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Izadpanah P, Dehghanzadeh T, Attar A, Hosseinpour A, Rahimikashkooli N. Hemoglobin A 1c levels and 1-year mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Future Cardiol 2024; 20:117-122. [PMID: 38602426 PMCID: PMC11216615 DOI: 10.2217/fca-2023-0121] [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: 10/04/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background: In this study, we investigated whether different levels of hemoglobin A1c (HbA1c) are associated with different short-term and 1-year mortality rates among diabetic patients undergoing percutaneous coronary intervention. Patients & methods: Clinical events including in-hospital, 1-month and 1-year mortality were compared between three groups based on HbA1c levels of patients (I: ≤5.6%, II: 5.7-6.4%, III: ≥6.5%). Results: Among 165 diabetic individuals, patients with abnormal HbA1c levels (≥6.5%) experienced significantly higher hospitalization days (7.65 ± 1.64 days) compared with those with normal HbA1c (4.94 ± 0.97 days) (p < 0.0001). In-hospital mortality was significantly higher in group III (14.5%) and II (5.5%) compared with group I (0%) (p = 0.008). Conclusion: HbA1c levels may be a reliable predictor of short-term clinical events in diabetic patients.
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Affiliation(s)
- Peyman Izadpanah
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7164954937, Iran
| | - Tara Dehghanzadeh
- School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran
| | - Armin Attar
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7164954937, Iran
| | - Alireza Hosseinpour
- School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran
| | - Nima Rahimikashkooli
- Internal Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7193613311, Iran
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Skovgaard D, Siersma VD, Klausen SB, Visnes H, Haukenes I, Bang CW, Bager P, Grävare Silbernagel K, Gaida J, Magnusson SP, Kjaer M, Couppé C. Chronic hyperglycemia, hypercholesterolemia, and metabolic syndrome are associated with risk of tendon injury. Scand J Med Sci Sports 2021; 31:1822-1831. [PMID: 33963621 DOI: 10.1111/sms.13984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022]
Abstract
Tendon injury is a considerable problem affecting both physically active and sedentary people. The aim of this study was to examine the relationship between markers for metabolic disorders (hyperglycemia, hypercholesterolemia, and metabolic syndrome) and the risk of developing tendon injuries requiring referral to a hospital. The Copenhagen City Heart Study is a prospective study of diabetic and non-diabetic individuals from the Danish general population with different physical activity levels. The cohort was followed for 3 years via national registers with respect to tendon injuries. Data from 5856 individuals (median age 62 years) were included. The overall incidence of tendon injury in both upper and lower extremities that required an out-patient or in-house visit to a hospital was ~5.7/1000 person years. Individuals with elevated HbA1c (glycated hemoglobin) even in the prediabetic range (HbA1c>5.7%) had a ~3 times higher risk of tendon injury in the lower extremities only, as compared to individuals with normal HbA1C levels. Hypercholesterolemia (total cholesterol>5 mmol/L) increased risk of tendon injury in the upper extremities by ~1.5 times, and individuals with metabolic syndrome had ~2.5 times higher risk of tendon injury in both upper and lower extremities. In conclusion, these data demonstrate for the first time in a large cohort with different physical activity levels that the indicators for metabolic syndrome are a powerful systemic determinant of tendon injury, and two of its components, hyperglycemia and hypercholesterolemia, each independently make tendons susceptible for damage and injury.
