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Loo G, Puar T, Foo R, Ong TK, Wang TD, Nguyen QN, Chin CT, Chin CW. Unique characteristics of Asians with hypertension: what is known and what can be done? J Hypertens 2024; 42:1482-1489. [PMID: 38509747 PMCID: PMC11296281 DOI: 10.1097/hjh.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/28/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Hypertension remains the leading modifiable risk factor for cardiovascular disease worldwide. Over the past 30 years, the prevalence of hypertension has been increasing in East and Southeast Asia to a greater extent as compared with other Western countries. Asians with hypertension have unique characteristics. This can be attributed to increased impact of obesity on Asians with hypertension, excessive salt intake and increased salt sensitivity, loss of diurnal rhythm in blood pressure and primary aldosteronism. The impact of hypertension on cardiovascular (particularly strokes) and chronic kidney disease is greater in Asians. These unique characteristics underpinned by the diverse socioeconomic backgrounds pose its own challenges in the diagnosis and management of hypertension in Asia.
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Affiliation(s)
- Germaine Loo
- Department of Cardiology, National Heart Centre Singapore
| | - Troy Puar
- Department of Endocrinology, Changi General Hospital
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Medical ACP, Duke-NUS Medical School, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Health System
- Cardiovascular Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Malaysia
| | - Tzung-Dau Wang
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Calvin W.L. Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
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2
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Shiraishi YA, Ishikawa Y, Ishikawa J, Matsumura M, Ishikawa S. Age and sex differences in the risk of cardiovascular diseases by chronic kidney disease in a general Japanese population. Heart Vessels 2023:10.1007/s00380-023-02264-7. [PMID: 37039880 DOI: 10.1007/s00380-023-02264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
The risk of cardiovascular diseases (CVD) by chronic kidney disease (CKD) stratified by age and sex has not been examined in detail in rural Japanese populations. Therefore, we herein investigated the long-term risk of CVD by CKD and performed an age- and sex-stratified risk analysis. We examined 5163 subjects who underwent health screening between 1992 and 1995 with calculated eGFR and follow-up information on CVD events. The mean follow-up period was 10 years. We analyzed the incidences of CVD events, including stroke and myocardial infarction (MI). We compared the risk of CVD between subjects with and without CKD using a Cox proportional hazards model adjusted for well-known CVD confounding factors. The total number of CVD events was 175. The hazard ratios (HRs) for all events, stroke, MI, and sudden death by CKD relative to non-CKD were 1.18 (95% C.I.:0.83-1.68), 0.96 (0.63-1.46), 3.02 (1.2-7.62), and 1.29 (0.43-3.87), respectively. HRs for MI were 7.24 in subjects < 65 years and 1.65 in those ≥ 65 years. HRs for MI by sex were 3.55 in men and 2.09 in women. A younger age and men sex were identified as independent risk factors for the risk of MI in the presence of CKD. These results suggest that among CKD patients, the management of a younger age group and men will effectively prevent MI.
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Affiliation(s)
- Yuko Ago Shiraishi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yukiko Ishikawa
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Iwai K, Ushigome E, Okada K, Yokota I, Majima S, Nakanishi N, Hashimoto Y, Okada H, Senmaru T, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Usefulness of Aerobic Exercise for Home Blood Pressure Control in Patients with Diabetes: Randomized Crossover Trial. J Clin Med 2022; 11:jcm11030650. [PMID: 35160103 PMCID: PMC8836688 DOI: 10.3390/jcm11030650] [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: 12/27/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Hypertension usually coexists with diabetes mellitus and significantly increases the risk of macrovascular complications. Blood pressure measured at home, especially nocturnal blood pressure, is particularly important because it is more strongly associated with target organ damage than clinical blood pressure measurements. Regular moderate aerobic exercise has been shown to have anti-hypertensive effects. This study aimed to investigate the effects of aerobic exercise on home blood pressure in patients with diabetes. This randomized crossover trial was based on outpatient treatment at a university hospital. In this randomized crossover trial, 124 patients with type 2 diabetes were randomly assigned to two groups over 56 days: an exercise preceding group (exercise intervention for 28 days and then no exercise intervention for the following 28 days) and an exercise lagging group (no exercise intervention for 28 days and then exercise intervention for the following 28 days). The associations between the nocturnal blood pressure and exercise intervention were assessed accordingly. A decrease in blood pressure was observed in the morning and evening, at 2 a.m. and 3 a.m. after exercise intervention; however, there was no significant difference between groups. Moderate exercise was not effective in lowering nocturnal blood pressure in this study.
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Affiliation(s)
- Keiko Iwai
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
- Correspondence: ; Tel.: +81-75-251-5505
| | - Kazufumi Okada
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido 060-0808, Japan; (K.O.); (I.Y.)
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido 060-0808, Japan; (K.O.); (I.Y.)
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Hiroshi Okada
- Department of Endocrinology and Diabetology, Matsushita Memorial Hospital, Osaka 570-8540, Japan;
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (K.I.); (S.M.); (N.N.); (Y.H.); (T.S.); (M.H.); (M.A.); (M.Y.); (M.F.)
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Hypertension in diabetes care: emerging roles of recent hypoglycemic agents. Hypertens Res 2021; 44:897-905. [PMID: 33990790 DOI: 10.1038/s41440-021-00665-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 02/03/2023]
Abstract
Patients with type 2 diabetes (T2D) frequently have multiple cardiovascular, metabolic, and renal comorbidities, such as hypertension, dyslipidemia, hyperuricemia, chronic kidney disease, and heart failure. Accordingly, this patient population often requires polypharmacy, which is associated with an increased risk of drug-drug interactions, poor adherence, and even adverse outcomes. Accumulating evidence on newer hypoglycemic agents, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, has highlighted the marked improvements in cardiovascular and renal outcomes associated with the off-target benefits for relevant comorbidities, including hypertension. These classes of hypoglycemic agents are unique, as they achieve consistently modest but significant reductions in systolic and diastolic blood pressure (BP), an effect that has not been targeted and observed with conventional hypoglycemic agents. In addition to this BP-lowering effect, these agents also have multifaceted beneficial impacts on other cardiometabolic and renal parameters, which appear to be helpful for providing an important comprehensive therapeutic approach to improve the prognosis in patients with T2D. The clinical advantages of these agents may reduce the dose and number of concomitant medications used to treat T2D and related comorbidities. These positive spillover effects may also enhance the clinical use of agents to achieve better diabetes care. As a consequence, the clinical significance of these hypoglycemic agents now extends beyond their hypoglycemic effects, thereby providing a new-normal strategy to use in an evidence-based, patient-centric approach to diabetes care.
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Dietary Soy Consumption and Cardiovascular Mortality among Chinese People with Type 2 Diabetes. Nutrients 2021; 13:nu13082513. [PMID: 34444673 PMCID: PMC8398979 DOI: 10.3390/nu13082513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Randomized controlled trials showed that soy intervention significantly improved blood lipids in people with diabetes. We sought to prospectively examine the association of soy consumption with the risk of cardiovascular death among individuals with diabetes. A total of 26,139 participants with a history of diabetes were selected from the Chinese Kadoorie Biobank study. Soy food consumption was assessed by a food frequency questionnaire. Causes of death were coded by the 10th International Classification of Diseases. The Cox proportional hazard regression was used to compute the hazard ratios. During a median follow-up of 7.8 years, a total of 1626 deaths from cardiovascular disease (CVD) were recorded. Compared with individuals who never consumed soy foods, the multivariable-adjusted risks (95% confidence intervals) of CVD mortality were 0.92 (0.78, 1.09), 0.89 (0.75, 1.05), and 0.77 (0.62, 0.96) for those who consumed soy foods monthly, 1–3 days/week, and ≥4 days/week, respectively. For cause-specific cardiovascular mortality, significant inverse associations were observed for coronary heart disease and acute myocardial infarction. Higher soy food consumption was associated with a lower risk of cardiovascular death, especially death from coronary heart disease and acute myocardial infarction, in Chinese adults with diabetes.
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Clarke GA, Hartse BX, Niaraki Asli AE, Taghavimehr M, Hashemi N, Abbasi Shirsavar M, Montazami R, Alimoradi N, Nasirian V, Ouedraogo LJ, Hashemi NN. Advancement of Sensor Integrated Organ-on-Chip Devices. SENSORS (BASEL, SWITZERLAND) 2021; 21:1367. [PMID: 33671996 PMCID: PMC7922590 DOI: 10.3390/s21041367] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023]
Abstract
Organ-on-chip devices have provided the pharmaceutical and tissue engineering worlds much hope since they arrived and began to grow in sophistication. However, limitations for their applicability were soon realized as they lacked real-time monitoring and sensing capabilities. The users of these devices relied solely on endpoint analysis for the results of their tests, which created a chasm in the understanding of life between the lab the natural world. However, this gap is being bridged with sensors that are integrated into organ-on-chip devices. This review goes in-depth on different sensing methods, giving examples for various research on mechanical, electrical resistance, and bead-based sensors, and the prospects of each. Furthermore, the review covers works conducted that use specific sensors for oxygen, and various metabolites to characterize cellular behavior and response in real-time. Together, the outline of these works gives a thorough analysis of the design methodology and sophistication of the current sensor integrated organ-on-chips.
