effective preventive strategies.
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Affiliation(s)
- Isabelle Johansson
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden; Capio S:t Görans Hospital, Stockholm, Sweden.
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23
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Karayiannides S, Djupsjö C, Kuhl J, Hofman-Bang C, Norhammar A, Holzmann MJ, Lundman P. Long-term prognosis in patients with acute myocardial infarction and newly detected glucose abnormalities: predictive value of oral glucose tolerance test and HbA1c. Cardiovasc Diabetol 2021; 20:122. [PMID: 34126971 PMCID: PMC8204442 DOI: 10.1186/s12933-021-01315-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Disturbances of glucose metabolism can be diagnosed by an oral glucose tolerance test (OGTT) and by glycated haemoglobin (HbA1c). The aim of this study was to investigate the association between newly detected disturbances of glucose metabolism and long-term prognosis after acute myocardial infarction (AMI) and to compare the predictive value of an OGTT and HbA1c. METHODS Patients under the age of 80 years with no known history of diabetes admitted for AMI at the Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden, from January 1st, 2006 until December 31st, 2013, were investigated with an OGTT and a HbA1c before discharge and were classified as having normal glucose tolerance (NGT), prediabetes or diabetes according to American Diabetes Association (ADA) criteria. Using nationwide, all-inclusive registers, patients were followed for the incidence of combined event [CE (first of myocardial infarction, heart failure, ischaemic stroke or mortality)] for a mean follow-up time of 4.8 years. Cox regression analysis was used to calculate Hazard Ratios (HR) and their 95% confidence intervals (CI). RESULTS Of the 841 patients who were investigated with both an OGTT and a HbA1c, 139 (17%) patients had NGT, 398 (47%) had prediabetes and 304 (36%) had diabetes according to OGTT. The corresponding figures using HbA1c were 320 (38%), 461 (55%) and 60 (7%). Patients with newly discovered diabetes were older and had a higher body mass index compared to those with NGT. OGTT was not predictive for CE. In contrast, prediabetes identified by a HbA1c was associated with an increased risk for CE (HR 1.31; 95% CI 1.05-1.63) compared to normoglycaemia. When comparing the prognostic value of different glucose and HbA1c cut-offs, only a HbA1c ≥ 39 mmol/mol was significantly associated with CE (HR 95% CI; 1.30:1.05-1.61). CONCLUSION In this single-centre study, in a recent contemporary cohort, we found that around two thirds of the patients admitted with AMI with no known history of diabetes had disturbed glucose metabolism, in accordance with previous studies. HbA1c in the prediabetes range, but not OGTT, added predictive value on the long-term outcome, in a cohort to whom a pathologic OGTT result was communicated with lifestyle advice.
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Affiliation(s)
- Stelios Karayiannides
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88, Stockholm, Sweden.
- Centre for Diabetes, Academic Specialist Centre, Region Stockholm, Sweden.
| | - Catarina Djupsjö
- Department of Medicine (K2), Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Kuhl
- Department of Medicine (K2), Karolinska Institutet, Stockholm, Sweden
- Division of Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Department of Medicine (K2), Karolinska Institutet, Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Medicine (K2), Karolinska Institutet, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pia Lundman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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24
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Kahles F, Rückbeil MV, Mertens RW, Foldenauer AC, Arrivas MC, Moellmann J, Lebherz C, Biener M, Giannitsis E, Katus HA, Marx N, Lehrke M. Glucagon-like peptide 1 levels predict cardiovascular risk in patients with acute myocardial infarction. Eur Heart J 2021; 41:882-889. [PMID: 31620788 DOI: 10.1093/eurheartj/ehz728] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/04/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS Glucagon-like peptide 1 (GLP-1) is a gut incretin hormone inducing post-prandial insulin secretion. Glucagon-like peptide 1 levels were recently found to be increased in patients with acute myocardial infarction. Glucagon-like peptide 1 receptor agonists improve cardiovascular outcomes in patients with diabetes. The aim of this study was to assess the predictive capacity of GLP-1 serum levels for cardiovascular outcome in patients with myocardial infarction. METHODS AND RESULTS In 918 patients presenting with myocardial infarction [321 ST-segment elevation myocardial infarction and 597 non-ST-segment elevation myocardial infarction (NSTEMI)] total GLP-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of hospital admission. The primary composite outcome of the study was the first occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Kaplan-Meier survival plots and univariable Cox regression analyses found GLP-1 to be associated with adverse outcome [hazard ratio (HR) of logarithmized GLP-1 values: 6.29, 95% confidence interval (CI): 2.67-14.81; P < 0.0001]. After further adjustment for age, sex, family history of cardiovascular disease, smoking, diabetes, hypertension, hypercholesterinaemia, glomerular filtration rate (GFR) CKD-EPI, hs-CRP, hs-Troponin T, and NT-proBNP levels the HR remained significant at 10.98 (95% CI: 2.63-45.90; P = 0.0010). Time-dependent receiver operating characteristic curve analyses illustrated that GLP-1 levels are a strong indicator for early events. For events up to 30 days after admission, GLP-1 proved to be superior to other biomarkers including hs-Troponin T, GFR CKD-EPI, hs-CRP, and NT-proBNP. Adjustment of the GRACE risk estimate by addition of GLP-1 increased the area under the receiver operating characteristic curve over time in NSTEMI patients. CONCLUSION In patients hospitalized for myocardial infarction, GLP-1 levels are associated with cardiovascular events.