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Affiliation(s)
- Dorthe Skovgaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Volkert D Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Soren Bering Klausen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Håvard Visnes
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Orthopedics, Sorlandet Hospital Kristiansand, Oslo, Norway.,Oslo Sports trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Inger Haukenes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christine W Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bager
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | | | - Jamie Gaida
- Institute for Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, ACT, Australia
| | - Stig Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Viktorinova A, Fabryova L, Malickova D, Choudhury S, Krizko M. Clinical Utility of the Logarithmically Transformed Ratio of Triglycerides-to- High-Density Lipoprotein Cholesterol and Its Relationship with Other Atherosclerosis-Related Lipid Factors in Type 2 Diabetes. Metab Syndr Relat Disord 2020; 19:205-212. [PMID: 33373539 DOI: 10.1089/met.2020.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Elevated triglyceride (TG) levels and reduced high-density lipoprotein-cholesterol (HDL-c) levels indicate lipid abnormalities, but their levels alone do not reflect the actual status of plasma atherogenicity and cardiovascular disease risk (CVD). TG and HDL-c levels directly affect the balance between plasma atherogenic and antiatherogenic factors, as well as values of the atherogenic index of plasma [AIP (logarithmically transformed ratio of TG-to-HDL-c)]. The aim of this study was to evaluate the AIP risk categories (an indicator of plasma atherogenicity) and the relationships of AIP with other atherosclerosis-related lipid parameters in patients with type 2 diabetes mellitus (T2DM) and their potential clinical utility. Methods: Standard lipid profile, AIP, and lipid hydroperoxides (LOOH) were investigated in 124 T2DM outpatients (mean age 52.7 ± 5.9 years) and 61 healthy subjects (mean age 50.9 ± 6.8 years). T2DM patients were subclassified according to the AIP risk category and glycemic control. Results: Higher levels of AIP, LOOH, and TG and lower HDL-c (all P < 0.0001) were observed in T2DM patients than in the control group. AIP positively correlated with LOOH, non-HDL-c, and the non-HDL/HDL ratio (all P < 0.0001). The TG level was strongly correlated with the LOOH level among T2DM patients (P < 0.0001). Conclusions: The close association of AIP with other atherosclerosis-related lipid factors reveals an increased plasma atherogenicity. AIP risk categories indicate the actual status of plasma atherogenicity and identify subjects who are at an increased atherogenic risk and the development of CVD. In this respect, AIP has a promising future in routine clinical practice.
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Affiliation(s)
- Alena Viktorinova
- Faculty of Medicine, Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Comenius University, Bratislava, Slovakia
| | - Lubomira Fabryova
- Department of Diabetology and Metabolic Diseases, Metabol Klinik, Lipid Clinic, MED PED Centre, Bratislava, Slovakia
| | - Danica Malickova
- University Hospital-St. Michael's Hospital, Bratislava, Slovakia
| | - Sawkat Choudhury
- National Blood Transfusion Service of Slovak Republic, Bratislava, Slovakia
| | - Marian Krizko
- University Hospital-St. Michael's Hospital, Bratislava, Slovakia
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Shang Y, Marseglia A, Fratiglioni L, Welmer A, Wang R, Wang H, Xu W. Natural history of prediabetes in older adults from a population-based longitudinal study. J Intern Med 2019; 286:326-340. [PMID: 31165572 PMCID: PMC6851857 DOI: 10.1111/joim.12920] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The natural history of prediabetes in older adults remains unknown. OBJECTIVES To assess the rate at which prediabetes progresses to diabetes, leads to death or reverts to normoglycaemia in older adults and to identify prognostic factors related to different outcomes of prediabetes. METHODS In the Swedish National Study on Aging and Care-Kungsholmen, 2575 diabetes-free participants aged ≥60 years were examined at baseline and followed for up to 12 years. At each wave, diabetes was diagnosed via medical examination, antidiabetic drug use, medical records or glycated haemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7% and normoglycaemia as HbA1c <5.7% in diabetes-free participants. Data were analysed with multinomial logistic regression. RESULTS At baseline, 918 (36%) individuals had prediabetes. Of them, 204 (22%) reverted to normoglycaemia (3.4/100 person-years, 95% CI 5.6-12.3), 119 (13%) developed diabetes (2.0/100 person-years, 95% CI 1.7-2.4) and 215 (23%) died (13.0/100 person-years, 95% CI 11.4-14.9) during the 12-year follow-up. The rates of reversion, progression and mortality were higher in the first 6-year than in the second 6-year follow-up, albeit not statistically significant. Lower systolic blood pressure (SBP), absence of heart diseases and weight loss promoted the reversion from prediabetes to normoglycaemia, whilst obesity accelerated its progression to diabetes. CONCLUSIONS During a 12-year follow-up, most of older adults with prediabetes remained stable or reverted to normoglycaemia, whereas only one-third developed diabetes or died. Lower SBP, no heart diseases and weight management may promote reversion to normoglycaemia, suggesting possible strategies for achieving normoglycaemia in older adults with prediabetes.