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Affiliation(s)
- Gabriel A. Clarke
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Brenna X. Hartse
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Amir Ehsan Niaraki Asli
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Mehrnoosh Taghavimehr
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Niloofar Hashemi
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran 11365, Iran;
| | - Mehran Abbasi Shirsavar
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Reza Montazami
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Nima Alimoradi
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Vahid Nasirian
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Lionel J. Ouedraogo
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
| | - Nicole N. Hashemi
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA; (G.A.C.); (B.X.H.); (A.E.N.A.); (M.T.); (M.A.S.); (R.M.); (N.A.); (V.N.); (L.J.O.)
- Department of Biomedical Sciences, Iowa State University, Ames, IA 50011, USA
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Bragg F, Halsey J, Guo Y, Zhang H, Yang L, Sun X, Pei P, Chen Y, Du H, Yu C, Clarke R, Lv J, Chen J, Li L, Chen Z. Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 7:100085. [PMID: 34327415 PMCID: PMC8315364 DOI: 10.1016/j.lanwpc.2020.100085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). METHODS In 2004-08, the China Kadoorie Biobank recruited >512,000 adults aged 30-79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). FINDINGS Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25-1.30), 1.18 (1.15-1.21), 1.17 (1.15-1.19) and 1.45 (1.38-1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. INTERPRETATION Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. FUNDING Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Jim Halsey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Hua Zhang
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Xiaohui Sun
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Canqing Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Junshi Chen
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - for the China Kadoorie Biobank (CKB) collaborative group (members listed in Supplementary appendix)
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences, Beijing 102308, China
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
- School of Public Health, Peking University Health Science Center, Beijing, China
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
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9
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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society. Diabetol Int 2021; 12:1-51. [PMID: 33479578 PMCID: PMC7790968 DOI: 10.1007/s13340-020-00471-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
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10
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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, Prevention, and Treatment of Cardiovascular Diseases in People With Type 2 Diabetes and Prediabetes - A Consensus Statement Jointly From the Japanese Circulation Society and the Japan Diabetes Society. Circ J 2020; 85:82-125. [PMID: 33250455 DOI: 10.1253/circj.cj-20-0865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University
| | | | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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11
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Nembaware V, Mazandu GK, Hotchkiss J, Safari Serufuri JM, Kent J, Kengne AP, Anie K, Munung NS, Bukini D, Bitoungui VJN, Munube D, Chirwa U, Chunda-Liyoka C, Jonathan A, Flor-Park MV, Esoh KK, Jonas M, Mnika K, Oosterwyk C, Masamu U, Morrice J, Uwineza A, Nguweneza A, Banda K, Nyanor I, Adjei DN, Siebu NE, Nkanyemka M, Kuona P, Tayo BO, Campbell A, Oron AP, Nnodu OE, Painstil V, Makani J, Mulder N, Wonkam A. The Sickle Cell Disease Ontology: Enabling Collaborative Research and Co-Designing of New Planetary Health Applications. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 24:559-567. [PMID: 33021900 PMCID: PMC7549008 DOI: 10.1089/omi.2020.0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sickle cell disease (SCD) is one of the most common blood disorders impacting planetary health. Over 300,000 newborns are diagnosed with SCD each year globally, with an increasing trend. The sickle cell disease ontology (SCDO) is the most comprehensive multidisciplinary SCD knowledge portal. The SCDO was collaboratively developed by the SCDO working group, which includes experts in SCD and data standards from across the globe. This expert review presents highlights and lessons learned from the fourth SCDO workshop that marked the beginning of applications toward planetary health impact, and with an eye to empower and cultivate multisite SCD collaborative research. The workshop was organized by the Sickle Africa Data Coordinating Center (SADaCC) and attended by 44 participants from 14 countries, with 2 participants connecting remotely. Notably, from the standpoint of democratizing and innovating scientific meeting design, an SCD patient advocate also presented at the workshop, giving a broader real-life perspective on patients' aspirations, needs, and challenges. A major component of the workshop was new approaches to harness SCDO to harmonize data elements used by different studies. This was facilitated by a web-based platform onto which participants uploaded data elements from previous or ongoing SCD-relevant research studies before the workshop, making multisite collaborative research studies based on existing SCD data possible, including multisite cohort, SCD global clinical trials, and SCD community engagement approaches. Trainees presented proposals for systematic literature reviews in key SCD research areas. This expert review emphasizes potential and prospects of SCDO-enabled data standards and harmonization to facilitate large-scale global SCD collaborative initiatives. As the fields of public and global health continue to broaden toward planetary health, the SCDO is well poised to play a prominent role to decipher SCD pathophysiology further, and co-design diagnostics and therapeutics innovation in the field.
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Affiliation(s)
- Victoria Nembaware
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston K Mazandu
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jade Hotchkiss
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Jill Kent
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kofi Anie
- London North West University Healthcare NHS Trust and Imperial College London, London, UK.,Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Daima Bukini
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Valentina Josiane Ngo Bitoungui
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, Dschang, Cameroon
| | - Deogratias Munube
- Department of Paediatric and Child Health, Makerere University/Mulago National Referral Hospital, Kampala, Uganda
| | - Uzima Chirwa
- University Teaching Hospitals-Children's Hospital, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Catherine Chunda-Liyoka
- University Teaching Hospitals-Children's Hospital, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Agnes Jonathan
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Miriam V Flor-Park
- Onco-hematology Unit, Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Kevin Kum Esoh
- Department of Biochemistry, Faculty of Science, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Mario Jonas
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Khuthala Mnika
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chandré Oosterwyk
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Upendo Masamu
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Jack Morrice
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Annette Uwineza
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Arthemon Nguweneza
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kambe Banda
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Isaac Nyanor
- Kumasi Centre for Sickle Cell Disease, Komfo Anokye Teaching Hospital, Accra, Ghana
| | - David Nana Adjei
- Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Nathan Edward Siebu
- Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Malula Nkanyemka
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Patience Kuona
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Bamidele O Tayo
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Andrew Campbell
- Division of Hematology, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Assaf P Oron
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, Washington, USA
| | - Obiageli E Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Vivian Painstil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Nicola Mulder
- Computational Biology Division, Faculty of Health Sciences, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Saito T, Ohmura H, Nojiri S, Daida H. Impact of sitagliptin combination therapy and hypoglycemia in Japanese patients with type 2 diabetes: a multi-center retrospective observational cohort study. J Pharm Health Care Sci 2020; 6:13. [PMID: 32518665 PMCID: PMC7271486 DOI: 10.1186/s40780-020-00169-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Patients with diabetes are at higher risk of developing polypharmacy because of the high frequency of comorbidities. There have been several reports on the hypoglycemic risk of the combination of hypoglycemic agents and other medications. This study aimed to investigate the hypoglycemic risk of drug-drug interaction between sitagliptin and other oral hypoglycemic agents or antihypertensive agents in Japanese patients with type 2 diabetes. Methods From January 2010 to March 2012, a total of 3247 patients were recruited and evaluated at outpatient clinics at Juntendo University Hospital, other satellite hospitals, and private clinics. This study was a sub-analysis of the Sitagliptin Registration Type 2 Diabetes-Juntendo Collaborating Project. Participants were limited to those treated with oral hypoglycemic agents, excluding insulin users, to investigate the association of the first hypoglycemic events with oral hypoglycemic agents or other medications within 6 months after starting sitagliptin. The factors related to the first hypoglycemic event were analyzed using Cox regression analysis. Results In total, 2956 patients with a mean age of 65.1 ± 11.3 years were included. A total of 46 hypoglycemic events (1.6%) were observed. One patient had severe hypoglycemia followed by emergency transport to the hospital. Sitagliptin was not associated with hypoglycemia, but its combination with sulfonylurea (hazard ratio: 4.42, 95% confidential interval: 1.36–14.42) or β-blocker (hazard ratio, 3.50, 95% confidential interval: 1.54–7.96) was significantly associated with hypoglycemia. Conclusions The drug-drug interactions between sitagliptin and sulfonylurea or β-blocker likely increases the hypoglycemic risk in Japanese patients with type 2 diabetes. Pharmacists should consider potential adverse events from drug-drug interaction in type 2 diabetes with polypharmacy, particularly those who are managed by several doctors or clinics.