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Affiliation(s)
- Florian Kahles
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Marcia V Rückbeil
- Department of Medical Statistics, University Hospital Aachen, Pauwelsstraße 19, Aachen 52074, Germany
| | - Robert W Mertens
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Ann C Foldenauer
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch for Translational Medicine and Pharmacology (TMP), Theodor-Stern-Kai 7, Frankfurt am Main 60596, Germany
| | - Maria C Arrivas
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Julia Moellmann
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Corinna Lebherz
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Moritz Biener
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Michael Lehrke
- Department of Internal Medicine I-Cardiology, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany
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25
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Ferrannini G, Savarese G, Rydén L. Sodium-glucose transporter inhibition in heart failure: from an unexpected side effect to a novel treatment possibility. Diabetes Res Clin Pract 2021; 175:108796. [PMID: 33845051 DOI: 10.1016/j.diabres.2021.108796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/17/2022]
Abstract
Sodium-glucose transporter-2 inhibitors (SGLT2i), originally launched as glucose-lowering drugs, have been studied in large cardiovascular outcome trials to ascertain safety. Surprisingly, these compounds reduced the risk of cardiovascular events (cardiovascular death, non-fatal myocardial and non-fatal stroke) and total mortality. The mechanisms behind this benefit are only partly understood, but a major contributor is the reduction of heart failure hospitalisations, evident already within weeks after the initiation of the SGLT2i. SGLT2 inhibition increases urinary glucose excretion, thereby improving glycaemic control in an insulin-independent manner. Moreover, SGLT2i potentially impact the cardiovascular system both indirectly via weight loss and blood pressure lowering and directly through osmotic diuresis and increased sodium excretion and presumably by improving myocardial energetics. The aim of this review is to summarise evidence from all major outcome trials investigating SGLT2i in patients with diabetes, as well as recent evidence from trials in heart failure patients without glucose perturbations, which pave the way for novel treatment of large groups of patients. The results of these studies have been taken into account in recently issued guidelines for the management of diabetes and cardiovascular disease. An important task for diabetologists, cardiologists and general practitioners is to incorporate them into clinical practice to the benefit of many patients.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Gianluigi Savarese
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Tuomilehto J, Wood D, Rydén L. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys. Cardiovasc Diabetol 2021; 20:38. [PMID: 33573665 PMCID: PMC7879645 DOI: 10.1186/s12933-021-01233-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Recent data from two nationwide cohorts of patients suggested no gender difference as regards the risk for diabetes-related CV complications but indicated the presence of a gender disparity in risk factor management. The aim of this study was to investigate gender differences in screening for dysglycaemia, cardiovascular risk factor management and prognosis in dysglycemic CAD patients. Methods The study population (n = 16,259; 4077 women) included 7998 patients from the ESC-EORP EUROASPIRE IV (EAIV: 2012–2013, 79 centres in 24 countries) and 8261 patients from the ESC-EORP EUROASPIRE V (EAV: 2016–2017, 131 centres in 27 countries) cross-sectional surveys. In each centre, patients were investigated with standardised methods by centrally trained staff and those without known diabetes were offered an oral glucose tolerance test (OGTT). The first of CV death or hospitalisation for non-fatal myocardial infarction, stroke, heart failure or revascularization served as endpoint. Median follow-up time was 1.7 years. The association between gender and time to the occurrence of the endpoint was evaluated using Cox survival modelling, adjusting for age. Results Known diabetes was more common among women (32.9%) than men (28.4%, p < 0.0001). OGTT (n = 8655) disclosed IGT in 17.2% of women vs. 15.1% of men (p = 0.004) and diabetes in 13.4% of women vs. 14.6% of men (p = 0.078). In both known diabetes and newly detected dysglycaemia groups, women were older, with higher proportions of hypertension, dyslipidaemia and obesity. HbA1c was higher in women with known diabetes. Recommended targets of physical activity, blood pressure and cholesterol were achieved by significantly lower proportions of women than men. Women with known diabetes had higher risk for the endpoint than men (age-adjusted HR 1.22; 95% CI 1.04–1.43). Conclusions Guideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Department of Neurobiology, Centre for Family Medicine, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, D2, 141 83, Huddinge, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, University Road, Galway, H91 TK33, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Karolinska University Hospital, Eugeniavägen 3, 17164, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Capio St Görans Hospital, Sankt Göransplan 1, 11219, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, University Road, Galway, H91 TK33, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden
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Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2021; 41:255-323. [PMID: 31497854 DOI: 10.1093/eurheartj/ehz486] [Citation(s) in RCA: 2388] [Impact Index Per Article: 796.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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28
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Koskinas K, Melmer A, Steiner N, Gübeli A, Wilhelm M, Laimer M. [Diagnosis, Prevention and Treatment of Cardiovascular Disease in People with Diabetes and Prediabetes]. PRAXIS 2021; 110:37-47. [PMID: 33406932 DOI: 10.1024/1661-8157/a003589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diagnosis, Prevention and Treatment of Cardiovascular Disease in People with Diabetes and Prediabetes Abstract. Diabetes is associated with an increased cardiovascular risk. In addition to optimizing glycemia, timely diagnosis and stringent control of cardiovascular risk factors is essential for individuals with diabetes. Therapeutic options include lifestyle-optimization, individualized drug therapy and targeted treatment of concomitant or secondary cardiovascular disease. Cardiovascular disease occurs more often in individuals with diabetes and includes heart failure, atrial fibrillation, coronary heart disease and sudden cardiac death. The correct choice of antidiabetic drugs and interventions can control cardiovascular risk factors, reduce cardiovascular risk and treat concomitant or secondary diseases in a targeted manner. This review is intended to provide guidance on diagnosis, treatment and choice of therapy for individuals with type 2 diabetes without and with concomitant or secondary cardiovascular disease.