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Affiliation(s)
- Y. Shang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - A. Marseglia
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - L. Fratiglioni
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - A.‐K. Welmer
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Functional Area Occupational Therapy & PhysiotherapyKarolinska University HospitalStockholmSweden
| | - R. Wang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - H.‐X. Wang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Stress Research InstituteStockholm UniversityStockholmSweden
| | - W. Xu
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
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Richter B, Hemmingsen B, Metzendorf M, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018; 10:CD012661. [PMID: 30371961 PMCID: PMC6516891 DOI: 10.1002/14651858.cd012661.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts. OBJECTIVES To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia. SEARCH METHODS We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining. SELECTION CRITERIA We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only. DATA COLLECTION AND ANALYSIS One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018. AUTHORS' CONCLUSIONS Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.
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Affiliation(s)
- Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Hernández M, López C, Real J, Valls J, Ortega-Martinez de Victoria E, Vázquez F, Rubinat E, Granado-Casas M, Alonso N, Molí T, Betriu A, Lecube A, Fernández E, Leslie RD, Mauricio D. Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes. Cardiovasc Diabetol 2017; 16:94. [PMID: 28750634 PMCID: PMC5532780 DOI: 10.1186/s12933-017-0576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND LADA is probably the most prevalent form of autoimmune diabetes. Nevertheless, there are few data about cardiovascular disease in this group of patients. The aim of this study was to investigate the frequency of carotid atherosclerotic plaques in patients with LADA as compared with patients with classic type 1 diabetes and type 2 diabetes. METHODS Patients with LADA were matched for age and gender in different proportions to patients with type 2 diabetes, and classic type 1 diabetes. None of the patients had clinical cardiovascular disease. All subjects underwent B-mode carotid ultrasound to detect atheroma plaques. Demographics were obtained from all subjects. RESULTS We included 71 patients with LADA, 191 patients with type 2 diabetes and 116 patients with type 1 diabetes. Carotid atherosclerosis was more frequent in patients with LADA compared with type 2 diabetes (73.2% vs. 56.9%, P = 0.0018) and classic type 1 diabetes (57.1%, P = 0.026); these changes occurred despite healthier macrovascular risk profiles in the former. Age (P < 0.001), smoking (P = 0.003) and hypertension (P = 0.019) were independently associated with carotid atherosclerosis. Multiple plaques were also more frequent in patients with LADA as compared with classic type 1 diabetes and type 2 diabetes (45.1% and 33.6% vs. 27.2%, respectively, P = 0.022). The frequency of carotid plaques increased with increasing diabetes duration in LADA patients compared with type 2 diabetes (85.7% vs. 58.8%, inverse OR 5.72 [1.5-21.8]; P = 0.009). CONCLUSIONS LADA patients do not present with less carotid atherosclerosis than patients with type 1 and type 2 diabetes. Their macrovascular risk occurs despite a healthier macrovascular risk profile than those patients with type 2 diabetes.
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Affiliation(s)
- Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Carolina López
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Joan Valls
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | - Emilio Ortega-Martinez de Victoria
- Department of Endocrinology and Nutrition, CIBEROBN-Spanish Biomedical Research Centre in Physiopathology of Obesity, Hospital Clínic, Barcelona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | | | - Minerva Granado-Casas
- Nursing School, Universitat de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Teresa Molí
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Elvira Fernández
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Richard David Leslie
- The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Dídac Mauricio
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
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Two-year prognosis of admission hemoglobin A1c following a primary percutaneous coronary intervention. Coron Artery Dis 2016; 27:673-681. [PMID: 27433996 DOI: 10.1097/mca.0000000000000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We sought to assess the effect of hemoglobin A1c (HbA1c) on the outcomes of a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND Many studies have shown the diagnostic and predictive value of HbA1c levels in patients with acute myocardial infarction. We assessed the prognostic role of HbA1c in short-term and long-term mortality in 796 consecutive patients with STEMI. METHODS AND RESULTS A total of 796 patients with STEMI undergoing primary PCI were prospectively enrolled between December 2013 and June 2015. The patients were divided into three groups on the basis of admission HbA1c levels: group I (HbA1c≤5.6%), group II (HbA1c 5.7-6.4%), and group III (HbA1c≥6.5%). The in-hospital and 2-year cardiovascular (CV) mortality and morbidity of all three patient groups were followed up. A significant association was found between HbA1c level and 2-year primary clinical outcomes, including CV mortality, heart failure/shock, and major adverse cardiovascular event (P<0.001). CONCLUSION HbA1c is an independent predictor of the in-hospital and long-term mortality, nonfatal reinfarction, and target vessel revascularization in STEMI patients treated with primary PCI.