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Affiliation(s)
- Tomoyuki Saito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421 Japan.,Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431 Japan
| | - Hirotoshi Ohmura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421 Japan
| | - Shuko Nojiri
- Juntendo University, Medical Technology Innovation Center, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431 Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421 Japan
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13
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Iwai K, Ushigome E, Yokota I, Majima S, Nakanishi N, Hashimoto Y, Okada H, Senmaru T, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Usefulness of Exercise for Home Blood Pressure Control in People with Diabetes: A Study Protocol for a Crossover Randomized Controlled Trial. Diabetes Metab Syndr Obes 2020; 13:4747-4753. [PMID: 33299337 PMCID: PMC7721122 DOI: 10.2147/dmso.s280117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The coexistence of hypertension and diabetes mellitus significantly increases the risk of macrovascular complications in patients with diabetes. Home blood pressure is important because it is more strongly associated with target organ damage and total mortality than clinic blood pressure measurements. Regular moderate aerobic exercise has antihypertensive effects. This study aims to examine the effect of aerobic exercise therapy on blood pressure at home in patients with diabetes. PATIENTS AND METHODS In this crossover randomized controlled trial, 110 patients with type 2 diabetes will be randomly assigned to two groups: an exercise preceding group and an exercise lagging group. During the exercise period, patients will be instructed to walk either 30 minutes twice each day or 60 minutes once each day for at least 3 days per week. During the non-exercise period, patients will be permitted to perform physical activity associated with activities of daily life. Patients will be followed up for 56 days. The primary outcome will be the mean nocturnal blood pressure from day 24 to 28 during the exercise period compared to that during the non-exercise period. The secondary outcome will include variation in nocturnal blood pressure, mean blood pressure values and variation of morning and evening blood pressure from day 24 to 28 in the exercise period compared to the non-exercise period, body weight, body mass index and bioelectrical impedance analysis. Biochemical tests such as hemoglobin A1c level, blood glucose level, serum lipid profile, renal function, uric acid levels and liver function tests will also be measured. DISCUSSION This randomized controlled trial will provide critical information regarding the effectiveness of moderate exercise on nocturnal blood pressure reduction. If successful, the results of this randomized controlled trial may increase exercise motivation in people with diabetes and may lead to improvement or prevention of target organ damage and overall mortality. TRIAL REGISTRATION Trial registration: University Hospital Medical Information Network, UMIN 000035973. Protocol version number: R000040969. Registration date: February 22, 2019. Recruitment began: June 19, 2019. The date of completion of recruitment: July 3, 2020. URL: http://www.umin.ac.jp.
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Affiliation(s)
- Keiko Iwai
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
- Correspondence: Emi Ushigome Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii Cho, Kamigyo-ku, Kyoto-city, Kyoto621-8585, JapanTel +81-75-251-5505Fax +81-75-252-3721 Email
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido060-0808, Japan
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Diabetology, Matsushita Memorial Hospital, Moriguchi, Osaka, 570-8540, Japan
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto602-8566, Japan
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14
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Garnett C, Johannesen L, McDowell T. Redefining Blood Pressure Assessment — The Role of the Ambulatory Blood Pressure Monitoring Study for Drug Safety. Clin Pharmacol Ther 2019; 107:147-153. [DOI: 10.1002/cpt.1690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Christine Garnett
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Lars Johannesen
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Tzu‐Yun McDowell
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
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15
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Association of general and central adiposity with blood pressure among Chinese adults: results from the China National Stroke Prevention Project. J Hypertens 2019; 36:2406-2413. [PMID: 30020239 DOI: 10.1097/hjh.0000000000001852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Heart Association concluded that waist circumference was a better predictor of blood pressure risk than BMI in Asians. However, data are inconsistent and information in Chinese, the largest global population group, is limited. METHODS Data was obtained from the Chinese National Stroke Prevention Project Survey of a nationally representative sample of middle-aged and older Chinese adults. A total of 135 825 individuals not taking any antihypertensive drugs were included in this study. Multiple linear regression analyses were conducted to examine the association between blood pressure and parameters of general adiposity, including BMI, height-adjusted weight, and parameters of central adiposity, including waist circumference, hip circumference, waist-hip ratio, and waist-height ratio. Results were shown as mean difference in blood pressure associated with one standard deviation higher level of adiposity. RESULTS The overall means ± standard deviation of BMI and waist circumference were 24.3 ± 3.18 kg/m and 84.0 ± 8.88 cm, respectively. BMI seemed more strongly associated with SBP/DBP (4.22 mmHg/SD; 2.60 mmHg/SD) than central adiposity markers. In addition, there were sex differences. For men, waist circumference showed a stronger association with SBP/DBP than BMI (4.04 vs. 3.79, P < 0.05; 2.26 vs. 2.13, P < 0.05). For women, BMI was more closely related to SBP/DBP than central adiposity parameters, such as waist circumference (4.59 vs. 3.41, P < 0.05; 2.98 vs. 2.24, P < 0.05). Additionally, in both urban and rural areas, waist circumference was mostly associated with SBP/DBP among men, whereas it was BMI among women. CONCLUSION Compared with central adiposity, blood pressure is more strongly associated with general adiposity in Chinese adults. Interestingly, there are significant sex differences in the relationship of blood pressure with general and central adiposity. Waist circumference is the strongest predictor for men but suboptimal for women, and BMI tend to a better predictor of blood pressure for women. In addition, our results for men are consistent with the recommendation of the American Heart Association in 2015 that waist circumference could be used for assessing the risk of blood pressure.
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16
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Bhatt S, Northcott C, Wisialowski T, Li D, Steidl-Nichols J. Preclinical to Clinical Translation of Hemodynamic Effects in Cardiovascular Safety Pharmacology Studies. Toxicol Sci 2019; 169:272-279. [DOI: 10.1093/toxsci/kfz035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Siddhartha Bhatt
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Carrie Northcott
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Todd Wisialowski
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Dingzhou Li
- Regulatory Strategy and Compliance, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Jill Steidl-Nichols
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
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17
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Wang S, Djama NM, Lai Y, Li H, Liao W, Liao Y, Bin J. Cardiovascular outcomes in patients with diabetes when initiating blood pressure lowering at baseline SBP between 130 and 140 mm Hg: A meta-analysis. J Clin Hypertens (Greenwich) 2019; 21:220-229. [PMID: 30637947 DOI: 10.1111/jch.13471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
Abstract
The efficacy and safety of blood pressure (BP) lowering initiated at baseline systolic BP (SBP) of 130-140 mm Hg in patients with diabetes remain controversial. The authors aimed to investigate the benefits and harms of BP lowering initiated at these levels for patients with diabetes. Medline and EMBASE were searched from inception to March 10, 2018. The primary outcome was major cardiovascular events. Random-effects model was used to pool all the estimates. Six trials with 21 574 diabetics were included. In diabetics, initiating BP lowering at baseline SBP of 130 and 140 mm Hg did not reduce the rate of major cardiovascular events (RR, 1.01 [95% CI, 0.93-1.10]), finding that was consistent in subgroup and sensitivity analyses. Moreover, BP lowering did not reduce the risks of myocardial infarction (RR, 0.99 [95% CI, 0.85-1.16]), stroke (0.83 [95% CI, 0.54-1.27]), heart failure (0.91 [95% CI, 0.79-1.04]), albuminuria (0.93 [95% CI, 0.84-1.04]), end-stage renal disease (0.93 [95% CI, 0.70-1.24]), cardiovascular death (1.25 [95% CI, 0.90-1.74]) and all-cause death (1.05 [95% CI, 0.94-1.17]) in patients with diabetes and baseline SBP of 130-140 mm Hg but possibly increase the risks of serious adverse events (RR, 2.00 [95% CI, 1.33-3.01]) and hypotension (5.30 [95% CI, 0.99-28.40]). In diabetics, initiating BP lowering at baseline SBP of 130-140 mm Hg may not produce any benefit but probably increase the risks of serious adverse events and hypotension. It may not be recommended to initiate BP lowering at a threshold of SBP lower than 140 mm Hg for diabetics.
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Affiliation(s)
- Shifei Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nima Moumin Djama
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanxian Lai
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairui Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
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18
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Niwa H, Takahashi K, Dannoura M, Oomori K, Miyoshi A, Inada T, Miyoshi H. The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index with Macroangiopathy in Patients with Type 2 Diabetes Mellitus. J Atheroscler Thromb 2018; 26:616-623. [PMID: 30487347 PMCID: PMC6629746 DOI: 10.5551/jat.45674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS This study elucidates the association of macroangiopathy development in type 2 diabetes patients with various arteriosclerosis risk factors (ARFs) and results of cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI). METHODS The correlation between current and past macroangiopathy development, with ARFs or CAVI/ABI data, was retrospectively analyzed using multivariate logistic regression in 816 patients with type 2 diabetes at a single center. C-statistics combining some independent variables selected using the stepwise method were evaluated. RESULTS CAVI was significantly correlated with macroangiopathies, including coronary artery disease (CAD), arteriosclerosis obliterans (ASO), and stroke with odds ratios (OR) of 1.20, 1.22, and 1.19, respectively. ABI significantly correlated with ASO and stroke with respective OR of 13.6 and 2.47, but not with CAD. Areas under the receiver operating characteristic curves (ROCs) revealed the accuracy of detecting ASO and stroke was increased by the combination of CAVI+ABI (0.94 and 0.74, respectively). However, areas under the ROC for the presence of CAD can be increased by the combination of CAVI and ARFs especially including dyslipidemia. CONCLUSION CAVI/ABI and some ARFs are useful tools in daily clinical care units to identify the current and past existence of macroangiopathy in patients with type 2 diabetes, but the prediction weights using these factors were different among CAD, ASO, and stroke.