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Affiliation(s)
- Konstantinos Koskinas
- Zentrum für Präventive Kardiologie, Universitätsklinik für Kardiologie, Interdisziplinäres Zentrum für Sport- & Bewegungsmedizin, Inselspital, Universitätsspital und Universität Bern
| | - Andreas Melmer
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Nicole Steiner
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Andreas Gübeli
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Matthias Wilhelm
- Zentrum für Präventive Kardiologie, Universitätsklinik für Kardiologie, Interdisziplinäres Zentrum für Sport- & Bewegungsmedizin, Inselspital, Universitätsspital und Universität Bern
| | - Markus Laimer
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
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Standl E, Khunti K, Hansen TB, Schnell O. The global epidemics of diabetes in the 21st century: Current situation and perspectives. Eur J Prev Cardiol 2020; 26:7-14. [PMID: 31766915 DOI: 10.1177/2047487319881021] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetes is on the rise worldwide, with a global prevalence in adults in 2017 being 8.8% of the world population, with the anticipation of a further increase to 9.9% by 2045. In total numbers, this reflects a population of 424.9 million people with diabetes worldwide in 2017, with an estimate of a 48% increase to 628.6 million people by 2045. Depending on age, global diabetes prevalence is about 5%, 10%, 15% and close to 20%, respectively, for the age groups 35-39, 45-49, 55-59 and 65-69 years. On a global scale, diabetes hits particularly 'middle aged' people between 40 and 59 years, which causes serious economic and social implications. Furthermore, diabetes affects especially low and middle income countries, as 77% of all people with diabetes worldwide live in those countries. In addition to overt diabetes, an estimated 352.1 million people worldwide are at risk of diabetes, i.e. have defined pre-diabetes, a figure which is anticipated to rise to 531.6 million by 2045. Some 70-75% of all patients with established coronary artery disease, e.g. with acute myocardial infarction, show concomitant diabetes or abnormal glucose regulation, i.e. close to 50% have overt diabetes, with as many as 20% of those being undiagnosed and another 25% having pre-diabetes.
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Affiliation(s)
- Eberhard Standl
- Forschergruppe Diabetes eV at Munich Helmholtz Centre, Germany
| | | | | | - Oliver Schnell
- Forschergruppe Diabetes eV at Munich Helmholtz Centre, Germany
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30
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Ferrannini G, Norhammar A, Gyberg V, Mellbin L, Rydén L. Is Coronary Artery Disease Inevitable in Type 2 Diabetes? From a Glucocentric to a Holistic View on Patient Management. Diabetes Care 2020; 43:2001-2009. [PMID: 32661109 DOI: 10.2337/dci20-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Affiliation(s)
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Viveca Gyberg
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
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31
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Chattopadhyay S, George A, John J, Sathyapalan T. Two-Hour Post-Load Plasma Glucose, a Biomarker to Improve the GRACE Score in Patients without Known Diabetes. Cardiology 2020; 145:553-561. [PMID: 32784310 DOI: 10.1159/000509180] [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: 12/30/2019] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess improvement in predictive performance of Global Registry of Acute Coronary Events risk score (GRS) by addition of a glucose matrix. METHODS 1,056 acute coronary syndrome (ACS) survivors without known diabetes had pre-discharge fasting (FPG) and 2-h post-load plasma glucose (2h-PG) measured. GRS was calculated. Major adverse cardiac events (MACE; death and non-fatal myocardial infarction) were recorded during follow-up. Cox proportional hazard regression predicted event-free survival. Likelihood ratio test, Akaike's information criteria, continuous net reclassification index (NRI>0), and integrated discrimination improvement (IDI) were used to test the additional prognostic value of glycaemic indices over GRS. RESULTS During a median follow-up of 36.5 months, 211 MACEs (20.0%), 96 deaths (9.1%), and 115 non-fatal re-infarctions (10.9%), occurred. 2h-PG, but not FPG, independently predicted MACE-free survival at all time points (HR 1.08, 95% CI 1.03-1.13, p = 0.002, at 3 years). Risk of MACE increased by 8-11% with every 1 mmol/L rise in 2h-PG. 2h-PG significantly improved the prognostic models containing GRS. Models containing GRS and 2h-PG yielded lowest corrected Akaike's information criteria compared to that with only GRS. 2h-PG, but not FPG, improved NRI>0 (NRI>0 0.169, p = 0.028 at 3 years) and IDI (IDI of 0.66%, p = 0.018 at 3 years) significantly at all time points during the follow-up. CONCLUSIONS 2h-PG, but not FPG, improves performance of GRS-containing models in predicting post-ACS prognosis in the short to medium term.