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Ojo O. The Use of Exenatide in Managing Markers of Cardiovascular Risk in Patients with Type 2 Diabetes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100941. [PMID: 27669277 PMCID: PMC5086680 DOI: 10.3390/ijerph13100941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/03/2016] [Accepted: 09/20/2016] [Indexed: 01/22/2023]
Abstract
Objective: This review examines the use of exenatide twice daily in managing changes in markers of cardiovascular risk in patients with type 2 diabetes. Background: Type 2 diabetes is a progressive metabolic disorder, which results from defects in insulin secretion and/or insulin action leading to chronic hyperglycaemia and associated cardiovascular complications. Despite the use of diet, exercise, oral antihyperglycaemic agents and insulin, the progressive nature of the condition means that the levels of the preventive and treatment measures would have to be increased and/or new therapies have to be developed in order to address the long term impact of type 2 diabetes. The advent of exenatide, a glucagon-like peptide-1 receptor agonist provides a useful basis for managing type 2 diabetes and related cardiovascular complications without the side effects of regular diabetes therapies. However, exenatide twice daily is often used in combination with other therapies, although the mechanism of exenatide in managing diabetes and and associated cardiovascular risks and complications remain complex and still evolving. Method: A range of databases including EBSCOhost online research database were used to access articles based on PICO (Population, Interventions, Comparative Interventions, Outcomes) framework and Boolean operators. Results: Eleven randomised controlled studies which met the inclusion criteria were selected for this review. Nine of the eleven studies showed significant decrease in body weight among participants in the exenatide group compared with placebo or control group while the other two studies did not report statistically significant differences in body weight. In adition, all the studies showed statistically significant decrease in glycated haemoglobin (HbA1c) in the exenatide group compared to controls except in one study. In the present review, the seven studies, which looked at the effect of exenatide twice daily on lipid profile, did not find any significant difference between the exenatide group and the control group except for High density lipoprotein-cholesterol in two of the studies. However, statistically significant decrease was observed between exenatide group and controls with respect to blood pressure (systolic and/or diastolic) in these studies. Discussion: It would appear that exenatide is more effective in reducing body weight in patients with type 2 diabetes when used in combination with metformin than when used alone or in combination with thiazolidinedione. The findings of this review would suggest that exenatide twice daily may be useful in managing cardiovascular risks and complications by reducing body weight, HbA1c and blood pressure.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London SE9 2UG, UK.
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9
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Buffarini R, Restrepo-Méndez MC, Silveira VM, Miranda JJ, Gonçalves HD, Oliveira IO, Horta BL, Gigante DP, Menezes AM, Assunção MCF. Distribution of Glycated Haemoglobin According to Early-Life and Contemporary Characteristics in Adolescents and Adults without Diabetes: The 1982 and 1993 Pelotas Birth Cohorts. PLoS One 2016; 11:e0162614. [PMID: 27626274 PMCID: PMC5023185 DOI: 10.1371/journal.pone.0162614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
Aim Glycated haemoglobin (HbA1c), a marker of glucose control in individuals with diabetes mellitus, is also related with the incidence of cardiometabolic risk in populations free of disease. The aim of this study was to describe the distribution of HbA1c levels according to early-life and contemporary factors in adolescents and adults without diabetes mellitus. Methods HbA1c was measured in adults aged 30 years and adolescents aged 18 years who are participants in the 1982 and 1993 Pelotas Birth Cohorts, respectively. Bivariate and multivariate analyses were performed to describe the HbA1c mean values according to early-life and contemporary characteristics collected prospectively since birth. Results The distribution of the HbA1c was approximately normal in both cohorts, with a mean (SD) 5.10% (0.43) in the 1982 cohort, and 4.89% (0.50) in the 1993 cohort. HbA1c mean levels were significantly higher in individuals self-reported as black/brown skin color compared to those self-reported as white in both cohorts. Parental history of diabetes was associated with higher HbA1c mean in adults, while stunting at one year old presented an inverse relation with the outcome in adolescents. No other early and contemporary factors were associated with HbA1c levels in adults or adolescents. Conclusions We found a consistent relationship between HbA1c and skin color in both cohorts. Further research is needed to understand the role of genomic ancestry on levels of HbA1c concentrations which may inform policies and preventive actions for diabetes mellitus and cardiometabolic risk.