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Affiliation(s)
| | - Kiyohiko Takahashi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Midori Dannoura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kazuno Oomori
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Arina Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | | | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.,Division of Diabetes and Obesity, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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Kinoshita M, Yokote K, Arai H, Iida M, Ishigaki Y, Ishibashi S, Umemoto S, Egusa G, Ohmura H, Okamura T, Kihara S, Koba S, Saito I, Shoji T, Daida H, Tsukamoto K, Deguchi J, Dohi S, Dobashi K, Hamaguchi H, Hara M, Hiro T, Biro S, Fujioka Y, Maruyama C, Miyamoto Y, Murakami Y, Yokode M, Yoshida H, Rakugi H, Wakatsuki A, Yamashita S. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017. J Atheroscler Thromb 2018; 25:846-984. [PMID: 30135334 PMCID: PMC6143773 DOI: 10.5551/jat.gl2017] [Citation(s) in RCA: 497] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Koutaro Yokote
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Seiji Umemoto
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hirotoshi Ohmura
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Shinji Kihara
- Biomedical Informatics, Osaka University, Osaka, Japan
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Tsukamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama, Japan
| | - Seitaro Dohi
- Chief Health Management Department, Mitsui Chemicals Inc., Tokyo, Japan
| | - Kazushige Dobashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University, Hyogo, Japan
| | - Chizuko Maruyama
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women's University, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Shizuya Yamashita
- Department of Community Medicine, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Rinku General Medical Center, Osaka, Japan
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20
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Blood pressure indices and cardiovascular disease mortality in persons with or without diabetes mellitus. J Hypertens 2018; 36:85-92. [PMID: 28800042 DOI: 10.1097/hjh.0000000000001509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined the associations between blood pressure indices (SBP, DBP, mean arterial pressure and pulse pressure) and cardiovascular disease (CVD) mortality among persons with or without diabetes mellitus (NON-DM) in a multiethnic cohort. METHODS We included 17 650 participants from National Health and Nutrition Examination Survey III and 1439 participants from Diabetes Heart Study (total n = 19 089, 16.3% had diabetes mellitus, mean age 48.5 years, 44.4% white, 27.1% black, 28.5% other race, 54.4% women). Cox proportional hazard, cubic spline and area under the curve analyses were used to assess the associations. CVD death was ascertained via social security registry or the National Death Index. RESULTS After a mean (SD) of 16.2 (6.1) years of follow-up, 17.9% of diabetes mellitus and 8.8% of those NON-DM died of CVD. Diabetes mellitus was associated with an increased risk of CVD death [hazard ratio (95% confidence interval): 1.50 (1.25-1.82)]. One SD increase in SBP was significantly associated with CVD mortality in NON-DM [1.28 (1.18-1.39)] but not diabetes mellitus [1.04 (0.88-1.23)] in the full Cox models. Adjusted cubic spline analysis showed significant nonlinear but different association between SBP and CVD mortality among diabetes mellitus (U-shaped) and NON-DM (J-shaped). The C-statistics of our full model in NON-DM and diabetes mellitus were (0.888 vs. 0.735, P < 0.001). SBP showed a trend toward improving C statistics in NON-DM but not diabetes mellitus. CONCLUSION The association between SBP and CVD mortality risk is nonlinear but different in diabetes mellitus (U-shaped) and NON-DM (J-shaped), explaining why aggressive blood pressure lowering may have different outcomes in these two groups.
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21
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Peters SAE, Wang X, Lam TH, Kim HC, Ho S, Ninomiya T, Knuiman M, Vaartjes I, Bots ML, Woodward M. Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration. BMJ Open 2018; 8:e019335. [PMID: 29511013 PMCID: PMC5855160 DOI: 10.1136/bmjopen-2017-019335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster. SETTING Asia Pacific Cohort Studies Collaboration. PARTICIPANTS Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline. OUTCOME MEASURES Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated. RESULTS During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP-smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP-smoking-cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%. CONCLUSIONS Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD.
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Affiliation(s)
- Sanne A E Peters
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xin Wang
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The First Hospital of Jilin University, Changchun, China
| | - Tai-Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Hyeon Chang Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suzanne Ho
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Kyushu University, Fukuoka, Japan
| | - Matthew Knuiman
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Woodward
- George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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22
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Haneda M, Noda M, Origasa H, Noto H, Yabe D, Fujita Y, Goto A, Kondo T, Araki E. Japanese Clinical Practice Guideline for Diabetes 2016. Diabetol Int 2018; 9:1-45. [PMID: 30603347 PMCID: PMC6224875 DOI: 10.1007/s13340-018-0345-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Atsushi Goto
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tatsuya Kondo
- Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
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23
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Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study. J Hypertens 2017; 34:2164-71. [PMID: 27512965 DOI: 10.1097/hjh.0000000000001068] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy). METHODS This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators. RESULTS Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P < 0.001; DBP: -1.5 mmHg, P < 0.001). The results stay statistically significant after further adjustment for C-reactive protein, waist circumference, and fasting glucose (odds ratio: 0.72, 95% confidence interval: 0.55-0.86; SBP: -2.4 mmHg, P < 0.05; DBP: -1.1 mmHg, P < 0.05). The protective association between vegetarian diet and hypertension appeared to be consistent across age groups. CONCLUSION Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.
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24
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Tatsumi Y, Ohkubo T. Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese. Hypertens Res 2017; 40:795-806. [PMID: 28701739 DOI: 10.1038/hr.2017.67] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of both hypertension and diabetes mellitus is increasing worldwide. Both diseases lead to severe complications such as cardiovascular and chronic kidney diseases, which increase the risk of death over a long period of time. Therefore, the prevention and aggravation of hypertension and diabetes mellitus are major challenges. Because few review articles have focused on the epidemiological perspective of hypertension and diabetes mellitus, we reviewed major observational studies mainly from Japan and from Western countries that have reported on the prevalence of hypertension and diabetes mellitus, the binominal risk of hypertension and diabetes mellitus, and the risk of their coexistence. Our investigation found that approximately 50% of diabetic patients had hypertension, and approximately 20% of hypertensive patients had diabetes mellitus. Those with either hypertension or diabetes mellitus had a 1.5- to 2.0-fold higher risk of having both conditions. These results were similar for both Japan and Western countries. Although comparing the results between Japan and Western countries was difficult because the risks were estimated using widely varying statistical analyses, it was revealed that the coexistence of hypertension and diabetes mellitus certainly increased the risk of complications regardless of the country. The definition, prevalence and medical treatment of hypertension and diabetes mellitus will change in the future. For early intervention based on the latest evidence to prevent severe complications, it is important to accumulate epidemiological knowledge of hypertension and diabetes mellitus and to update the evidence for both Japan and other countries.
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Affiliation(s)
- Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Teikyo University, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Teikyo University, Tokyo, Japan
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25
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Tanaka A, Node K. Amelioration of arterial pressure lability: an unmissable target for diabetes management. Hypertens Res 2017; 40:629-631. [PMID: 28298651 DOI: 10.1038/hr.2017.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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26
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Evaluation of the Effectiveness of Tai Chi versus Brisk Walking in Reducing Cardiovascular Risk Factors: Protocol for a Ranomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070682. [PMID: 27399735 PMCID: PMC4962223 DOI: 10.3390/ijerph13070682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022]
Abstract
Physical inactivity is one of the major modifiable lifestyle risk factors for cardiovascular disease (CVD). This protocol aims to evaluate the effectiveness of Tai Chi versus brisk walking in reducing CVD risk factors. This is a randomized controlled trial with three arms, namely, Tai Chi group, walking group, and control group. The Tai Chi group will receive Tai Chi training, which consists of two 60-min sessions each week for three months, and self-practice for 30 min every day. The walking group will perform brisk walking for 30 min every day. The control group will receive their usual care. 246 subjects with CVD risk factors will be recruited from two outpatient clinics. The primary outcome is blood pressure. Secondary outcomes include fasting blood for lipid profile, sugar and glycated haemoglobin (HbA1c); body mass index, waist circumference, body fat percentage; perceived stress level and quality of life. Data collections will be conducted at baseline, 3-month, 6-month and 9-month. Generalized estimating equations model will be used to compare the changes in outcomes across time between groups. It is expected that both the Tai Chi and walking groups could maintain better health and have improved quality of life, and that Tai Chi will be more effective than brisk walking in reducing CVD risk factors.