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Affiliation(s)
- Sudipta Chattopadhyay
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, United Kingdom,
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes, and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
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Guía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD). Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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33
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Ferrannini G, De Bacquer D, De Backer G, Kotseva K, Mellbin L, Wood D, Rydén L. Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease-A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V. Diabetes Care 2020; 43:726-733. [PMID: 32079627 DOI: 10.2337/dc19-2165] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/24/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.,Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,European Society of Cardiology, Sophia Antipolis, France
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
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Jennings CS, Kotseva K, Bassett P, Adamska A, Wood D. ASPIRE-3-PREVENT: a cross-sectional survey of preventive care after a coronary event across the UK. Open Heart 2020; 7:e001196. [PMID: 32354740 PMCID: PMC7228656 DOI: 10.1136/openhrt-2019-001196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To quantify the implementation of the third Joint British Societies' Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3) after coronary event. METHODS Using a cross-sectional survey design, patients were consecutively identified in 36 specialist and district general hospitals between 6 months and 2 years, after acute coronary syndrome or revascularisation procedure and invited to a research interview. Outcomes included JBS3 lifestyle, risk factor and therapeutic management goals. Data were collected using standardised methods and instruments by trained study nurses. Blood was analysed in a central laboratory and a glucose tolerance test was performed. RESULTS 3926 eligible patients were invited to participate and 1177 (23.3% women) were interviewed (30% response). 12.5% were from black and minority ethnic groups. 45% were persistent smokers, 36% obese, 52.9% centrally obese, 52% inactive; 30% had a blood pressure >140/90 mm Hg, 54% non-high-density lipoprotein ≥2.5 mmol/L and 44.3% had new dysglycaemia. Prescribing was highest for antiplatelets (94%) and statins (85%). 81% were advised to attend cardiac rehabilitation (86% <60 years vs 79% ≥60 years; 82% men vs 77% women; 93% coronary artery bypass grafting vs 59% unstable angina), 85% attended if advised; 69% attended overall. Attenders were significantly younger (p=0.03) and women were less likely to attend (p=0.03). CONCLUSIONS Patients with coronary heart disease (CHD) are not being adequately managed after event with preventive measures. They require a structured preventive cardiology programme addressing lifestyle, risk factor management and adherence to cardioprotective medications to achieve the standards set by the British Association for Cardiovascular Prevention and Rehabilitation and JBS3 guidelines.
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Affiliation(s)
- Catriona S Jennings
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | | | - Agnieszka Adamska
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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Mitchell S, Malanda B, Damasceno A, Eckel RH, Gaita D, Kotseva K, Januzzi JL, Mensah G, Plutzky J, Prystupiuk M, Ryden L, Thierer J, Virani SS, Sperling L. A Roadmap on the Prevention of Cardiovascular Disease Among People Living With Diabetes. Glob Heart 2020; 14:215-240. [PMID: 31451236 DOI: 10.1016/j.gheart.2019.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | | | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, and Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, United Kingdom; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - George Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jorge Plutzky
- Preventive Cardiology, Cardiovascular Medicine, Brigham and Women's Hospital, Shapiro Cardiovascular Centre, Boston, MA, USA
| | - Maksym Prystupiuk
- Department of Surgery №2, Bogomolets National Medical University, Kyiv, Ukraine
| | - Lars Ryden
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Jorge Thierer
- Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigación Clínica CEMIC, Buenos Aires, Argentina
| | - Salim S Virani
- Cardiology and Cardiovascular Research Sections, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Laurence Sperling
- Emory Heart Disease Prevention Center, Department of Global Health Rollins School of Public Health at Emory University, Atlanta, GA, USA.
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Zhou J, Sheng Z, Liu C, Zhou P, Li J, Chen R, Song L, Zhao H, Yan H. Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study. J Diabetes Res 2020; 2020:1763567. [PMID: 32685552 PMCID: PMC7327614 DOI: 10.1155/2020/1763567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. METHODS AND RESULTS We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n = 182) non-DM patients and 34.3% (n = 95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p = 0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p = 0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p = 0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (p for trend = 0.002), lipid-rich plaque (p for trend = 0.001), and TCFA (p for trend = 0.003). A/C > 1.22 but not ABG > 140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. CONCLUSIONS In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928.
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Affiliation(s)
- Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
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Sandini M, Strobel O, Hank T, Lewosinska M, Nießen A, Hackert T, Büchler MW, Schimmack S. Pre-operative dysglycemia is associated with decreased survival in patients with pancreatic neuroendocrine neoplasms. Surgery 2019; 167:575-580. [PMID: 31889543 DOI: 10.1016/j.surg.2019.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diabetes mellitus is associated with increased risk of pancreatic cancer and impaired postresection survival. For pancreatic neuroendocrine neoplasms, no evidence is available for a similar effect of diabetes mellitus. The aim of this study was to evaluate the glycemic profile in patients with pancreatic neuroendocrine neoplasms and to assess the potential impact of glycemic control on the pathology and long-term outcomes in patients undergoing resection of pancreatic neuroendocrine neoplasms. METHODS Pancreatic resections from 2001 to 2017 for pancreatic neuroendocrine neoplasms were analyzed from prospective databases. Blood glucose and HbA1c levels were collected from preoperative tests. Preoperative dysglycemia was defined as a blood glucose ≥140 mg% and/or HbA1c ≥6.5%. Uni- and multivariate analyses were performed according to the presence of perioperative dysglycemia. Survival analyses were performed by Kaplan-Meier curves and Cox-proportional hazards method. RESULTS Four hundred and seventeen patients were analyzed. Medical history was positive for diabetes mellitus in 88 (21.1%) patients. Blood glucose evaluation identified 30 additional patients without a prior diagnosis of diabetes mellitus who had preoperative dysglycemia. No differences regarding pathologic characteristics or outcomes were detected between diabetics and non-diabetics. Conversely, patients with dysglycemia had greater rates of metastasis (16.8% vs 27.4%; P = .027) as well as vascular, perineural, and lympho-vascular involvement than those with normal blood glucose (89.2% vs 57.4%; P < .001, 90.0% vs 65.1%; P = .046, and 89.3% vs 61.3; P = .006, respectively). Preoperative dysglycemia was associated with impaired overall survival (hazard ratio = 1.57 [1.01-2.46]) and recurrence-free survival (hazard ratio = 1.78 [1.01-3.12]). By multivariate analysis, preoperative dysglycemia was independently associated with recurrence-free survival (hazard ratio 2.32 [1.29-4.17]), together with lymph-node involvement (hazard ratio = 2.01 [1.14-3.57]) and metastatic disease (hazard ratio = 5.10 [2.73-9.55]). CONCLUSION Preoperative dysglycemia, but not diabetes mellitus per se, is associated with advanced disease and impaired long-term outcomes in patients undergoing resection for a pancreatic neuroendocrine neoplasm. For those patients, closer surveillance and strict glycemic control are warranted.