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Affiliation(s)
- Romina Buffarini
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
- * E-mail:
| | - María Clara Restrepo-Méndez
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3rd floor, 96020–220, Pelotas, Brazil
| | - Vera M. Silveira
- Clinical Medical Department, Faculty of Medicine, Federal University of Pelotas, Rua Félix da Cunha 614, Centro, 96010–000, Pelotas, Brazil
| | - Jaime J. Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Department of Medicine, School of Medicine, Lima, Peru
| | - Helen D. Gonçalves
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Isabel O. Oliveira
- Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário s/n, Capão do Leão, 96010–900, Pelotas, Brazil
| | - Bernardo L. Horta
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Denise P. Gigante
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Ana Maria Menezes
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Maria Cecília F. Assunção
- Department of Nutrition, School of Nutrition, Federal University of Pelotas, Campus Anglo, Gomes Carneiro 1, 96010–900, Pelotas, Brazil
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Jarczok MN, Koenig J, Li J, Mauss D, Hoffmann K, Schmidt B, Fischer JE, Thayer JF. The Association of Work Stress and Glycemic Status Is Partially Mediated by Autonomic Nervous System Function: Cross-Sectional Results from the Mannheim Industrial Cohort Study (MICS). PLoS One 2016; 11:e0160743. [PMID: 27532642 PMCID: PMC4988666 DOI: 10.1371/journal.pone.0160743] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/25/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Work stress is associated with an increased risk of pre-diabetes, Type 2 diabetes, and inflammation, as well as decreased autonomic nervous system function as measured, for example, via heart rate variability. We investigated the extent to which the association between work stress and glycemic status is mediated by vagally-mediated heart rate variability (vmHRV) and/or inflammation. METHODS Cross-sectional data from the Mannheim Industrial Cohort Study (MICS) with 9,937 participants were analyzed. The root mean squared successive differences (RMSSD) from long-term heart rate monitoring during work and night time periods was used to index vmHRV. Fasting plasma glucose and glycosylated hemoglobin were assessed to determine glycemic status. High sensitive C-reactive protein levels were observed as a measure of systemic inflammation and the Effort-Reward-Imbalance scale was used to evaluate work stress. Mediation models were adjusted for age, sex, and occupational status, and estimations were bootstrapped (5,000 replications). RESULTS Effort-Reward-Imbalance was significantly negatively associated with RMSSD and both glycosylated hemoglobin and fasting plasma glucose during both work and night time periods. Effort-Reward-Imbalance was observed to have a significant direct effect on glycosylated hemoglobin and significant indirect effects, through RMSSD, on both glycemic measures during both time periods. Introducing C-reactive protein as a further mediator to the model did not alter the indirect effects observed. C-reactive protein, as an exclusive mediator, was observed to have smaller direct and indirect effects on the glycemic measures as compared to when Effort-Reward-Imbalance was included in the model. CONCLUSIONS Our results suggest that the association between work stress and glycemic status is partially mediated through vmHRV independent of systemic inflammation as measured by C-reactive protein. We conclude that work stress may be an additional factor that promotes development of hyperglycemic-metabolic states. If supported by prospective evidence, these results may lead to new approaches for primary prevention of hyperglycemia in the workplace.
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Affiliation(s)
- Marc N. Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, UniversityHospital Heidelberg, Heidelberg, Germany, Bergheimer Strasse 20, 69115, Heidelberg, Germany
| | - Julian Koenig
- The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Daniel Mauss
- Department of Occupational Medicine Allianz SE, Königinstrasse 28 80802, Munich, Germany
| | - Kristina Hoffmann
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Burkhard Schmidt
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Julian F. Thayer
- The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America
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Schöttker B, Rathmann W, Herder C, Thorand B, Wilsgaard T, Njølstad I, Siganos G, Mathiesen EB, Saum KU, Peasey A, Feskens E, Boffetta P, Trichopoulou A, Kuulasmaa K, Kee F, Brenner H. HbA1c levels in non-diabetic older adults - No J-shaped associations with primary cardiovascular events, cardiovascular and all-cause mortality after adjustment for confounders in a meta-analysis of individual participant data from six cohort studies. BMC Med 2016; 14:26. [PMID: 26867584 PMCID: PMC4751667 DOI: 10.1186/s12916-016-0570-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/26/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To determine the shape of the associations of HbA1c with mortality and cardiovascular outcomes in non-diabetic individuals and explore potential explanations. METHODS The associations of HbA1c with all-cause mortality, cardiovascular mortality and primary cardiovascular events (myocardial infarction or stroke) were assessed in non-diabetic subjects ≥50 years from six population-based cohort studies from Europe and the USA and meta-analyzed. Very low, low, intermediate and increased HbA1c were defined as <5.0, 5.0 to <5.5, 5.5 to <6.0 and 6.0 to <6.5% (equals <31, 31 to <37, 37 to <42 and 42 to <48 mmol/mol), respectively, and low HbA1c was used as reference in Cox proportional hazards models. RESULTS Overall, 6,769 of 28,681 study participants died during a mean follow-up of 10.7 years, of whom 2,648 died of cardiovascular disease. Furthermore, 2,493 experienced a primary cardiovascular event. A linear association with primary cardiovascular events was observed. Adjustment