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27
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Olomu A, Khan NNS, Todem D, Huang Q, Bottu S, Qadri S, Holmes-Rovner M. Blood Pressure Control in Hypertensive Patients in Federally Qualified Health Centers: Impact of Shared Decision Making in the Office-GAP Program. MDM Policy Pract 2016; 1:2381468316656010. [PMID: 30288401 PMCID: PMC6125053 DOI: 10.1177/2381468316656010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 05/14/2016] [Indexed: 01/13/2023] Open
Abstract
Background: Hypertension (HTN) in people with diabetes doubles the risk of cardiovascular disease. Prior patient activation studies largely show improved communication but little impact on behavior or health outcomes. We sought to 1) assess the impact of Office-Based Guidelines Applied to Practice (Office-GAP) Program on blood pressure (BP) control; 2) determine the rate and predictors of BP control in patients with HTN and/or diabetes mellitus (DM) in federally qualified health centers. Methods: Sample: Patients with coronary heart disease (CHD) and/or DM with history of HTN; analyzed patients with DM and HTN compared to HTN without DM. INTERVENTION Office-GAP included physician training, patient activation, and an Office-GAP decision checklist. Two-site intervention/control design; data collection at baseline and after 3, 6, and 12 months. Logistic regression with propensity scoring assessed impact on BP control over time. Results: Of 243 patients, HTN was present in 75% at baseline; 32% had BP controlled. Consistent trend showed Office-GAP slightly improved the rate of BP control across time, while the control arm showed a nonsignificant decrease in the rate of BP control across time, compared to baseline. BP improved at 6 months at the intervention site compared to control site (odds ratio = 2.92; 95% confidence interval = 1.11-7.69). Conclusion: BP control was better at the intervention site compared to the control site at 6 months. Office-GAP shows promise to implement guidelines-based patient-centered care that improves BP.
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Affiliation(s)
- Adesuwa Olomu
- Adesuwa Olomu, MD, MS, Department of
Medicine, Michigan State University, 788 Service Road, B329 Clinical Center,
East Lansing, MI 48824, USA; telephone: 517-353-3730; e-mail:
| | - Nazia Naz S. Khan
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
| | - David Todem
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
| | - Qinhua Huang
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
| | - Shireesha Bottu
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
| | - Syeda Qadri
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
| | - Margaret Holmes-Rovner
- College of Human Medicine (AO, NNK, SB, SQ),
Michigan State University, East Lansing, MI, USA
- Department of Epidemiology and Biostatistics (DT,
QH), Michigan State University, East Lansing, MI, USA
- Center for Ethics and Humanities in the Life
Sciences and Department of Medicine (MHR), Michigan State University, East
Lansing, MI, USA
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28
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Statistical power analysis of cardiovascular safety pharmacology studies in conscious rats. J Pharmacol Toxicol Methods 2016; 81:128-35. [PMID: 27071954 DOI: 10.1016/j.vascn.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/25/2016] [Accepted: 04/04/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Cardiovascular (CV) toxicity and related attrition are a major challenge for novel therapeutic entities and identifying CV liability early is critical for effective derisking. CV safety pharmacology studies in rats are a valuable tool for early investigation of CV risk. Thorough understanding of data analysis techniques and statistical power of these studies is currently lacking and is imperative for enabling sound decision-making. METHODS Data from 24 crossover and 12 parallel design CV telemetry rat studies were used for statistical power calculations. Average values of telemetry parameters (heart rate, blood pressure, body temperature, and activity) were logged every 60s (from 1h predose to 24h post-dose) and reduced to 15min mean values. These data were subsequently binned into super intervals for statistical analysis. A repeated measure analysis of variance was used for statistical analysis of crossover studies and a repeated measure analysis of covariance was used for parallel studies. Statistical power analysis was performed to generate power curves and establish relationships between detectable CV (blood pressure and heart rate) changes and statistical power. Additionally, data from a crossover CV study with phentolamine at 4, 20 and 100mg/kg are reported as a representative example of data analysis methods. RESULTS Phentolamine produced a CV profile characteristic of alpha adrenergic receptor antagonism, evidenced by a dose-dependent decrease in blood pressure and reflex tachycardia. Detectable blood pressure changes at 80% statistical power for crossover studies (n=8) were 4-5mmHg. For parallel studies (n=8), detectable changes at 80% power were 6-7mmHg. Detectable heart rate changes for both study designs were 20-22bpm. DISCUSSION Based on our results, the conscious rat CV model is a sensitive tool to detect and mitigate CV risk in early safety studies. Furthermore, these results will enable informed selection of appropriate models and study design for early stage CV studies.
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Gijsberts CM, Groenewegen KA, Hoefer IE, Eijkemans MJC, Asselbergs FW, Anderson TJ, Britton AR, Dekker JM, Engström G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Holewijn S, Ikeda A, Kitagawa K, Kitamura A, de Kleijn DPV, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Okazaki S, O’Leary DH, Pasterkamp G, Peters SAE, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CDA, Bots ML, den Ruijter HM. Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events. PLoS One 2015; 10:e0132321. [PMID: 26134404 PMCID: PMC4489855 DOI: 10.1371/journal.pone.0132321] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.
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Affiliation(s)
- Crystel M. Gijsberts
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Karlijn A. Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Marinus J. C. Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Todd J. Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Annie R. Britton
- Department of Epidemiology and Public Health University College London, London, United Kingdom
| | - Jacqueline M. Dekker
- Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Gunnar Engström
- Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Greg W. Evans
- Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Jacqueline de Graaf
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Bo Hedblad
- Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Suzanne Holewijn
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Ai Ikeda
- Osaka Medical Center for Health Science and Promotion, Osaka, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women Medical University, Tokyo, Japan
| | - Akihiko Kitamura
- Osaka Medical Center for Health Science and Promotion, Osaka, Japan
| | - Dominique P. V. de Kleijn
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- Cardiovascular Research Institute & Surgery, Singapore, Singapore
| | - Eva M. Lonn
- Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthias W. Lorenz
- Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Giel Nijpels
- Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Shuhei Okazaki
- Stroke Center, Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daniel H. O’Leary
- Department of Radiology, Tufts Medical Center, Boston, MA, United States of America
| | - Gerard Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joseph F. Polak
- Department of Radiology, Tufts Medical Center, Boston, MA, United States of America
| | - Jacqueline F. Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Christine Robertson
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher M. Rembold
- Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Maria Rosvall
- Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | | | - Matthias Sitzer
- Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany and Department of Neurology Klinikum Herford, Germany
| | - Coen D. A. Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hester M. den Ruijter
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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Cavero I. 14th Annual Meeting of the Safety Pharmacology Society: threading through scientific sessions for originality and novelty. Expert Opin Drug Saf 2015; 14:999-1008. [DOI: 10.1517/14740338.2015.1034104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Park JB, Kario K, Wang JG. Systolic hypertension: an increasing clinical challenge in Asia. Hypertens Res 2015; 38:227-36. [PMID: 25503845 PMCID: PMC4396396 DOI: 10.1038/hr.2014.169] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 12/21/2022]
Abstract
Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.
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Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kengne AP, Libend CN, Dzudie A, Menanga A, Dehayem MY, Kingue S, Sobngwi E. An assessment of discriminatory power of office blood pressure measurements in predicting optimal ambulatory blood pressure control in people with type 2 diabetes. Pan Afr Med J 2014; 19:231. [PMID: 25838859 PMCID: PMC4377096 DOI: 10.11604/pamj.2014.19.231.2608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 02/04/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ambulatory blood pressure (BP) measurements (ABPM) predict health outcomes better than office BP, and are recommended for assessing BP control, particularly in high-risk patients. We assessed the performance of office BP in predicting optimal ambulatory BP control in sub-Saharan Africans with type 2 diabetes (T2DM). METHODS Participants were a random sample of 51 T2DM patients (25 men) drug-treated for hypertension, receiving care in a referral diabetes clinic in Yaounde, Cameroon. A quality control group included 46 non-diabetic individuals with hypertension. Targets for BP control were systolic (and diastolic) BP. RESULTS Mean age of diabetic participants was 60 years (standard deviation: 10) and median duration of diabetes was 6 years (min-max: 0-29). Correlation coefficients between each office-based variable and the 24-h ABPM equivalent (diabetic vs. non-diabetic participants) were 0.571 and 0.601 for systolic (SBP), 0.520 and 0.539 for diastolic (DBP), 0.631 and 0.549 for pulse pressure (PP), and 0.522 and 0.583 for mean arterial pressure (MAP). The c-statistic for the prediction of optimal ambulatory control from office-BP in diabetic participants was 0.717 for SBP, 0.494 for DBP, 0.712 for PP, 0.582 for MAP, and 0.721 for either SBP + DBP or PP + MAP. Equivalents in diabetes-free participants were 0.805, 0.763, 0.695, 0.801 and 0.813. CONCLUSION Office DBP was ineffective in discriminating optimal ambulatory BP control in diabetic patients, and did not improve predictions based on office SBP alone. Targeting ABPM to those T2DM patients who are already at optimal office-based SBP would likely be more cost effective in this setting.
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Affiliation(s)
- Andre Pascal Kengne
- South African Medical Research Council & University of Cape Town, Cape Town, South Africa
| | | | - Anastase Dzudie
- Service of Internal Medicine, General Hospital of Douala, Douala, & Buea faculty of Health Sciences, Buea, Cameroon
| | - Alain Menanga
- Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon
| | | | - Samuel Kingue
- Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon
| | - Eugene Sobngwi
- Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon
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Hao G, Wang Z, Guo R, Chen Z, Wang X, Zhang L, Li W. Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies. BMC Cardiovasc Disord 2014; 14:148. [PMID: 25344747 PMCID: PMC4221690 DOI: 10.1186/1471-2261-14-148] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/17/2014] [Indexed: 01/13/2023] Open
Abstract
Background The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM. Method PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM. Results Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality. Conclusions Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM. Electronic supplementary material The online version of this article (doi:10.1186/1471-2261-14-148) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Zengwu Wang
- Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No, 167 Beilishi Road Xicheng District, Beijing 100037, China.