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Affiliation(s)
- Marta Sandini
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Thomas Hank
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Magdalena Lewosinska
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Anna Nießen
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Simon Schimmack
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany.
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Chattopadhyay S, George A, John J, Sathyapalan T. Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes. Eur Heart J 2019; 39:2740-2745. [PMID: 29701834 DOI: 10.1093/eurheartj/ehy233] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/06/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Global Registry of Acute Coronary Events (GRACE) risk score (GRS), a powerful predictor of prognosis after acute coronary event (ACE), does not include a glucometabolic measure. We investigate whether 2 h post-load plasma glucose (2h-PG) could improve GRS based prognostic models in ACE patients without known diabetes mellitus (DM). Methods and results A retrospective cohort study of 1056 ACE survivors without known DM who had fasting plasma glucose (FPG) and 2h-PG measured pre-discharge. Death and non-fatal myocardial infarction were recorded as major adverse cardiac events (MACE) during follow-up. GRS for discharge to 6 months was calculated. Cox proportional-hazards regression was used to identify predictors of event free survival. The predictive value of 2h-PG alone and combined with GRS was estimated using likelihood ratio test, Akaike's information criteria, continuous net reclassification improvement (NRI>0), and integrated discrimination improvement (IDI). During 40.8 months follow-up 235 MACEs (22.3%) occurred, more frequently in the upper 2h-PG quartiles. Two-hour PG, but not FPG, adjusted for GRS independently predicted MACE (hazard ratio 1.091, 95% confidence interval 1.043-1.142; P = 0.0002). likelihood ratio test showed that 2h-PG significantly improved the prognostic models including GRS (χ2 = 20.56, 1 df; P = 0.000). Models containing GRS and 2h-PG yielded lowest corrected Akaike's information criteria, compared to that with only GRS. 2h-PG, when added to GRS, improved net reclassification significantly (NRIe>0 6.4%, NRIne>0 24%, NRI>0 0.176; P = 0.017 at final follow-up). Two-hour PG, improved integrated discrimination of models containing GRS (IDI of 0.87%, P = 0.008 at final follow-up). Conclusion Two-hour PG, but not FPG, is an independent predictor of adverse outcome after ACE even after adjusting for the GRS. Two-hour PG, but not FPG, improves the predictability of prognostic models containing GRS.
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Affiliation(s)
- Sudipta Chattopadhyay
- Department of Cardiology, Milton Keynes University Hospital, Standing Way, Milton Keynes, UK
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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Rydén L, Shahim B, Standl E. On the prognostic value of post-load glucose in patients with coronary artery disease. Eur Heart J 2019; 39:2746-2748. [PMID: 29893842 DOI: 10.1093/eurheartj/ehy320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lars Rydén
- Department of Medicine, Heart and Vascular Theme, S1:02, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bahira Shahim
- Department of Medicine, Heart and Vascular Theme, S1:02, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eberhard Standl
- Diabetes Research Group e.V. at Munich Helmholtz Center, Neuherberg, Germany
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Velders MA, Calais F, Dahle N, Fall T, Hagström E, Leppert J, Nowak C, Tenerz Å, Ärnlöv J, Hedberg P. Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction. Ups J Med Sci 2019; 124:187-192. [PMID: 31429631 PMCID: PMC7182365 DOI: 10.1080/03009734.2019.1650141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Newer therapeutic agents for type 2 diabetes mellitus can improve cardiovascular outcomes, but diabetes remains underdiagnosed in patients with myocardial infarction (MI). We sought to identify proteomic markers of undetected dysglycaemia (impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) to improve the identification of patients at highest risk for diabetes. Materials and methods: In this prospective cohort, 626 patients without known diabetes underwent oral glucose tolerance testing (OGTT) during admission for MI. Proximity extension assay was used to measure 81 biomarkers. Multivariable logistic regression, adjusting for risk factors, was used to evaluate the association of biomarkers with dysglycaemia. Subsequently, lasso regression was performed in a 2/3 training set to identify proteomic biomarkers with prognostic value for dysglycaemia, when added to risk factors, fasting plasma glucose, and glycated haemoglobin A1c. Determination of discriminatory ability was performed in a 1/3 test set. Results: In total, 401/626 patients (64.1%) met the criteria for dysglycaemia. Using multivariable logistic regression, cathepsin D had the strongest association with dysglycaemia. Lasso regression selected seven markers, including cathepsin D, that improved prediction of dysglycaemia (area under the receiver operator curve [AUC] 0.848 increased to 0.863). In patients with normal fasting plasma glucose, only cathepsin D was selected (AUC 0.699 increased to 0.704). Conclusions: Newly detected dysglycaemia, including manifest diabetes, is common in patients with acute MI. Cathepsin D improved the prediction of dysglycaemia, which may be helpful in the a priori risk determination of diabetes as a motivation for confirmatory OGTT.