for cardiovascular risk factors explained about 50% of the excess risk and attenuated hazard ratios (95 confidence interval) for increased HbA1c to 1.14 (1.03-1.27), 1.17 (1.00-1.37) and 1.19 (1.04-1.37) for all-cause mortality, cardiovascular mortality and cardiovascular events, respectively. The six cohorts yielded inconsistent results for the association of very low HbA1c levels with the mortality outcomes and the pooled effect estimates were not statistically significant. In one cohort with a pronounced J-shaped association of HbA1c levels with all-cause and cardiovascular mortality (NHANES), the following confounders of the association of very low HbA1c levels with mortality outcomes were identified: race/ethnicity; alcohol consumption; BMI; as well as biomarkers of iron deficiency anemia and liver function. Associations for very low HbA1c levels lost statistical significance in this cohort after adjusting for these confounders. CONCLUSIONS A linear association of HbA1c levels with primary cardiovascular events was observed. For cardiovascular and all-cause mortality, the observed small effect sizes at both the lower and upper end of HbA1c distribution do not support the notion of a J-shaped association of HbA1c levels because a certain degree of residual confounding needs to be considered in the interpretation of the results.
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Affiliation(s)
- Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany. .,Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany.
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf`m Hennekamp 65, 40225, Düsseldorf, Germany
| | - C Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf`m Hennekamp 65, 40225, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, München-Neuherberg, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Postfach 1129, Neuherberg, Germany
| | - T Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - I Njølstad
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - G Siganos
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - E B Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - A Peasey
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - E Feskens
- Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV, Wageningen, The Netherlands
| | - P Boffetta
- Institute for Translational Epidemiology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos, Athens, 11527, Greece
| | - A Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos, Athens, 11527, Greece
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), PO Box 30, FI-00271, Helsinki, Finland
| | - F Kee
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
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Noh J, Kim E, Seo H, Kim SG. Independent association between glycated hemoglobin and arterial stiffness in healthy men. J Diabetes Investig 2015; 7:241-6. [PMID: 27042277 PMCID: PMC4773663 DOI: 10.1111/jdi.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/23/2015] [Accepted: 06/21/2015] [Indexed: 11/01/2022] Open
Abstract
Aims/Introduction Materials and Methods Results Conclusions
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Affiliation(s)
- Jin‐Won Noh
- Department of Healthcare Management and Institute of Global Healthcare Research Eulji University Seongnam Korea
| | - Eun‐Jung Kim
- Department of Economics Korea University Seoul Korea
| | - Hyun‐Ju Seo
- Department of Nursing College of Medicine Chosun University Gwangju Korea
| | - Soo Geun Kim
- Department of Occupational Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Korea
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13
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Gordon-Dseagu VLZ, Mindell JS, Steptoe A, Moody A, Wardle J, Demakakos P, Shelton NJ. Impaired glucose metabolism among those with and without diagnosed diabetes and mortality: a cohort study using Health Survey for England data. PLoS One 2015; 10:e0119882. [PMID: 25785731 PMCID: PMC4365017 DOI: 10.1371/journal.pone.0119882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/03/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The extent that controlled diabetes impacts upon mortality, compared with uncontrolled diabetes, and how pre-diabetes alters mortality risk remain issues requiring clarification. METHODS We carried out a cohort study of 22,106 Health Survey for England participants with a HbA1C measurement linked with UK mortality records. We estimated hazard ratios (HRs) of all-cause, cancer and cardiovascular disease (CVD) mortality and 95% confidence intervals (CI) using Cox regression. RESULTS Average follow-up time was seven years and there were 1,509 deaths within the sample. Compared with the non-diabetic and normoglycaemic group (HbA1C <5.7% [<39 mmol/mol] and did not indicate diabetes), undiagnosed diabetes (HbA1C ≥6.5% [≥48 mmol/mol] and did not indicate diabetes) inferred an increased risk of mortality for all-causes (HR 1.40, 1.09-1.80) and CVD (1.99, 1.35-2.94), as did uncontrolled diabetes (diagnosed diabetes and HbA1C ≥6.5% [≥48 mmol/mol]) and diabetes with moderately raised HbA1C (diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48 mmol/mol]). Those with controlled diabetes (diagnosed diabetes and HbA<5.7% [<39 mmol/mol]) had an increased HR in relation to mortality from CVD only. Pre-diabetes (those who did not indicate diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48 mmol/mol]) was not associated with increased mortality, and raised HbA1C did not appear to have a statistically significant impact upon cancer mortality. Adjustment for BMI and socioeconomic status had a limited impact upon our results. We also found women had a higher all-cause and CVD mortality risk compared with men. CONCLUSIONS We found higher rates of all-cause and CVD mortality among those with raised HbA1C, but not for those with pre-diabetes, compared with those without diabetes. This excess differed by sex and diabetes status. The large number of deaths from cancer and CVD globally suggests that controlling blood glucose levels and policies to prevent hyperglycaemia should be considered public health priorities.