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Kengne AP. The ADVANCE cardiovascular risk model and current strategies for cardiovascular disease risk evaluation in people with diabetes. Cardiovasc J Afr 2014; 24:376-81. [PMID: 24337215 PMCID: PMC3902381 DOI: 10.5830/cvja-2013-078] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 12/17/2022] Open
Abstract
Purpose To critically examine existing approaches to cardiovascular disease (CVD) risk evaluation in people with diabetes, and discuss the use of accurate and validated absolute CVD risk tools as an appropriate basis for CVD prevention in people with diabetes. Methods This was a narrative review using evidence from the ADVANCE study and all relevant publications identified via PubMed MEDLINE. Results There is sufficient evidence that diabetes does not confer a CVD risk equivalent to that in non-diabetic people with existing CVD in all circumstances. In people with diabetes, CVD risk follows a gradient. Reliably capturing this gradient depends on an adequate combination of several risk factors. Many global CVD risk tools applicable to people with diabetes have been developed. Those derived from older cohorts are less accurate in contemporary populations and many newer tools have not been tested. The ADVANCE risk engine, recently developed from the large multinational ADVANCE study, showed acceptable performance on the ADVANCE population and largely outperformed the popular Framingham risk equation when tested on the multinational DIAB-HYCAR cohort of people with type 2 diabetes. Conclusions The high-risk status conferred by diabetes does not preclude estimation of absolute CVD risk using tools such as the ADVANCE risk engine and its use as the basis for initiating and intensifying CVD preventative measures. Adopting such an accurate and validated tool will likely improve prescriptions and outcomes of diabetes care.
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Comparative proteomic study reveals 17β-HSD13 as a pathogenic protein in nonalcoholic fatty liver disease. Proc Natl Acad Sci U S A 2014; 111:11437-42. [PMID: 25028495 DOI: 10.1073/pnas.1410741111] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is characterized by a massive accumulation of lipid droplets (LDs). The aim of this study was to determine the function of 17β-hydroxysteroid dehydrogenase-13 (17β-HSD13), one of our newly identified LD-associated proteins in human subjects with normal liver histology and simple steatosis, in NAFLD development. LDs were isolated from 21 human liver biopsies, including 9 cases with normal liver histology (group 1) and 12 cases with simple steatosis (group 2). A complete set of LD-associated proteins from three liver samples of group 1 or group 2 were determined by 2D LC-MS/MS. By comparing the LD-associated protein profiles between subjects with or without NAFLD, 54 up-regulated and 35 down-regulated LD-associated proteins were found in NAFLD patients. Among them, 17β-HSD13 represents a previously unidentified LD-associated protein with a significant up-regulation in NAFLD. Because the 17β-HSD family plays an important role in lipid metabolism, 17β-HSD13 was selected for validating the proteomic findings and exploring its role in the pathogenesis of NAFLD. Increased hepatic 17β-HSD13 and its LD surface location were confirmed in db/db (diabetic) and high-fat diet-fed mice. Adenovirus-mediated hepatic overexpression of human 17β-HSD13 induced a fatty liver phenotype in C57BL/6 mice, with a significant increase in mature sterol regulatory element-binding protein 1 and fatty acid synthase levels. The present study reports an extensive set of human liver LD proteins and an array of proteins differentially expressed in human NAFLD. We also identified 17β-HSD13 as a pathogenic protein in the development of NAFLD.
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Pre-existing hypertension dominates γδT cell reduction in human ischemic stroke. PLoS One 2014; 9:e97755. [PMID: 24840735 PMCID: PMC4026520 DOI: 10.1371/journal.pone.0097755] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/24/2014] [Indexed: 02/05/2023] Open
Abstract
T lymphocytes may play an important role in the evolution of ischemic stroke. Depletion of γδT cells has been found to abrogate ischemia reperfusion injury in murine stroke. However, the role of γδT cells in human ischemic stroke is unknown. We aimed to determine γδT cell counts and γδT cell interleukin 17A (IL-17A) production in the clinical setting of ischemic stroke. We also aimed to determine the associations of γδT cell counts with ischemic lesion volume, measures of clinical severity and with major stroke risk factors. Peripheral blood samples from 43 acute ischemic stroke patients and 26 control subjects matched on race and gender were used for flow cytometry and complete blood count analyses. Subsequently, cytokine levels and gene expression were measured in γδT cells. The number of circulating γδT cells was decreased by almost 50% (p = 0.005) in the stroke patients. γδT cell counts did not correlate with lesion volume on magnetic resonance diffusion-weighted imaging or with clinical severity in the stroke patients, but γδT cells showed elevated levels of IL-17A (p = 0.048). Decreased γδT cell counts were also associated with older age (p = 0.004), pre-existing hypertension (p = 0.0005) and prevalent coronary artery disease (p = 0.03), with pre-existing hypertension being the most significant predictor of γδT cell counts in a multivariable analysis. γδT cells in human ischemic stroke are reduced in number and show elevated levels of IL-17A. A major reduction in γδT lymphocytes also occurs in hypertension and may contribute to the development of hypertension-mediated stroke and vascular disease.
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Zhu D, Gao P, Holtbruegge W, Huang C. A randomized, double-blind study to evaluate the efficacy and safety of a single-pill combination of telmisartan 80 mg/amlodipine 5 mg versus amlodipine 5 mg in hypertensive Asian patients. J Int Med Res 2014; 42:52-66. [PMID: 24391142 DOI: 10.1177/0300060513503756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of telmisartan 80 mg/amlodipine 5 mg (T80/A5) single-pill combination versus A5 in patients with essential hypertension not adequately controlled on A5 monotherapy. METHODS Asian patients ≥18 years old, with inadequately controlled blood pressure (BP) at enrolment, who failed to achieve a seated diastolic BP (DBP) goal (≥90 mmHg) following 6-weeks' open-label A5 treatment, were randomly allocated 1 : 1 to 8 weeks' double-blind treatment with T80/A5 single-pill combination or A5. RESULTS A total of 324 patients entered the double-blind treatment phase. The adjusted mean ± SE reduction in seated trough DBP from baseline to week 8 was significantly greater with T80/A5 (12.4 ± 1.0 mmHg) than A5 (10.2 ± 0.9 mmHg [primary endpoint, n = 314]). Results were similar in the subset of 262 Chinese patients. Treatment-related adverse events were 1.9% with T80/A5 and 2.4% with A5. CONCLUSIONS In Asian patients with hypertension, T80/A5 single-pill combination provided improved BP reduction after 8 weeks' treatment compared with A5 monotherapy. Both treatments were well tolerated.
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Affiliation(s)
- Dingliang Zhu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Central hemodynamic modifications in diabetes mellitus. Atherosclerosis 2013; 230:315-21. [PMID: 24075763 DOI: 10.1016/j.atherosclerosis.2013.07.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/02/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
Arterial stiffness in hypertension is markedly influenced by age, mean arterial pressure (MAP) and heart rate, whereas factors influencing this parameter in diabetes mellitus are not yet fully understood. The aim of our study was to compare central hemodynamics in diabetics (n = 126) versus non-diabetic controls (n = 203), most of whom were hypertensive, and with similar MAP. Anthropometric, laboratory and clinical measurements were collected. Hemodynamic parameters (central blood pressure, aortic pulse wave velocity [PWV], augmentation index [AIx] and pulse pressure amplification [PPA]) were measured using applanation tonometry. PWV and AIx were significantly higher in diabetics, after adjustment for age, gender, MAP, and heart rate. After further adjustment for metabolic syndrome, only the difference in PWV persisted (P < 0.0001). PPA was marginally altered though not significantly. In diabetics, PWV did not correlate with MAP, suggesting that other structural alterations, resulting from insulin resistance, may account for diabetic arterial stiffening to a greater extent than, and independently of, blood pressure. Chronic treatment with insulin was associated with increased PWV, independently of blood pressure, diabetes control and duration, or other common confounding variables. In conclusion, hypertensive diabetics had greater arterial stiffness than hypertensive controls. In diabetes, multiple factors affect arterial stiffening independently of hemodynamic status. Notably, insulin therapy (IT) is associated with more severe arterial stiffness, suggesting a consistent relationship between these parameters. It remains to be determined whether IT should be considered as a marker of diabetes severity that leads to increased arterial stiffness, or whether it has a direct/indirect effect on arterial wall modifications.
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Echouffo-Tcheugui JB, Kengne AP. On the importance of global cardiovascular risk assessment in people with type 2 diabetes. Prim Care Diabetes 2013; 7:95-102. [PMID: 23623209 DOI: 10.1016/j.pcd.2013.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/20/2013] [Accepted: 03/24/2013] [Indexed: 12/17/2022]
Abstract
This narrative review examines the concept of diabetes as a cardiovascular disease (CVD) risk equivalent, the rationale and approaches to absolute CVD risk estimation in type 2 diabetes. In people with diabetes, CVD risk follows a gradient. Reliably capturing this gradient depends on the combination of several risk factors. Existing CVD risk tools applicable to people with diabetes have shown a modest-to-acceptable performance. Future improvements may include updating existing models or constructing new ones with improved predictive accuracy. Ultimately, developed models should be tested in independent populations, and the impact of their uptake on clinical decision making and the outcome of care assessed.