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Affiliation(s)
- Matthijs A. Velders
- Department of Medicine, Västmanland County Hospital, Västerås, Sweden
- CONTACT Matthijs Velders Department of Medicine, Västmanland County Hospital, Sigtunagatan, 721 89 Västerås, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Nina Dahle
- Centre for Clinical Research, Uppsala University, Falun, Dalarna, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jerzy Leppert
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Christoph Nowak
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Åke Tenerz
- Department of Medicine, Västmanland County Hospital, Västerås, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Pär Hedberg
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
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Kiviniemi AM, Lepojärvi ES, Tulppo MP, Piira OP, Kenttä TV, Perkiömäki JS, Ukkola OH, Myerburg RJ, Junttila MJ, Huikuri HV. Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care 2019; 42:1319-1325. [PMID: 31076416 DOI: 10.2337/dc18-2549] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/10/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare cardiac mortality in patients with CAD and prediabetes with that in CAD patients with normal glycemic status and type 2 diabetes. RESEARCH DESIGN AND METHODS The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included patients with CAD after revascularization (79%), optimal medical therapy, or both. Patients had type 2 diabetes (n = 834), impaired glucose tolerance (IGT; n = 314), impaired fasting glucose (IFG; n = 103), or normal glycemic status (n = 697) as defined on the basis of the results of an oral glucose tolerance test. The primary end point was cardiac death. Major adverse cardiac event (MACE: cardiac death, heart failure, or acute coronary syndrome) and all-cause mortality were secondary end points. RESULTS During a mean ± SD follow-up of 6.3 ± 1.6 years, 101 cardiac deaths, 385 MACEs, and 208 deaths occurred. Patients with IGT tended to have 49% lower adjusted risk for cardiac death (P = 0.069), 32% lower adjusted risk for all-cause mortality (P = 0.076), and 36% lower adjusted risk for MACE (P = 0.011) than patients with type 2 diabetes. The patients with IFG had 82% lower adjusted risk for all-cause mortality (P = 0.015) than the patients with type 2 diabetes, whereas risks for cardiac death and MACE did not differ significantly between the two groups. The adjusted risks for cardiac death, MACE, and all-cause mortality among patients with IGT and IFG did not significantly differ from those risks among patients with normal glycemic status. CONCLUSIONS Cardiac mortality or incidence of MACE in patients with CAD with prediabetes (i.e., IGT or IFG after revascularization, optimal medical therapy, or both) does not differ from those values in patients with normal glycemic status.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - E Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Robert J Myerburg
- Division of Cardiology, Miller School of Medicine, University of Miami, Miami, FL
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Mann BK, Bhandohal JS, Hong J. An Overall Glance of Evidence Supportive of One-Hour and Two-Hour Postload Plasma Glucose Levels as Predictors of Long-Term Cardiovascular Events. Int J Endocrinol 2019; 2019:6048954. [PMID: 31929794 PMCID: PMC6935819 DOI: 10.1155/2019/6048954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022] Open
Abstract
This review summarizes the vast literature describing the long-term epidemiological studies with emphasis on postprandial glucose as a stronger predictor of cardiovascular complications as compared to fasting glucose and HbA1c. Many molecular studies also supported this fact by illustrating that postchallenge hyperglycemia is associated with elevated biomarkers of systemic inflammation in the plasma and thus increasing the chances of vascular damage. Large-scale studies have proved that vascular stiffness, brachial-ankle pulse-wave velocity, carotid intima thickness, and left ventricular hypertrophy have been associated with postprandial glucose as compared to fasting glucose or glycosylated hemoglobin.
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Affiliation(s)
- Baldeep K. Mann
- New York City Health and Hospitals/Metropolitan Hospital Center, New York, NY, USA
| | | | - Jungrak Hong
- New York City Health and Hospitals/Metropolitan Hospital Center, New York, NY, USA
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Incidence of cardiovascular events in patients with stabilized coronary heart disease: the EUROASPIRE IV follow-up study. Eur J Epidemiol 2018; 34:247-258. [PMID: 30353266 DOI: 10.1007/s10654-018-0454-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
The EUROASPIRE surveys (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) demonstrated that most European coronary patients fail to achieve lifestyle, risk factor and therapeutic targets. Here we report on the 2-year incidence of hard cardiovascular (CV) endpoints in the EUROASPIRE IV cohort. EUROASPIRE IV (2012-2013) was a large cross-sectional study undertaken at 78 centres from selected geographical areas in 24 European countries. Patients were interviewed and examined at least 6 months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1 year after this baseline screening were registered. The primary outcome in our analyses was the incidence of CV death or non-fatal myocardial infarction, stroke or heart failure. Cox regression models, stratified for country, were fitted to relate baseline characteristics to outcome. Our analyses included 7471 predominantly male patients. Overall, 222 deaths were registered of whom 58% were cardiovascular. The incidence of the primary outcome was 42 per 1000 person-years. Comorbidities were strongly and significantly associated with the primary outcome (multivariately adjusted hazard ratio HR, 95% confidence interval): severe chronic kidney disease (HR 2.36, 1.44-3.85), uncontrolled diabetes (HR 1.89, 1.50-2.38), resting heart rate ≥ 75 bpm (HR 1.74, 1.30-2.32), history of stroke (HR 1.70, 1.27-2.29), peripheral artery disease (HR 1.48, 1.09-2.01), history of heart failure (HR 1.47, 1.08-2.01) and history of acute myocardial infarction (HR 1.27, 1.05-1.53). Low education and feelings of depression were significantly associated with increased risk. Lifestyle factors such as persistent smoking, insufficient physical activity and central obesity were not significantly related to adverse outcome. Blood pressure and LDL-C levels appeared to be unrelated to cardiovascular events irrespective of treatment. In patients with stabilized CHD, comorbid conditions that may reflect the ubiquitous nature of atherosclerosis, dominate lifestyle-related and other modifiable risk factors in terms of prognosis, at least over a 2-year follow-up period.