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Affiliation(s)
- Vanessa L. Z. Gordon-Dseagu
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
- * E-mail:
| | - Jennifer S. Mindell
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
| | - Alison Moody
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
| | - Jane Wardle
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
| | - Nicola J. Shelton
- Department of Epidemiology and Public Health, UCL (University College London), 1–19 Torrington Place, London, WC1E 6BT, United Kingdom
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14
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Rebnord EW, Pedersen ER, Strand E, Svingen GFT, Meyer K, Schartum-Hansen H, Løland KH, Seifert R, Ueland PM, Nilsen DWT, Nordrehaug JE, Nygård O. Glycated hemoglobin and long-term prognosis in patients with suspected stable angina pectoris without diabetes mellitus: a prospective cohort study. Atherosclerosis 2015; 240:115-20. [PMID: 25770690 DOI: 10.1016/j.atherosclerosis.2015.02.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 01/23/2015] [Accepted: 02/23/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Associations of glycated hemoglobin A1c (HbA1c) levels to incident coronary and cardiovascular events among non-diabetic patients with coronary artery disease are unclear. We investigated relations of HbA1c to long-term prognosis in such patients. METHODS A prospective cohort of 2519 patients undergoing elective coronary angiography for suspected stable angina pectoris (SAP) was divided into pre-defined categories according to HbA1c (%) levels (<5.0, 5.0-5.6 (reference), 5.7-6.4), and followed for median 4.9 years. The primary end-point was major coronary events (including non-fatal and fatal acute myocardial infarctions, and sudden cardiac death). Secondary end-points were death from cardiovascular disease (CVD) and all-cause mortality. Hazard ratios (HRs) (95% confidence intervals [CIs]) were obtained by Cox regression. RESULTS Median age at inclusion was 62 years, 73% were males, median HbA1c was 5.6% and random plasma-glucose 5.4 mmol/L. After multivariate adjustment, HbA1c levels within the pre-diabetic range were not associated with risk of major coronary events, HR (95% CI): 1.13 (0.79-1.62); P=0.49, death from CVD or all-cause mortality HR (95% CI): 0.95 (0.55-1.66) and 1.04 (0.70-1.53), respectively; P≥0.85. Similarly, there was no significant association between HbA1c values within the lowest category and risk of study outcomes, (P≥0.18). CONCLUSION In non-diabetic patients with suspected SAP, there was no overall association between HbA1c levels and prognosis, questioning an independent role of glycemia in the pathogenesis of atherosclerotic complications in these patients.
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Affiliation(s)
- Eirik Wilberg Rebnord
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway.
| | - Eva Ringdal Pedersen
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway.
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway.
| | | | - Klaus Meyer
- BEVITAL, Laboratoriebygget, 9th Floor, Jonas Lies veg 87, 5021 Bergen, Norway.
| | - Hall Schartum-Hansen
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.
| | | | - Reinhard Seifert
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway.
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Dennis W T Nilsen
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Division of Cardiology, Stavanger University Hospital, 4011 Stavanger, Norway.
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Division of Cardiology, Stavanger University Hospital, 4011 Stavanger, Norway.
| | - Ottar Nygård
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; K. G. Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway.
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