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Pires PW, Dams Ramos CM, Matin N, Dorrance AM. The effects of hypertension on the cerebral circulation. Am J Physiol Heart Circ Physiol 2013; 304:H1598-614. [PMID: 23585139 DOI: 10.1152/ajpheart.00490.2012] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Maintenance of brain function depends on a constant blood supply. Deficits in cerebral blood flow are linked to cognitive decline, and they have detrimental effects on the outcome of ischemia. Hypertension causes alterations in cerebral artery structure and function that can impair blood flow, particularly during an ischemic insult or during periods of low arterial pressure. This review will focus on the historical discoveries, novel developments, and knowledge gaps in 1) hypertensive cerebral artery remodeling, 2) vascular function with emphasis on myogenic reactivity and endothelium-dependent dilation, and 3) blood-brain barrier function. Hypertensive artery remodeling results in reduction in the lumen diameter and an increase in the wall-to-lumen ratio in most cerebral arteries; this is linked to reduced blood flow postischemia and increased ischemic damage. Many factors that are increased in hypertension stimulate remodeling; these include the renin-angiotensin-aldosterone system and reactive oxygen species levels. Endothelial function, vital for endothelium-mediated dilation and regulation of myogenic reactivity, is impaired in hypertension. This is a consequence of alterations in vasodilator mechanisms involving nitric oxide, epoxyeicosatrienoic acids, and ion channels, including calcium-activated potassium channels and transient receptor potential vanilloid channel 4. Hypertension causes blood-brain barrier breakdown by mechanisms involving inflammation, oxidative stress, and vasoactive circulating molecules. This exposes neurons to cytotoxic molecules, leading to neuronal loss, cognitive decline, and impaired recovery from ischemia. As the population ages and the incidence of hypertension, stroke, and dementia increases, it is imperative that we gain a better understanding of the control of cerebral artery function in health and disease.
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Affiliation(s)
- Paulo W Pires
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48824, USA
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Type 2 diabetes in older people; the importance of blood pressure control. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:233-237. [PMID: 23667714 DOI: 10.1007/s12170-013-0301-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Diabetes and hypertension often coexist and their coexistence substantially promote cardiovascular disease (CVD) and chronic kidney disease. Control of blood pressure to a level of 140/90 mm Hg in people with diabetes can prevent or at least delay CVD and chronic kidney disease.. In the past many society treatment guidelines have stressed tight blood pressure control (=< 130/80) for people with diabetes. But recommendations for such tight blood pressure control have not been supported by recent large randomized control trials, especially in in elderly. Here we review the recent literature regarding the benefits of blood pressure control in elderly patients with diabetics. We further focus on evidence for specific levels of blood pressure treatment goals, in this population subset..
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Ushigome E, Fukui M, Hamaguchi M, Tanaka T, Atsuta H, Ohnishi M, Oda Y, Yamazaki M, Hasegawa G, Nakamura N. Beneficial effect of calcium channel blockers on home blood pressure variability in the morning in patients with type 2 diabetes. J Diabetes Investig 2013; 4:399-404. [PMID: 24843686 PMCID: PMC4020236 DOI: 10.1111/jdi.12052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/10/2012] [Accepted: 12/21/2012] [Indexed: 01/14/2023] Open
Abstract
Aims/Introduction Recent studies have shown the association between blood pressure variability and cardiovascular events. The present study was designed to investigate the relationship between antihypertensive drug class and home blood pressure variability in patients with type 2 diabetes. Materials and Methods We compared home blood pressure variability among patients treated with calcium channel blockers (n = 44), with angiotensin II receptor blockers and/or angiotensin‐converting enzyme inhibitors (n = 159), and with calcium channel blockers combined with angiotensin II receptor blockers and/or angiotensin‐converting enzyme inhibitors (n = 183). Next, we analyzed the effect of calcium channel blockers on morning blood pressure variability using multiple linear regression analysis. Results Coefficient variation of morning systolic blood pressure in patients treated with calcium channel blockers was significantly lower than that in patients treated with angiotensin II receptor blockers and/or angiotensin‐converting enzyme inhibitors (P = 0.036). Multivariate linear regression analyses showed that treatment with calcium channel blockers was significantly correlated with coefficient variation of morning systolic blood pressure (β = −0.264, P = 0.001). Conclusions The present study implies a possibility for validity on selecting calcium channel blockers in hypertensive patients with type 2 diabetes to reduce home blood pressure variability.
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Affiliation(s)
- Emi Ushigome
- Department of Endocrinology and Metabolism Kyoto Prefectural University of Medicine Graduate School of Medical Science Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism Kyoto Prefectural University of Medicine Graduate School of Medical Science Japan
| | | | | | | | | | - Yohei Oda
- Social Insurance Kyoto Hospital Kyoto
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism Kyoto Prefectural University of Medicine Graduate School of Medical Science Japan
| | - Goji Hasegawa
- Department of Endocrinology and Metabolism Kyoto Prefectural University of Medicine Graduate School of Medical Science Japan
| | - Naoto Nakamura
- Department of Endocrinology and Metabolism Kyoto Prefectural University of Medicine Graduate School of Medical Science Japan
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Woodward M, Huxley R, Ueshima H, Fang X, Kim HC, Lam TH. The Asia pacific cohort studies collaboration: a decade of achievements. Glob Heart 2012; 7:343-51. [PMID: 25689943 DOI: 10.1016/j.gheart.2012.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022] Open
Abstract
The Asia Pacific Cohort Studies Collaboration (APCSC) was established in the late 1990s when there was a distinct shortfall in evidence of the importance of risk factors for cardiovascular disease in Asia. With few exceptions, most notably from Japan, most of the published reports on cardiovascular disease in the last century were from Western countries, and there was uncertainty how far etiological associations found in the West could be assumed to prevail in the East. Against this background, APCSC was set up as a pooling project, combining individual participant data (about 600,000 subjects) from all available leading cohort studies (36 from Asia and 8 from Australasia) in the region, to fill the knowledge gaps. In the past 10 years, APCSC has published 50 peer-reviewed publications of original epidemiological research, primarily concerned with coronary heart disease, stroke, and cancer. This work has established that Western risk factors generally act similarly in Asia and in Australasia, just as they do in other parts of the world. Consequently, strategies to reduce the prevalence of elevated blood pressure, obesity, and smoking are at least as important in Asia as elsewhere- and possibly more important when the vast size of Asia is considered. This article reviews the achievements of APCSC in the past decade, with an emphasis on coronary heart disease.
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Affiliation(s)
- Mark Woodward
- George Institute, University of Sydney, Sydney, Australia.
| | - Rachel Huxley
- Division of Epidemiology and Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hirotsugu Ueshima
- Department of Health Science, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Xianghua Fang
- Department of Epidemiology and Social Medicine, Capital Medical University, Beijing, China
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Dzudie A, Choukem SP, Dehayem MY, Kengne AP. Blood pressure variables and prevalent electrocardiographic left ventricular hypertrophy in sub-Saharan African individuals with type 2 diabetes. J Diabetes 2012; 4:424-31. [PMID: 22642785 DOI: 10.1111/j.1753-0407.2012.00209.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate whether brachial blood pressure (BP) variables (systolic BP [SBP], diastolic BP [DBP], pulse [PP] and mean arterial pressure [MAP]) are similar determinants of prevalent electrocardiographic left ventricular hypertrophy (LVH) in sub-Saharan Africans with type 2 diabetes (T2D). METHODS The study included 420 individuals (49% men) with T2D who were receiving chronic care in two main referral centers in the two major cities (Douala and Yaounde) of Cameroon. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (20) with the risk of LVH. Discrimination was assessed and compared with c-statistics and relative integrated discrimination improvement (RIDI; %). RESULTS The multivariable adjusted OR (95% CI) for prevalent LVH with each SD higher pressure variable was 1.61 (1.22-2.11) for SBP, 1.27 (0.99-1.63) for DBP, 1.62 (1.23-2.15) for PP and 1.44 (1.11-1.87) for MAP. Comparison of c-statistics revealed no difference in the discrimination power of models with each of the BP variables (P > 0.09). However, RIDI showed enhanced discrimination in the models when other BP variables were replaced with PP. However, this enhancement was marginal for SBP. Using BP combinations modestly improved discrimination. CONCLUSIONS The best predictors of prevalent LVH in the present study population were PP and SBP, whereas DBP was the least effective predictor. These findings have implications for cardiovascular risk stratification and monitoring of risk-reducing therapies.