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Kok MM, von Birgelen C, Sattar N, Zocca P, Löwik MM, Danse PW, Schotborgh CE, Scholte M, Hartmann M, Kant GD, Doelman C, Tjon Joe Gin M, Stoel MG, van Houwelingen G, Linssen GCM, IJzerman MJ, Doggen CJM, van der Heijden LC. Prediabetes and its impact on clinical outcome after coronary intervention in a broad patient population. EUROINTERVENTION 2018; 14:e1049-e1056. [PMID: 29313817 DOI: 10.4244/eij-d-17-01067] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS It is unclear whether detection of prediabetes (pre-DM) by routine assessment of glycated haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) among patients undergoing percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) may help identify subjects with increased event risk. We assessed the relation between glycaemia status and one-year outcome after PCI. METHODS AND RESULTS Glycaemia status was determined in 2,362 non-diabetic BIO-RESORT participants, treated at all four study sites, to identify pre-DM (HbA1c 42-47 mmol/mol; FPG 6.1-6.9 mmol/L) and unknown diabetes mellitus (DM) (HbA1c ≥48 mmol/mol; FPG ≥7.0 mmol/L). Another 624 patients had medically treated DM. The main composite endpoint consisted of death, myocardial infarction, or revascularisation. Glycaemic state was known in 2,986 participants: 324 (11%) patients had pre-DM, 793 (27%) had DM (known or new), and 1,869 (63%) patients had normoglycaemia. Pre-DM and DM patients differed from normoglycaemic patients in cardiovascular risk factors. The composite endpoint occurred in 11.1% in pre-DM, 10.5% in DM, and 5.7% in normoglycaemia (p<0.001). Pre-DM was associated with a twofold higher event risk compared to normoglycaemia (adj. HR 2.0, 95% CI: 1.4-3.0). CONCLUSIONS Following PCI with contemporary DES, all-comers with pre-DM had significantly higher event risks than normoglycaemic patients. In non-DM patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify subjects with increased event risk.
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Affiliation(s)
- Marlies M Kok
- Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Shahim B, Kjellström B, Gyberg V, Jennings C, Smetana S, Rydén L. The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease. Diabetes Technol Ther 2018; 20:596-602. [PMID: 30074818 DOI: 10.1089/dia.2018.0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Point-of-care equipment for measuring glucose saves time and costs for both patients and professionals and minimizes preanalytic errors when screening for or managing dysglycemia, that is, impaired glucose tolerance and type 2 diabetes. The accuracy of such devices has, however, been questioned compared with analyses at an accredited hospital laboratory. OBJECTIVE To investigate the agreement between glucose measurements made by the point-of-care HemoCue® Glucose 201 RT System (HemoCue, Ängelholm, Sweden) and local hospital laboratories. MATERIAL Patients with established coronary artery disease (CAD) recruited in Sweden and the United Kingdom within the auspices of the European Action on Secondary and primary Prevention by Intervention to Reduce Events (EUROASPIRE) V survey (n = 87; 18-80 years) with or without previously known dysglycemia were investigated. Plasma glucose values collected in the fasting state (n = 85) and 60 (n = 57) and 120 (n = 72) min after a glucose load were analyzed both using HemoCue monitors and local hospital laboratories. The two measurement techniques were compared using a bias plot according to Bland-Altman, the surveillance error grid, and Spearman correlation test. RESULTS The bias plot method showed small differences between the HemoCue and local hospital laboratory methods, the HemoCue and central hospital laboratory, and the local hospital laboratories and the central hospital laboratory. In the surveillance error grid, 98.6% of the values were in the deep green zone, indicating no risk and the remaining values (1.4%) were within the light green zone, indicating "slight lower risk." CONCLUSION The HemoCue point-of-care system is accurate for dysglycemia screening in patients with CAD.
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Affiliation(s)
- Bahira Shahim
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Barbro Kjellström
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Viveca Gyberg
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
- 2 Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet , Huddinge, Sweden
| | - Catriona Jennings
- 3 Faculty of Medicine, NHLI Imperial College London , Hammersmith Campus, London, United Kingdom
| | - Stina Smetana
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Lars Rydén
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
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Norhammar A, Mellbin L, Cosentino F. Diabetes: Prevalence, prognosis and management of a potent cardiovascular risk factor. Eur J Prev Cardiol 2018; 24:52-60. [PMID: 28618910 DOI: 10.1177/2047487317709554] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This review highlights the increased risk of cardiovascular disease and the dismal prognosis after acute coronary events when diabetes is present. Although there have been improvements in this area, diabetes still confers an increased risk. In order to achieve successful outcomes in individuals with diabetes, extensive treatment of risk factors and the use of all available evidence-based therapies are needed. In this context, glucose-lowering therapies and antithrombotic and revascularisation strategies are detailed in this review. Emerging data indicate that novel glucose-lowering drugs may impact cardiovascular outcome with mechanisms that are beyond glucose control. In addition, this review addresses hidden diabetes and impaired glucose tolerance in patients with acute and stable coronary artery disease and how they influence future cardiovascular risk.