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Affiliation(s)
- Anastase Dzudie
- Department of Medicine, Douala General Hospital and Buea University, Douala, South Africa
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Ke YN, Dong YG, Ma SP, Yuan H, Ihm SH, Baek SH. Improved Blood Pressure Control with Nifedipine GITS/Valsartan Combination Versus High-Dose Valsartan Monotherapy in Mild-to-Moderate Hypertensive Patients from Asia: Results from the ADVISE Study, a Randomized Trial. Cardiovasc Ther 2012; 30:326-32. [PMID: 23134522 DOI: 10.1111/1755-5922.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yuan-Nan Ke
- Cardiovascular Department; China-Japan Friendship Hospital; Beijing; China
| | - Yu-Gang Dong
- Cardiovascular Department; The First Affiliated Hospital of Zhongshan University; Guangzhou; China
| | - Shu-Ping Ma
- Cardiovascular Department II; Hebei Provincial Hospital; Shijiazhuang; China
| | - Hong Yuan
- Cardiology Department; The Third Xiangya Hospital of Central South University; Changsha; China
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine; Bucheon St. Mary's Hospital; The Catholic University of Korea; Bucheon; Korea
| | - Sang Hong Baek
- Cardiovascular Division; The Catholic University of Korea, School of Medicine, Seoul St Mary's Hospital; Seoul; Korea
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46
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Kengne AP, Czernichow S, Stamatakis E, Hamer M, Batty GD. Gamma-glutamyltransferase and risk of cardiovascular disease mortality in people with and without diabetes: pooling of three British Health Surveys. J Hepatol 2012; 57:1083-9. [PMID: 22796154 DOI: 10.1016/j.jhep.2012.06.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 06/24/2012] [Accepted: 06/27/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS The relation between gamma-glutamyltransferase (GGT) and mortality risk has been little explored in people with diabetes. We examined (a) the association of GGT with cardiovascular disease (CVD) and all-cause mortality in people with and without diabetes; and (b) the predictive validity observed when adding GGT to a CVD risk algorithm. METHODS Participants were 17,852 adults from three British cohorts representative of the general population in England (N=1) and Scotland (N=2). Follow-up was to December 2009 (Scottish cohorts) and February 2008 (English cohort). Cox models were used to compute the hazard ratio (HR) and 95% confidence interval (95% CI) for a standard deviation (SD) increase log(e)(GGT) in relation to mortality according to diabetes status. The value of adding GGT to a CVD risk engine was assessed through c-statistic and relative integrated discrimination improvement. RESULTS In an analytical sample of 17,852 participants, 583 (3.3%) had baseline diabetes. During 10.1 years of follow-up, there were 235 deaths from all causes (77 from CVD) in diabetics. Corresponding results for non-diabetics were 2859 and 719. The age- and sex-adjusted HR (95%CI) for a one SD increase in log(e)(GGT) in relation to CVD mortality risk in participants with diabetes was 1.43 (1.13-1.81) and in those without diabetes was 1.27 (1.18-1.37). Corresponding results for total mortality were 1.24 (1.08-1.44) and 1.30 (1.25-1.34). Thus, there was no evidence that diabetes status modified the strength of the GGT-mortality relationship (p value for interaction ≥0.16). Adding GGT to model with classical predictors only marginally enhanced the prediction of CVD in both people with and without diabetes. CONCLUSIONS Higher GGT levels are a risk factor for all-cause and cardiovascular disease death in people with and without diabetes. However, knowledge of GGT does not improve cardiovascular predictions beyond traditional risk factors.
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Affiliation(s)
- Andre Pascal Kengne
- South African Medical Research Council and University of Cape Town, South Africa.
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Papp R, Csaszar A, Paulik E, Balogh S. Correlations between prescription of anti-hypertensive medication and mortality due to stroke. BMC Cardiovasc Disord 2012; 12:15. [PMID: 22409659 PMCID: PMC3323458 DOI: 10.1186/1471-2261-12-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 03/12/2012] [Indexed: 12/29/2022] Open
Abstract
Background One of the most important risk factors for stroke is hypertension. A number of studies have attempted to identify the most effective anti-hypertensive therapeutic group for stroke prevention. Using an epidemiologic approach we aimed to find correlations based on Hungarian data on stroke-mortality and on prescription routine of anti-hypertensive therapeutics in three different counties, showing significant difference in stroke mortality. Methods We have used the official yearly reports on stroke-mortality for the period 2003-2008. Based on the significant differences in the change in mortality due to stroke three counties were selected: Baranya, Bekes and Hajdu-Bihar. The usage of antihypertensive therapeutic groups was analyzed. The correlation of stroke mortality difference and different antihypertensive treatment habits was analyzed by using normality test, time series analyses, correlation coefficient, paired samples test, one sample test and chi-square test. Results For the year 2003 stroke-mortality standardized with the county population number was highest in county Bekes, followed by county Baranya and county Hajdu-Bihar. For each year stroke mortality has shown significant (p < 0.0001) difference between the three counties and the ranking/order of the counties has been preserved over time. During the period of our study, an increase in the number of days of treatment was observed for most of the anti-hypertensive drugs listed. We have observed that the increased use of high-ceiling diuretics resulted in a mortality advantage, and the reduction in use of calcium channel blockers with direct cardiac effect had negative consequences. Conclusions The authors acknowledge that by limiting the study to three counties the findings cannot be generalized to the whole Hungarian population. Two trends can still be identified: i) increased number of days of treatment (and therefore the probable use) of high-ceiling diuretics is associated with reduction in mortality due to stroke and its immediate complications; ii) reduction in the use of non-dihidropiridin CCBs does not seem justified, as their use appears to be advantageous in stroke prevention. Authors put emphasis on the importance of the adherence of the patients to the preventive therapies. Health care professionals could provide an important added value to the life long preventive therapies by improving the compliance of their patients, giving personalized care and advice.
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Affiliation(s)
- Renata Papp
- National Institute of Primary Health Care, (84-88 Jasz Str.), Budapest 1135, Hungary
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Kengne AP, Batty GD, Hamer M, Stamatakis E, Czernichow S. Association of C-reactive protein with cardiovascular disease mortality according to diabetes status: pooled analyses of 25,979 participants from four U.K. prospective cohort studies. Diabetes Care 2012; 35:396-403. [PMID: 22210562 PMCID: PMC3263864 DOI: 10.2337/dc11-1588] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE C-reactive protein (CRP) is associated with the risk of cardiovascular disease (CVD); whether the effects are modified by diabetes status still is unclear. This study investigated these issues and assessed the added value of CRP to predictions. RESEARCH DESIGN AND METHODS Participants were drawn from representative samples of adults living in England and Scotland. Cox proportional hazards regression models were used to relate baseline plasma CRP with all-cause and CVD mortality during follow-up in men and women with and without diabetes. The added value of CRP to the predictions was assessed through c-statistic comparison and relative integrated discrimination improvement. RESULTS A total of 25,979 participants (4.9% with diabetes) were followed for a median of 93 months, during which period there were 2,767 deaths (957 from CVD). CRP (per SD log(e)) was associated with a 53% (95% CI 43-64) and 43% (38-49) higher risk of cardiovascular and all-cause mortality, respectively. These associations were log linear and did not differ according to diabetes status (both P ≥ 0.08 for interaction), sex, and other risk factors. Adding CRP to conventional risk factors improved predictions overall and separately by diabetes status but not for CVD mortality, although such improvements only were marginal based on several discrimination statistics. CONCLUSIONS The association between CRP and CVD was similar across diabetes status, and the effects are broadly similar across levels of other conventional risk factors.
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Affiliation(s)
- Andre Pascal Kengne
- NCRP for Cardiovascular and Metabolic Diseases, South African Medical Research Council and University of Cape Town, Cape Town, South Africa.
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Ishikawa T, Shimizu M, Kohara S, Takizawa S, Kitagawa Y, Takagi S. Appearance of WBC-Platelet Complex in Acute Ischemic Stroke, Predominantly in Atherothrombotic Infarction. J Atheroscler Thromb 2012; 19:494-501. [DOI: 10.5551/jat.10637] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Echouffo-Tcheugui JB, Ogunniyi MO, Kengne AP. Estimation of absolute cardiovascular risk in individuals with diabetes mellitus: rationale and approaches. ISRN CARDIOLOGY 2011; 2011:242656. [PMID: 22347635 PMCID: PMC3262525 DOI: 10.5402/2011/242656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 10/13/2011] [Indexed: 12/27/2022]
Abstract
Purpose. To examine the usefulness of cardiovascular risk estimation models in people with diabetes. Methods. Review of published studies that compare the discriminative power of major cardiovascular risk factors single or in combination in individuals with and without diabetes, for major cardiovascular outcomes. Results. In individuals with and without diabetes, major risk factors affect cardiovascular risk similarly, with no evidence of any significant interaction. Accounting for diabetes-specific parameters, cardiopreventative therapies can significantly improve risk estimation in diabetes. General and diabetes-specific cardiovascular risk models have a useful discriminative power, but tend to overestimate risk in individuals with diabetes. Their impact on care delivery, adherence to therapies, and patients' outcome remain poorly understood. Conclusions. The high-risk status conferred by diabetes does not preclude the estimation of absolute cardiovascular risk estimation using global risk tools in individuals with diabetes, as this is useful for the initiation and intensification of preventive measures.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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