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Affiliation(s)
- Anna Norhammar
- 1 Cardiology Unit, Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.,2 Capio S:t Görans hospital, Sankt Göransplan, Stockholm, Sweden
| | - Linda Mellbin
- 1 Cardiology Unit, Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Francesco Cosentino
- 1 Cardiology Unit, Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
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47
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Nam HK, Cho WK, Kim JH, Rhie YJ, Chung S, Lee KH, Suh BK. HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents. J Korean Med Sci 2018; 33:e93. [PMID: 29542302 PMCID: PMC5852422 DOI: 10.3346/jkms.2018.33.e93] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/12/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Oral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes. Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth. METHODS This retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6-6.9 mmol/L; 2-hour glucose 7.8-11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determined using the area under the receiver operating characteristic curve (AUC). RESULTS At diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabetes, and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1c was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and a specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected. CONCLUSION Pediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.
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Affiliation(s)
- Hyo Kyoung Nam
- Department of Pediatrics, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea.
| | - Young Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kee Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Byung Kyu Suh
- Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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48
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“Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents. JACC Cardiovasc Interv 2018; 11:448-459. [DOI: 10.1016/j.jcin.2017.10.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 01/27/2023]
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Shahim B, Gyberg V, De Bacquer D, Kotseva K, De Backer G, Schnell O, Tuomilehto J, Wood D, Rydén L. Undetected dysglycaemia common in primary care patients treated for hypertension and/or dyslipidaemia: on the need for a screening strategy in clinical practice. A report from EUROASPIRE IV a registry from the EuroObservational Research Programme of the European Society of Cardiology. Cardiovasc Diabetol 2018; 17:21. [PMID: 29368616 PMCID: PMC5781265 DOI: 10.1186/s12933-018-0665-4] [Citation(s) in RCA: 12] [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: 12/13/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Dysglycaemia defined as type 2 diabetes (T2DM) and impaired glucose tolerance (IGT), increases the risk of cardiovascular disease (CVD). The negative impact is more apparent in the presence of hypertension and/or dyslipidaemia. Thus, it seems reasonable to screen for dysglycaemia in patients treated for hypertension and/or dyslipidaemia. A simple screening algorithm would enhance the adoption of such strategy in clinical practice. Objectives To test the hypotheses (1) that dysglycaemia is common in patients with hypertension and/or dyslipidaemia and (2) that initial screening with the Finnish Diabetes Risk Score (FINDRISC) will decrease the need for laboratory based tests. Methods 2395 patients (age 18–80 years) without (i) a history of CVD or TDM2, (ii) prescribed blood pressure and/or lipid lowering drugs answered the FINDRISC questionnaire and had an oral glucose tolerance test (OGTT) and HbA1c measured. Results According to the OGTT 934 (39%) had previously undetected dysglycaemia (T2DM 19%, IGT 20%). Of patients, who according to FINDRISC had a low, moderate or slightly elevated risk 20, 34 and 41% and of those in the high and very high-risk category 49 and 71% had IGT or T2DM respectively. The OGTT identified 92% of patients with T2DM, FPG + HbA1c 90%, FPG 80%, 2hPG 29% and HbA1c 22%. Conclusions (1) The prevalence of dysglycaemia was high in patients treated for hypertension and/or dyslipidaemia. (2) Due to the high proportion of dysglycaemia in patients with low to moderate FINDRISC risk scores its initial use did not decrease the need for subsequent glucose tests. (3) FPG was the best test for detecting T2DM. Its isolated use is limited by the inability to disclose IGT. A pragmatic strategy, decreasing the demand for an OGTT, would be to screen all patients with FPG followed by OGTT in patients with IFG.
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Affiliation(s)
- Bahira Shahim
- Cardiology Unit, Department of Medicine, Heart and Vascular Theme, Karolinska Institute, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine, Heart and Vascular Theme, Karolinska Institute, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany
| | - Jaakko Tuomilehto
- Department of Neurosciences and Preventive Medicine, Danube-University Krems, Krems, Austria.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - David Wood
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Heart and Vascular Theme, Karolinska Institute, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Shahim B, De Bacquer D, De Backer G, Gyberg V, Kotseva K, Mellbin L, Schnell O, Tuomilehto J, Wood D, Rydén L. The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA 1c in Patients With Coronary Artery Disease: A Report From EUROASPIRE IV: A Survey From the European Society of Cardiology. Diabetes Care 2017; 40:1233-1240. [PMID: 28637653 PMCID: PMC5566283 DOI: 10.2337/dc17-0245] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Three tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS FPG, 2h-PG, and HbA1c were used to screen 4,004 CAD patients without a history of diabetes (age 18-80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes. RESULTS Complete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA1c predicted the primary outcome, whereas the 2h-PG, dichotomized as <7.8 vs. ≥7.8 mmol/L, was a significant predictor (hazard ratio 1.38, 95% CI 1.07-1.78; P = 0.01). During follow-up, diabetes developed in 78 of the 2,609 patients (3.0%) without diabetes at baseline. An FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, whereas HbA1c 5.7-6.5% and 2h-PG 7.8-11.0 mmol/L were both significant independent predictors. CONCLUSIONS The 2h-PG, in contrast to FPG and HbA1c, provides significant prognostic information regarding cardiovascular events in patients with CAD. Furthermore, elevated 2h-PG and HbA1c are significant prognostic indicators of an increased risk of incident diabetes.
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Affiliation(s)
- Bahira Shahim
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Disease Risk Unit, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, U.K
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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